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Are Planks A Good Core Exercise?

6/23/2016

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Many of my patients have worked with trainers or used workouts found on the internet to help them strengthen their core muscles prior to seeing me for back pain.  Sit-ups on the slant board, crunches, and Roman Chair back extensions are popular core exercises.  Certain yoga poses seem to engage the core to a degree and can offer a kind of introduction to core strengthening as well.  But perhaps the most commonly promoted exercise for strengthening the core is the plank.  Planks are performed by getting into a push-up position (putting your weight either on your hands or elbows) and then holding the legs and torso in a straight line above the floor for a protracted period of time.  

The core can be thought of as having four separate quadrants: front (rectus abdominus), back (lower back and buttock muscles), and left and right sides (obliques and transversus abdominus).  Unlike sit-ups, crunches, and back extensions which each work only one of the four quadrants of the core, planks, when done correctly, engage three of the four quadrants (front and sides).  In this way, planks are a more comprehensive core exercise than sit-ups, crunches, or back extensions.  But there is a bit more to the story and before we rate planks as a core exercise we need to discuss the differences between exercises that involve motion and those that do not.

Exercises that cause muscles to shorten as they contract are referred to as concentric exercises, while exercises that cause muscles to lengthen as they contract are referred to as eccentric exercises.  When you do a push up, the part where you move upward from the ground is powered by concentric contraction of chest (pectoral) and triceps muscles which become progressively shorter the higher up you go.  If you then lower yourself quite slowly to touch your chest back down to the floor, those same muscles progressively lengthen while contracting, resulting in eccentric work.  Planks do not involve movement, so there is neither shortening nor lengthening of muscle fibers.  Exercises that involve muscle contraction without motion (shortening or lengthening of muscle fibers) are referred to isometric exercises.  

Of the three forms of exercise (concentric, eccentric, and isometric), isometric conditioning is the least effective for building muscle strength.  Isometric exercises such as planks are often used in clinical practice as the first phase of rehabilitation because they are a gentler form of exercise and carry less risk of injury when patients are de-conditioned and particularly vulnerable.  Following surgeries or prolonged immobilization, planks, yoga poses, and other forms of isometric exercise can be very useful for establishing base stability safely.  But base stability is insufficient for back health and will not provide a sculpted, chiseled mid-section. 

Kore Power Trainer offers three levels of workouts: Core Stabilization, Basic Workout, and Advanced Workout.  The Core Stabilization routine engages each of the four quadrants of the core in isometric exercise for one minute.  This makes it more effective than planks which do not engage the back quadrant.  Once Core Stabilization becomes easy to do, we recommend that you move to the Basic Workout which involves both concentric and eccentric work.  Four minutes of the Basic Workout, 3-5 times per week, can build sufficient core strength to reduce, eliminate, and prevent many forms of chronic back pain as well as help give a chiseled appearance to the mid-section.  

Though popular in the fitness world (for now), planks actually rank quite low as a core strengthening exercise.  For a truly powerful core and a sculpted mid-section, you must do concentric and eccentric work.  We invite you to try 4 minutes on a Kore Power Trainer.  

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Why Is a Core Workout Important?

6/22/2016

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The 'core' is a term used to describe several different muscles in the lower back buttocks, abdomen, and sides which function together during bending, lifting, straining, pushing and pulling.  Broad, full-body activities such as these require coordinated work between the upper and lower body with the low back as the connection between them.  Strong core muscles not only help power many of these activities working in conjunction with the arms, legs, chest, and shoulders, but they also support the lower spine.  When core muscles are weak and de-conditioned, the physical stress of lifting, pushing, pulling, etc., can overwhelm them, causing microscopic tearing known as a 'strain' injury.  Even more harmful is the effect that a weak core has on the discs and joints of the lower (lumbar) spine.  When core muscles are strong they act to bolster and support the spine.  In a sense they act like a weight-lifter's belt, encircling the lower back, keeping it strong and tight and absorbing some of the burden of forces applied through the back during heavy activity.  

When core muscles are weak, those forces are transferred exclusively to the small joints and discs of the lumbar spine.  However, these structures are not well designed to bear extreme loads and over time, they too can become overwhelmed.  When a joint is overwhelmed, the ligaments holding them together get stretched and torn.  This is called a 'sprain' injury.  When a person with a de-conditioned core tries to lift a heavy object the forces applied to the lower back can result in both overwhelmed muscles and joints.  We call this a lumbar strain and sprain.  Repeated lumbar strain and sprain injuries take their toll on discs.  Each episode causes microscopic tearing and over time, multiple tiny tears begin to coalesce and form larger tears that ultimately lead to disc herniations.  

Disc herniations occur when the softer material inside the disc (called the nucleus) is squeezed out through tears caused by repeated lumbar sprain and strain injuries.  This nuclear material can wind up trapping nerves causing pain, numbness, and/or weakness down the leg sometimes referred to as sciatica.  Sciatica caused by a pinched nerve is a more serious condition and once discs have herniated, the nuclear material can never be put back inside the disc.  

Ever wonder why people shrink in height as they age?  The most common reason is repeated injury to the intervertebral discs.  Discs act as weight-bearing shock absorbers for the spine, and when they herniate, they lose height.  This diminishes their ability to absorb forces and makes us shorter.  Discs normally bear twice as much weight as the smaller lumbar facet joints, but when they herniate and loss their height more of the weight-bearing function gets shifted to the smaller lumbar facet joints causing them to undergo excessive wear and tear as well.  Osteoarthritis is the body's response to excessive wear and tear.  It consists of thickening of joints to compensate for weakened muscles and damaged ligaments and discs.  A sedentary lifestyle leads to a weak core and a weak core sets the stage for recurrent lumbar strain and sprain injuries, disc herniations, and ultimately, chronic degenerative osteoarthritis.  This is why a core routine is so vitally important!  A four minute core workout on your own bed, 3-5 times per week using Kore Power Trainer can promote and maintain sufficient core strength to support the spine, prevent many lumbar strain and sprain injuries, and slow or halt this process.  Think about it.  Can you commit to 4 minutes of exercise every other day? 
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WHAT EXACTLY IS THE "CORE"?

2/18/2015

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THE CONCEPT OF THE CORE

There is no official medical definition for the commonly used term, 'core.'  It appears to have grown out of the work of Joseph Pilates–a gymnast, acrobat, body builder and dance teacher who nearly a century ago had the insight that sedentary lifestyle increased the risk of back injuries and ill-health.  Pilates developed a series of exercises designed to promote strength in the area of the body that to him seemed most neglected.  Even athletes and physical performers, he noted, tended to focus on developing strong upper and lower bodies but not the area in-between: lower back and midsection.  Muscles in this area–even in people who exercise regularly–often remain weak and underdeveloped.  Followers of his methods came from all walks of life, but professional dancers especially took notice of the fact that improving strength in the muscles of the lower trunk improved their performances, helped them to overcome back pain, and seemed to reduce injuries.  These muscles of the lower trunk came to be called 'core muscles,' and today they are collectively referred to as 'the core' by many doctors, therapists, Pilates instructors and trainers.    

Today, a strong core is one of the most widely agreed upon goals in the fitness world and is a central focus of many physical therapy and chiropractic practices.  As a chiropractic doctor, I developed a core routine for patients which drew from the work of Pilates, various yoga styles, physical trainers and medical professionals.  It was performed on the floor and took about 40 minutes to complete.  It helped patients get well faster and for those who stayed with the routine, it kept them out of my office.  I taught back classes based this routine and promoted the idea of curing back pain by developing a strong core as an alternative to long-term treatment management or so-called 'maintenance care.'  Millions of people rely on the chronic use of chiropractic manipulation and elaborate stretching routines to manage back pain.  But this can be costly and it sucks up a lot of time.  Many back problems can be cured and chronic back pain is in many cases preventable simply by attaining and maintaining good core strength.  

THE PROBLEM

When we are in pain we have strong motivation to do whatever we have to do to feel better.  However, once the pain goes away, often so does our motivation.  Most patients will stop doing their home care routines within 3 months of completion of care.  We get busy, catch cold, take a vacation, or just start skipping days until that elaborate 40 minute routine becomes a kind of distant errand that we intend to get back to when we have the time.  Pretty soon we are back to old habits.  We do a few crunches at the gym and convince ourselves that this is sufficient.  After all, we are feeling fine again.  Gaining real strength takes time but de-conditioning occurs quickly and the stage is now set for a new injury or episode of back pain to once again take place.  A few months may pass and then we go to lift a heavy piece of furniture or sleep in a twisted position and wake up in pain again.  Over time the episodes tend to occur more frequently, last longer, and become more intense.  Eventually, back pain becomes chronic.  At this moment one in five Americans is experiencing back pain!  This is an epidemic number.  

A strong core requires some ongoing maintenance.  There's no way around it.  But for most people a 40 minute floor routine does not fit into their busy lifestyle.  Nor does driving to a Pilates or yoga studio 3-5 times per week to do 60-90 minute classes.  Time and cost are real hurdles in the lives of busy working people.  Statistically, less than 10% of patients maintain compliance with home care beyond 3 months.  I don't blame them.  It was hard for me too!  I found it tedious and time consuming.    

THE SOLUTION

For more than two decades I asked myself, "How do I better motivate patients, friends, and family members to keep up their core routine?"  In the Spring of 2011, while traveling, I began to play around with doing sit-ups while hanging off the side of a bed.  I did this because I not want to lie on the hotel room floor which looked unclean.  Also, it occurred to me that hanging off the bed with my torso unsupported would enable me to work up and down (against gravity) instead of forward and back.  I thought this might make it more difficult and less boring.  I had my wife anchor down my feet using her body weight.  With my hips at the edge of the mattress, I suspended my torso off the bed, and started doing sit-ups.  I couldn't believe how intense it was!  With my floor routine, I had to do at least 200 crunches to feel like I had gotten a good stomach workout,  But hanging off the edge of the bed, working up and down instead of forward and back, I was done in about 12 reps!  And the next day I felt real workout soreness.  It was then that I realized that the problem I had with my patients would never be solved by becoming the world's best motivational doctor. instead, what was needed was a much more efficient approach to getting and maintaining a strong core.  Kore Power Trainer was conceived out of this experiment and now, five years later, after several prototypes and refinements, I am able to share Kore Power Trainer with you.  Can you manage 4 minutes 3-5 times per week?  If you can make that commitment, you can have a strong core.  This is real.   

THE EXTRA BENEFIT

Using a Kore Power Trainer for 4 minutes, 3-5 times per week will give anyone a strong core. In addition, the more I did KPT, the more toned and ripped my mid-section became.  I must admit that I liked how it made me feel to have chiseled abs and sides.  As a triathlete, I began sharing KPT with teammates and friends who were spending a lot of time working their lower and upper bodies, but were often experiencing sore lower backs.  The response I got was nothing short of astonishing.  People began asking if they could buy extra KPTs to give to their friends or to take with them when they travelled.  KPT can be rolled up to the size of one shoe and easily packed into a suitcase, backpack, or briefcase.  We began selling KPTs not just to patients but to people who wanted to look great in a swimsuit.  I don't mind if vanity helps motivate someone to doing a core routine!  Overcoming back pain, preventing injuries, and looking your best are the returns you can expect with a 4 minute investment, 3-5 times per week when you own a Kore Power Trainer!

My sincere thanks to all of you who have provided feedback along the way.  We could not have made it to this point without you.  

-Dr. Berkoff


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IS KPT SAFE FOR ME?

10/6/2014

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KPT IS SAFE AND EFFECTIVE FOR MOST BUT NOT ALL PEOPLE:

One important question I have been getting from a lot of you is, "Can anyone use Kore Power Trainer?"  Patients with back pain are especially concerned about the possibility of making their condition worse and rightly so!  Many of you have tried various therapies in the past, sometimes with not so great results.  The last thing I want is for anyone to ever get hurt using Kore Power Trainer, but please understand that no form of treatment is risk-free.  Any medicine, therapy, or exercise program which can help you to improve your condition can also potentially cause harm.  Even over-the-counter medicines like Motrin or Tylenol can have potentially serious side effects.  A good percentage of my clinical practice is devoted to treating injuries sustained during yoga, Pilates, and various other forms of exercise and conditioning training.  It is always a good idea to speak with your doctor before starting any new exercise program.  Prudence informs me to say the same about KPT.  Please know that KPT was designed to be used widely by most–but not all–people, regardless of age or level of fitness.  We have developed three different routines based on core strength and fitness level, so even beginners can get started using KPT.  IT IS IMPORTANT TO USE PROPER TECHNIQUE.  Before beginning KPT, be sure to watch the instructional videos on this website which demonstrate proper technique and highlight the common mistakes that increase risk of injury.  Getting a strong core helps improve or eliminate back pain caused by most conditions.  But there are some exceptions.  

EXCEPTIONS:

1) Orthostatic Hypotension: The first and most notable contraindication to using Kore Power Trainer is orthostatic hypotension.  When you stand up, the veins in your legs, if working properly, push blood upward to the heart which in turn pumps oxygenated blood to the brain.  In some people the veins don't do their job, not enough blood gets to the heart and therefore, not enough blood and oxygen make it to the brain when they stand up.  If you get dizzy when you sit-up in bed or get up too quickly from a chair, you probably have orthostatic hypotension and because KPT workouts involve going up and down, this form of exercise could make you feel light-headed or even cause you to faint.  Speak with your doctor before attempting any new form of exercise.  If you have orthostatic hypotension, it is especially important to ask your doctor if you can do exercise that works your torso in an up and down fashion.  If you suffer from orthostatic hypotension, KPT is mostly likely not for you!

2) Acute Disc Herniation:  Most adults have disc herniations in their spine.  In fact, more than half of adults who have never experienced back pain have disc bulges and/or herniations on MRI evaluation.  The presence of a disc lesion is not a diagnosis and is usually not the cause of back pain.  KPT is safe and effective for many patients with disc herniations.  However, acute disc injuries in which a herniation takes place suddenly, pinching a nerve, and resulting in severe pain, weakness, or numbness down the leg that does not respond to conservative treatments such as traction, manipulation, NSAIDs, etc., can be a serious mechanical problem which, during this acute stage, can be made worse by attempting any form of core strengthening.  Please check with your doctor before attempting any core strengthening if you have or suspect you may have an acute disc herniation.  

3) Acute Back Strain:  KPT works by strengthening the muscles of the core.  If you recently experienced a strain of one or more of those muscles, exercising them can make the strain worse or prevent them from healing.  Acute strain injuries need time to rest and heal before you engage in intense exercise.  Once the acute episode has passed, core strengthening is the key to preventing the next episode, so KPT makes perfect sense.  Check with your doctor and get clearance for core strengthening, then set-up your KPT and get to work!

4) Advanced Osteoporosis:  If your bones have been weakened by advanced osteoporosis, any form of intense exercise can potentially cause injury.  Please check with your doctor before attempting any core strengthening if you have or suspect you may have an advanced osteoporosis.

5) Pain During or Following KPT:  As a general rule, if your condition is made worse by any form of exercise you should stop doing it immediately!  it may be that the particular form of exercise is not right for you in your current condition or that you are not doing the exercise correctly.  This is especially true of intense exercise such as you will get using KPT.  Please watch all the videos posted here on www.korepowertrainer.com to be sure that you are using proper technique before attempting KPT.  

If you have specific questions or concerns, please feel free to send us an email at: [email protected]

-Dr. Berkoff


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    Dr. Berkoff is the inventor of Kore Power Trainer.  He has been in clinical practice in La Jolla, California, since 1989.  

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