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Core stabilisation training for middle-and long-distance runnersBy Michael Fredericson, Tammara Moore

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Dr. Michael Fredericson is anAssociate Professor at StanfordUniversity School of Medicine inPalo Alto, California, USA. A for-mer distance runner himself, hehas worked with numerous eliterunners as physician for theStanford University Cross-Coun-try & Track Teams, the Nike FarmTeam, Medical Director for the2002 and 2003 USA NationalTrack & Field Championships, andphysician for the 2004 USAOlympic Trials.

Tammara Moore is a physicaltherapist specialising inorthopaedic manual therapy andsports rehabilitation and isfounder of Sports & OrthopedicLeaders Physical Therapy in Oak-land, California, USA. She is aLead Instructor for Active ReleaseTherapy® and a consulting physi-cal therapist for sports teams atthe University of California atBerkeley. She is active in the careof elite runners and has workedwith runners of the Nike FarmTeam, at the 2004 USA OlympicTrials and at the World Champi-onship Ironman Triathlon.

A strong foundation of muscularbalance and core stability is essen-tial for middle- and long-distancerunners. In their experience work-ing with elite runners, even thoseat an Olympic level, the authorshave found that weakness or lackof sufficient co-ordination in coremusculature can lead to less effi-cient movements, compensatorymovement patterns, strain, over-use, and injury. This article brieflydiscusses the theory behind coretraining for injury prevention andimproving a distance runner’s effi-ciency and performance. It thendetails a systematic progression ofcore exercises that can be easilyincorporated into a runner’s train-ing programme. The programmestarts with restoration of normalmuscle length and mobility to cor-rect any muscle imbalances. Next,fundamental lumbo-pelvic stabili-ty exercises are introduced, teach-ing the athlete to activate thedeeper core musculature. Whenthis has been mastered, advancedlumbo-pelvic stability exercisesusing the Physioball are added forgreater challenge. As the athletemakes the transition to the stand-ing position, sensory-motor train-ing is used to stimulate the sub-cortex and provide a basis for moreadvanced functional movementexercises, which promote balance,co-ordination, precision, and skillacquisition.

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Introduction

or middle- and long-distance run-ners—whose events involve balancedand powerful movements of the body

propelling itself forward and catching itself incomplex motor patterns—a strong foundationof muscular balance is essential. In many run-ners, however, even those at an Olympic level,the core musculature is not fully developed.Weakness or lack of sufficient coordination inthe core musculature can lead to less-effi-cient movements, compensatory movementpatterns, strain, overuse, and injury. This arti-cle briefly discusses the theory behind coretraining for injury prevention as well as forimproving a distance runner’s efficiency andperformance. It then details a systematic pro-gression of core exercises that can be incor-porated easily into every runner’s trainingprogramme.

The role of the core

The core musculature is composed of 29pairs of muscles that support the lumbo-pelvic-hip complex. These muscles help tostabilise the spine, pelvis, and kinetic chainduring functional movements. When the sys-tem works efficiently, the result is appropriatedistribution of forces; optimal control andefficiency of movement; adequate absorptionof ground-impact forces; and an absence ofexcessive compressive, translation, or shear-ing forces on the joints of the kinetic chain.

The first stage in developing a stable core isto develop the abdominal muscles. Richard-son et al1 have discovered that there are twodifferent types of muscles fibres (slow-twitchand fast-twitch) that make up the abdominalmuscles, and that because of this differentfibre composition, different exercise regimensare required to properly train these muscles.Slow-twitch fibres primarily make up thelocal muscle system—the muscles of thedeeper abdominal muscle layers. These mus-cles are closer to the centre of rotation of thespinal segments and, with their shorter mus-cle lengths, are ideal for controlling inter-segmental motion, maintaining mechanical

stiffness of the spine, and are best suited torespond to changes in posture and extrinsicloads. The key muscles of this system includethe transversus abdominus, multifidi, internaloblique, deep transversospinalis, and pelvicfloor muscles. Co-contraction of these mus-cles produces force via the thoracolumbarfascia and the intra-abdominal pressuremechanism stabilises and resists forces actingon the lumbar spine.

Fast-twitch fibres, on the other hand, pri-marily make up the global muscle system,which includes the superficial or outer-layermuscles. These muscles possess long leversand large moment arms that are capable ofproducing high outputs of torque, with anemphasis on speed, power, and larger arcs ofmovement.2 The main muscles in this layer arethe erector spinae, external oblique, and rec-tus abdominis muscles—the muscles that arestrengthened by traditional back and abdom-inal exercises and that assist with gross spinalmovements.

Interestingly, Hodges and Richardson3, 4

have shown that it is not simply that deep-layer abdominal muscles are recruited duringstabilisation of the spine, but it is how theyare recruited that is important. The transverseabdominus and the multifidi are considered“stabilising muscles” (muscles that are con-tinually modulated by the central nervoussystem and provide feedback about joint posi-tion), while the global and larger torque-pro-ducing muscles control acceleration anddeceleration. The authors found that the co-contraction of the deeper-layer transverseabdominus and multifidi muscle groupsoccurs prior to any movement of the limbs,and believe that this neuromuscular pre-acti-vation is critical in stabilising the spine priorto any movement.

The core programme

Stability work should be started only afterthe athlete has achieved good mobility, asadequate muscle length and extensibility arecrucial to proper joint function and efficiency.Although beyond the scope of this article, a

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thorough evaluation of the muscular systemshould include an assessment of the musclesfor over-activity, shortening, weakness, inhi-bition, and quality of motion. This is bestaccomplished by a skilled physician or thera-pist using muscle-length tests, strength tests,and tests for the efficiency of basic move-ment patterns and neuromuscular control. Athorough postural observation and video tap-ing of the athlete’s running gait will help inassessing and identifying any movementimbalances.

Preliminary stretches for shortened musclesshould include proprioceptive neuromuscularfacilitation (PNF) type or contract-relaxstretches that strive for isometric contraction,followed by end-range stretching. These areeffective techniques for maintaining musclelength and joint mobility. Active ReleaseTechniques® (a specialised method for softtissue mobilisation) when used in conjunctionwith stretching techniques, have shown greatpromise in restoring muscle length and soft-tissue extensibility. Athletes can also do theirown self-mobilisation with use of a foam roll.

Proprioceptive: Relating to stimuli thatare produced and perceived by the body,especially those connected with position

and movement.

Specific exercises for the runner shouldprogress from mobility to stability, to reflex-ive motor patterning, to acquiring the skills offundamental movement patterns, and finally,to progressive strengthening. These sequencesmay not be applicable to all athletes; there-fore, the key is to analyse the individual ineach exercise category and then to tailor anexercise regimen that will best suit that run-ner’s needs. For example, it has been shownthat runners prone to iliotibial band syndromeoften have weakness in their hip abductorsthat predisposes them to increased stress onthe iliotibial band.5 Thus, a preventative train-ing programme for runners with this syn-drome must target the hip abductors, partic-ularly the posterior aspect of the gluteusmedius that assists external rotation or indecelerating internal rotation of the hip.

Other muscles that prove weak or inhibited onevaluation should also be strengthened on acase-by-case basis.

The purpose of basic core stabilisation exer-cises is not only to increase stability, but moreimportantly— it is to gain co-ordination andtiming of the deep abdominal-wall muscula-ture. It is extremely important to do thesebasic exercises correctly, as they are the foun-dation of all other core exercises and move-ment patterns. These basic exercises empha-sise maintaining the lumbar spine in a neutralposition (which is the midrange positionbetween lumbar extension and flexion.),allowing for the natural curvature of thespine.

This first stage of core stability trainingbegins with the athlete learning to stabilisethe abdominal wall. Proper activation of thesemuscles is considered crucial in the firststages of a core stability programme, beforeprogressing to more dynamic and multi-pla-nar activities.

We recommend the technique as describedby McGill.6 This involves a sub-maximal iso-metric contraction of the three layers of theabdominal wall (rectus, obliques, and trans-verse) producing a true muscular girdlearound the spine to buttress against bucklingand shear instability.

Fundamental lumbo-pelvic stability

The exercise programme should progresssequentially through the fundamental move-ments as detailed below. The following exer-cises are to be performed three times perweek to maximise results. The athlete beginswith one to two sets of 15 repetitions andprogresses to three sets of 15-20 reptitions.These exercises are taught initially in either asupine, hook-lying position, or all-foursquadruped position. The athlete can progressto the more functional standing exercises, ascontrol is developed. Important conceptstaught at this stage include not tilting thepelvis or flattening the spine. We also empha-sise normal rhythmic breathing.

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SUPINE BENT-KNEE RAISES

This is a fundamental exercise for recruitingthe deep abdominal muscles and for lumbo-pelvic control.

The athlete lies on her back, with knees bentand feet flat on the floor. She then braces theabdominal wall, holding the lumbar spine in aneutral position, and slowly raises one foot15-30cm off the ground with alternate legs.Common errors when performing this exerciseinclude rocking the pelvis, abdominal protru-sion, or an inability to maintain the neutral(midrange) lumbar curve. If this happens, dis-continue the exercise for a rest period. Quali-ty more than quantity is stressed.

Progression: The exercise can progress toalternately extending the legs and lowering tothe ground. Once the athlete can maintainstability with alternate leg lifts. She can addalternate, overhead arm raises for greaterchallenge. The arm raises should be performedslowly, while maintaining lower abdominalbracing.

Figure 1: Supine Bent-Knee Raises

QUADRUPED WITH ALTERNATEARM/LEG RAISES

This exercise prepares the athlete for the pro-prioceptively more challenging, more dynamicexercises of the trunk. It specifically engagesthe multifidi—the deep transverse spine sta-biliser and extensor of the lumbar spine.

The athlete should position herself on allfours. She then braces the abdominal wall as

described above. While maintaining amidrange/neutral curve of the lumbar spine,the athlete should raise the right arm and theleft leg (opposite upper and lower limbs) intoa line with the trunk, while preventing anyrocking of the pelvis or spine (excessive trans-verse- or coronal-plane motion). If it helps tomaintain alignment, the athlete may use anobject, such as a foam roller or woodendowel, placed along the spine, for added tac-tile feedback. The leg should be raised only tothe height at which athlete can control anyexcessive motion of the lumbo-pelvic region.She then performs the exercise raising the leftarm with the right leg.

Progression: A Physioball underneath thetrunk can provide significantly more proprio-ceptive challenge owing to its unstable sur-face. The goal once again is for the athlete tomaintain lumbar stability while the oppositearm and leg are raised slowly.

Figure 2: Quadruped with Alternate Arm/LegRaises

BRIDGING

Bridging is a fundamental core-stabilityand gluteal-strengthening exercise.

The athlete begins the exercise on her back,in a hook-lying position, with arms resting ather sides. She activates the abdominals and

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squeezes the gluteal cheeks prior to initiatingthe movement. The athlete lifts the pelvis andhips off the ground while maintaining neutrallumbar alignment. There should be no rota-tion of the pelvis. The hips should be alignedwith the knees and shoulders in a straightline. The athlete should hold the position for10sec and then slowly lower the pelvis to thefloor.

Progression: In the lifted-bridge position,while maintaining neutral lumbar and pelvicalignment, the athlete can lift one foot offthe ground and extend the leg. By placing herarms across her chest, she can increase thechallenge of stabilising the lumbo-pelvicregion. To progress further, the athlete canraise both arms up to the ceiling and thenmove one arm out to the side. She shouldbring the arm back to the centre and repeatwith the other side.

Figure 3: Bridging

PRONE PLANK

This is a fundamental, static core-stabilityexercise.

The athlete supports herself with her fore-arms resting on the mat, elbows bent at 90º,and the toes resting on the mat. The athletemaintains the spine in a neutral position,recruits the gluteal muscles, and keeps thehead level with the floor. She is instructed tobreath normally throughout the exercise, whilemaintaining the abdominal brace. We suggestholding the position for 20sec, working up toone minute for two to three repetitions. Nocompensatory motion, such as increased lum-bar lordosis or sag, should be seen.

Progression: In this position, the athletecan add leg lifts for more difficulty: one legcan be lifted off the mat, held for five sec-

onds, and then repeated on the opposite side.Figure 4: Prone Plank

SIDE PLANK

This is a fundamental, static core-stabilityexercise designed to challenge the athlete’sbody against gravity in the coronal/frontalplane and is an ideal exercise to train thequadratus lumborum.

The athlete is lying on her right side withthe right arm extended in a straight line upfrom the shoulder, with the forearm restingon the mat. She then raises the pelvis fromthe floor and holds it in a straight-line “plank”position. The hips should not be allowed tosag toward the floor. We suggest holding theposition for 20sec, working up to one minuteholds for two to three repetitions.

Progression: The top foot can be raised toincreasingly challenge the core and glutealmusculature.

Figure 5: Side Plank

Advanced lumbo-pelvic stability

Once the athlete demonstrates good stabilitywith all static core exercises, they can bereplaced with more advanced exercises on thePhysioball detailed below. These exercisesshould be performed at least two times perweek to maximise results. The athlete progress-es to two sets of 10-15 repetitions. Quality ismore important than quantitiy; the athlete mustmaintain lumbar neutral and keep the spine inperfect alignment throughout the exercises.Ne

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SEATED MARCHING ON A PHYSIOBALL

This exercise is more difficult becausethe athlete positions her body againstgravity in a seated position on an unstablesurface.

The athlete begins by sitting upright on aPhysioball, with the lumbar spine in a neutralposition (midrange). She places her feet hip-width apart. While bracing the abdominalmuscles, she lifts one leg and foot off theground. (The limb does not need to be liftedvery high, just enough to be off the ground—approximately 5cm to start.) The athleteshould focus on controlling the weight shift-ing to the weight-bearing limb while main-taining lumbo-pelvic stability.

Progression: Once lumbo-pelvic stabilitycan be maintained with alternate leg lifts, theathlete can add opposite arm lifts.

Figure 6: Seated Marching on a Physioball

SPINAL FLEXION ON PHYSIOBALL

The athlete pre-activates her abdominalbrace in the starting position and maintainsthis as she rolls back into spinal extension.She then slowly raises the body, focusing therotation in the thoracic spine. Picture thehead and neck as a rigid block on the thoracicspine to prevent flexing the cervical spine. Theathlete concentrates on attempting to touchthe bottom of her ribs to her pelvis (ASIS).The hands can be placed over the ears toeliminate pulling on the neck.

Progression: The athlete holds a 2.0 to4.0kg medicine ball in front of the chest withthe arms extended (see Figure 7b).

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Figure 7: Spinal Flexion on Physioball

ALTERNATE LEG BRIDGE WITHSHOULDERS ON BALL

The athlete starts this exercise by sitting onthe Physioball and walking forward with hisfeet on the ground, slowly leaning back untilhis back rests on the ball. This is called thebridge position. The head, neck, and shoulder

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blades should be supported on the ball. Kneesshould be bent at a 90° angle, with feet onthe ground. While bracing the abdominalmuscles, the athlete raises the foot andextends the leg off the ground. The weightwill be shifted to one side, and the athleteshould focus on maintaining stability of thelumbo-pelvic region. The athlete should strivefor stability and balance, while holding thisposition for 10sec and alternating lowerlimbs.

Progression: The athlete lifts the arms up inthe air or out to the sides.

Figure 8: Alternate Leg Bridge with Shoulderson Ball

LEG CURLS ON A PHYSIOBALL

The purpose of this dynamic exercise is torecruit both actions of the hamstrings—hipextension and knee flexion—while maintain-ing dynamic stability of the lumbar spine.

In a supine position on the floor, the ath-lete places both feet on the Physioball.(Shoes should be removed to allow increasedproprioception from the exteroceptors of thefeet.) The athlete keeps her arms on the floorat the sides of the body for balance and rais-es the hips off the ground until the knees,hips, and shoulders create a straight line.She should focus on holding the spine in aneutral midrange position. In this position,the athlete then pushes the ball forwardwith the feet while maintaining the bridge.

The goal is to keep the pelvis elevated (hipextension) as both legs extend and flex atthe knees. While the knees extend and flexfrom this elevated bridge position, the ath-lete focuses on maintaining lumbo-pelvicstability.

Progression: The athlete can continue withsingle leg hamstring curls in the same posi-tion (see Figure 9b).

(a)

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Figure 9: Leg Curls on a Physioball

Exteroceptor: A sensory receptorthat receives external stiumuli.

ABDOMINAL ROLLOUT

The athlete kneels behind the ball, withboth hands on the ball. Keeping the abdomi-nal muscles braced and lower back in a neu-

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tral position, she then rolls the ball away fromher body a short distance until there is astraight line from the shoulder to hips. Whilemaintaining alignment, she pulls the ball backta short distance, then pushes it away again.The movement should occur only at theshoulders, not the back.

Progression: The athlete can graduallystraighten the body until she is up on hertoes. There should be a straight line fromthe back of the head to the knees. Now shecan again move the ball away and backtoward the body a short distance with thearms.

Figure 10: Abdominal Rollout

SQUAT BALL THRUST

Keeping the abdominal muscles braced andlower back and shoulder blades in a neutralposition, he athlete uses her abdominal con-traction to move the ball forward and back.Keep the spine in neutral alignment through-out the movement. If the exercise shown istoo challenging, start with the shins insteadof the toes on the ball.

Progression: The athlete can perform theexercise with only one foot on the ball (seeFigure 11b).

(a)

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Figure 11: Squat Ball Thrust

Development of balance and motorcontrol

The following movements require reflexivecontrol. The athlete can establish this controlusing an unstable surface and taking advantageof the numerous proprioceptors in the soles ofthe feet, and by activating the neck muscles,which contribute greatly to postural regulation.This sensory-motor training is an attempt toprovide the sub-cortex with a basis for move-ment that is progressively more challenging. Itinvolves exercises that stimulate balance, coor-dination, precision and skill acquisition.

Various devices are useful to progressivelychallenge balance, including a balance boardwith a whole sphere underneath the board(which creates multi-planar instability) or arocker-board with a curved surface underneaththe board (which allows single-plane motion).Dynamic foam rollers are an inexpensive alter-

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native to the boards that also can be used tochallenge balance, proprioception, and stabili-ty. These include half-rollers and full-sizedrollers. Two other items that are invaluable tochallenge balance and core stability and aidproprioceptive training in the standing positionare the Bosu Balance Trainer and the Dyna Disk(these can be used interchangeably.) The Bosuhas two functional surfaces that integratedynamic balance with sports-specific or func-tional training: the domed surface is convex,the other side is flat and can be used for lesschallenge. The Dyna Disk is an air-filled plasticdisc that can be firmly inflated. It has a small-er diameter than the Bosu and can be used likethe Bosu Trainer, as it creates an increased pro-prioceptive challenge to the athlete whilestanding on it. The Dyna Disk is unstable anddoes not have a base like the Bosu trainer.

FORWARD/BACKWARD ROCKING

In this exercise, a rocker-board is used tochallenge balance in the frontal plane ofmotion. Standing on the rocker-board withboth feet in perfect postural alignment, theathlete gently rocks forward and backward.(To maintain ideal posture, the athlete cancreate an imaginary line through the joints ofthe ankle, knee, hip, and shoulder. The earshould align in a straight line with thesejoints, with no excessive extension [swayback]of the lumbar spine or anterior pelvic rota-tion.) While rocking, there should be no excessbody movement in the coronal or transverseplanes. This exercise should be performed forseveral minutes. The goal is to optimally alignthe spinal curves and lower extremities.

Progression: The athlete canprogress to a slight flexed-kneeposition, with fast and slow move-ments to stimulate the rightingreflexes and balance reactions.She also can progress the steppingmotion to the three axes ofmotion.

Figure 12: Forward/BackwardRocking

SINGLE-LEG BALANCE—3 PLANES

This next exercise progresses the athlete toa single-leg stance. The rocker-board is usedin the three planes of motion. This exercisealso can be performed with a balance board,which is more demanding as it incorporatesall planes of motion simultaneously.

The athlete takes one step forward whilemaintaining alignment and balance, control-ling aberrant motion, mimicking a forwardrunning motion. The goal is to maintainlumbo-pelvic alignment. The athlete controlsmovement in the three planes of motions byplacing her feet in various positions on theboard. The athlete then alternately steps for-ward and backward onto the rocker-board.

Progression: Once the athlete achievesstatic stability and can remain stable whilestanding on the rocker board, she can add anaccessory motion. The athlete can swing thearm and the non-weight-bearing opposite leg(as though mimicking running). No excessivemotion in the pelvis or lumbar spine shouldoccur during the swing phase.

Figure 13: Single-leg Balance—3 Planes

WEIGHT TRANSFERS WITHPROPER ALIGNMENT

The preceding exercise progresses to“falling” onto an unstable surface. Figure 14shows a rocker-board and “falling” onto acircular balance board. Again, the emphasis ison spinal alignment from the head to thesacrum. The athlete steps forward quickly

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and catches herself from falling over with aquick forward movement of the leg onto theboard.

Figure 14: Weight Transfers with ProperAlignment

Functional Movement Training

Functional movements require acceleration,deceleration, and dynamic stabilisation. Afunctional exercise regimen specific to thedemands of running includes single-leg drills,three-dimensional lunges, resistive diagonalpatterns of the upper and lower extremities,and tri-planar movement sequences. Athletescan progress through the three planes ofmotion by performing similar exercises onbalance boards, the Dyna Disk or Bosu typetrainers, as static trunk and core stabilityhave been mastered. Once these exercises areperformed at a high level, the coach can beassured the athlete has the necessary corestability to start plyometric drills.

SINGLE-LEG BALANCE WITHHIP FLEXION

This exercise provides a functional move-ment pattern that is similar to running. Theexercise seeks to increase stability of thelower abdominal muscles while using a for-ward motion at the hip. The exercise isdesigned to develop sagittal-plane control.

While balancing on one leg, the athleteimitates a running motion. As the upper thighis lifted forward in a running motion, she con-centrates on maintaining the abdominalbrace and lumbo-pelvic stability while avoid-ing excessive anterior or posterior pelvic rota-

tion. The athlete raises the opposite armsimultaneously into flexion, while maintain-ing postural alignment with an erect spine,allowing only the extremities to move.

Progression: Once the athlete can maintainlumbar spine stability without effort, she canattach a pulley or resistive cord to the ankleto increase the challenge to the hip flexors

Figure 15: Single-leg Balance with Hip Flexion

MULTI-DIRECTIONAL LUNGES

The athlete begins this exercise with a for-ward lunge. Again, the emphasis is on main-taining a neutral spine position and abdomi-nal brace throughout the entire movement.As the athlete steps forward, knee flexion ofthe forward leg is limited to 90º. The kneejoint should be over the ankle joint and thepatella aligned with the second toe. The lowerpart of the leg should be perpendicular to theground, as shown in Figure 16.

Progression: Once strength and stability inthe forward (sagittal) plane have beenachieved, the athlete can begin stepping outat oblique angles, creating a narrower lungeor a wider lunge in the coronal or transverse

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Figure 16: Multi-directional Lunges

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planes. The athlete can also step out onto anunstable surface such as a Bosu Trainer orDyna Disk, which vastly increase the proprio-ceptive and dynamic core-stability challenge.

RESISTED ALTERNATE ARM/LEGSTEP-UPS

This exercise is a continued progression ofmulti-directional lunges and must not bestarted until strength and stability in thatexercise has been achieved.

This exercise utilises a sports cord to resistshoulder and hip flexion while doing Step-ups. The movement pattern is similar to therunning gait. The athlete’s opposite arm andleg are resisted simultaneously to increase thestrength and co-ordination of this movementpattern.

Figure 17: Resisted Alternate Arm/Leg Step-ups

MULTI-DIRECTIONAL RESISTEDALTERNATE ARM/LEG STEP-UPS

This is a continued progression of the pre-vious exercise. Once strength and stability is

achieved in the frontal plane of motion, theathlete can begin stepping up at a 45°.

STANDING PULLEY OR MEDICINE BALLROTATION

This resistive, dynamic trunk pattern chal-lenges the core with a rotational movementpattern while the athlete maintains stabili-ty in the hips and pelvis. It requires strictbracing of the abdominal muscles and lock-ing the rib cage and pelvis together to avoidunnecessary stress from torsion on thespine.

The athlete stands with feet about shoul-der-width apart and knees slightly bent. Sheactivates the abdominal brace prior to themovement. It is important to emphasisepostural alignment, with the scapulaeretracted and depressed. The athlete shouldmaintain neutral spinal angles throughoutthe movement. Holding a straight-arm posi-tion (elbows extended) while grasping thepulley handle or medicine ball with bothhands, the athlete rotates the trunk by acti-vating the abdominal obliques and spinalrotators. She concentrates on keeping thearms extended in front of the chest. It isimportant that the pelvis remains stable inthe movement. Resistance is perpendicularto the body.

This exercise can be done in the same man-ner using a 2.0 to 4.0kg medicine ball.

Progression: The athlete can add diagonalmotions with the pulley or medicine ball.

Figure 19: Standing Pulley or Medicine BallRotation

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Figure 18: Multi-directional Resisted Alter-nate Arm/Leg Step-ups

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FORWARD LUNGE WITH A MEDICINEBALL WITH TRUNK ROTATION

The purpose of this exercise is to challengethe trunk muscles with appropriate weightshift, balance, and control on one leg. It usesa resistive movement of the trunk with alunge that demands a high level of lumbo-pelvic and lower extremity stability as theathlete moves the ball in a diagonal patternacross the body.

The athlete will need approximately 30mto complete this exercise. She standsupright, holding onto a 2.0 to 4.0kg medi-cine ball, with arms outstretched, perpendi-

cular to the body. She steps forward with themedicine ball in front of her chest with thearms extended. Once the lunge portion iscompleted, she rotates the trunk by bringingthe ball across her body towards the sameside as the front leg and then returns theball to midline as the next step is made. It isimportant that the knee joint on the step-ping limb does not come forward past thevertical angle relative to the ankle joint. Thesecond toe is aligned perpendicular with thepatella.

STANDING REVERSE WOOD-CHOPWITH A MEDICINE BALL

This exercise is a resistive diagonal pat-tern of the trunk that demands a high levelof lumbo-pelvic stability and combinesupper- and lower-chain integration as theball is moved in a diagonal pattern acrossthe body.

The athlete stands, holding onto a 2.0 to4.0kg medicine ball with both hands, withthe feet approximately shoulder-widthapart. While holding the arms in front of thebody with elbows extended, the athlete

Sample Programme

Summer/Fall—Base Training/General Preparation(3 x /week, 2 sets of 15-20 reptitions for each exercise)Restore mobility/address any muscle imbalances Fundamental core stability exercisesSensory-motor stimulation

Winter—Specific Preparation(2-3 x /week, 2 sets of 10-15 reptitions for each exercise)Advanced core stability exercisesFunctional movement training

Spring/Summer—Competition(1-2 x /week. 1-2 sets of 8-12 repetitions for each exercise)Similar to specific preparation training with the addition of plyometric exercises

Figure 20: Forward Lunge with a MedicineBall with Trunk Rotation

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moves the ball from a lower position at thehip, raising it across the body to the oppositeshoulder, simulating a wood-choppingmotion. The motion is then reversed by start-ing at the lower knee position and bringingthe ball diagonally across the body, endingoverhead at the opposite shoulder. This exer-cise also can be performed with resistivecords or a pulley system simulating the samemotions.

Progression: The athlete can progress tostanding on one leg, using the opposite armto complete the motion.

Figure 21: Standing Reverse Wood-chop witha Medicine Ball

Conclusion

This article is intended to provide an under-standing of the importance of core muscula-ture to middle- and long-distance runnersand to offer exercises that will help themachieve desired stability, balance, and neuro-muscular control. It is highly recommended,however, that athletes consult a skilled prac-titioner to address individual needs and max-imise results from a programme of thisnature.

Please send all correspondence to:

Michael Fredericson, MDE-mail: MFRED2@STANFORD.EDU

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Core stabilisation training for middle- and long-distance runners

REFERENCES

RICHARDSON, C.; JULL, G.; HODGES, P.; HIDE, J.:Therapeutic exercise for spinal stabilization andlow back pain: Scientific basis and clinicalapproach. Edinburgh: Churchill Livingstone, 1999.

COMERFORD, M.J.; MOTTRAM, S.L.; Movement andstability dysfunction. Contemporary developments.Manual Therapy. 2001; 6(1): 15-26.

HODGES, T.W.; RICHARDSON, C.A.: Inefficient muscu-lar stabilization of the lumbar spine associatedwith low back pain: A motor evaluation of trans-verse abdominus. Spine. 1996; 21(22): 2640-2650.

HODGES, T.W.; RICHARDSON, C.A: Altered trunk mus-cle recruitment in people with low back pain withupper limb movement at different speeds. Archiveof Physical Medical Rehabilitation. 1999 Sep;80(9): 1005-1012.

FREDERICSON, M.; COOKINGHAM, C.L.; CHAUDHARI,A.M.; DOWDELL, B.C.; OESTREICHER, N,;SAHRMANN, S.A.: Hip abductor weakness in dis-tance runners with iliotibial band syndrome. Clin-ical Journal of Sport Medicine. 2000 July; 10(3):169-175.

McGILL, S.; Ultimate back fitness and performance.Wabuno Publishers, 2004.

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