Unravelling ‘Core Stability’

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There are many myths and misconceptions about ‘core stability’ which has become a popular concept in both the rehabilitation and fitness industries in recent years. Even women’s magazines now implore you to ‘train your core’.

In our clinic we are seeing an increasing number of people who have fallen victim to an often misguided approach and undertaken exercise regimes that have led to back pain and/or related hip and leg problems which can be linked to improperly ‘training their core’.

The confusion probably comes from a poor understanding and misinterpretation of research findings and further, their misappropriation for claims that specifically strengtheng the abdominal muscles can assist with things such as improved movement and postural stability, pain relief and injury prevention. The ‘evidence’ for these particular claims is simply not there! Debate is beginning to surface questioning the real benefits of ‘core training’.

Here we look at where the concept originated, what research has really shown us and why only concentrating on the abdominal muscles can be counterproductive and even deleterious.

We also look at alternatives to concentrating on abdominal strengthening and ‘core stability’.

Where did the notion of ‘core stability’ come from?

The concept probably arose initially as a result of some Australian research into postural control which showed that the deepest stomach muscle (transversus abdominis) was slower to contract in people with back pain.

Studies showed that rather than being actually ‘weak’, this abdominal muscle also had more trouble achieving and then sustaining a low grade contraction. There is also evidence that other muscles such as the low back muscles, pelvic floor muscles and diaphragm can also show similar altered motor behaviour in people with back pain.

The researchers considered that all these muscles contribute to the stability of the low back (the original concept of ‘core stability’). While they recommended that initially these muscles should be trained in isolation, they also stressed the need to then train them together as team players in order to properly support the low back.

However, somehow their message was lost and it seems that the deep abdominal muscle has become ‘it’.

Around the same time, popular medical thinking involved the concept that most back pain was due to ‘instability’ of the spine. While some research has shown beneficial results from specific, tailored ‘real’ core muscle training in those who actually do have spinal instability, most back pain is not due to ‘instability’. However, ‘instability’ and ‘core’ have become inextricably linked in a symbiotic relationship.

Why over-training your core can be harmful

‘Core stability training’ has often become mistakenly synonymous with ‘strengthening your abs’ (abdominal muscles). Unfortunately the real implications of the research have often been misunderstood and many of the ‘core muscle training’ programmes offered within the gym and fitness industry are poorly conceived and delivered, frequently adopting directives such as ‘suck the stomach in” – with the emphasis on ‘pulling in’,  ‘holding’ and curling the spine forward.

Trouble can develop when people including those with back pain have too much of this movement and actually lack the ability to ‘extend up’ against gravity – an action that incidentally, should still also involve activity in the stomach muscles.

The undue focus on the abdominal muscles also probably stems from certain longstanding ‘mythconceptions’ around the perceived importance of the abdominal muscles as a group – that weak stomach muscles lead to back pain; or that if you have back pain you need to strengthen them; that they are the most important muscles responsible for stabilising the spine; that strengthening them protects you from injury.

But the abdominals are only part of the problem!

Things that can go wrong

While back pain research has shown problems with underactivity in the deep abdominal muscles, evidence is also beginning to mount that that back pain and related problems can also be associated with overactive and ‘too strong’ abdominal muscles!

Overworking the abdominal muscles can create too much tightness around the centre of the body which can adversely affect important aspects of our functioning for example:

  • Altered spinal posture and difficulty effectively controlling movements of the trunk, and so the tendency for
    • increasing incidence of low back pain and allied disorders
    • unhelpful and unsupportive breathing patterns
    • neck and shoulder tension and pain
    • stress urinary incontinence

What about Pilates?

Part of the popularity of Pilates training is due to the fact it focuses mainly on the stomach muscles – a perceived problem area for those hoping to achieve the ideal shape promoted in current beauty myths.

Joseph Pilates its founder, worked with elite gymnasts and dancers whose needs are not necessarily those of people with back pain or those who want to ‘get fit’ or improve posture and shape.

Many people have found benefits from the exercises based on his techniques, but there now appears to be a wide variation in what is often delivered as ‘Pilates’ It has tended to become a one size fits all approach irrespective of the particular needs of the client. In clinical practice two main client subgroups are apparent with differeing functional needs; one of which will benefit more from a Pilates based approach, while the other group will experience aggravation. In addition, many Pilates schools instruct their clients to flatten the low back and ‘tuck the tail under’ which unfortunately jeopardises control of the natural arch in the low back – important for healthy back function.

While some of the real strengths in this approach are the requirement for concentration and awareness of breathing and more specific ‘inner movement’ control, practitioners need to be highly skilled in the identification and correction of aberrant patterns of response.

A better alternative to ‘core stability’: ‘lower core control’

Unfortunately, the idea that the spine is ‘unstable’ has fostered the concept of needing ‘core stability’ – and this has more often than not come to mean ‘not letting it move’. And this mythconception is where so much of the poor training emanates from.

Rather, you need to gain proper control of your ‘core’ hence the term ‘core control’ is more apt. This relies on deep muscles around your spine and within your pelvis working together with the deep stomach muscles as team players to support and control appropriate spinal postures and discrete, rather subtle yet functionally very important patterns of movement.

More importantly, your functional ‘core’ is actually lower than most people realise, hence this control should occur lower down than usually happens – we have termed it ‘lower core control’. Proper core control also has a lot to do with how we organize our breathing in posture and movement.

Improved control of the ‘lower core’ enables the pelvis and base of the spine to better support posture and movements of the whole spinal column. ‘Lower core control’ is also fundamental in being able to develop functional strength as well as the ability to stretch more efectively and safely without reinforcing unhealthy stresses on the spine.

‘Lower core control’ can be learned and practiced as part of daily movement. Based upon contemporary evidence, an understanding of the movement problems experienced by people with spinal pain and their actual functional needs, we have developed The Key Moves™ Programme of Therapeutic Exercise and Movement Classes.

This tailored exercise approach offers small group supervised training in the development of more appropriate ‘core control’ strategies to support improved overall posture and movement function. Gaining proper control of your ‘lower core’ can lead to safer, much enhanced results from other forms of exercise such as walking and swimming. This is particularly so for the more challenging exercise programs such as yoga, and even those more vigorous forms, such as the martial arts.