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Linking the Core with Upper Extremity Function

Core stability plays a crucial role in upper extremity performance and injury prevention for athletes and physical therapy clients.  

The core serves as a link between the upper and lower extremities, facilitating coordinated movements and force transmission during activities like throwing, hitting, or serving. The core is also an important link between upper and lower extremities with normal daily activities such as reaching overhead, carrying/lifting objects, and pushing yourself up off the ground or chairs. A stable core provides a solid foundation for the peripheral muscles to generate and transfer forces efficiently. Think of the core as your foundation for your upper body; if your foundation isn’t solid the rest of the house is going to be crooked.  

Poor core stability can increase the risk of upper extremity injuries like shoulder impingement or elbow tendinitis. Conversely, improving core stability through targeted exercises may enhance upper limb athletic performance metrics like throwing velocity or hitting power. 

In a study on baseball players, it was found that 50% of the kinetic energy(force) during a throw comes from the core musculature. It was also demonstrated that a decrease in 20% of the kinetic energy developed by the trunk resulted in a requirement of 34% more arm velocity or 80% more shoulder mass to deliver the same energy to the ball. 


For individuals recovering from upper extremity injuries or surgery, incorporating core stabilization exercises is recommended 

- Early phase: Activate and train deep core muscles (transversus abdominis, multifidus) with low-load isometric holds like dead bugs or pallof presses. 

- Intermediate phase: Progress to anti-movement exercises challenging proximal stability with distal mobility (planks, bird dogs). Integrate core bracing during upper limb movements.  

- Advanced phase: Integrate multi-planar core stability challenges like lifting/carrying, pushing/pulling, and reactive stabilization drills relevant to sport/activity demands. 


A systematic, progressive core training program can optimize force transmission, improve neuromuscular control, and reduce excessive compensatory movements that may contribute to upper extremity pathology. Assessing core endurance, strength ratios, and movement quality guides progression. 


In summary, addressing core deficits is an essential component of upper extremity rehabilitation and performance training for physical therapy clients and athletes. An integrated, phased core training approach enhances proximal stability for distal mobility. 


Info pulled from continuing education at the APTA Combined Sections Meeting 2024 in Boston, MA. Presenters were: Christine Eddow, PT, PhD, DPT, OCS, WCS, CHT; and Gunnar Fillerup, PT, DPT OCS, CSCS 


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