Core Strength a Focus of Physical Therapy for Cancer Patients at The James

OSUCCC  James Core Strength

For many cancer patients, the road to recovery – and regaining their strength and mobility – begins with rebuilding their core strength.

“In general, core strength is important for everyone, but even more so for cancer patients,” said Cari Utendorf, PT, DPT, MBA, CLT-LANA, a physical therapist at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James).

Utendorf recently led a JamesCare for Life lunch-and-learn on core strengthening for several cancer patients and their caregivers.

Cancer patients often undergo surgical procedures, as well as radiation and chemotherapy treatments, that can reduce their energy, core strength and balance. The loss of core strength can lead to back pain, bad posture and muscle injury and a loss of mobility. Patients who have had surgery and/or radiation in the abdominal region are at an even greater risk of losing core strength and, “many women with breast cancer undergo hormone therapy that can increase their risk of osteoporosis (a weakening of the bones) and lose core strength without proper exercise,” Utendorf said.

For all these reasons, she explained, it’s important for cancer patients to understand the importance of core strength and learn a few basic exercises. A strong, stable and flexible core is the foundation of good physical health.

The muscles that make up the core include the transversus abdominus, multifidus, diaphragm and pelvic floor muscles. “They should be strong to help you support your spinal column, and also allow it to be flexible and mobile,” Utendorf said.

But first, before a patient begins doing core-building exercises, it’s important to locate and activate the transversus abdominus and multifidus.

The transversus abdominus?

“Find your hip bone, go in about an inch or two and then up about half an inch, and that’s where the transversus abdominus is located,” Utendorf said of this layer of muscle on the front and side of the abdominal wall.

“Can you feel it?” she asked. Some of the lunch-and-learn participants nodded, others looked at Utendorf with a puzzled expression.

“Right before you say ‘Oh,’ you can feel a tiny movement, a contraction,” she explained. Several more people were then able to locate and activate (or flex) their transversus abdominus as they said “Oh.”

The multifidus? It’s a thin muscle located on the lower spine.

“It’s a little harder to find,” Utendorf said. “Find your lower spine, towards your buttocks.”

After a few more prompts, everyone was able to find their multifidus.

“The tricky part is activating both together as you start doing an exercise, maybe you need three hands,” Utendorf said, and everyone laughed. “When I first see a patient (at a physical therapy session at the OSUCCC – James), we work on this. The ability to activate both muscles without causing any pain is the base of all the exercises we do.”

Learning how to activate these two muscles takes some awareness and practice, “but makes the exercises much more effective,” Utendorf said, adding it’s something you can do while watching television, or even at work. “Nobody can see what you’re doing.”

Utendorf then described a series of basic core-strengthening exercises the participants could do at home, such as bridges, hip-rotation exercises, arm and leg extensions from all fours, and the prone Superman, an exercise in which you lie on your stomach and lift your arms and then legs.

If these exercises sound familiar, it’s because “many of the exercises we do are from yoga and Pilates,” Utendorf said.

“How fast should we do the exercises?” someone asked.

“Do them slowly,” Utendorf said. “It takes more muscle control to do it slowly. And if you do it fast, you’re relying more on momentum and won’t build strength.”

Someone else asked how many repetitions she should do.

“Start with one set of 10, and work up to three sets of 10,” Utendorf said.

During a physical therapy session a week after the lunch-and-learn, Utendorf introduced the concept of activating the transversus abdominus and multifidus to a patient.

“I can feel it,” the woman said as she located her transversus abdominus, said “oh” and felt it move “very slightly.” She then located her multifidus, and began activating both of these core muscles as she did a series of exercises.

Helping cancer patients regain their core strength, their mobility and their quality of life is what motivates Utendorf. “If I can help someone get from ‘sit’ to ‘stand’ and start moving again, which can have a huge impact on their life, that’s what makes this so rewarding.”