Everyone keeps talking about your core: ‘keep your core strong,’ ‘activate your core,’ ‘stabilize your core’ etc.  But what does that really mean?  What IS your core?  How do you REALLY activate it?

Your core primarily consists of your transversus abdominus, multifidus, and pelvic floor.  More secondary components of the core muscles include your  rectus abdominus, obliques, gluteal muscles, hip rotators, hamstrings, quadriceps, and latissimus dorsi.  The core’s primary role is to stabilize your spine and pelvis during dynamic movement, for example running, twisting, or walking. These muscles help lock everything in place and also help transfer forces so your bones don’t jar against each other.

The scientific article: The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain by Richardson, CA et al, is a study of the core muscles before walking or lifting.  It demonstrated the activation of core muscles milliseconds BEFORE walking or lifting or moving from sit to stand is performed. By placing external electrodes over these muscles, an analysis of each muscle’s activation, force, and timing was recorded.  It also compared the activation sequence in people with healthy lower back versus people with painful non-healthy lower back.

To summarize, this article found that when transferring weight from one foot to the other, picking up an object, taking a step,  the transversus abdominus and pelvic floor were activated milliseconds before the rest of the secondary core muscles were activated.

The study noted that people with lower back, hip/pelvic pain, the transversus abdominus and pelvic floor muscles were activated either simultaneously or after the other core muscles, not before, as demonstrated in people without pain.  In some cases the core muscles did not become activeated at all.

So how do you activate the transversus abdominus and pelvic floor? Correctly? And keep it active? A licensed physical therapist at EMH Physical Therapy teaches you how to locate and palpate the transversus abdominus, how to recruit the pelvic floor muscles and develop awareness for both muscle groups.  We then teach you how to strengthen these muscles and incorporate them during movement patterns.

What are the benefits?  By having a stronger core you can expect to move freely- no more catching or sharp pains.  Patients have told us they can walk and run faster, have better endurance, can bend down and lift easier and our youth athletes are able to return playing sport pain free.

The core muscles are the powerhouse of your body.  If you have back pain, becoming aware of your core muscles through guided physical therapy will be the key to resuming a pain free lifestyle.


Have you ever injured your shoulder? There are many diagnoses that your doctor can give you and some of the terminology they use can be confusing or even scary!  For example, “rotator cuff strain”, “subacromial impingement”,” bursitis”,” labral tear” and” shoulder osteoarthritis” are some of the most common names, but what do they mean and how can your shoulder become painfree with physical therapy?

Most shoulder diagnoses are very specific to the actual structure or tissue that is injured in the shoulder complex.   As physical therapists, our job is concerned not only with what structures are injured but HOW you injured your shoulder so we can teach you to heal and protect your shoulder.  Did you play tennis for a number or years?  Do you lift weights at the gym?  Did you slip and fall on an outstretched hand?

None of the above?  A poor ergonomic  work place or performing repetitive, incorrect movements at work/home and even some incorrect sleeping positions could throw off a very delicate system of muscles and nerves that control the mobility and stability of one’s shoulder.

Your doctor has probably mentioned the importance of the rotator cuff, a group of 4 muscles:  the supraspinatus, subscapularis, infraspinatus and teres minor that very closely surround the ball and socket  of the shoulder joint.  Studies have shown that these muscles contract together in a “presetting phase” which begins before any movement of the actual shoulder occurs to enhance the joint’s stability.  Without proper flexibility and strength of these small but important muscles, the “presetting phase” is altered or delayed and the bigger muscle groups such as the chest muscles, biceps and trapezius take over causing altered muscle patterns and joint mechanics which can lead to many shoulder injuries

Physical therapists (PT’s) are trained to palpate all the muscles of the shoulder  for tenderness or myofascial restrictions and can test the flexibility, strength of each muscle so we can create an treatment plan for you.    At EMH Physical Therapy we perform manual therapies to your neck, shoulder, upper back and arms; we teach an individuallized stretching and strengthening program and we  incorporate neuromuscular re-education techniques to help you return to optimum shoulder health.  Your posture and/or mechanics of your sporting activity are also evaluated and corrected to ensure you do not go back to old habits once your pain is eliminated.   By following our guidelines, most patients with shoulder injuries can return to full painfree function!