Definition: Core Dysfunction is any disruption of the ability of the core system which is innermost abdominal core muscles (including the diaphragm, transverse abdominis, pelvic floor and muscles within the paraspinal reticular sheath (the multifidus, and erector spinae groups), to effectively distribute loads across the spine and pelvis, to create stability and to maintain alignment.
Causes: Direct damage to the core system or muscle incoordination as a learned compensatory mechanism from pain (back pain, abdominal pain, pelvic pain) typically lasting longer than 2 weeks. Some causes include surgery of the abdomen, pelvis or back (such as appendectomy, hernia repair, cesarean section, hysterectomy, prostatectomy), tearing/episiotomy or other trauma during childbirth, spinal or pelvic fractures.
Symptoms: recurring back pain, recurring spinal/pelvic misalignment, diastasis rectus abdominis, abdominal weakness or bulging, stress urinary/fecal or gas incontinence, pelvic organ prolapse, pelvic pain or dyspareunia, pelvic floor weakness, perineal numbness or pain, difficulty passing stool.
Evaluation: Common findings on examination may include Inability to belly breathe and/or ability to draw in the lower abdomen, misalignment of spine or pelvis, diastasis rectus abdominis, poor posture and may exhibit compensating patterns such as breath holding with lower leg lifting or bending. Pelvic floor weakness, paresthesia, pelvic organ prolapse (cystocoele, rectocoele), groin hip or deep buttock pain. The evaluation for core dysfunction is appropriate when the patient is not in acute pain and after other potentially life threatening diagnoses on the differential for back/pelvic/abdominal pain are ruled out.
Diagnostic studies: Core Ultrasound: The Quick Core Exam - preliminary diagnoses of core dysfunction. The Core System Assessment - can identify what muscles of the core system are affected - and further clarifies the diagnosis. A more in depth assessment of the pelvic floor muscles may be required by a pelvic floor therapist.
Diagnosis: Specific core dysfunction such as muscle atrophy of the abdominal wall, muscle incoordination, diastasis rectus abdominis, pelvic floor dysfunction, pelvic organ prolapse, pelvic floor weakness, pelvic floor muscle incoordination, fascial compromise of the abdominal wall or pelvic floor. Symptoms can be included in the list of diagnosis include those listed under Symptoms above.
Treatment: Treatment for core dysfunction includes correction of misalignment through manipulation or manual therapy. Restoration of core function by retraining the individual to activate the core system by isolating individual muscles of the core system then restoring the function of the system in the correct sequence of activation. This can be done in an outpatient setting with a trained medical provider, through an online exercise program such as the Mommy Ready Postpartum Program or a combination of both. Use of Core Ultrasound for biofeedback significantly increases the success of the individual to correctly perform core strengthening exercises. Referrals to address specific complications such as to a pelvic floor therapist (for inability to consciously relax the pelvic floor, pelvic floor mapping, perineal numbness, or scar tissue mobilization) or surgical specialties - for surgical referral for repair of fascial compromise (hernia or a diastasis rectus that is unable to obtain tension after 4 to 6 months of correct TA strengthening, perineal revision or pelvic floor muscle detachment).