Lumbo-Pelvic Hip Complex (aka the CORE) strengthening program

As the primary stabilizer of the spine and pelvis, the lumbo-pelvic hip complex (LPHC) is the crux of movement and gait, and influences all structures above and below it. The major joints of this complex are the sacroiliac joint (sacrum and pelvis), and the iliofemoral joint (femur and pelvis) (Clark & Lucett, 2011). Optimal arthrokinematics depends on normal range of motion, balanced length-tension relationships, and muscular strength. Weak, underactive muscles or neuromuscular fatigue can impair movement of the LPHC during walking, and increased trunk stiffness despite higher muscle activation may be a protective reaction response to fatigue (Chang et al., 2016). The protective response is relevant because lower thoraco-lumbar vertebrae are highly vulnerable to compression and injury, due to their regional skeletal structure which lacks any peripheral support. Therefore, it is important to fortify all the surrounding muscular structures in the LPHC region. Primary muscles associated with the LPHC in the lower extremity are the Gastrocnemius/Soleus, Adductor complex, Hamstring complex, Hip flexors and Abdominal complex. In the upper extremity LPHC muscles include Erector spinae, Intrinsic core stabilizers, Lastissimus dorsi, TFL/IT band, and Glute med/max.

Compensations during assessments

The overhead squat movement assessment (OHS) usually reveals compensations, and in particular excessive forward lean. In most cases the compensation occurs as the result of a past or current local, upper or lower extremity injury. With a modification of lifting the heels during the squat assessment, if the compensation persists, it is an indication that the issue resides in the LPHC and a corrective exercise continuum can be devised to correct movement. Additionally, during a single leg squat (SLS) assessment, if you tend to compensate with a mild inward trunk rotation when on left stance leg, and a pronounced inward trunk rotation when on right stance leg, this indicates weakness in internal and external obliques, and Gluteus Medius & Maximus. In the excessive forward lean compensation, potential overactive muscles are Gastroc/Soleus, Hip flexor complex and abdominal complex. Underactive muscles include Anterior tibialis, Gluteus maximus, Erector spinae and Intrinsic core stabilizers. During SLS, compensations are the result of overactive Internal oblique, TFL, and Adductor complex (ipsilateral stance leg), and External oblique (contralateral stance leg). Inward trunk rotation compensation reveals underactive Internal oblique (contralateral stance leg), and External oblique and Glute med/max (ipsilateral stance leg).

Addressing compensations with “core” strengthening

A multifaceted “core” strengthening and stabilization program which integrates passive (skeletal & arthro components), active (core musculature), and neural (mechanoreceptor messaging center) control subsystems, can correct LPHC instabilities and weakness, and reduce injury risk to lower extremities (Huxel Bliven & Anderson, 2013). The LPHC must maintain the spine structurally erect within its physiological range of motion during perturbation, and maintain structural integrity while the transfer of torque and momentum occur between upper and lower body movement (Huxel Bliven, & Anderson, 2013). Huxel Bliven, & Anderson (2013) describe the “core” as a 3-dimensional space composed of muscles which contract together to create a corset-like stabilization around the spine and trunk. Superior to inferior is the diaphragm to the pelvic floor and hip girdle, anterior-lateral to posterior are the obliques to the paraspinal and gluteal muscles. Further, balancing exercises to integrate all 3 subsystems will greatly enhance proximal stability during distal mobility and dynamic movement.

Included is a table of notable impairments during assessments (you can watch yourself in the mirror to notice if you are making any of these compensations). Also included is a corrective exercise continuum to help strengthen the core and LPHC and alleviate compensations. Let me know if you're interested in seeing a video clip of these exercises which follow the corrective exercise continuum structured according to the National Academy of Sports Medicine. I'm happy to support your pursuit of the Luminance of Movement!

LPHC core strengthening.pdf

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