Neuromuscular Control and Muscle Recruitment
The neutral spine position is pain free and where core stability training should begin. This position is midway between lumbar flexion and extension and is the position of power and balance for exercise and sport activities. It is often the safest position for initiating core stability training. Athletes can find neutral spine position through manual repositioning exercises: in neutral spine, anterior and posterior pelvic tilts are repeated and then returned to the neutral position. With time, the athlete gains proprioceptive and kinesthetic awareness of the neutral position.
Based on the functional classification of core musculature, local stabilizers are recruited before larger global stabilizers and mobilizers. Abdominal hollowing and abdominal bracing exercises are commonly used to improve the neuromuscular control of the local stabilizers. Altered neuromuscular control is a predisposing factor in LBP. Tsao et al notes that such altered neuromuscular control is a predisposing factor rather than a result of LBP. Selective recruitment exercises can help to reorganize motor control patterns in the central cortex to improve muscle recruitment patterns. These exercises can be performed by palpating the deep anterior muscles and then either “drawing in” (abdominal hollowing) or co-contracting (abdominal bracing) the core musculature. In addition to voluntary recruitment of the local stabilizers, diaphragmatic breathing exercises can improve core stability. The diaphragm serves as the superior boundary of the
abdominal cavity. Contracting the diaphragm increases intraabdominal
pressure and generates a co-contraction of the pelvic floor muscles (pubococcygeus, puborectalis, and iliococcygeus) and transverse abdominus.