I find it difficult to assist patients with activation and improving core muscles.  I came across this article thought it would be beneficial to aid in core muscle activation and integrate movement patterns with core stabilization exercises.  I plan to use this treatment technique as a precursor to integrating more advanced proprioceptive neuromuscular facilitation (PNF) patterns and eventually to their home exercise program (e.g. supine marching, dead bugs, etc.).  Hopefully you will find this article helpful to draw a connection between static to dynamic core stability exercises.

(Click the link for access to the article)

You JH, Kim SY, Oh DW, Chon SC. The effect of a novel core stabilization technique on managing patients with chronic low back pain: a randomized controlled, experimental blinded study. Clin Rehab. 2014; 28(5): 460-469.

The study compared individuals in the control group who completed a core stabilization exercise that consisted of drawing in the lower abdomen and holding for 20 seconds, completing 10 repetitions, for 3 sets with individuals from the experimental group.  The experimental group also completed the previously mentioned exercise as well as another exercise with the individual in supine while holding ankle dorsiflexion against 30% of maximal voluntary contraction for 20 seconds, completing 10 repetitions for 3 sets.  The treatment was completed for 8 weeks and then progressed to drawing in the lower abdomen while simultaneously maintaining ankle dorsiflexion for the 20 sec x 10 reps x 3 sets.  All subjects had to maintain a blood pressure cuff at 40 mmHg that was placed at the lumbar spine (L5 region) during stabilization exercises.

The purpose of this article was to identify the effect of a core stabilization exercise on physical function, pain, and core stability in patients with chronic low back pain.  They based their research on the premise that voluntary control of core muscles is difficult and pain can cause inhibition of neuromuscular motor patterns.  Lumbo-pelvic core instability has been consistently identified as an important factor in chronic lower back pain.  Core stability is essential for rehabilitation of patients with low back pain and core instability.  The primary principal that they wanted to study was the idea of irradiation.

Irradiation is the spread and increase of muscle strength in response to resistance, possibly resulting from a stimulus-induced summation in muscle fibers.  

This will help to increase the number of motor units activated in a neuromuscular response.  The muscles that cause dorsiflexion of the ankle irratiate to the deep core muscles via proprioception neuromuscular facilitation.  The PNF flexion patterns primarily involve dorsiflexion, knee flexion, hip flexion, and flexion of the trunk with deviations of internal/external rotation and adduction/abduction at the hip.

Also, there is fascia that links the ankle dorsiflexors to the thoraco-lumbar fascia, which is the primary site of attachment of the abdominal muscles (e.g. transverse abdominis, internal obliques, erector spinae, multifidus, gluteus maximus, latissimus dorsi, and quadratus lumborum).

I hope this article is helpful to you and your patients that have difficulty transitioning from a static exercise to eventually a dynamic core stability exercise.