Misconceptions of “The Core”

Core strengthening, training, and stabilization have become popular terms in exercise discussion.  However, they are often misused or referred to incorrectly.  Core exercises are often thought of as exercises of abdominal muscles (crunches, etc), or back muscles (lat pulls, rows, roman chair, etc.).  Although these are great for strengthening certain muscles of the trunk, they are not true core exercises.  Core muscles are not the abdominals, back extensors, or “prime movers” of the spine.  They are much smaller and more specific “stabilizers” of the spine.  Their responsibility is to control the vertebral movement, not initiate it.  These muscles reduce the amount of shear force at each vertebral level and give the spine balance and control.  They consist of the transverse abdominus, multifidus, pelvic floor muscles, and many of the smaller muscles that link each vertebrae together.  Training these muscles is not only essential for spine rehabilitation, but for functional training and activities of daily living. 


To truly work the core stabilizers, one must first learn to fire them volitionally, and once that is mastered they must be trained in an unstable environment.  This can be accomplished through a great deal of therapeutic ball use and balance oriented training to stimulate these muscles to centrally control the spine.  The improved functioning of the core muscles will result in “prime mover” strength being enhanced, more efficient, and the spine becoming more protected.


Therefore, understanding the use of the term “Core” is very important in understanding how spine rehabilitation progresses.  SLIERS therapists understand the core and are committed to correctly training and rehabilitating spine patients for the rigors of working and activities of daily living.  




Winter Aches and Pains

With the colder season in full swing, many of us no longer engage in the activity we used to in the summer.  That, combined with the changes in weather can often cause arthritis to flare up.  There are many ways to help prevent these winter aches and pain from getting the better of us.  One of the best ways is to perform gentle exercises in your home on a daily basis.  Exercise will help maintain the health of your joints, the flexibility of your muscles and increase your energy levels.  Staying active is important during the winter, especially if you are experiencing Seasonal Affective Disorder.  The SAD symptoms will often lead to less activity, strength and tolerance for your favorite hobbies causing a downward spiral into poor health.

            If you happen to be experiencing a flare up of arthritic pain, either from weather changes or lack of activity there are many gentle alternatives to regular exercise, such as isometrics.  Isometric exercises maintain a steady position while you flex your muscles for a short period of time.  Since your arm or leg isn’t moving, you will not get irritate the arthritis.  Your muscles stay strong and your joints stay stability and your circulation increases.  Always remember to breathe continuously during exercise and stop if it causes any discomfort.

            During painful flare ups you need to protect your joints, but that doesn’t mean sitting and resting all day; you have to stay active.  When you are active during a flare up, be sure to:

  • Protect the smaller joints – use the big ones instead
  • Avoid repetitive activity – if you have to get a big project done, do it in small parts throughout the day instead of all at once
  • Avoid awkward positions – these can slowly take their toll, so don’t hyper-extend or hyper-flex your joints.


If you have any questions call your doctor or physical therapist.

Arthritis Tips: Make your car more user friendly!

Is you car a pain?  Not just because of gas prices but because it makes you literally hurt to use it? Let’s start with simply unlocking and opening the door which could be painful if you have arthritis affecting your hands.  There is adaptive equipment to help you enjoy going for a ride in the car.

This device comes in handy for opening your car

This device comes in handy for opening your car



This tool can making ulocking the door or turning the ignition a snap

This tool can making ulocking the door or turning the ignition a snapwww.dkimages.com/.../Security/Keys/Keys-02.htmlThis gives leverage to make turning any key easier



This device will help make getting out of your car easier

This device will help make getting out of your car easierwww.aidsforarthritis.com/catalog/clearance.htmlYou can add a satin pillowcase to your seat to make sliding in and out easier OR and heated seat cushion


This gas cap wrench makes it easier to fill up, at least easier on the hands not necessarily the wallet.
This gas cap wrench makes it easier to fill up, at least easier on the hands not necessarily the wallet.

Also, remember to keep a Ziploc bag in the glovebox if your joints are swollen to use ice.


Safe Setup at Work

Ergonomics: the study of work.

            The study of work is important for us to understand because there are many possible ways we can get hurt at work.  From the desk job to the construction site;  there are easy ways to reduce our risk for injury.

            OSHA or the “Occupation Safety and Health Administration” is a division of the Department of Labor focused on preventing injury, illness and death in the workplace.  It is a great resource to begin with if you are interested in learning more about ergonomics.

            Many injuries are preventable if we adapt our work places appropriately.  We must change the job site to fit our needs, instead of the other way around.  In the office be sure you are in good alignment when using the computer.  Sitting slouched at the computer is one of the most common ways to get an overuse injury (tendonitis, bursitis or impingement) in your shoulders.  Many diagrams and resources are available through www.osha.gov and many other commercial websites.  These websites outline general tips to follow in different work settings to reduce the risk for a costly and time consuming injury.  There are many resources available for all kinds of jobs (office work, electrical contractors, shipping yards, etc).

            If you ever have questions about preventing work related injuries contact our SLIERS clinic on Americana at 706-7530.  We have many specialists available to assist employers and employees in preventing work related injuries.

My Favorite Strech-Piriformis.

We see so many patients presenting with lower back pain, and usually from chronic or repetitive use, combined with inner core instability.  We administer the standard inner core exercises focusing on the pelvic floor, the transversus abdominus, and the transversospinales, or multifidus muscles.  These exercises are wonderful for beginning the stabilization process.


Also, if indicated, we facilitate stretches; of the Piriformis, or external hip rotators, the lower thoracic spine, the hamstrings, and the quadriceps.  These work well to release the lower back, but my personal favorite would have to be stretching the piriformis.


And my favorite way of stretching the piriformis is by crossing one leg on top of the knee of the other, and bending over in a seated position, keeping the “down” leg in a solid 90 degree bend.  I think what is most appealing is the relative level of ease in this stretch.  It is good for people who have trouble doing the same motions while on their back, and it allows for more of the whole body to relax into the stretch, using gravity instead of lifting the crossed legs up and working against gravity.  Almost every patient I’ve coached in this stretch says “oh yeah, I feel that.”


One important tip:  try and imagine that while you are bending forward in the chair that your only fulcrum is at your hips, keeping your chin up as you lean forward.  Imagine your hips are a hinge and this is where you are bending.  Also, if the person can not totally cross their legs (elderly or more stiff folks) then they can cross them as far their comfort level, then lean forward.


This stretch, combined with thorough deep tissue massage when indicated, in the lower Lumbar region including the Quadratus Lumborum , Gluteus Maximus/Medius, and Piriformis without major contraindicated spinal pathology, are  most certainly highly beneficial therapeutic protocols.


Paul Greear NCTMB

Nampa North

New- Back School!

Do you or anyone you know have back pain?  Back School provided through St. Luke’s ♦ Idaho Elk’s Rehabilitation Services will help answer any questions you have and give helpful hints to manage your back pain.

            We will discuss common causes of back pain and why some people are more likely to experience it than others.  Ways to prevent back pain will be covered along with which treatments are most effective for different conditions.  After the lecture there will be time for a question and answer portion where we can discuss any current problems or past experiences.

            Call 489-5085 RSVP and reserve a seat or with any questions.

Back School

2nd Tuesday of the month

6:00 – 7:00 pm

RSVP required

St. Luke’s ♦ Idaho Elk’s Rehab Services

520 S. Eagle Rd. Ste. 2106

Meridian, ID 83642


Quick fix for Neck Pain

Ok, here’s the latest quick self-fix i’ve discovered for sore and aching erector spinae muscles(not to rival self trigger point work with the Thera- cane…):  Take two tennis balls, tape them together but leave some of the crease between (duct tape works really well).
You now have a little wall massager.  Place it against a wall, move your back against the taped tennis balls so that the crease fits your spinous processes, and do wall squats, working and varying the pressure of the tennis balls to your desired intensity.  Feels really good if you can get some pressure inbetween the rhomboids, and if you’re good you can even work around the superior edges of the scap.
Then reposition lower and work into a lower squat (yep, watch your knees) and work some of the lower lumbar, multifidus muscle (this takes skill!).
Wha Lha! you have now discovered another effective self massage technique.  Don’t be suprised if your coworkers look at you funny as you piston up and down, making goofy, feel good faces. 

Paul Greear NCTMB
Nampa North