Inside The Core – Choose the Best and Most Accurate Assessment
What Fitness Professionals Need to Know When Choosing the Best Core Assessment
The lumbar spine, particularly the lumbopelvic junction, also know as the core,
is comprised of twenty-nine dynamic muscles. Each designed to stabilize, transmit force and work synergistically during daily and sport movements. Within these muscles, there are four that are particularly important to remember. They include the transverse abdominis,
obliques, multifidus and quadratus liumborum. Research by Paul Hodges, PT discovered that when someone suffers a low back injury, the transverse abdominis becomes absent or delayed. Further research has shown those with chronic low back pain, the mulifidus is weaker than those without an injury.
Assessing The ‘Four Horseman’
There are a multitude of assessments at the finger tips of a fitness professional. Choosing
the most accurate and objective assessments should be the cornerstone of any fitness
The plank and the side plank are two objective tests that should be in your
fitness arsenal. The four point plank test challenges the erector spinae and paraspinal
muscles. While the side planktest challenged the obliques and quadratus lumborum
Four Point Plank Test
Grading for both tests is as follows:
Normal: Able to lift pelvis off and hold straight 15-20 second count.
Good: Able to lift pelvis off but has difficulty holding spine straight for 15-20 seconds.
Fair: Able to lift pelvis off but has difficulty holding spine straight for 10-15 seconds.
Poor: Able to lift pelvis off but cannot hold for 1-10 seconds.
Trace: Unable to lift pelvis.
Steps for side plank testing:
- Position the client in a side lying position with the elbows flexed at 90 degrees while resting the upper body on the elbow.
- Ask your client to lift their pelvis off the table/floor while keeping the legs straight.
- Observe the ability of the client to maintain and hold this straight erect position(torso, hips and legs).
- Once the client’s hips dip down, trunk side bends or knees bend, then mark their time.
- Repeat the test 2-3x per side, recording their best time.
This test assesses the client’s ability or inability to properly contract the multifidi. Have the client lie prone, then palpate multifidi muscle which is ~1” above ilium. Provide instructions asking the client to extend their hip 1-2” off the table and observe what muscles the client elicits.
To teach the client to contract the multifidi first, palpate the muscle (figure 1) (instruct the client to perform an anterior pelvic tilt (which shortens and contracts the multifidi), and then have them lift one leg straight up into the air.
Common compensatory movement is to activate the glutes or hamstrings first, then contract the lower back (this is dysfunctional) as seen in figure 2.
Look at the pointed finger, her glute maximus is contracting before multifidi. The multifidi are supposed to fire first, followed by the glute maximus and then the hamstring musculature.
Continuum of Care
In order to work with any potential client who has experienced a prior injury, surgery or other dysfunction, the fitness professional should ensure they understand the following:
- Functional anatomy
- Understanding the kinetic chain
- Joint movements and actions
- Exercise prescription
- Periodization training/program design
- Post rehabilitation principles
If you are weak or don’t understand these areas, study and learn the essentials. Second, if a client seems very complicated or you are confused, contact the client’s physical therapist through a phone call or email.
Written By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM