Level 3 Certificate

In Personal Training
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE
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CONTENTS
1 MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF
THE CORE

3 The Pelvis

5 Joint Actions

12 The Vertebrae

28 Posture and Core Stability

37 Flexibility

50 Marketing Terminology

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The Pelvis
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE

The Structure of the Pelvis (Hip) Girdle

The pelvic girdle consists of the right and left hip bones.

Each hip bone is made up of the:

• Ilium

• Ischium

• Pubis

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Pelvic Articulations

There are four articulations within the pelvis:

• Sacroiliac Joints (x2)

• Sacrococcygeal symphysis

• Pubic symphysis

Sacroiliac Joints (x2):

Between the ilium of the hip bones,
and the sacrum

Sacrococcygeal Symphysis
Between the sacrum and the coccyx.

Pubic Symphysis
Between the pubis bodies of the two
hip bones.

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Joint Actions
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE

Upper Body Movements

Elbow Extension Elbow Flexion Forearm Pronation

Forearm Supination Shoulder Abduction Shoulder Adduction

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Shoulder Extension Shoulder Flexion Shoulder Lateral Rotation
(External Rotation)

Shoulder Medial Shoulder Transverse Shoulder Transverse

Rotation Adduction Abduction
(Internal Rotation) (Horizontal Flexion) (Horizontal Extension)

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Shoulder Transverse Shoulder Transverse
Extension Flexion
(Horizontal Extension) (Horizontal Flexion)

Wrist Extension Wrist Flexion Wrist Adduction

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Lower Body Movements

Ankle Dorsiflexion Ankle Plantar flexion Hip Abduction

Hip Adduction Hip Extension Hip Flexion

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Hip Lateral Rotation Knee Extension
(External Rotation)

Hip Medial Rotation Knee Flexion

(Internal Rotation)

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Spinal Movements

Spine Extension Spine Lateral Flexion

Spine Flexion Spine Rotation

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Joint Actions

Joint Actions Description

Flexion Refers to movement where the angle between two bones decreases

Extension Refers to movement where the angle between two bones increases

Refers to movement where the angle between two bones decreases and on the
Horizontal Flexion
horizontal plane.

Refers to movement where the angle between two bones increases and occurs on the
Horizontal Extension
horizontal plane.

Refers to movement of the spine laterally away from the midline of the body. This
can be seen when we bend to one side. Refers to movement of the spine laterally
Lateral Flexion
away from the midline of the body. Lateral extension refers to the increased
angle at the spine. This can be seen when we bend to one side.

Abduction Movement of a body segment away from the midline of the body.

Adduction Movement of a body segment toward the midline of the body.

This is a movement where the joint is the pivot and the body segment moves in a
Circumduction
combination of flexion, extension, adduction and abduction.

Protraction This is forward movement of the scapula that results in ‘hunching’ of the shoulders.

This is backward movement of the scapula as they pull together to ‘square’ the
Retraction
shoulders and push the chest out.

Elevation Refers to the raising of the scapula to a more superior level (shrugging the shoulders).

Depression Refers to the scapula moving to a more inferior position as they are pulled downwards.

Hand - movement so the palm of the hand faces upward or forward (anteriorly). Foot –
Supination combination of inversion, plantar flexion and adduction of the foot occurring at the
same time.

Hand – movement so the palm of the hand faces downward

Pronation or backward (posteriorly). Foot – combination of eversion,
dorsiflexion and abduction of the foot occurring at the same time.

Plantar Flexion Moving the top of the foot away from the shin or ‘pointing’ the toes.

Dorsiflexion Moving the top of the foot toward the shin or ‘raising’ the toes.

Eversion The movement of the foot to bring the sole of the foot to face outward.

Inversion The movement of the foot to bring the sole of the foot to face inward.

Refers to a pivoting or ‘twisting’ movement. Rotation is broken down further into medial
Rotation
and lateral rotation.

The movement of a body segment where the front (anterior) of the segment rotates
Medial Rotation
medially (inwards) towards the midline of the body.

The movement of a body segment where the front (anterior) of the segment rotates
Lateral Rotation
laterally (outwards) away from the midline of the body.

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The Vertebrae
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE

The Vertebral Column

The vertebral column consists of the 24 vertebrae, the sacrum, and the coccyx. A total of 33
vertebrae are within the vertebral column including the sacrum and coccyx. The spinal cord passes
from the foramen magnum of the skull through the vertebral canal within the spinal vertebral
column.

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The Sections of the Vertebral Column

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Cervical Vertebrae

The cervical vertebrae are the first seven (C1-C7). C1 is known as the atlas. C2 is known as the axis.
C7 is known as the vertebra prominent or vertebra prominens. Each vertebra of the vertebral column
consists of an anterior body (except C1) and a posterior vertebral arch. The disc-like body of the
vertebrae is weight bearing, and its upper and lower surfaces give attachment to the inter-vertebral
discs.

The space between the body and the arch is the vertebral foramen, an opening that provides a
passage for the spinal cord. Where the body and arch of two vertebra articulate (meet), a foramen
is formed. This inter-vertebral foramen is an aperture for the transmission of the spinal nerves. The
cervical vertebrae are the smallest of the true vertebrae and are unique in that there is a foramen in
the transverse processes of C1-C7 that give passage to the vertebral artery and the vertebral vein.

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Thoracic Vertebrae

The thoracic vertebrae are the 8th through to 19th vertebrae (T1 - T12). Each thoracic vertebra of the
vertebral column consists of an anterior body and a posterior vertebral arch. The disc-like body of the
vertebrae is weight-bearing, and its upper and lower surfaces give attachment to the inter-vertebral
discs.

Facets on the lateral side of the body articulate with the heads of the vertebrosternal ribs and false
ribs. The vertebral arch is a composite structure; it consists of a pair of pedicles and a pair of laminae
and supports 7 processes. The space between the body and the arch is the vertebral foramen, an
opening that provides a passage for the spinal cord.

Where the body and arch of two vertebra articulate, a foramen is formed for the transmission of the
spinal nerves. The transverse processes articulate with the tubercles of the vertebrosternal ribs and
false ribs (except T11 and T12).

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Lumbar Vertebrae

The lumbar vertebrae are the 20th through to 24th vertebrae (L1 - L5). Each lumbar vertebra consists
of a heavy anterior body and a posterior vertebral arch. The disc-like body of the vertebrae is weight-
bearing, and its upper and lower surfaces give attachment to the inter-vertebral discs. The long,
slender transverse processes are situated in front of the articular processes instead of behind them,
as in the thoracic vertebrae.

The superior tubercle of the transverse process is connected with the superior articular process to
form the mammillary process; the inferior tubercle at the base of the transverse process is called the
accessory process.

The spinal cord ends and the cauda equina begins, at or near L3. Because of this lumbar punctures
are most often done between L4 and L5, where potential damage to the spinal cord is minimised.

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Sacral Vertebrae (Sacrum)

The Sacrum includes the sacral vertebrae, and are the 25th through to 29th (S1 - S5). These 5
vertebrae fuse in early adulthood to for the sacrum, a large triangular bone located between the hip
bones.

Its upper part (base) articulates with the last lumbar vertebra (L5) by an inter-vertebral disc and its
lower part (apex) articulates with the coccyx. The body of the first segment is large, resembling that of
a lumbar vertebra, but each succeeding segment is smaller, flatter and more curved. The upper half of
the lateral surface is a cartilage-covered articulation for the ilium.

The vertebral canal runs throughout the greater part of the bone, forming a passage for the sacral
nerves and its walls are perforated by the anterior and posterior sacral foramina, through which
these nerves exit. The female sacrum is shorter and wider than the male and directed more obliquely
backwards, increasing the size of the pelvic cavity.

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Coccygeal Vertebrae (Coccyx)

The coccyx (tail-bone) is the terminal portion, 30th through to 33rd vertebra of the vertebral column
and forms part of the posterior wall of the pelvic cavity. It is formed by the fusion of the 4 vertebrae.

The first is the largest and resembles the lumbar vertebrae. The last 3 diminish in size; the last piece is
often simply a nodule of bone. The anterior surface of the coccyx provides attachment for the anterior
sacrococcygeal ligament and the levator ani and supports part of the rectum.

The posterior surface, at the base, articulates with the sacrum by a fibrocartilage joint. The borders of
the coccyx are narrow and provide attachment on either side to several ligaments. The terminus, or
apex, is rounded, and is attached to the tendon of the external sphincter.

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Vertebral Positions C1 - S5

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Ligaments Of The Spine

The ligaments of the spine support and reinforce the joints of the vertebral column.

These joints include the joints between the vertebral bodies, joints between vertebral arches and the
craniovertebral joints. Ligaments connecting the vertebral bodies include the anterior and posterior
longitudinal ligaments.

The vertebral arches are connected by the ligamentum flavum, the interspinous ligaments, the
supraspinous ligament, the nuchal ligament, and the inter transverse ligaments.

Two types of the craniovertebral joints exist: The atlantoaxial and the atlantic-occipital.

The former connects the axis to the atlas, while the latter connects the atlas to the occipital bone.
The craniovertebral joints are reinforced by the atlantic-occipital membranes, the alar ligaments, the
transverse ligaments of the atlas, and the tectorial membranes.

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Ligaments of the spine reinforce the articulations of the vertebral column as the spine moves and
bends. The anterior and posterior longitudinal ligaments connect the vertebral bodies and limit
extension and flexion, respectively. Adjacent transverse processes are connected and supported by
the inter transverse ligaments.

NB: Light blue highlights the ligament.

Anterior Longitudinal Ligament (ALL)

Primary spine stabiliser. About one inch wide, the ALL runs
the entire length of the spine from the base of the skull to the
sacrum. It connects the front (anterior) of the vertebral body to
the front of the annulus fibrosis.

Supraspinous Ligament Posterior Longitudinal

Ligament (PLL)
This ligament attaches the tip of each
spinous process to the other. Primary spine stabiliser. About one inch
wide, the PLL runs the entire length of the
spine from the base of the skull to sacrum.
It connects the back (posterior) of the
vertebral body to the back of the annulus
fibrosus.

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Interspinous Ligament Ligamentum Flavum
This thin ligament attaches to another The strongest ligament. This yellow ligament is
ligament, called the ligamentum the strongest one. It runs from the base of the
flavum, which runs deep into the spinal skull to the pelvis, in front of and between the
column. lamina, and protects the spinal cord and nerves.
The ligamentum flavum also runs in front of the
facet joint capsules.

Intertransverse Ligament Nuchal Ligament

The intertransverse ligaments are The ligament that runs from the base of your
ligaments that are placed between the external occipital protuberance (the bump on the
transverse processes of the spine. In back of your head) to the spinous process of the
the cervical region, they consist of a few 7th cervical vertebrae.
irregular, scattered fibres that are often
replaced by muscles.

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Muscles And Tendons Of The Spine
The muscular system of the spine is complex, with several different muscles playing important
roles. The primary function of the muscles is to support and stabilise the spine. Specific muscles are
associated with the movement of parts of the anatomy. For example, the Sternocleidomastoid muscle
assists with movement of the head, while the Psoas Major muscle is associated with flexion of the
thigh.

Muscles, either individually or in groups, are supported by fascia. Fascia is strong connective tissue.
The tendon that attaches muscle to bone is part of the fascia. The muscles in the vertebral column
serve to flex, rotate, or extend the spine.

• Anterior Scalene • Interspinales • Longus Capitis

• Middle Scalene • Intertransversarii • Longus Colli

• Posterior Scalene • Quadratus Lumborum

• Rotatores Breves • Semispinalis Capitis

• Rotatores Longi • Semispinalis Cervicis

• Semispinalis Thoracis

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• Semispinalis • Iliocostalis Cervicis • Longissimus Capitis

• Multifidus • Iliocostalis Thoracis • Longissimus Cervicis

• Rotatores • Iliocostalis Lumborum • Longissimus Thoracis

• Spinalis Cervicis • Spinalis • Splenius Capitis

• Spinalis Thoracis • Longissimus • Splenius Cervicis

• Iliocostalis

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Posture

The spine develops from a single curve during foetal development into four curves, two concave, and
two convex. The cervical and lumbar regions with concave curves give the greatest range of movement.

NEUTRAL SPINE
A neutral spine describes the ideal position to
minimise stress on the vertebrae and its ligaments.

In turn, achieving this posture during physical

activity will help to reduce the risks of back pain. It
will also allow musculature to perform in a balanced
way and maintain this optimal spinal curvature.

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POSTURAL ABNORMALITY (DEVIATION)

Deviation from optimal spinal posture can be common. Pregnancy can enhance the curvature of the
lower spine to shift the centre of gravity backwards and compensate for the extra weight at the front.

Postural abnormality can be present at birth, or can occur at any stage of life, and can be temporary
or permanent.

Some of the major postural deviations are below:

KYPHOSIS LORDOSIS SCOLIOSIS

An abnormally excessive convex Defined as an excessive inward Defined as the abnormal lateral
curvature of the spine as it occurs curve of the lower back. curvature of the spine.
in the thoracic and sacral regions.
NB: Lordosis can occur at the NB: A sideways curve which is
NB: Characterised by an cervical spine also. often s-shaped or c-shaped.
abnormally rounded upper back.

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Muscle Imbalance

The term “muscle imbalance” refers to a condition in the body that is present when opposing muscles
are out of balance with one another in terms of strength, length and/or tension. Opposing muscles
are those that perform opposite functions. They may oppose one another spatially left-to-right or
front-to-back. For example, quadriceps are responsible for extending the knee and the hamstring is
responsible for flexing it. One is on the front of the thigh, and the other, the back.

When opposing muscle groups are imbalanced, one group is tighter and shorter than the other,
which is elongated and lax. Imbalances can cause pain both directly and indirectly. The muscle that
is shorter and tighter is chronically tense; muscle memory has trained it to stay in its shortened
position. Tense muscles can develop knots called trigger points that cause localized and referred pain.
The weaker muscle is prone to strain.

Muscle imbalances can interfere with posture. Tight muscles exert a pulling force on nearby strictures.
If a muscle connected to the lumbar spine is tight, for example, it can pull the spine forward
and create what is called anterior pelvic tilt. If an imbalance causes postural distortion, pain and
dysfunction may be felt throughout the body.

What Causes Muscle Imbalance?

Generally, repetitive activity is to blame. This could occur from poor exercise habits or from
repetitive movements required by your work. When you engage a muscle, the brain sends a signal
to its opposing muscle to relax; this allows the engaging muscle to tense up without resistance. The
process is called reciprocal inhibition. Once muscle memory sets in, the tension and laxity can become
chronic.

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Posture and Core Stability
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE

Long periods of inactivity or sitting down can have an adverse effect on posture; posture being the
optimal alignment of a joint or joints. In addition, badly designed programs that place an emphasis on
a limited number of muscles or activities that are very repetitive can also adversely affect posture.

Sitting, arguably the most negative postural stress encourages a rounded upper back and protracted
shoulders as well as a forward head position. Sitting using a computer keyboard is a prime example
of another “posture buster” and a habitually rounded upper back is commonly referred to as
hyperkyphosis. This hyper kyphotic posture then becomes the norm – even in the standing position.

Poor posture is caused by shortened muscles, poor flexibility and a lack of strength in the muscles
responsible for maintaining good posture against gravity and bad habits such as slouching.

As sedentary jobs and subsequently poor posture are so common, instructors should endeavour
to include stretches and strengthening exercises in their training programs which help to undo the
damage of habitual sitting and slouching. This generally involves stretching the muscles on the front
of the body and strengthening those on the back.

EXERCISES THAT MEET THE FOLLOWING CRITERIA WILL

ALSO HELP ADDRESS POSTURAL ISSUE:
• Involve a full range of movement

• Be compound, functional movement patterns

• Are performed standing and/or unsupported

• Utilise free weights and cables rather than machines

The development of a strong and stable core is championed by many

as the key to improved/pain-free function and sporting excellence.

Understanding Static and Dynamic posture is necessary for trying

to promote sound functional movement. There are a number of areas
that must be considered in gaining a complete and well-informed
understanding of this often misunderstood and controversial area.

Areas that are often misunderstood:

• The structures that makeup the core

• The function of the core

• Core activation as the foundation to good posture

• What equipment is commonly used in core training

• Exercise prescription

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The structure of the Core

If you remove the arms and legs, the core is what remains. Often the core is considered to include
only the abdominal and lower back muscles. This is too narrow a view since when discussing the core
muscles the powerful hip and upper back muscles should not be overlooked.

ELIPHINSTONE AND POOK (1998): DEFINE THE FUNCTIONAL ROLE OF THE CORE AS:
“The ability of your trunk to support the effort and forces from your arms and legs, so that
muscles and joints can perform in their safest, strongest and most effective positions.”

The core (trunk) can be thought of as providing a link between the lower and the upper body. With
that in mind, the main focus of core training is to address any functional deficit in trunk stabilisation
and/or movement in order to provide the necessary spinal support and a strong and adaptable
platform for the actions of our arms and legs.

THE BODY IS COMPOSED OF A SERIES OF MUSCLE LAYERS:

• Deep

• Middle

• Outer

NB: All 3 must be considered when discussing the core

Deep Layer Muscles

• Intertransversarii

• Rotatores

• Multifidus

• Interspinales

MOVEMENTS OF THE SPINE AND EXTREMITIES CAN BE DIVIDED INTO TWO CATEGORIES:
• Physiological movements

• Accessory movements

Gross physiological movements are responsible for large motions of the body e.g. bending.
In contrast, accessory muscles are responsible for controlling movements that occur within a joint.
Think when bending to pick up an object from the floor the spine moves into a flexed position
(physiological) however there is also movement at each vertebral segment (accessory).

Each segment depending on the task will bend, rotate or slide (shear) on top of one other. To control
all accessory motions, there are small position sense muscles that cross from one vertebral segment
to another. It is of vital importance to have good position sense muscle function if an injury is to be
avoided.

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Middle Layer (Inner Unit) Muscles

• Transverse abdominis (TVA) • Diaphragm

• Internal obliques • Pelvic floor

• Multifidus

The spine is stabilised when these muscles contract as they create a non-compressible cylinder
around it. This also forms the working foundation from which the arms and legs can function
optimally. Richardson et al (1999), showed that inner unit activation occurs prior to involvement
of the extremities and that faulty inner unit recruitment increased the likelihood of low back
dysfunction.

Outer Muscle Layer Muscles

• Rectus abdominis • Latissimus dorsi

• External obliques • Gluteals

• Erector spinae • Adductors

The above form muscle slings. These muscle slings contribute to the ability to maintain an
optimal working relationship between joints and to integrate the various body segments for
successful motion.

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The Risks of Instability and Postural Deviation

PANJABI (1992) DEFINES CLINICAL SPINAL INSTABILITY AS:

“A significant decrease in the capacity of the stabilising system of the spine to maintain the
inter-vertebral neutral zones within physiological limits which results in pain and disability”.

Failure to stabilise/control core movement increases the risk of acute (short term) and chronic (long
term) injury to the vertebral column. The key role of the trunk muscles in providing stability to the
lumbar spine is well established (Granata and Marras, 2000).

It should be noted, that our increasingly sedentary lifestyles do little to promote the optimal function
of the core. For example, habitual seated positions do little to promote neutral spines, but rather
promote flexed postures which actually place the core at a biomechanical disadvantage. Similarly,
the use of backrests reduces the need for core activation, therefore, increasing the risk of acute
and chronic injury to the spine and its associated structures. Just as a sedentary lifestyle can have a
negative impact on core function so too can some of our exercise choices. Within the fitness industry,
for example, there is often an over-reliance on fixed path resistance machines.

Machines are popular choices with both trainers and clients for many reasons; since they offer a
supported environment they place few if any demands on the core musculature. These
machines also train the body in terms of individual muscle groups and so do little to promote the
integrated function of our various body parts. So in effect, machines train us to be strong in isolated
muscle groups whilst placing limited demands on the core, if not supplemented and balanced with
exercises that progressively challenge the core, this is a recipe for dysfunction and injury.

Postural deviations such as kyphosis or lordosis also create muscular dysfunction around the core and
reduce the ability to hold good form and maintain a neutral spine during exercise and activity. When
the exercise increases the forces placed through the joints and the core, the muscles will shift into
their ‘strongest’ positions, which inevitably falls in line with their dominant posture.

It is often the case, but not the rule that an increasingly sedentary lifestyle and becoming overweight
can lead to postural deviations and weakness within core musculature. Too much time in a seated
position can lead to reductions in core muscle activation and a lack of neural drive so that even
relatively light loads placed upon the core muscles exceed their ability to cope. Abdominal obesity
shifts the centre of gravity forward which in turn leads to an increased chance of postural deviations
like lumbar lordosis or a swayback posture where the hips are translated forward. Such postural
deviations lead to incorrect loading patterns which increase the strain in the spine and surrounding
joint structures.

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Ligaments and Discs

Spinal discs sit between each pair of vertebrae, providing both shock absorption and an element of
support for the spine. Ligaments run the entire length of the vertebral bodies (e.g. the anterior and
posterior longitudinal ligaments) and between spinous and transverse processes (interspinous and
intertransverse ligaments) and also help guide and support spinal movement. However, without its
supporting musculature, despite its passive structures the human spine is inherently unstable and
can only withstand a load of 4-5 lb before it buckles into flexion (Panjabi et al, 1989).

It is, therefore, a basic principle of core stabilisation that during movement, a failure to activate local
stabiliser muscles will result in excessive forces being placed on these passive structures.

Intra-abdominal Pressure
Some identifiable core muscles contract simultaneously causing an increase in pressure within the
abdomen which helps to maintain stability and reduce pressure on the inter-vertebral discs in the
lumbar spine.

As Norris (2000) states:

“Intra-abdominal pressure is created by synchronous contraction of the abdominal muscles, the

diaphragm, and the muscles of the pelvic floor.”

The trunk should be thought of as a cylinder. The diaphragm forms the lid of the cylinder and the
pelvic floor the base. The walls of the cylinder are created by the deep abdominals (TVA and the
internal obliques). During contraction of the abdominals the walls are pulled in and up while if a deep
breath is taken, the diaphragm is lowered, compressing the cylinder and the abdominal contents from
the top. Provided that the pelvic floor (the base of the cylinder) has sufficient integrity, it will resist the
action of the diaphragm and the downward displacement of the internal organs (viscera). This is how
the non-compressible cylinder is formed. This gives the torso stiffness and a more rigid structure.

Such a structure is better able to resist the stresses placed on the lumbar spine, particularly during
lifting movements. This stabilises the spine and forms the working foundation from which the bodies
extremities can function optimally. As Twomey and Taylor (1987) state, making the trunk into a more
rigid cylinder reduces axial compression and shear loads and transmits loads over a wider area.

Note: a good example of the natural functioning of IAP would be when muscles contract
reflexively to defend the abdomen from a punch to the stomach.

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The Thoracolumbar Fascia (TLF)

The TLF is a broad, flat sheath of fascia that stretches across the thorax and lumbar region and is
involved in passive and active stabilisation of the spine. It serves as an anchor for many muscle
attachments, especially that of the Transverse Abdominis (TVA), and aids stability for the second to
the fifth lumbar vertebrae.

The function of the TLF can be likened to the tightening of the strings on a girdle around the waist.
Stability is created by lateral tension or a pulling action from the TVA and internal obliques that is
transferred to the fibres of TLF. This, in turn, creates a hoop-like tension through the TLF. This tension
produces an extension force on the lumbar spine, which resists the natural pull of lifting movements
into spinal flexion. This phenomenon has been referred to as TLF gain (Gracovetsky, 1985).

The TLF can be seen as adding to the tension and the ability to resist the stress of the walls of the non-
compressible cylinder created by IAP and therefore, adding to our core stability.

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Neutral Spine

A neutral position for the lumbar spine is midway between full flexion and full extension as
determined by the position of the pelvis. An increase in anterior pelvic tilt will result in greater spinal
extension and conversely, an increase in posterior pelvic tilt will produce greater spinal flexion.

A neutral spine position is maintained exclusively through muscular activity, thereby placing minimal
stress on the passive structures of the spine (ligaments and discs).

Optimal spinal alignment is also found whilst in a neutral position therefore the best position from
the trunk muscles can work.

Integrated Core Function

We should not overlook the contribution of the more superficial outer unit musculature in this
stabilising role. As an example of this, it should be seen that the contraction of gluteus maximus
muscles via their attachment to the TLF will have the effect of tightening this fascia. Consequently,
an efficient gluteal function is fundamental to back stability as are many other superficial muscles.

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Abdominal Bracing

The act of tightening or stiffening the abdominal muscles (as if bracing for a punch in the stomach)
is believed by McGill, (2002) to be the most effective method of stabilising the core. This bracing
technique activates a simultaneous or co-contraction of the abdominal and lumbar extensor muscles.
McGill recommends the performance of an abdominal brace in exercise/rehabilitative and functional
situations.

To teach abdominal bracing McGill recommends stiffening a joint, like the elbow, to demonstrate.
Actively stiffen the biceps and triceps and palpate the muscles on each side of the joint to get the idea.
This can be practised at different percentages of maximum contractions e.g. 10, 20, 50%. Once the
basic idea has been grasped replicate this co-contraction on the torso. With abdominal bracing the
abdominal wall is neither pushed out nor pulled in.

Core equipment
Equipment such as stability balls, BOSU and
wobble boards are commonly associated
with training for core stability. Each piece of
equipment has an unstable surface amplifying
the instability of the user. This enforced
instability increases the activation of the core
musculature which, has to work harder to
provide the necessary stabilisation.

The heightened activation that these training

mediums provide means that their use
is appropriate as a starting point for any
programme targeted at the core musculature.
What must be remembered is that the core will
be at work in all situations and, therefore, core
training is not solely about the use of these
mediums.

Consequently, in the interests of maintaining the functionality of our training at some point in the
exercise progression these mediums should be side lined in favour of exercises performed on a more
familiar and more stable surface – the floor!

SOME CORE EXERCISE POSSIBILITIES ARE IN THE VIDEO BELOW:

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Exercise Prescription

To progressively train the core muscles, select exercises based on increasing amounts of core
contribution. This may be done using a variety of different training modalities body positions and
movements.

A possible exercise progression first utilises floor-based positions and unstable surface training to
address any existing deficiencies in core function.

Clients would then be given more functional exercises in standing positions which seek to place
demands on the core in all three planes of motion:

• Sagittal

• Frontal

• Transverse

Downloadable resources for multi-planar exercises:

36
Flexibility
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE

Introduction

Flexibility is best defined as the range of movement at a joint or joints and is influenced by joint
structure, the shape of the bones and cartilage involved and the length and elasticity of the muscles
that cross the joint.

Flexibility varies significantly from person to person and is specific to individuals. Poor flexibility can
have an adverse effect on posture and function but so too can excessive flexibility or hypermobility.

While flexibility is, in many ways, genetic, some sports and activities are responsible for a reduction
in flexibility. For example, long periods of sitting can shorten several important muscles including
the hamstrings and hip flexors whereas jogging and cycling, activities that utilise a small range of
movement, can also cause muscles to shorten. This phenomenon is called adaptive shortening.

Some activities are linked to or require a high degree of flexibility; the most obvious examples being
dance, gymnastics and most martial arts. Flexibility is developed by stretching which involves moving
the muscle origin and insertion further apart.

THERE ARE SEVERAL NOTABLE BENEFITS TO STRETCHING:

• Increased range of movement. • Decreased muscle viscosity

resulting in smoother movements.
• Reduced muscle tension.
• Improved coordination.
• Increased physical and mental
relaxation. • Improved proprioception.

• Reduced risk of non-specific back • Improved circulation.

pain.
• Improved posture.
• Possible reduced risk of DOMS
(delayed onset muscle soreness). • Possible reduced risk of injury.

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Range Of Motion

The range of motion (R.O.M) is the amount of motion available at a specific joint.

THE TABLE PROVIDES EXAMPLES OF JOINTS AND THE RANGES OF MOTION AVAILABLE AT
THOSE JOINTS.

Instructors should also ensure that there is an equal volume of pushing and pulling exercises and
that dynamic and static stretches are utilised. Care should also be taken to ensure that all prescribed
exercises are performed using good form.

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Factors Affecting Flexibility

Flexibility can vary significantly from one individual to another and the potential for developing
flexibility is, in part, limited by several factors:

Heredity
Hypermobility is a hereditary trait; some people are born with a tendency toward hypermobility or,
what is incorrectly referred to as “double joints”. Hypermobility increases the risk of injury and joint
dislocation and it essential that muscles are strengthened to protect at-risk joints.

Age
Babies are very flexible but, as they start to walk and more joint stability is required, muscles begin to
tighten up. Younger people tend to be naturally more flexible than older people and muscle elasticity
tends to decline with age unless regular stretching is performed.

Exercise history
Years of running or cycling can adversely affect flexibility while performing full-range movements such
as deep squats, high kicks and other dynamic activities will enhance it. A well-designed resistance
training program utilising full ranges of movement will positively influence flexibility whereas the
same program performed using a shortened range of movement will reduce flexibility.

Temperature
Direct or indirect heat make muscles and tendons more elastic. Conversely, a decrease in
temperature can significantly reduce flexibility.

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Gender
Women tend to be naturally more flexible than men. The reasons are two-fold. Women have a higher
amount of the hormone relaxin which does exactly what its name suggests – it relaxes soft tissue and
muscle.

This facilitates greater flexibility. Relaxin levels increase significantly during pregnancy so that the
women’s body can stretch to accommodate the growing foetus and for the birth itself. Additionally,
women are statistically more likely to participate in activities such as dancing or gymnastics where
flexibility is important and therefore developed.

Fashion
High heels and tight skirts can adversely affect flexibility because they place muscles in a shortened
position or restrict the range of movement.

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Methods Of Stretching
There are several methods and types of stretching that an instructor should be familiar with so that
they can choose the right one for their client:

ACTIVE STRETCHING
Active stretching involves effort from the individual doing the stretching. This may be because
they adopt and hold a stretch themselves or use the antagonist of the target muscle to stretch the
opposing muscle.

Examples include using the middle trapezius, rhomboids and posterior deltoids to horizontally extend
the shoulders and retract the shoulder girdle to stretch the pectoralis major and anterior deltoids.

PASSIVE STRETCHING
Passive stretching uses an external force or a prop to stretch the target muscle. For example, a length
of rope to stretch the hamstrings of one leg while lying on your back or the use of a partner. Passive
stretches are usually better when a longer than usual stretch is required as they are comfortable and
require little or no input from the client.

FACILITATED STRETCHING
Facilitated Stretching uses an isometric contraction of the target muscle to prepare it to stretch. This
method encourages active stretching on the part of the client, avoiding additional passive stretching
when possible. Facilitated stretching can be done with a partner or by yourself e.g. using a towel

NB: If a training partner or instructor is providing stretching assistance, it is essential that the force
of the stretch is applied gradually and carefully and is accompanied by good communication between
both parties as it’s all too easy to overstretch and cause injury.

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Dynamic (Warm-Up Stretches)

Dynamic stretches involve taking a

muscle or group of muscles through
a wide range of movement without
stopping in the fully extended
position. For example, to stretch the
hamstrings, you could swing your
legs forward from your hips in an
alternating high kick.

Dynamic stretches are always

performed smoothly and in a
controlled manner to minimise
the risk of injury and should mimic
the movements or activities of the
following workout or sport. Other
examples of dynamic stretches
include forward lunges with a
waist twist, wide-foot squats and
repeatedly reaching your arms up
above your head.

Dynamic stretches are normally

best performed in sets of 10 - 15
repetitions and usually; 3 - 5 dynamic
stretches; 1 - 2 sets each, are all that
is required.

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Ballistic

This form of stretching involves using momentum and bodyweight to stretch a muscle beyond its
normal point of bind. This is done using repetitive bouncing movements. For the vast majority of
exercisers, this method is not recommended as rapidly and forcefully exceeding the point of bind may
cause injury.

However, for certain sports people and for stretching adhesions and stubborn fibrous tissue in
physiotherapy and rehabilitation, it may be necessary to use ballistic stretching.

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Static (Cool Down Stretches)

As the name suggests, static stretches

involve little or no movement. The muscle
in question is stretched until the point
of bind (end of the range) is reached
and that position is then held with no
bouncing.

This should result in a mild stretching

sensation but no actual pain in the target
muscle or joints. Static stretches can
be used to maintain the current level
of flexibility (maintenance stretching)
or increase flexibility (developmental
stretching).

Maintenance stretches are held for 10

to 15 seconds and then released

Developmental stretches are held for

30-seconds and then released

Developmental stretches are usually

increased incrementally as muscles
gradually relax. In general, the longer a
stretch is held, the greater the increase
in flexibility will be. Care should be taken
not to force a stretch or stretch a cold
muscle as injury can result. It is also
important to ensure that increases in the
depth of a stretch come from elongation
of the target muscle and not nearby
joints e.g. rounding the lower back in a
hamstring stretch.

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Proprioceptive Neuromuscular Facilitation (PNF)

Proprioceptive neuromuscular facilitation (PNF) was first developed by Margaret Knott PT and
Herman Kabat MD in the 1940s as a method of treating neurological dysfunctions. The treatment
involved re-education of developmental movements and postures. This approach helped patients
become more efficient in their movements and activities of daily living (ADLs). Muscle recruitment is
enhanced through the use of the appropriate reflex and proprioceptive stimuli.

The efficient recruitment of motor patterns involves the use of the following PNF techniques:
• Resistance: resistance applied to a muscle contraction will facilitate a smooth motor response
through optimal muscle contraction and relearning. The type and degree of resistance vary to
achieve the appropriate motor response.

• Irradiation: irradiation is the overflow of neuronal excitation from stronger motor units to weaker
ones, or units that may be inhibited by injury. This is done by applying graded resistance to larger
muscle groups to enhance contraction in the weaker groups.

• Traction: the application of traction perpendicular to the arc of motion is used to facilitate an
enhanced motor response.

• Manual pressure: neuromuscular responses are influenced by contact with the skin and deeper
pressure receptors.

• The stretch reflex: The stretch reflex is a stimulus that increases the state of responsiveness of a
motor unit to cortical stimulation. This reflex is stimulated by the quick elongation of muscle. The
stretch stimulates muscle spindles to create a contraction. The muscle spindle and its reflex work
as a feedback device that operates to maintain optimal muscle length. The reflex produces a brief
isolated contraction.

• Approximation: A compressive force to approximate joint surfaces can facilitate a motor response
and promote stability.

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The 3 Types of PNF Methods

Contract-Relax
This is also known as "active assisted" stretching in some of the literature. The Golgi tendon organs lie
in the tendon of a muscle that mediates the stimulation of inhibitory interneurons in the spinal cord
that causes relaxation of that muscle's motor neuron. They also make excitatory connections with
the motor neurons that supply the antagonists of that muscle. Since the Golgi tendon organs are in
series with the muscle fibres they are stimulated by both passive stretch and active contraction of the
muscle.

The Golgi tendon organ, therefore, acts as a transducer in a feedback circuit that helps to regulate
muscle force through inhibition and relaxation of the muscle. The contract-relax technique uses the
development of tension in a muscle by isotonic contraction to facilitate the relaxation and therefore
stretch a muscle.

By facilitating the relaxation of muscles we can improve circulation and improve extensibility of
myofascial tissues. To accomplish this the muscle is placed in a maximally stretched position and
resistance is applied to a muscle contraction of the muscle that is being stretched (direct contraction)
or that muscles antagonist (reciprocal relaxation).

Movement occurs during this contraction. Following this contraction the limb is relaxed and upon
relaxation is actively or passively stretched further.

• Direct Contraction: For example, when stretching the hamstring, the hip is placed in 90 degrees
with the patient lying on his back. The knee is flexed against moving resistance isotonically and
then relaxed. The hip held at 90 degrees, the knee is moved into its fully extended position so as
to apply a stretch to the hamstring.

• Reciprocal Relaxation: For example, when stretching the hamstring, the hip is placed in
90 degrees with the patient lying on his back. The knee is then extended against resistance,
contracting the quadriceps. The activity in the quadriceps causes reciprocal inhibition of the
hamstrings allowing for a greater stretch.

Hold-Relax
The hold-relax PNF stretching technique is used to facilitate the relaxation of muscles to gain range
of motion. This method uses an isometric contraction rather than an isotonic one. To achieve this the
limb is placed in pain-free range and an isometric contraction is sustained. The limb is then moved
into the new range. The hold-relax method of PNF stretching is facilitated by the Golgi tendon organ to
allow a reflexive relaxation of the muscle. It can be done individually or with assistance from a trainer
or physical therapist. The danger of the hold-relax PNF stretching technique is that with this inhibition
of muscle activity, it may predispose an athlete to injury if done prior to an athletic event.

Contract-Relax-Antagonist-Contract
The first part of this stretch is similar to the hold-relax whereby the muscle being stretched is
isometrically contracted for 3 to 6 seconds, then the antagonist muscle will immediately contract for 3
to 6 seconds. The joint is then pushed into its new range.

An example of a PNF stretching exercise to increase range of motion in the hamstrings is lying on your
back with one leg pointing upwards. A partner carefully pushes the extended leg in the direction of
the head of the one lying down. When the hamstrings are activated the partner prevents movement
by keeping the leg in place. After the hamstrings relax again, the partner carefully pushes the leg even
further towards the head. This process is repeated until the maximum point of bind it achieved.

A more advanced form of flexibility training that involves both the stretching and contraction of the
muscle group being targeted. PNF stretching was originally developed as a form of rehabilitation, and
to that effect, it is very effective.

46
Methodology

1. The person who is to be stretched assumes the

position.

The PT the places the person into a stitched

position. This is called their point of bind.

2. The person then contracts the stretched

muscle (60-80% effort) for 3 - 6 seconds while the
PT inhibits the movement.

NB: The force of the contraction should be

relevant to the condition of the muscle. Ensure
the person does not apply a maximum effort!

3. The person then relaxes the muscle,

immediately the PT cautiously pushes passed
the persons current "point of bind" and normal
range of movement approximately for a further
5-20 degrees.

Allow 30 seconds of recovery (whilst in the new

bind).

Repeat the procedure 2 - 4 times.

ADVANTAGES
• Large increases in the range of motion.

DISADVANTAGES
• For most exercises a partner is necessary.

• Decreases in maximum strength after

performing PNF.

NB: When your client's range of motion has to be

increased, PNF is a very useful method.

Because of the large amount of stress on the

muscles, it is best to perform it on a separate
day instead of a training day. Just like static
stretching a proper warm-up beforehand is
necessary.

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Neuromuscular Mechanisms

PNF STRETCHING: THE ROLE OF THE STRETCH REFLEX

The muscle spindle is a long thin nerve receptor found within the muscle. Information from this
receptor transmits information to the spinal cord regarding muscle length and the speed of
lengthening. When a muscle is stretched quickly this muscle spindle fires and causes a reflexive
contraction within that muscle that is undergoing the stretch. The greater the speed of stretch, the
stronger the reflex contraction in the muscle being stretched.

PNF STRETCHING: AUTOGENIC INHIBITION:

Inhibition of the antagonist muscle group is mediated by the muscle spindle. If the agonist muscle
contracts, then the spindle fires, sending messages to the spinal cord causing the antagonist muscle
to relax.

PNF STRETCHING: RECIPROCAL INHIBITION

The Golgi tendon organ is a nerve receptor found in tendons. This receptor fires when tension
increases within the tendon. This tension can be due to stretch or contracting muscle.

When the Golgi tendon organ fires a signal is sent to the spinal cord causing the agonist muscle to
relax. During PNF stretching, these three mechanisms all work together to allow normal smooth
movements and can be manipulated through PNF techniques to increase our ability to stretch.

48
When To Stretch?
Stretching should be part of virtually every workout but is important that the right stretches are used
at the right time. For example, static developmental stretches cause muscle relaxation and can inhibit
force production so they are not really suited to the warm-up.

However, if a client has very bad flexibility in one or several muscles which makes the performance
of a particular exercise more difficult than normal, statically stretching hypertonic muscles may be
beneficial e.g. statically stretching the calves prior to squats. In contrast, the active nature of dynamic
stretches means they are not really suitable for cool downs.

In the majority of cases, stretching is a safe and very beneficial activity however some population
groups could suffer injury or health concerns as a result of stretching. An instructor should know who
is and isn’t a suitable candidate for flexibility training.

Considerations when flexibility training include:

• Avoid any developmental or ballistic stretches during pregnancy because of the softening effects
of relaxin.

• Do not force a stretch if the movement is inhibited by a bony block.

• Avoid stretching the muscles surrounding a fracture site for 8-12 weeks post-injury.

• Stop stretching if any sharp muscle or joint pain occurs.

• Stop stretching if any muscle cramps occur.

• Do not stretch joints or tissue that is infected.

• Avoid stretching any muscle or joint that is acutely inflamed.

• Do not stretch any bruised or sore muscles if the cause was over-stretching.

Flexibility training is all too easily left out of exercise programs because of lack of time, not seeing the
value or lack of knowledge. However not stretching can increase acute and chronic injury risks and
regaining lost flexibility takes much longer than developing and maintaining it in the first place.

49
Marketing Terminology
MODULE 2:
AXIAL SKELETON AND THE STRUCTURE AND FUNCTION OF THE CORE

Food Labelling
Understanding and interpreting food labels is an essential skill for anyone interested in nutrition.
Food manufacturers are required by law to put certain information on their labels and this
information can be helpful when deciding what to eat.

Marketing Terminology

There are a wide variety of terms that are used by food manufacturers in an effort to promote the
food they produce. The FSA provides numerous guidelines as to what terms manufacturers can and
cannot use. Terms like “fresh”, “pure”, and “natural” all carry certain connotations that can heavily
influence consumers and so many such terms and their meanings are regulated.

While each of these terms conjures up images of healthy food produced naturally, in reality they can
be used and misused (as they are 75% of the time) to mislead consumers.

For example, the term “traditional” emotes images of recipes handed down through the generations
but the food in question may actually be a factory produced version of something that as once made
in the home.

50
Nutrition Label Basics

Food label layout and contents must follow a certain universal format and include the following
information:

• Identify macronutrient and calorie values per 100g/ typical serving

• List ingredients in order of weight

• Manufacturer’s details

• Potential allergens in the product

• Total volume or weight

• A “best before date”

• Storage instructions

• Preparation instructions

The label provides average nutritional values but it should be stressed that a 20% margin of error is
permissible by law and, in a 2005 BBC study, it was revealed that out of 70 products tested for 570
nutrients, only 7% actually matched the stated values and food sold loose or cooked in-house is not
covered by the same labelling legislation.

In the UK, food manufacture, marketing, sales and labelling is controlled by the Food Standards
Agency or FSA for short. This independent body acts in the public interest and serves as an advisory
body to the government regarding food. The current food manufacture and labelling standards, the
1990 Food Safety Act and the Eat Well Plate both fall under the auspices of the FSA.

51
Food Additives And Labelling

In addition to the common food marketing terms, an entire sub-language of marketing terms exists
for foods aimed at dieters and those interested in healthy eating. Some of these terms are also
regulated by the FSA but, like regular marketing terms, can be used and interpreted in more than
one way.

Food manufacturers are allowed to use a large number of food additives but additives must be listed
on food labels. Not so many years ago, this meant food labels contained lots of so-called “E numbers”
that identified the added ingredients. However, more recently, the health-conscious majority of
consumers have become more label-savvy and know to avoid foods containing ingredients like E101.

To counter this, but still keep true to the law, many food manufacturers now list added ingredients
by their real chemical names. Additives are used for a variety of purposes but, generally, this is to
increase food profitability rather than the healthful qualities of the food in question. Additives include
anti-foaming agents, carrier solvents, bulking agents, firming agents, and flavour enhancers, flour
treatment agents, glazing agents, modified starches and raising agents.

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Additive Categories
Although not as commonly used as in the past, E numbers reveal what category of additive(s) are
present:

Additive Safety
Officially, food additives are deemed to be safe when consumed in small quantities and relatively
infrequently, however:

• 150 additives have had concerns raised after signs of adverse reactions

• 70 additives are known to cause allergic reactions in some people

• 30 additives are known to be harmful

Artificial additives are a relatively new addition to our food and so it’s not really knowing what sort
of long term effect they will have on health and well-being. For that reason alone it is worth trying
to keep intake of artificial ingredients to a minimum. To do that, personal trainers should make the
following recommendations:

Avoid Advise
• Processed foods • Buy organic whenever possible
• Fast foods • Use whole, fresh produce
• Confectionery • Bake at home so you can choose the
• Soft drinks and cordials ingredients
• Pre-packaged meals • Always read the food labels first and
• Refined baked goods make an informed choice
• Reduced or lower fat foods • Do not replace naturally occurring
• Cheap sausages or burgers sugar with artificial sweeteners

53