The power in the middle: 7 questions about the “powerhouse” and why a tight waistband can help you find a stable center

Whether they’ve fallen off a horse, tumbled down the stairs, or suffered a stroke, many rehab patients need to build up new stability after accidents or illnesses. Only then will they be able to cope with and excel in their everyday lives. 

One excellent way to learn to safely walk, stand, and get up and moving again is to strengthen your core muscles through Pilates. With exercises for a "stable core," systematic whole-body training not only contributes to recovery, but lays a foundation for so much more. In this interview, Sabrina Rohde explained to us what a “stable core” and "so much more” really means, why core strength is so important, and how patients can (re)achieve it. Sabrina is the head of therapy and patient management at Caspar Health, a long-time physical therapist, and an enthusiastic Pilates practitioner and teacher.

Let’s start out by diving into the topic of a stable core, and why Caspar Health dedicates seminars to this topic.

At Caspar Health, we deal a lot with patients who suffer from various forms of back pain. Whether it's problems with the sacrum, sciatica, lumbago, or intervertebral disc issues, many back complaints can be alleviated or preventively treated by deep stability training, i.e. creating a stable core. That's why Pilates training is particularly useful for our rehab patients, and why we also offer seminars on this topic. 

What do we mean by "stable core" and why do we need it?

A stable core describes the main muscles in the torso area. In Pilates, we also refer to the stable core as the powerhouse. The powerhouse consists of a floor, walls, and a roof. The floor in this formulation would be the pelvic floor, while the walls are the deep abdominal and back muscles, and the roof is the diaphragm. All of this together forms a kind of “house” in the torso. And everything that belongs to the stable core ensures that we can maintain an upright posture. 

It is often said that the more stable the torso is, the faster and more powerful movements of the arms and legs can be. That’s why soccer players train their core muscles so intensively. The center of the body is an essential starting point for physical efficiency and strength. 

Sabrina Rohde is a physiotherapist and health manager. At Caspar Health, she is not only responsible for the recovery of our patients, but as head of Therapy and Patient Management at Caspar Clinic, she also focuses on what is often neglected elsewhere: Healthy leadership. What motivates her and her team is getting positive feedback from patients. "The gratitude we receive every day drives me, it drives the team, and it makes every day fun."

What role does a stable core play in patients' complaints? Can you give us a few examples?

Besides stabilizing the body, a strong core is critical for good balance. Many of our patients have had hip or knee surgeries, and their balance is impaired as a result. For them, it is especially important to strengthen their core muscles. With exercises designed to craft a stable core, we can help them gain and maintain their balance. A stable core also helps everyone stay in shape and prevent falls. Because as we get older, we often find it harder to keep our balance at all times. 

In addition, a stable core reduces the risk of injury and thus has a preventive effect. It improves your posture immensely, we can better assess our body and this helps, for example, to prevent back problems or further posture-related damage.

You’re a trained Pilates instructor. How did you get into this, and what does a stable core mean to you personally?

I have been a trainer for more than 15 years in different areas, such as spine training, aqua gymnastics, and much more. With all this, I realized that I am a huge fan of offering support that is suitable for patients with different limitations. I was looking for a method that was in line with my learnings from both a medical and physiotherapeutic point of view. I wanted to find something that didn’t involve extreme positions or putting excessive stress on various structures, but one that patients could really do without too much exertion, even if they have back problems, are not very well trained, or need to practice coordination again following a stroke. 

Could you give us a little insight into how to activate the center of the body? What needs to be observed in the process?

The core building block of Pilates is to activate the powerhouse. We do this by pulling in our belly button and trying to maintain strength there. To try this out, it is a good idea to slide onto the front edge of the chair and sit upright. Then, pull in the belly button as tightly as you can. 

It helps to imagine a pair of tight trousers that you try to button up at the front – that’s the kind of tension you want to engage. Usually, the pelvic floor is automatically lifted during this movement. Then, you hold that tension, and then let it relax again. In addition to that, there’s the Pilates breathing into the arches of the ribs. In fact, rather than focusing on doing the movement perfectly, it’s even more important to focus on your breathing. At first this is difficult, but you can learn it quickly with regular practice. The more often you manage to consciously keep your belly button firmly retracted, the more likely it is that your body will do this automatically. Then, suddenly one day when you're cleaning out the dishwasher, you’ll realize your belly button has retracted all on its own.

What can patients who have very little time in their day-to-day lives do to strengthen their cores? 

It’s pretty easy to integrate this powerhouse exercise into your daily life, because it can be done with each of your everyday movements, from cleaning up to vacuuming to shopping. Simply pull your belly button inwards and try to maintain the tension. This protects your back and increases your core stability. A patient once said to me, "I always do my pelvic movements at the bus stop. Everyone looks at me, but it gets me to practice regularly." That's exactly the right thing to do: Pick fixed times, fixed activities, during which you do the exercise, such as while vacuuming or collecting your grandkids from school. There are also many exercises for strengthening the core in the Caspar software. It gives you guidance on doing these exercises anytime, anywhere. 

Beyond the physical benefits, are there any other bonuses that Pilates offers? 

Pilates offers a very intense acquaintance with the body. For example, many people are not very familiar with their breathing. However, during cold season especially, it’s a great incentive to know how to inhale and exhale consciously into all areas of your body in order to ventilate the lungs. But Pilates also improves your general body awareness. 

For patients with back pain, when you compare traditional back exercises to Pilates ones, the Pilates group consistently shows better results when it comes to pain management. The participants say: "I got to know my body much better. I got in better touch with my body, so I was able to really assess whether the pain was more in my stomach, my hips, my sacrum, etc.” Pilates creates the awareness to be able to perceive of the physical areas of your body individually and to experience and lean into all of them in a more precise way.