Starfish Therapies

December 16, 2017

What is Core Strength?

therapy ball

Why are pediatric PTs always talking about core strength and what does that term that is thrown around so frequently even mean? And is core strength the same as trunk strength and is that the same as core stability? Hopefully, this brief overview will help to clear the air!


Core: When we think of the “core” of the body, our first thought is the abdominal musculature.  While the abdominals play a crucial role in all of our functional movements, they are just one of the many important muscle groups that make up the “core.” We can also add shoulder, scapular, back, and hip muscles to the list. We can think of anything from the neck down to the upper leg as part of the “core.”


Core Strength: Core strength refers to the ability of the indicated muscle or muscles to perform as movers. For example, a sit up or moving from extension to flexion requires core strength.


Core Stability: Core stability refers to the ability of the indicated muscle or muscles to perform as stabilizers, therefore, preventing movement of a joint or joints. When we are referring to core stability, we are most often referring to how well the core muscles can work to prevent unwanted movement of the lower part of the spine and pelvis. For example, when we squat to pick up our kids, laundry baskets or grocery bags, we want the abdominal muscles to work as stabilizers to prevent unwanted movement of the lower spine.


Trunk Strength/Stability: Okay, okay, so what is trunk strength? Well, as pediatric therapists, we often use the term “trunk” and “core” interchangeably. They are just two different terms that mean the same thing. So, if you see both terms in a report or other documentation pertaining to your child or yourself, feel free to ask us! Most likely, we are talking about the same thing but we strive to improve our consistency and you can help by bringing it to your attention.


For more information on the importance of the core musculature as well as for tips/ideas on how to improve the function of the core, take a look at some of our previous blog posts.


Core Strength – Building a Solid Foundation


Core = More than Just Abs


Having a Ball with Core Muscle Strength




October 29, 2017

Core Workout: Hungry Hippos meets Wreck it Ralph

I happened to walk by another one of my therapists using a really fun and creative way to work on core strength with kids. I know I have done my share of walkouts over a ball or peanut with a kiddo but this was so much more fun. In addition to working on the core, it also works on upper extremity strength, shoulder stability, and motor planning.

She helped to stabilize his feet on the ground while both of his hands were on a scooter board. There were several bowling pins set to the front and to an angle from the kiddo. He had to hold his core tight while pushing the scooter board out to knock over the bowling pin and then bring the scooter board back. The goal was to see how many he could knock over at a time. They had a target number and he ‘won’ that round if he hit the target number. You can always tell when a game is fun when they want to do more rounds even though they say on one break ‘this is hard.’ I’m pretty sure I would have trouble doing even one repetition!

Here is a brief video of the activity.

Has anyone else tried any other variations of this? We’d love to hear about them.

May 14, 2017

Ideas to Target the Core



modified plank

I don’t know about you, but I know my core muscles (abdominals, back extensors, shoulder girdle, and hips) can always stand to be stronger. This also goes for our kids, typically developing as well as kids with a neuromuscular challenge. While there are lots of ideas for targeting specific muscle groups, sometimes its good to do exercises that get a bigger bang for their buck. There are some exercises that can target multiple areas of the core at the same time. Here are a few:

  • Planks – Planks are great for getting all areas of the core. Of course they are not easy, especially if you want to maintain good form. For those just starting out with a plank you can go on your hands and knees and bring your hips in a straight line with your trunk. To make it harder to you can move to your hands and toes (or forearms and toes) and keep your whole body in a straight line. To make it even easier, you can use a bench or a table and put your hands on there so you are at an incline. The goal is to be able to hold your body in a straight line without having your belly sag or your hips sticking up in the air. Find the level of difficulty that lets you maintain that straight body. And start small. If you can hold it for 15 seconds then do that. Slowly increase your time and then increase the difficulty!
  • Wheelbarrow Walking – This also targets multiple areas, the hips don’t get as much work unless you are being supported by the ankles, but its still great for the shoulders and trunk. You can use a scooter board and sit on it and hold them by their trunk, or their hips, or their thighs, or their ankles (the further out you hold them, the harder it is). Use a hallway and have something fun like a book or a puzzle at the end that they get to do something with each time they get down there. You can also use a rolling stool. This changes the angle and makes it harder. Even harder is you just standing and walking while supporting them. Again, the goal is to hold the body straight so find the level of support that allows them to do this and gradually work your way out towards their ankles and up to you standing!
  • Walk Outs – Use an exercise ball or a peanut ball or even a foam roller (the exercise ball will be the hardest because it can move in multiple directions). Place a puzzle and its pieces a little out of reach and have them lie on their stomach on the ball and then slowly walk out their hands as far as they can go while maintaining a straight trunk and hips. Then put a piece in the puzzle and walk their hands back. Keep repeating until all the pieces are done. You can also use beanbags, or other toys that involve multiple pieces.
  • Bridging – This one really targets the hips but also works on the trunk. I’ve talked about ways to work on this in other posts. You can get creative with how to make it fun, such as balls or cars going underneath. You can also make it harder by putting one foot on an elevated surface and the other one on the floor, or both feet on an exercise ball or peanut (or other unstable surface). You could just do one leg and keep the other leg up in the air. You can do reps of up and down, or you can go up and hold it for longer and longer periods of time.

What are some of your favorite ways to work on the whole core?

November 5, 2012

Core Strengthening with a Tunnel

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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We love tunnels and our kids love tunnels so we often find ways to incorporate them into therapy.  We have standard tunnels with a ‘solid’ form and we have lycra tunnels that provide resistance that the kids have to work against.  I thought I would take a moment and share one of the activities that we use our tunnel for to work on core strength (primarily) but other things as well.

We love to put the tunnel over top of our crash pad, although you can use pillows or couch cushions instead.  Then we have them crawl through the tunnel over the crash pad.  Often times they won’t be able to maintain hands and knees because it is a bit challenging but with practice their core gets stronger so they can crawl all the way through.  If you have them doing reps you may notice that they will start off maintaining hands and knees but with increased repetitions they aren’t able to maintain it.  This is because they don’t have the endurance in their core muscles to complete higher number of reps.  Since core muscles are mainly used in an endurance type fashion, to help keep our trunk stable as we go about our day to day activities, making this a high repetition activity is a must.  We use puzzles or toys with multiple pieces to keep the kids going over and over and over.

Some things to consider when you are setting up.  The softer the surface, the harder it will be for the child.  If you want to ease them into it find something that is a little firmer.  Next would be the steeper the incline or decline the harder it will be.  For a kiddo just starting out using a flatter surface will be easier.  You can also start them out on softer and steeper and as the repetitions increase make it firmer and flatter.

In addition to working on core strengthening it also gives kiddos a chance to crawl which many kids skip in this day and age.  With crawling they get to work on motor planning between their left and right sides as well as between their arms and legs and use reciprocal patterning.  All in all we love this activity!

How have you used tunnels?


January 18, 2012

Core = More Than Just Abs

I tend to be guilty of thinking of abs and core as being synonymous.  So I often have to remind myself that there is a lot more to the core than just those abdominal muscles that I’m personally awful about exercising (I definitely hate doing ab work).

So what is the core if its not just abs?

Your core pretty much encompasses from your neck to your hips.  This means it includes front, back and sides of your mid section.  It includes your shoulder and shoulder blade muscles.  It includes your gluts and other hip muscles.  Basically your core is the foundation that the rest of your movement occurs off of.  Think of it as the cornerstone of your body.

When kids work on their core aren’t trying to develop a six pack but rather improve the endurance and coordination of the muscles that fall within the core.  You don’t just want your child’s core to turn on when they want to do a sit up or a side bend, you want them to turn on so that your child can sit up straight throughout the day while they try to learn in school.  You want their core to work while they are trying to play or to eat.  If their core is strong they have better use of their hands and arms for fine motor skills and better use of their feet and legs for gross motor skills.

So, when working on core muscles, its not just about overall strength, its about their ability to stay turned on for long periods of time (endurance) or their ability to cooperate with the other muscles around them (coordination) as well as their ability to react to what is happening in a split second (help maintain balance/upright position).

Working on the individual muscle strength is important so don’t get rid of those sit ups or trunk extensions but its important to make sure you are working the core as a whole.

How you may ask?  Well here are some ideas:

  • Using a ball or core work is fun for the child and can work on the muscles activating together  and reacting quickly, as well as keeping them turned on for longer periods of time to build their endurance.  There are a lot of resources out there for ball work ideas and here are two, ‘Having a Ball with Core Muscles Strength‘, and ‘Therapy Ball Exercise Ideas
  • Having kids perform a plank and some variations are great ideas also – you can have them turn on their right or left side for a plank or face down.
  • Animal walking is a great way to develop dynamic cores strength as well as make it fun and work on kids imaginations!
  • Wheelbarrow walking
  • Climbing is a great way to also work on core muscles strength.  Anything from a climbing wall to a ladder to a climbing net to crawling up and stairs.  The more dynamic the surface (such as a net) the more challenge your core will get.  It also involves the hips and shoulders.  If your child needs lots of help then start with something really stable like crawling up stairs (also a great way to develop hip and glut strength).
  • The sit-n-spin is also a fun way to work on the trunk while having fun!
  • Here are some other fun suggestions for core exercises

I also mentioned that your core involves shoulders and hips.  This is important to remember because if your child doesn’t have muscles that can stabilize their shoulder blade it makes using their arms a lot harder.  Can you imagine trying to form your letters correctly when handwriting if your shoulder area wasn’t strong?  Any of the exercises that are listed above that involve weight bearing through the hands and arms will work on shoulder girdle stability such as:  wheelbarrow walking, crawling, bear walking, push ups, and plank.  In addition here are some other gross motor ideas that can strengthen the core and have a direct effect on handwriting and fine motor skills.  Another idea is to have the kiddo use some thera-band and try to pull you up by pulling on the thera-band and pulling their arms back.  They think its hysterical that you are ‘stuck’ and need help!

Lastly, a lot of times when I am working on posture with a kiddo or having them sit on a ball they tend to slouch from their shoulders all the way to their hips.  There can be a few reasons for this such as weakness or tight hamstrings but the reason I want to look at is challenges with coordinating the trunk muscles so that they can tilt their pelvis forward and get that nice straight posture that helps with learning and attention.  If you spend just a little bit of time working on this with kids they start to pick it up pretty quickly.  If it gets overlooked, it can contribute to tight hamstrings and ongoing poor posture that is harder to correct as they get older.

What I generally do to teach coordination of the trunk muscles for an anterior pelvic tilt is I work on reaching with the kiddo.  The easiest is to have the child sitting on a firm surface (or even a slightly downhill surface) on the floor or a chair.  If you have two people its even easier.  Find things they want to reach for whether its toys or an ipad app and hold it in front and above them.  If you stabilize their hips while they are reaching (with both hands) and give them some cues at their low back they will start to tilt their pelvis forward while reaching.  Its important for them to reach using both hands in the beginning while they are working on getting the coordination of their flexors and extensors so that they stay symmetrical.  Also watch for if they keep their chin tucked or if they really extend their head and neck to try to stabilize.  I usually remind them to put their chin down and use their eyes to look up.  Once they get the coordination down you can start to challenge them by having them reach off to one side or add a dynamic surface such as a therapy ball, disc or peanut.

What are other ideas you use for core muscle control and upright posture?

February 8, 2010

Some Ideas for Developing Core Strength

Core strength is so critical for all of us, but especially for growing kids as they learn and develop new skills.  In addition to it helping with their gross motor skills it also helps with their fine motor skills because the more solid their trunk is, the easier it is to manipulate their hands.  There are a plethora of ways to work on core strength and we’ve already touched on some of them in ‘Having a Ball With Core Muscle Strength‘.  Here are some other ways to challenge your child’s core strength (and possibly your own as well)!

Climbing a ladder is one of my favorites.  To climb a ladder you need to use arms and legs which really encourages the engaging of your core muscles.  The simplest is a stationary ladder that is solidly built at a play structure.  From there you can branch out to the twisting and turning shapes that playground ladders come in these days.  Some of my favorites to add to the challenge are the ones that move such as net ladders, or chain ladders or those plastic segmented ladders that shift as you get to each new section.  In addition to just having your child climb, try to encourage them to switch which foot they are leading with to keep their glut development balanced.

Wheelbarrow walking uses weight bearing through the arms while your child is walking on their hands and you are holding them at their hips or legs or feet.  The further out you hold them the harder it is for them.  I usually start in close at their hips/waist and as they progress I will slowly move my support out further to continue to challenge them.  I also watch to see if they are completely sagging in the middle.  If that is happening I will either give them a small rest or move my hands so that they are getting a little more support.

Crab walking is also fun.  This may take some coordination so the first step wold be to get your child to make a table top.  If they can do that, the next step is to have them try to take a step with their feet and then hands.  Eventually they will be able to walk with hands and feet simultaneously.  If they are sagging in the middle have them reset.  The flatter they keep their middle the more they are working their core muslces.

You can always do the pilates plank move either on their forearms or on their hands with their arms straight.  Make it a contest to see who can hold it the longest but don’t let them stick their bottom up or drop their belly down.  Sometimes if you see how far out they can walk their hands and then have them hold it for a certain count when they reach the farthest point, you can entice them into doing plank and they don’t even realize it!

There’s always the basic sit up which for the little ones generally starts as a pull to sit with them holding onto your hands and then they pull on your hands to get themselves into a sitting position.  Eventually you want to progress so that they can sit up without using your hands.  Depending on how they are doing I will have them either reach for me while trying to sit up (I am holding their knees so their legs stay down) or I will have them cross their arms across their chest.  When you are stabilizing their legs they are using their hip flexors also but as they get stronger they will be able to do this without any help.  Another way to increase their strength is to have them try to lie down without using their hands and without crashing.  To functionally encourage stronger abs help and encourage your child to sit up from lying on their back, without rolling onto their belly first.

Play around with these ideas and have fun with your kids while encouraging good core muscle strength!  Do you have any fun and creative ideas for strengthening your core?

November 2, 2009

Having a Ball with Core Muscle Strength

Axel ball 1 Axel Ball 2

To follow up last week’s post ‘Core Strength:  Building a Solid Foundation‘ I wanted to look at some ideas for how to build that foundation.  There are so many ways to strengthen your child’s core muscles.  Using an exercise ball is just one of them, although there are so many options from this one piece of equipment.

You can work on individual sets of muscles.  For examples:

Situps – These are just like they sound.  Have your child sit on the ball and lay back.  While you are holding their hips or legs have them sit up.  Try to have them do it without using their hands to help push themselves up.  You could have them reach for you or you could have them cross their arms over their chest.   This way they have to use more of their abdominals.  To do extra strengthening have them try to lie down without ‘crashing’ down.  The slower they lie back down the more they are working their muscles!

Trunk Extension – This is the opposite of the previous exercise.  Have your child lie on their stomach (on the ball) with you holding them at their hips.  I like to put bean bags or some other toy on the ground and have them pick one up, using both hands, and lift up so they can put the toy on the couch.  Initially I may need to give them some extra support at their trunk so they can lift up high enough or roll the back slightly so they don’t have as far too lift.  The further forward they are on the ball the harder their muscles have to work.  You can also have them work in the opposite direction by taking the toy off the couch and lowering back down to place it on the floor.  (I find this one harder to convince the kids to do but its still possible!)  The more you can encourage them to lift up without having to push up with their hands, the more they will be working their back extension muscles.

Side Lifts – This is very similar to the previous two.  Basically, have your child lie on their side with you holding them at their hips.  Ask them to lift up so they are lifting their side up off the ball.  It usually works better if you have a toy or something they are reaching for, like giving you a high five!  The more you can have them lift straight without twisting the more you are targeting specific muscles.

Twisting is a good way to strengthen although it opens a whole new can of worms!

Besides working on individual sets of muscles you can also work on the way the core muscles work together to help your child maintain their balance and have effective balance reactions.  The way to do this is to have your child sit on the ball with you holding them at the hips or thighs.  Some options are:

Bouncing – Bounce them up and down on the ball while they try to hold their head and trunk in and upright position.  This is usually a great activity to do in between other exercises.

Slow Movement – Have your child sit on the ball and slowly move the ball in a direction and hold it there.  This will cause your child to work to keep their trunk and head upright and hold it so that they are working on the endurance of their postural muscles.  You can make it fun by having someone blow bubbles and have your child reach for them, or reach for a toy.  If I am by myself a lot of times I will use songs and have them clap or modify songs like ‘If you’re happy and you know it’ so that they are touch their head, reaching for the ceiling, touching their shoulders, etc.  The goal is to have them use their trunk muscles and not their hands for staying upright.

Fast Movement – This is very similar to the previous exercise except you are moving at a slightly more rapid pace and not sitting at one position for long periods of time.  This will work on your child’s ability to adapt to changes in position.  You may have to start out slow and then get faster as they become more adept at it.  Make sure when you are moving that you aren’t using the same pattern all the time (i.e. always clockwise movement).  Switch it up and use diagonals and circles and any pattern you can think of!

Hopefully this was helpful in giving you some ideas of how to ‘Have a Ball’ with your child’s core muscle strengthening!

Here are some other resources on using an exercise ball with kids:

October 26, 2009

Core Muscles: Building a Solid Foundation


We have all been inundated with the different types of exercises and classes and gimics for us as adults to maintain our core strength (i.e. abdominals and backs) so that in our ever advancing age,  we can protect our backs!  Well having strong core muscles is essential for our children also.  By core muscles I mean their abdominals, back extensors, the muscles that stabilize their shoulder blades, and their hip muscles.  The key is for all of these muscles to work in harmony with each other.  It is our core muscles that allow us to have good posture in both sitting and standing, as well as that help us maintain our balance and give us the ability to use our arms and legs in a more precise and coordinated manner.  In fact in terms of development our children should begin developing their strength from their core and then progressing out to their extremities (arms and legs).

I have noticed more and more children who have a weak set of core muscles.  This can present in a few ways.  The child may have poor endurance and is unable to keep their core muscles turned on unless continuously stimulated.  These are the kids that you see who look like they are ‘melting’ when they are sitting still.  They slump forward and have to lift their head to see what is right in front of them.  This is the beginnings the forward head and rounded shoulder posture that so many adults have from sitting in front of a computer screen!  Some kids may not have the strength to do a sit up.  Often times when they are lying on the floor they will need to roll onto their stomach to get into a sitting position because they don’t have the strength to come up into sitting from their back.  Another aspect of weak core muscles may be the inability to coordinate the muscles together.  Your child may be able to activate their abdominals to bend forward, or their back muscles to straighten their back but they aren’t able to coordinate the timing between the two of them to correct for sudden changes in movement effectively.  This affects their balance reactions and their ability to perform higher level gross motor skills.

Often when I am working with a child on a ball to develop their core muscles, a parent will ask why we are still working on that since they seem to be doing well with it.  Or they’ll say that their child’s abdominals seem to be really strong so they shouldn’t have to work on them anymore.  I usually tell them that as adults we are supposed to be doing abdominal and core work daily (Pilates is one type of exercise that focuses on core strength development) to maintain our strength, so it makes sense that it would be just as important for a child, especially one who is growing and changing at a rapid rate.  In addition, it is important to be working on all of the factors that I mentioned above, not just the strength of one muscle group in isolation.

Think of core muscles as being the foundation for your body (similar to the foundation of a house).  When the core muscles are strong and well coordinated it is easy to build and develop skills, just like when the foundatino of the house is strong and sturdy the house will develop according to plan!

December 30, 2017

Top Ten Blog Posts of 2017

2017-03-28 23.24.31

It’s been a few years since we did a top ten list at the end of the year (that may be because for a few years we weren’t very consistent with posting). Since we managed to get out a post every week of this year (yes, we are patting ourselves on the back) we thought we would take a look back and see what posts were the most read by you our readers!

Here are our top 10 overall from 2017:

10.  Encouraging Rolling From Back to Stomach

9.  What Does High Tone Mean?

8. Easter Egg Hunt For Motor Skills

7.  Having a Ball with Core Muscle Strength

6.  Avoiding the ‘Container Shuffle’ with Your Baby

5.  My Child Isn’t Rolling Over:  Should I Be Concerned?

4.  A Multi-Tasking Activity

3.  A Glossary of Sitting

2. What Does Low Tone Mean?

1.Motor Learning: Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

Interestingly enough, all of these were published prior to 2017, so I decided to dig a little deeper and find out our top ten that were published in 2017. Those are:

10. Halloween Inspired Gross Motor Games

9. Single Leg Stance

8. Transitional Movements

7. 10 Things You Didn’t Know a Pediatric PT Could Help With

6. Crossing Midline

5. Taking the Vision out of Balance

4. Core Workout: Hungry Hippos Meets Wreck it Ralph

3. Eccentric Abs (and no, I don’t mean odd!)

2. Ideas to Target the Core

1.Righting Reactions

Happy New Year, thanks for a great 2017 and we look forward to seeing you in 2018!

December 9, 2017

Holiday Gift Giving Guide

twister yoga
It’s always amazing how fast the year goes by and how quickly another holiday season is already upon us! With that said, it’s time to start thinking about what gifts we can give to the children in our lives that they are sure to love but that will also encourage practice of motor skills and/or general physical activity.
Here are a couple of ideas to get you moving in the right direction!
  1. Pewi Ybike Walking Buddy and Ride On Toy: This is great for babies/toddlers in the pre-walking phase as they can work on reciprocal stepping using it as a ride on toy and can also use it as a push toy building balance and control.  It’s a little on the pricey side but toddlers will continue to enjoy zooming around on this one way beyond those first steps!
  2. Teeter Popper: We haven’t had the opportunity to try this one out but this wobble board looks like all kinds of fun.  It can promote sitting and standing balance, core stability and provides plenty of sensory feedback since the suction cups on the bottom pop as kids make the board move. Check out the video on amazon through the provided link for a demonstration.
Here are some of our Favorite Toys that can be used to encourage gross motor activity:


  1. Squigz
  2. Stomp Rocket
  3. Laugh and Learn Piggy Bank
  4. Stacking Cups
  5. Twister
  6. Melissa and Doug Puzzles (musical instruments, shapes, farm animals)
  7. Feed the Woozle
  8. Cones and Hurdles
  9. Spots
  10. Stand and Play Parking Garage
  11. Balance Board
  12. Monster Feet
  13. Yoga Ball
  14. Ring Toss
  15. Hippity Hop
  16. Scooter Board
  17. Activity Table
  18. Balls of all kinds (o-balls, playground ball, gertie ball)
  19. Hopscotch
  20. Activity Cards
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