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Why is addressing the core important for tennis elbow treatment?

What I've found over the years of treating tennis elbow is that if you just focus on the elbow, it's always going to come back. It's never going to heal 100%. You have to look much further away from the elbow to make sure that it was going to fully heal. In short, start at the core!

If you start at the core, you work through lots of different exercises for the core to get stronger. Then you can use your core strength as you work on your shoulder blades. Then the rotator cuff muscles around the shoulder. Then moving down to the elbow.

Mat Pilates exercises are part of the Comprehensive Elbow Pain Relief Program. So adding core strengthening exercises to your routine are really going to benefit you. It's going to help with your elbow and obviously it's also going to help with any kind of back pain as well.

The first exercise is to learn how to correctly activate your core muscles. This is not as easy as it sounds! There's no machine in the gym you can jump on to do this, you have to consciously "know" how to switch these muscles on. But which muscles are we talking about?

The most crucial core muscle is the transversus abdominis. Transversus abdominis is one of the four abdominal muscles and it is the deepest one inside. When people talk about the core, this is generally what they are talking about because it circles your back and your pelvis like a back brace.

Transversus abdominis can be quite a lazy muscle. If any of the other abdominals are working, it doesn't want to switch on. So, it really needs to be worked in isolation by itself. There are a couple of strategies that we use to achieve this and we're going to bring in one of the other core muscles to help switch the transversus on and that's the pelvic floor. Let's try it!

Start by lying on your back with your knees bent and your feet flat on the floor. Transversus abdominis is located at the belly button and below. So, find your belly button. You're going to put one hand on your tummy below your belly button and one hand on your tummy above your belly button. Imagine splitting your tummy into the upper and lower half.

Now your hands are not there to push or press. They're just going to feel what the muscles underneath are doing. I want you to focus on sucking in your lower tummy. As you switch on the lower tummy muscles, you should feel the contraction just underneath the lower hand. It's a very subtle motion.

Many times, when people are learning this, they start to feel their upper tummy pulling in. That's where the other abdominal muscles are. That's where your six-pack is and it really wants to work and help. But we don't want it to work because if it does, the transversus abdominis—the muscle you are trying to switch on—will switch off!

A strategy to get around this is that you're not going to think about your stomach. If your brain sends the message down to your stomach to say, “come on, tummy, switch on”, everything tends to jump in so you're not going to think about your stomach because you don't want those other abdominals working. So, you're going to focus on your pelvic floor.

Keep your hands in the same position, one on the lower half and one on the upper tummy. You're going to imagine you are in the restroom, urinating. Stop the flow! You're just going to focus on the muscles that essentially stop you from peeing. You're going to hold the pelvic floor tight and you should feel a very slight tightening across your lower tummy as you squeeze the pelvic floor muscles. The pelvic floor and transverse abdominis are very closely linked and when you do that pelvic floor contraction, you can get a nice core contraction.

A different way to feel this is if you feel where your hip bones are at the front of your pelvis and you're going to bring your fingers towards the midline so towards the center an inch and then down an inch and that fleshy area right there is a good place to feel transverse abdominis. It's such a deep muscle covered by all the other abdominals that area down towards the groin is a good place to feel it contract. If you put your fingers lightly on that spot, do the pelvic floor contraction again and see if you feel that subtle contraction of the transversus underneath your fingers. Keep breathing normally but maintaining the contraction of the pelvic floor and the transverse abdominis.

As you release the contraction you should feel a very slight release underneath your fingers. Your goal is to be able to switch that contraction on and hold it for 10 seconds and then release it and you're going to try and do 10 every hour throughout the day. I know it's a lot, but if you can get your core working your body will thank you! Please add them in and feel free to let me know if you have any questions. This exercise can be found in my book Tennis Elbow Relief, available on Amazon.

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