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Think of the core as a cylinder, said Brian Catania, a physical therapist at ChristianaCare Rehabilitation Services in Newark, Del. “It wraps 360 degrees, and all of those muscles interact with each other in a systematic way.”

It’s the oblique muscles, which connect the lower rib cage to the pelvis on each side of the body, that rotate and flex the trunk and spine.

One critical component missing in most core routines is rotation, Mr. Catania said. Many athletic activities, including tennis, baseball and Premier League penalty kicks, involve rotating the body. So do daily motions like loading the dishwasher and shoveling snow, along with walking and running.

A small study conducted by Mr. Catania and Travis Ross, another physical therapist at ChristianaCare, found that core exercises incorporating rotation strengthen the obliques better than more traditional exercises like situps and planks. Rotation exercises also strengthen the multifidi, which is important because strength in these muscles protects against back injury, Mr. Ross said.

Mr. Ross and Mr. Catania designed a set of seven core rotation exercises which Mr. Hernandez has incorporated into pre-practice and pre-game training with the Rams.

Exercises that rotate the spine have been a source of controversy among athletic trainers, with some arguing that the lumbar spine — the five vertebrae centered on the belly button — can be harmed in the process. Catania and Ross say their regimen is carefully designed to rotate muscles higher in the torso, along the thoracic vertebrae and rib cage, while the lumbar spine remains in a relatively neutral position.

Catania acknowledges the exercises are arduous — his wife reminds him all the time after she performs some — but says clients and even his spouse find them effective and worthwhile.

“Once they experience it and feel the difference and see how it can help them, the buy-in comes,’’ Catania said. “But it is hard.”

Two NFL teams have picked up an exercise routine developed by ChristianaCare physical therapists to reduce muscle injuries and ankle sprains.

The routine developed by Brian Catania and Travis Ross was published in the Journal of Sports Rehabilitation in March, after seven years of work.

Catania says they presented their findings to NFL trainers.

"They were doing a whole series on the spine and felt like the core was an important component of that, so they asked if we would present it at their symposium in March of 2021," Catania said.

“We reasoned that if we could identify ways to improve the strength of the core muscles, common lower extremity injuries would be less likely to occur,” said Catania, who also is the program manager at ChristianaCare’s Rehabilitation Services location in Glasgow. “But it had to be a two-part approach. We needed to develop a reliable screening tool to examine the core muscles and then also come up with a targeted exercise program to strengthen those muscles.”

The innovative work of two Delaware athletic trainers is catching the attention of the NFL. NBC10’s Tim Furlong explains why.