For the Love of Health

Strengthening the Core with Brian Catania and Travis Ross

• ChristianaCare • Season 1 • Episode 24

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0:00 | 18:22

If you've been involved in any type of fitness routine, you've likely tried exercises that focus on the body's midsection. Maybe you've tried crunches or planks, but have you heard of the Row Dog or the Upside Down Turtle?

On this episode of For the Love of Health, ChristianaCare Physical Therapists Brian Catania and Travis Ross deep dive into their nationally recognized Sling Activation Sequence and why you need to be thinking about the core differently.


Brian Catania, MPT, SCS, ATC, is a physical therapist and site manager of ChristianaCare Rehabilitation Services at Glasgow who has attracted national attention for trailblazing new types of therapy.

Travis Ross, PT, DPT is an outpatient orthopedic and sports Physical Therapist at ChristianaCare in Newark, Delaware since 2006. He co-created the Sling Activation Sequence, which has been used to prevent and reduce injuries by athletes across the country.

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Speaker 1

So if you're only training one side, the side that looks good at the beach, you're missing the whole cylinder and you're going to kind of break down over time.

Speaker 2

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 3

Hello everyone, I'm Megan McGerman.

Speaker 2

And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3

If you've ever been involved in a fitness routine, I'm sure you've tried exercises that focus on the body's midsection, also called the core. Maybe you've tried crunches or planks, but have you heard of the row dog or the upside down turtle?

Speaker 2

They might be new, but those are just two exercises that are part of Christiana Care's approach to strengthening and priming the dozens of muscles that make up the core. It's an approach that's been published in the Journal of Sport Rehabilitation, featured in the Philadelphia Inquirer and the New York Times.

Speaker 3

And now the two Christiana Care physical therapists are here to break it down for us Brian Catania and Travis Ross. Brian and Travis, thank you both so much for your time today.

Speaker 1

Thank you for inviting us. I had a good time. Megan and Jason thanks for having us on.

Speaker 4

We're excited to be here and honored to be your guests.

Speaker 3

Let's start with the whole body. How many muscles are in the entire human body?

Speaker 4

Depends what source you check and which body you're looking at, but let's say, on average about 700 muscles.

Speaker 1

Some people are born with an extra muscle. Some are born without a usual muscle that you have. You can break it down into small muscles and deep inside the body.

Speaker 3

Okay, so that sounds like its own episode in and of itself. But today we're talking about the core specifically. How many muscles are in the core?

Speaker 1

So you could break it down into individual spinal levels. There's a muscle that goes to every piece of one vertebrae to another vertebrae and there's six sets in that. And then we have the big ones. We all know the good six-pack abs. They're very important, but there's a whole cylinder of the core.

Speaker 4

The core actually wraps, as Travis said, in a 360-degree cylinder, with the top being the diaphragm, so you learn how to breathe with your diaphragm You're not blowing out steam out the top and also your pelvic floor muscles pelvic floor muscles, which are also important interaction of the course you don't have a like a leaky floor, so to speak and then the body of the cylinder, like you think. He said six pack abs that people train in seven minutes, so to speak. Well, there's actually four layers of the abdominal muscles that also, as you go deeper, interact with the deeper layers of the back muscles. That is why there's different ways to train the core and there's different core muscles. But the more you understand how those fiber orientations run, the better understanding how to activate them and connect them. So how many muscles are there Depends how you look at the core.

Speaker 2

Obviously, there are plenty of people who follow those seven minute abs or what have you, and plenty of ways to focus on those. But if we're talking about this cylinder and strengthening that, as you are, you've developed your own exercises to do that, your own program to do that. How do you come to that? How do you develop new exercises that people haven't come up with before?

Speaker 4

Ten years ago we were asked to help at the University of Delaware with the lacrosse team who was having a lot of low back injuries, groin strains, hamstring strains and hip flexor strains. And we also had a runner at the time in the clinic who was also at University of Delaware who had chronic hamstring strains for her first three years of competing and couldn't train at a high level. So and there was a lot of research coming out at that time that showed, well, these deeper muscles, if they're not activating or clicking on or they're atrophied, then they can influence what's going on downstream. So it's important to look there. But at the time it wasn't like, well, do you just do it with like straight plane planks? Is that really working? So we started asking, we got curious and we were like like Trav, what, what are other options? Do we have to to work on these muscles? So that kind of got us down the path of well, let's look at the fiber orientation.

Speaker 1

We saw a runner who was you don't think there's that much rotation in that sport. And then you have your lacrosse team, where there's a lot of rotation in that sport. And how can those two sets of people be so similar with different kind of rotational sports? And so when we're looking at that rotational aspect or the lack of rotational, there's a common piece that brought them both together that was causing their injuries still in the same. So we had to look at that dynamic core and see how each of them are related to each other.

Speaker 4

Even though they're playing different sports and then we kind of broke it into six different parts and we didn't exclude the diaphragm and the pelvic floor. They're still part of our program, but at the time to do the research you can't have all these variables to prove what you're doing. So when you go into research you have to eliminate some variables so that you have reliability. That's how we ended up with the six major parts of the body of the cylinder.

Speaker 3

Obviously, we're sitting at a desk right now. You can't show me all of these exercises, but we do have videos. We will link to that. We've done that. Do break down these exercises. Walk us through what you came up with and why it's so unique in this field.

Speaker 4

The SAS, the sling activation sequence. It's a sequence of seven exercises that will hit all the muscles, global and local, and help them to work together so that you've activated your full cylinder.

Speaker 1

It's not actually a sling, it's a grouping of muscles. Everybody always Googles it. So what do I wear when I'm doing this sling activation, like I Googled it, and I see arm slings? We just kind of generalized the term sling, developed as like a synergy, a chain of muscles. That chain of muscles can also be called a sling. Basically, going from a group of muscles in your core, connect it to your lower body.

Speaker 4

We looked at the trunk, like, let's say, ribs six down to the waist, and how they interact with the lower extremities. So, for example, if we use the internal oblique as the lateral sling, it's connected to your glute medius on the side so it makes your leg go out to the side but it also keeps your body upright as you land from running on that side so you don't dip and go that way. And then we looked at the front and you have an X in the front, so the external oblique travels across to your opposite side adductors, your groin muscles. If you're swinging to kick a soccer ball or you're going to do a lacrosse shot, this side is going to connect to that other side to generate your power and transfer the forces of the forces. And then in the back you have your big latissimus dorsi and your erector spinae on the right side that travels to the opposite side, glute max, with the deeper muscles being Megan's favorite muscles, the multifidus.

Speaker 3

I find it interesting to say personally, it's what I'm saying.

Speaker 4

And that kind of formed the cylinder. So then we could, with somebody on the exam table, we could test them in those different positions. And was there compensations? Oh, all right, you're not using this muscle, so we can see that. Or your multifidus doesn't swell and we can feel that.

Speaker 1

So we found that when that multifidus doesn't kick in as much as we want down the body, they develop compensation patterns.

Speaker 1

They'll either use the front of their hip inappropriately and bend the wrong way, instead of staying nice and straight and still on the table when we test it, they kind of wiggle around where they're strong, where everything's kicking in for them. When that multifidus is firing and when we wake those muscles up and we get the right pattern of muscles going in, kind of like a synergy and like a chain of events, everybody's still and that's a very stable system to help reduce injuries we're finding and for our athletes that aren't injured, or before you go and work out, we have implemented these before a workout. We call them kind of like a primer. You kind of want to wake up these deep muscles before we hit a big event, before you hit a big lift, before you hit a 5K, before your tournament or something like that. You know everybody believes in a good warm-up. This is the warm-up before the warm-up. Many programs have the core at the end because no one's going to do the core at the beginning. You know you're not going to make it through the whole.

Speaker 2

You know's very vital to set you up for building strength on top of that strong core down and up the chain Once that core is ready. If somebody is doing an ab routine, eventually they're going to see if they're doing it right. They're going to see something here, but you're talking about muscles that are less surface. How do you know these are working? How do you know, when you've been working with someone, that you've strengthened these muscles? How can you tell?

Speaker 1

the good is when you're working efficiently, those larger muscles are kicking in too. So those side abs that we always like to work out in the summer really kick in and they will be more defined and they do connect to a more defined leg, the deeper muscles that Brian's talking to. It takes some practice to feel if that's kicking in appropriately. That's something we've trained ourselves to feel. We developed our program not to work in a shortened position. I'm not saying crunches are wrong, but you're staying in a really tight and flexed position all the time to do your abs and you know we're talking about standing up tall and having good posture. But if you've trained yourself to be short in the front, you're going to be a little stooped unless we really lengthen those front six pack abs. So they are important, but I do like to train in a lengthened, longer position to give you that length. So, like Brian says, when you're doing these exercises you're not trunk swaying to one way or flexing. You want to stay nice, tall and strong and present.

Speaker 4

Anecdotally in the research when we were in the lab, so to speak, the core lab, we had a program that was all straight plane and a lot of it was abdominal crunches and things like that, and a few of the subjects that we didn't necessarily report on, because that's not what we were studying, had shortened so much in that little bit of time and they had lost their ability to rotate through their thoracic spine, like they lost. They put too much tone into the rectus abdominis and we were looking at each other like, oh my gosh, they got weaker.

Speaker 1

It was after one session of exercise, so it's eight minutes.

Speaker 4

Yeah, it's like eight minutes. So these seven minute ab programs, yeah, you're putting input into the body.

Speaker 1

The input you're putting in actually matters you should know what you're doing, and it's only focused on one part of that cylinder that Brian was talking about. If you're doing and it's only focused on one part of that cylinder that Brian was talking about If you're hitting just the front of a cylinder, you need to put attention on the sides, the back, the top and the bottom. So if you're only training one side the side that looks good at the beach you're missing the whole cylinder and you're going to kind of break down over time.

Speaker 3

The Sling Activation Series caught the attention of the National Football.

Speaker 4

I had taught in the University of Delaware's athletic training program for eight years the rehab of athletic injury and several of those students went on to work in the NFL and they were familiar with our research. They have a symposium every year before the combine for all their medical professionals and that year was the COVID year and it was on the spine and they said we need some people to talk about the core. And then we got invited to present to all 32 teams at their combine symposium and we had to do it virtually, which was very challenging because this is more of a hands-on lab. So we presented a virtual lab to all the people and it was well-received. The Ravens invited us down later when it was more appropriate for a full day in service, so they implemented it there and then the Rams did more of a virtual conference with us and it was the year they won the Super Bowl.

Speaker 3

You can take credit for that.

Speaker 4

That's fine, Well we'd like to say it's one of the variables that kept them healthy, because their PTATC said availability is playability and they wanted something to prime their core to mitigate the risk.

Speaker 2

A lot of what we're bringing up here has to do with athletics and athletes, but based on what you said, and especially with the way of being somebody who's almost 50 and realizing that body change that's happening with me, these are exercises that can work just even if you're not an athlete. This is good for everybody. This program you've created.

Speaker 1

Yes, so we treat this clinically, from your weekend warriors to people just trying to walk more without low back pain. I mean we modify the program. I mean we're doing this for athletes. So this program is pretty tough but you do scale it down. There's lots of modifications, but the most important thing is to link those slings, connect the core.

Effective Core Exercise Techniques

Speaker 4

So there's different levels of function and ability. So it's applying the right exercise at the right time, right, the right care at the right time. So knowing that. So you asked are these exercises appropriate for everyone? They can be adapted and applied to everyone. We clinically use it, We've taught, we have someone in each of our sites at Christiana Care Rehab Services that's trained in the core sling system to be able to identify where the weakness is and be able to prescribe. And what we're describing here is it matters what exercises you do with the body that you have. That's what we do. We prescribe the exercises that are appropriate for your current functional ability.

Speaker 2

And so what has the feedback been like from the patients that you've been seeing at the ChristianaCare Rehabilitation Services?

Speaker 4

It's nice to hear that they've seen it like in the New York Times or the Philadelphia Inquirer and those kinds of things, or the NFL had adopted it. But when they feel the difference in themselves, that's when they've truly bought in and then they're going to continue doing the exercises or whatever we've prescribed outside of our care, and it kind of helps them stop doing the movement patterns that were kind of causing things to break down.

Speaker 1

So by just like cleaning up how they're moving with a lot of these exercises like, oh, I wasn't supposed to move like that when I'm doing this exercise. That was why my hip has been hurting, and as we clean that up, it's like I can do these exercises and not have so much pain and understand my body. Like Brian says, it connects to their body and you know it's not hard but you're sweating and so it's something's really inside you like turning on. It's really your sympathetic nervous system is just getting primed because it likes that feedback. It loves the.

Speaker 1

The rotate through the system and the way we teach the rotation is through the rib cage. Okay, that's where I want everybody to rotate a lot. When we get in trouble, we start rotating through our lower back, through that L3 multifidus and that's what shuts that down. When you're trying to rotate through there, things start breaking down. So our system is kind of built on getting your kind of your chest and rib cage to rotate instead of the low back and that's going to save your chronic low back and it's going to keep all your compensations from coming back.

Speaker 3

Before we let you go, let's talk about what anyone listening to this maybe can do. We'll certainly link to all of those videos the official SAS exercises, but if someone is listening, maybe driving to work right now and thinking, well, I need to work on all of this. Are there little things that they can maybe do sitting at their desk today to keep it front of mind and work on rotating in?

Speaker 4

that rib cage. I think it's okay to feel that way, because now you're ready to start to do something about it. I think we all feel that way and we drift away from our core quite frequently, even Travis and I, from doing the research. We look at each other sometimes and like.

Speaker 4

I haven't done it in like two weeks. I need to prime the core, so to speak, first. Before you do them, watch the videos. These are different exercises. Just don't jump all in. There's a reason. We have a ball to squeeze to stabilize your lumbar spine. So it's not all. The rotation isn't happening there. It's happening where Travis just talked about, through the thoracic rib cage, because that's more our transfer of energy and that's where a lot of the core muscles activate from. So watch the videos first, and then Travis is going to give you a little demonstration of something you can do at your desk.

Speaker 3

For anyone just listening and not watching this on YouTube Travis had a ball under his chair, which I feel like is probably you. Travel with that everywhere. You don't even want to know If you're not watching the YouTube version, and you're listening right now. You can always hop over to the YouTube version to see him do this, but Brian will narrate as well.

Speaker 4

So if we're watching Travis, he has a nine-inch Pilates ball that you can purchase anywhere. It's filled, but it's squishy enough to produce that resistance that we need to activate your core. So you activate your adductors, the pelvic floor, and then you build that resistance. It gives you that feedback Right.

Speaker 1

So, as I'm squeezing, I'm just kind of like I can just lightly do it. You don't want to like max me, pop it, but just a general squeeze and that kind of makes me sit up tall so it gets me out of this desktop position. So, like a lot of my desk workers who work eight hours at the desk and then they go for a run, they are really tight in their chest and their stomach and in their hip flexors so it's keeping us bent. So this I mean you do need to stand up, but this is a good thing you can do in your chair. So you get a good squeeze here and cross and he'll let you talk right there.

Speaker 4

Yeah, and as you see, travis, he's rotating through these lower six ribs, right where all those oblique muscles are. That transverse abdominus is right in there. So he's created the resistance with the ball squeeze and now he's rotating as far as he can until he feels the tension at his end range. Because as you go back and forth and you're using your oblique muscles to do the twisting, he'll start to gradually increase that length. So you don't just plow through it on the first one, right, you gradually ease in and awaken those muscles and gradually, as they build the heat, you'll be able to go a little further.

Speaker 1

And the big thing about the ball squeeze too. It doesn't let my pelvis or my low back shimmy or arch or flex, so all the motion gets kind of like stabilized and we call it like a neutral. We want everything kind of stacked Then above it. I want my cylinder to rotate above it.

Speaker 4

And Megan just for you. When Travis does that deep in his low back here, he's got a swelling of the multifidus. Oh let's go and test her. What is it?

Speaker 3

called it.

Speaker 4

all ties back to the multifidus Deeper muscles of all the spine, but really we're trying to protect the lumbar spine in this case.

Speaker 3

I think Jason and I are about to do an exercise afternoon at our desks, for sure.

Speaker 4

Absolutely. Thank you so much. Excellent, thank you all. We enjoyed being on Absolutely.

Speaker 3

Thank you so much. Excellent Thank you. We enjoy being on Absolutely, and we'll have links to their sling activation series videos we mentioned, as well as more information on Brian and Travis's work in the show notes for this episode.

Speaker 2

And don't forget to subscribe to, for the Love of Health, on Apple Podcasts or Spotify, and follow Christiana Kerr on social media.

Speaker 3

We'll be back in two weeks with another great conversation.

Speaker 2

Until then, thanks again for joining us for the love of health.

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Megan McGuriman

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