For the Love of Health

Why Priming Your Core Matters for Every Body with Brian Catania and Travis Ross

• ChristianaCare • Season 3 • Episode 20

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0:00 | 25:07

How's your posture? Can you turn at your hips without feeling any pain? Can you suck in your navel?

Two years ago we were joined by ChristianaCare physical therapists Travis Ross and Brian Catania to discuss their nationally recognized Sling Activation Sequence for athletes. Since then, Travis and Brian have been refining their work to show how core strengthening is for everyone, from pro athletes to 77 year old grandmothers who just enjoy staying active.

We discuss how pain leads in inhibition, why sitting and device posture and quietly shut down proper activities, and how the core can be reactivated with the right techniques. But this isn't just a theoretical discussion in broad generalities - we also offer specific ways to test your own core at home, as well as safe guidance on how to get your core back in shape. And in a separate video, we travel to Brian and Travis's practice in Newark to attempt some of the exercises ourselves, with tips on what to look for and how to take build on what's taught.

Don't let bad posture control your life - sit up, tune in, and learn what you can do to get your core back on track.

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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Quick Posture And Core Check

SPEAKER_03

Consistently priming your core throughout the week is just as important as waking up and brushing your teeth.

SPEAKER_04

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. Hello everyone, I'm Jason Tekarski.

SPEAKER_00

And I'm Megan McGurman. Welcome to For the Love of Health, brought to you by Christiana Care.

SPEAKER_04

As you are settling in to listen to or watch this episode, let's take a second to focus on our bodies, shall we? And are you slouched a little bit? Are you not sitting the way you should be? Megan's taking the care of it and paying attention to how she is or isn't sitting as we talk about it. Judging and I've got to judge. No. So that's the question. How are you using your core in whatever it is you're doing right now? And we've got people here who can speak very specifically to how you use your core.

SPEAKER_00

Christiana Care physical therapists, Travis Ross, and Brian Catania have been on the podcast before, letting everyone know how important the core is. This time we brought them back because I know I have still not learned two years later how important that core is and how many pieces of the core there are. Brian and Travis, help us out. Thanks for joining us today.

SPEAKER_05

Thank you for inviting us. This is our second round to do this with you guys.

SPEAKER_03

Yep, we're pretty excited. This is uh gonna be one of our most outstanding things that we've done all day.

The Core Sling Research Story

SPEAKER_00

I hope so. As you mentioned, Travis, this is your second time being on the podcast. It's been two years, which seems unbelievable, but you are one of our most popular episodes. We had to have you guys come back to continue to talk about the core. And that first episode, we talked about this work being nationally recognized. But for those who have yet to listen or watch that first episode, we'll link it in our show notes here. But give a brief overview of that work.

SPEAKER_03

Well, it started when we were doing some work with the University of Delaware. We did some research on the core because we were having trouble identifying where these core weaknesses were, and some athletes were breaking down. We didn't quite understand why. So we dove deeper, literally deeper into the core and found your favorite muscle, the multifidus.

SPEAKER_00

The multifidus, I remember. I do.

SPEAKER_03

But also these other links of how like the external oblique can affect the opposite side adductor group. And in your back, your lack can affect your opposite side glute and that multifidus, and then the side core. So we found this whole cylinder of work, and then we developed an assessment tool as well as we call it the sling activation sequence. So it's a it's a grouping of core exercises that works your whole core cylinder and published it in peer-reviewed journal. And then the NFL had us um speak at their combine meeting where all their teams were present and all the people that work with their teams. I guess it went from there. They've been several teams implemented in the NFL, a couple in the NBA. And um every now and then we just never know when people are going to reach out to us, right, Treff?

SPEAKER_05

Absolutely. So we get a lot of teams are still reaching out to us from time to time. We're working with a lot of colleges, um, and everybody's kind of interested. Uh, we got a lot of momentum since even your guys' podcast had a lot of people come up to us. It's been a great experience. Um, just getting the word out. The core seems to be just a very trendy, impactful thing that a lot of people like to get a grasp on. And we kind of tried to simplify it as much as we could. I mean, it's still very complicated. But since that momentum goes and people are still more interested in as a patient, as an athlete, as clinicians, as doctors, we have people reaching out to us from a lot of different spaces of how we can do things better, how we can simplify things. And we kind of created the best system we could to pull things from the multifidus and bring it into the posterior sling screening and just making it a very complicated uh subject as easy as we could and and make it for everybody from athletes to uh 77-year-old women who still like to run to people just trying to like walk again. You know, it goes from a huge spectrum of people who have really it's made a big impact on a lot of people from different ranges of of health and and well-being.

How The Program Has Grown

SPEAKER_04

That's a good recap of what's happened that got us to that first podcast. It's been two years since then, and I'm sure you guys haven't been like resting on your laurels or anything since then. So, how has this work progressed since that time? Has there been anything new you've discovered or anything new you've worked into the program since then?

SPEAKER_03

So what's published is like the basic exercises, but obviously we have had to modify those based on the patient that comes in to see us. We have a continuing education series that we've educated in each of our rehab offices. There's a a practitioner that is, I guess you could say, core sling certified, so to speak, but they've gone through the education process with us to make sure they have the corrective manual correctives because there's ways to turn the core back on with your hands and do that, as well as then prescribing these exercises to where you might be shut down or inhibited in those areas. So I I think that's been an advancement. We've also developed the standing SAS, which you're aware of, Megan. You came down and shot the videos and they're now published. Um anything.

SPEAKER_05

From there, we've kind of taken it on to uh making it more functional for each patient. So we took it from, like Brian said, we had the basic screen that we did, basic exercise program that we did for the research. And from then, we did that on at college athletes at the time. And so we've had to scale it back to make it more simpler for our older population or our less physically inclined patients. And then we've kind of structured that where the athletes are like, I want more than that. So we've really put a lot more resistance into it, a lot more standing opportunities, jumped it into their sport, and we've really grown it. And everybody needs to be challenged for their level. So we've we've had the challenge of really heightening our game up with the the professional athletes to, you know, the very basics of getting the very multifidus, the very one segment of the multifidus to kick on in that self and just have it cascade from there on up. And we've really kind of refined that a lot more and we're a lot more comfortable in developing that.

SPEAKER_00

You mentioned the 77-year-old woman who still wants to run. How are you adjusting everything to that? You know, her grandson on the UD football team doing the same exercises seems wild.

Scaling From Pros To Seniors

SPEAKER_05

I mean, there's a spectrum. I didn't say run fast. She just enjoys being out there and has a lot of people say, you're too old. And, you know, she does have her arthritis and does have her aches and pains. But what's safe for her to push through? If there's a certain level where she's just not turning on the right muscles, it is unsafe. It is detrimental. So we work on certain things that activate for her to get back out there. And, you know, her knee arthritis is still there, some spinal arthritis is still there. What can she push through and what is is safe to activate first to prime? That's what we developed the system for, is mostly to prime the system and then go out there and be able to accomplish more physical things, uh, whether that be getting up, taking care of their grandkids, or running uh two miles. She likes to run two miles. So from every level and and and and range emotions are a lot limited from 77 to like a 15-year-old. But we're still able to get them to push themselves to the maximum functional capacity each person can do. And and they appreciate it, especially, you know, if you're still running at that age, it's if you go to 5Ks, you're not seeing very many 77-year-old runs. There are out there and my my hat's off to them, and there's they're they're knowing how to prime their core and prime their body and take care of themselves to be out there and healthy as they can.

SPEAKER_00

Do you run into people in your clinics who are saying, I've been an athlete my whole life? What do you mean I need to prime the core? What is the multifidus? Why is this the first time I'm hearing of any of this?

SPEAKER_03

Yes. And I also think there's a lack of awareness that they don't realize they have lost access to their core. It's like they lost a room in their house where they just shut the door and we help them to wake it up and activate that muscle so they can recruit it again. So I would say anybody that's had back pain has probably lost access to their core. Just like if you've had knee swelling or knee pain, you see the quad atrophy, but you can visually see that. Whereas these muscles, you don't visually see it unless we have like an MRI or a real-time ultrasound. And then you we uh have seen published in the literature and ourselves this fatty infiltrate that comes in from lack of use, right? So it gets marbolized. But in the brain, that's like smudged tissue. And when you can actually turn that on again and and wake those muscles up, it's like unlocking this whole new area in your body that you didn't know existed. But now you're recruiting centrally rather than just relying on your extremities to do all the work, which is not great for your extremities because then it leads to overuse and disuse in your core and that uh, like I said, that marbolized kind of fatty infiltrate that that's not something that that your brain can recruit again, right? It's it's smudged.

Losing Access To Your Core

SPEAKER_05

Brian makes a good point. You don't know what you don't have access to. You just keep running yourself into a deficit and start to burn out those overusing those knees, overusing the hips. And so you don't know what you have you lost access to. So when you prime them or make them into awareness, it's like opening that door again, and they have access to that. They're like, How was I doing this any other way? And that's kind of we don't know what we don't have until you show them the show them the light, show them the way to go, and it just becomes more efficient. They'll use it that way.

SPEAKER_03

And their lights, the eyes just light up when they can recruit that again. Like it's it's like completely shut down and then it turns on for them, and then they have some exercise they can use. And I and I would say that consistent use of those muscles is important. Consistently priming your core throughout the week is just as important as waking up and brushing your teeth.

SPEAKER_05

It's that pattern.

SPEAKER_04

You got to keep refreshing that pattern. You've mentioned the core being kind of shut off for people, which which sounds like an odd idea for somebody who's obviously not in the know the way you guys are. Is is that something that just happens as you get older, or is it from disuse, or is there a certain thing that like once you hit 25, you've lost access to your core unless you really get on it? What does this losing access mean?

SPEAKER_03

So you mentioned when you're born and you develop, right? We we start with rolling, and that's a core exercise. And then you start crawling, which is another really good core exercise to start to build these muscles and develop these muscles so that you're always recruiting centrally. So I guess innately we we are born to do this, but as you um develop, grow, let's say you get hurt, that pattern starts to shut down, starts to become smudged in the brain, you start to alter your pattern. Like even this something as simple as an ankle sprain. And then that has to be recovered. You have to retrain that so that you learn how to push off your big toe again, but also all the way up the chain to let's say your S2, S1, L5 multifidus in the glute. Because you have an ankle sprain, it shuts down the glute because you're not pushing off the foot anymore. Let's say you had a back injury and and you strained your back, so to speak. Those deeper muscles do not get woken up until they're challenged and forced to be recruited in a way that is non-painful. Right? Pain equals inhibition. Shuts everything down along that pathway that's painful until you come to physical therapy and we teach you how to use it again. Oh my gosh, it's not painful. Well, and I'm I'm not avoiding using it anymore because the pattern that you had to develop to avoid the pain was to avoid using that muscle.

Injury Pain Sitting And Shutdown

SPEAKER_05

So you can also go with prolonged postures. So unfortunately, as we age five, six, and on, we're in school. In college, we're sitting. And then when we go to work, we're sitting more than we're standing and moving around for a lot of people. What this does is this shortens the front of your body. My hips are always flexed, my my trunk is kind of curled, I'm kind of slouched, things shorten. And then when I have to go and use it longer, and I got to use the back of my spine and back of my core, things aren't working as efficiently. So things kind of positionally shut down. Everything's kind of a little shorter on this side, stretched down on the back, and then you go to do an athletic move. Usually you be being in a chair. Uh so either we have an injury, we're in prolonged positions for too long, we get injury, you know, there's a so many bad patterns you could be into. Uh, our job is to identify those bad patterns, kind of turn it around, find out what you're not using, get you access to the core, get you back, like Ryan said, from the central core out. So everything comes from the spine. Your core kicks on and to anticipate every movement every before your your limbs start to move. So if that core is shut down a little bit, the whole body isn't stabilized, isn't safe, isn't structured. So then we get a compensation. Some other body part has to make up for it. And then boom, we have a cascade of dominoes of you overusing something that isn't the most efficient posture, isn't the most efficient position, and things get worn out from there. So it's usually time or a trauma or just and then bad patterns happen. And we all do that. And that's kind of why we we like to kind of re-reharness or or kind of reactivate that core, re-wake it up, teach it the right patterns, show the body how it can. And like Brian says, once they have that that space awake again, once they have access to that that movement, it's like the best part of our job. It clicks that light on. You can see how we talk about super passionately. Uh, them getting that back and it being seamless, they're like, what was I doing before? Like, that's not even teaching what you're doing before.

SPEAKER_04

Let's not revisit that.

SPEAKER_05

I'm not saying you can only move one way. There's a whole variety that we have that you should move and can move, but when you're only limited to one pathway, it's gonna break down. So variety is a spice, but there is uh an efficient way to move um to access each of our core pieces that we use segmentally. And once we have those strong patterns, then variability is great.

SPEAKER_03

Yeah. So I think pain or swelling and or injury and what Travis was speaking to, disuse, right? Like deconditioning, you lose access, right? You lose it, you use it or lose it.

SPEAKER_04

A lot of it has seems to have to do with just how our society is, with the positions that we are so frequently in as part of our schooling and and and job and trying to get ourselves out of that structure.

SPEAKER_03

Yeah, like being in front of the computer, being on our devices. I mean, they're great tools to help us do our jobs or school more efficiently, but at the end of the day, we still need to move and put the work into our physical body.

SPEAKER_05

And there is just as much injury as uh our physical manual labor people as our desk jobs. Yeah. Same pretty similar incidents.

SPEAKER_03

I think they're saying the desk or sitting is the new smoking.

SPEAKER_05

So it's pretty detrimental. So we have to sit. I sit a lot at my job, but then you have to balance it.

SPEAKER_00

So for those who are listening who don't have access to the two of you as physical therapists and are thinking, okay, well, what should I be doing? You know, we will put all of the videos we've done previously in the show notes, but just day to day, what can people be doing to say, oop, I need to make sure my core is working and I'm not just hunched over my desk for eight hours a day.

SPEAKER_03

So we're starting from a range of people there, right?

SPEAKER_01

So that's general, general guidance, maybe. That's a good question. I understand.

Easy Ways To Feel Activation

SPEAKER_03

That's a hard question in the sense of making general recommendations. I I would think you would want to stay within the ranges that you're comfortable in, but even just putting your hands on your ribs and just being able to turn like that, do you feel the muscles kick in? And then, like if you extend your back, can you feel feel those deep, deeper muscles? There should be a swelling in the back. And if it's more of a sinking in, so to speak, then then you're getting the more global movers squashing the little guys, the local movers. Whereas you want the swelling of the the local the deeper core muscles so that the global guys, the more external ones, like your erector spinae and your obliques and your rectus abdominis can do their job of of transferring these big forces if if that makes sense. So to make a general recommendation, just put your hands on those muscles and see if can I even tighten my core. Like some people have lost the ability to even like draw their belly button in or extend their back. And I mean that's that's a basic just can I do that? But it should just kick in when you stand up, right? Like as you push into the floor, you should feel those muscles kick in.

Neutral First Then Rotation Later

SPEAKER_05

And the and the best way to kind of access the core, the core does everything 360. It will bend me forward, it will bend me sideways, it will bend me back, it will rotate me. So, how to start from there? We usually kind of go back to the basics. You want to sit one plane of motion at a time. And usually rotations are very aggressive. You can twist at the low back, and we can cause more problems if we twist the wrong places. So that's why Brian R just like go out there and twist and you know, do your thing. Just go all go all crazy with it. I like to start one plane at a time. We all know the setups. That's one plane that's going straight forward and backwards. I like you to stay longer. I don't like the compression. I know I'm not sitting in the best posture, but I like to lengthen the abs and move them around, not just stay really tight and crunch. But then we also have a little side bending you have to do. And we have some back extensions. Back extensions are really good for you if you're healthy enough to do them. So a lot of times we have to kind of put you in a neutral position where your spine isn't bent, isn't flexed, isn't twisted, as neutral as you can, then we'll move in a arm or a leg. And that will indirectly advance your core. So sometimes we have to start by just moving arms and legs instead of just twisting and bending at the core. From then, once we're healthy and we're moving the right spots, we like to add some rotation. And where we like to add our rotations through the thoracic spine. The more we can rotate through our chest and rib cage and the less at our low back, the more we can save our uh lumbar stenosis and our lumbar ridiculopathies, the surgeries that come with that, because they're not supposed to twist. It is supposed to keep us, like I said, in spinal neutral. That's where they work out the best. And as we start loading, loading, become more safe in those neutral positions, then we can start accessing, like everyone loves deadlifts. Deadlifts are the best exercise for my favorite multifitus muscle, but not everybody can do that. Like Brian says, we we lose access to them, they shut down. And for the thing that works for them the best, they're not there for you when you need it after an injury. And even prolonged after injury, we're not, even because the pain goes away doesn't mean the muscles have come back, just your pain had gone away. And it's and that's like, oh, I keep getting it's that time of year, my low back, my chronic low back pain's back again. Every time I do this, maybe they didn't get it. Uh, the muscles kicking on as symmetry, they didn't get it as full, or they missed a plane. We got them bending forward, we got them bending sideways, we got them arching back, but we never added that rotation. And that rotation is the last phase because it's the most aggressive phase, but it also hits these muscles the best. And that's kind of what our research was kind of focused on is getting that rotation, but you have to be healthy enough to get there. So that's why we're not kind of throwing rotation at everybody right away. The thing you need to do is rotate hardcore right away, because it needs to be a building block. And what we usually do first is like counter-rotation or anti rotation of having forces hit you in a rotational way, but you don't go anywhere. You stay neutral, we say. Instead of having that trauma turn you and twist you, you have to be able to resist that. That resisted torsion comes from your core. And that's what if that torsion, if that control isn't there, that's going to set you up for an injury down the line.

SPEAKER_04

I'm sure this is gonna be a pretty entertaining video addition to watch because I know Brian, as everything you were saying about can you move your put suck your navel in and everything? Megan and I are sitting here, like, oh, let me see, can I do this? You know, making these really awkward movements here.

SPEAKER_03

So Well, I think what would be best, Jason, is you and Megan come down to Springside with Travis and I and we'll show you how to activate your core and make sure you're doing it right.

SPEAKER_00

Let's do it. I'll do it. We'll take you through it.

SPEAKER_04

Sure, we're not so absolutely not doing it right. I can tell you that right now.

SPEAKER_03

Well, you're not alone, but there is hope, right? Like your brain will register, and once we cue you in with our hands, you'll be able to kick those muscles in and you'll feel better about yourself.

SPEAKER_00

Well, that will be a fantastic addition to this episode. So we will make that happen.

SPEAKER_04

Can't wait. Which, you know what? Let's ask that question as well. How much of the world do you see through your work? When you're sitting here looking at us, are you watching our posture saying, Oh, Jason, I don't want to know the answer to that question.

SPEAKER_03

So I think we turn it off. Yeah, we we've had to learn how to filter it so we can see it. And our wives helped us with that. Oh, that's smart. Yeah, I think our wives were like, not every person needs your insight.

SPEAKER_00

At like a wedding or whatever.

SPEAKER_03

What they're moving in efficiently. You need to filter that. Not the general public.

SPEAKER_05

When they come to the clinic, then it's not looking at soccer games. Like, they're that guy we gotta help his rib four. Like, not today. Not today.

SPEAKER_04

This this is not the time or place. Right. Yeah. So we talked a little bit about what people can try to figure out and do on their own. But is there some way that a a person listening to this would be able to just figure out what does or doesn't work for them? You know, again, ideally they're coming into the office to see you guys. But if not, is there something they can say, oh, that hurts? Maybe I need to work on this instead of that.

The Pilates Ball Self Test

SPEAKER_05

Well, how do they for that occasion? The multifidus. Well, that and what helps the multifidus the best. You know the thing I bring? Your ball. That's I brought the ball. That's what makes the video work.

SPEAKER_04

He never forgets. So not our faces from boiling in the naval, it's the ball, right?

SPEAKER_00

The ball that makes the must watch.

SPEAKER_05

Your guys' homework will be to take this ball, it's a nine inch Pilates ball with a little squish to it. And we we talked this about the last discussion. I probably talked about it a lot better last time. But I want you to squeeze it between your knees, sit up nice and tall. And if there's a place When you're rotating from side to side and you feel um something something hurts, I can't go very far one way than the other. Grab your abs, feel that should be hard one way. How come it's not hard when I go the other way? Kind of feel something kicking in. If you feel it in your hip flexors, guess what? You're you're being using compensation. Those hip flexors are gonna wear out. That's one of those compensations that you're gonna use that are slowly gonna wear that out, and it's gonna cause something down the line. Abs shut off, hip flexors turn on. We get these uh arched backs, and we're kicking too much erector spinae in the back and not enough core in the front, and that's when we start seeing degeneration in the back. That's where we start seeing hip issues and knee issues. So it's right from the line. So little tests like that, be very slow on the on the rotation, stop at the pain. But that would be like, what can I do? Do I need to do this? Oh, I can't twist. And if we have people that coming in there, our world is built to reach that seatbelt like this and to plug it in here and anything more. Most people don't know. My golfers are really good and they'll have a great backswing, but that follow through isn't quite there. That's something that you need to identify. But that's that's a rotational sport. They're supposed to be a little bit better, but you have to even it up as much as we can. Everybody that else that isn't in a rotational sport, it is really hard. You like we said, we don't know what you don't have access to until you hit, oh, I already had pain. And then we're at a cascade of muscles shutting off, and then it's and it's just kind of plain catch up from there. You can get ahead of it, like we're gonna get into in a few weeks or so. We'll get ahead of it, and you guys can be uh in tune to your bodies and see what patterns work for you guys and see what patterns you're you're stuck in. And that's kind of like I said, the best part of our job is having that light turn on, like wow, I have access to that. And there's something not, it's easy. Why haven't I always been doing it? So that's kind of like why we do our job. We love it.

Links Videos And Closing Notes

SPEAKER_00

Well, we are excited for the light to turn off. Terrified, but excited. Brian and Travis, thank you very much. And to our listeners, uh, make sure you click on that link of our exercises that come out with this episode.

SPEAKER_05

It's gonna be great.

SPEAKER_03

You'll be shining your lights. Thank you guys. Thanks.

SPEAKER_00

We talked about a lot of different links in this episode, so go right to the show notes right now or in the description of this YouTube channel. There is a link to the original Christiana Care for the Love of Health podcast episode with Brian and Travis, where we talk about their core sling exercises. There are also links to the exercises, and before you go crazy, some of them are with actual professionals doing these exercises. But you can also, if you're so inclined, maybe want to feel a little better about yourself, also check out Jason and I going down to Christiana Care Springside location to test out these core exercises with Brian and Travis.

SPEAKER_04

How can this possibly end badly? It'll be great. Very special episode. It will all be great.

SPEAKER_00

And if if you just want a good laugh, maybe you should check that out.

SPEAKER_04

That's that's worth the price of admission right there. And of course, you can stay up to date on all the latest for the love of health by following Christiana Care on your favorite social media platform.

SPEAKER_00

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

SPEAKER_04

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

Head Shot

Megan McGuriman

Co-host