Core stability: A circus act!

core stability

Core stability has been around for quite a number of years now.  It has been capitalized heavily in physiotherapy treating low back pain and in the fitness world…. but have we been sitting on this bandwagon for too long with others enjoying the rewards, and being duped as to what core stability really is? It appears we have according to this recent systematic review that showed core stability training was not more effective than any other forms of exercise (reference). SO GIVE IT A REST WITH CORE STABILITY ALREADY, JEEZ!

So for those of you that wish to read on…

So what is core stability?  Have you ever been told to brace your core?  Do you actually know what that means?  Well you may have been told at one time to engage, brace, activate your core by your personal trainer, pilates instructor or your physiotherapist. This is the action of drawing in your abdominal muscles or more specifically your transversus abdominus (TrA) and (possibly) your pelvic floor muscles in an attempt to provide stability to your spine. Now I will say at this point that there is an exception to this rule. If you do have pelvic health issue then it’s best you speak to these lovely ladies.

http://entropy-physio.com/for-patients

 

multifidus-system-side

Your spine is surrounded by very strong ligaments and several layers of muscle. Your TrA is actually involved in several functions controlling abdominal pressure for respiration, vocalisation, defecation, vomiting etc (reference).  So you are using your core in everyday functions that we don’t always have to think about.  In actual fact consciously bracing your core actually provides no difference in spinal stability compared to if you didn’t consciously brace your core (reference), so why bother? The premise of pulling things in to engage your core creates the illusion of stiffness and we don’t want to be stiff in our spine all the time.  Some studies have found that bracing your core actually compresses your spine which can also give pain.  Furthermore we have a clever little anticipatory system that actually fires our stability muscles prior to performing movement or lifting load.  This was shown in healthy individuals with no history of low back pain (reference). So those of us in the gym being told too brace your core as hard as you can is probably not so necessary.

Back Pain

The concept behind trunk bracing, stabilizing (call it what you will) was capitalized by clinicians after two leading researchers in spinal pain, injury and research found that the timing of the trunk muscles was delayed (not shut off!) in patients with low back pain. It was derived that this could be a cause of chronic low back pain(CLBP), and the health and exercise industry went bonkers! (referencereference). As with all research there’s a for and against argument. The against argument to Hodges study was this nice little study done with ultrasound doppler showing no delay in abdominal muscle in patient with CLBP (reference).

“Core” stability training filtered into the fitness industry after it was concluded that bracing your core was seen as a preventative measure to strengthen and protect your back (reference). Thus, conscious activation of your abdominal muscles would increase strength and inherently reduce the incidence of low back pain.  It became the exercise of choice for physiotherapists and has perhaps become overused (and still currently is) (reference), even I jumped onto the bandwagon!  There is no standardized approach to core stability training and due to the multifactorial components of CLBP it would be naive to purely focus on the trunk to facilitate recovery.

Now for all those that do Pilates, this is a great adjunct but unless you can relate what you do in a Pilates class to function, I feel there is very little value in just doing pilates to help your back pain or improve your function. As a Pilates instructor I believe that it is a great way to enhance mindfulness towards your body, to tune yourself into your body. Trying to reconnect with muscles is important. However, activating your core in isolation has been shown not to do anything for back pain or functional deficits. (reference). Furthermore there is some evidence that suggests performing a spinal stabilization exercise program did not have any more benefit over education and a standard exercise program for chronic low back pain. (reference, reference, reference).

My personal and clinical opinion now is that it was seen as a safe way to teach patients with low back pain how to perform exercise in a non-threatening way. Patients would lie on their back not move in ways that they might feel vulnerable and then could be progressed to functional tasks.

Movement is what’s important

The idea that having absolute rigidity when you move is incorrect.  Humans are dynamic individuals needing to adopt many postures in order to perform multiple movements and tasks throughout the day.  Your trunk is a combination of your trunk muscles (internal and external oblique, Rectus abdominus, TrA), spinal muscles (Erector Spinae group, Psoas, Quadratus Lumborum Multifidus) pelvic floor and diaphragm to provide the spine and body with dynamic control during movement with individual muscles being more active in different postures, handling different loads and at different speeds of movement (reference, reference). Your trunk is responsible for energy transfer between the lower body and upper body supported by many other muscles.  It is a reciprocal relationship between muscles that allow us to adopt a variety of dynamic movements and postures. (referencereferencereferencereference)

So is there any real value in consciously isolating your core whilst you move?  Well, that depends on the context. If you are about to be punched in the stomach you might brace, or if you’re lifting a car off a trapped cat that is about to get mauled by a vicious dog, I would say yes. However to brace for absolutely everything that you do, then no, give your abdominals a break! I understand the value of teaching “core” exercises initially (perhaps you want to break the association of core exercise and back pain, and need to acknowledge and teach it first) but don’t keep working them, move on! No seriously MOVE! Is it more about having body awareness and recognizing variability of movement?  I would say yes (reference). So rather than lying on the floor and consciously bracing your core it would make more sense to perform the activity that is required as part of your training regime or working lifestyle.  This is performed under controlled conditions where there is minimal risk of re-injury (reference).

So let’s not get to hung up on needing to work your core all the time. Having conscious awareness of your muscles and body is important. In a back pain sense if you need to move in different ways then this when it is important, but otherwise you want to have free, unrestricted, flowing movement that doesn’t always need your core.

Along with movement variability there is a growing body of evidence out there that actually thinking about how you move plays a large part on how you actually move (referencereferencereference) check out the video in the audio/video section scroll down to neuroplasticity and in the top left hand corner of the asapscience video you will see a menu full of videos, select the scientific power of thought (here).

Thanks for having a read.

TNP

P.S. I had to add a video to this as my comments are supported by other health professionals and have been researched extensively. You can view the video and others here

This has been written as an educational source for the public I welcome your comments, opinions, thoughts and questions.

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7 thoughts on “Core stability: A circus act!

  1. Hi Paul, it does make sense to me to focus more on building conscious awareness of our bodies rather than trying to isolate and activate my core in my daily working lifestyle (although I’m still trying to figure out how to build that awareness!)

    When doing Pilates, I stay focused on keeping myself straight and doing the exercises correctly. I still find it challenging though to maintain regular deep breaths as I’m doing the different moves. During the process however, my body does not feel like it’s relaxing, although I do enjoy the stretches and I certainly feel good afterwards with just slight pain in the muscles (happy hormones from the thought of exercising?) When I wake up, the very stiff back is there again first thing in the morning. It’s not until recently that I’ve paid more attention and realised that this has been happening for quite some time now (over a year).

    Could muscle tension be the cause of stiff back or back pain considering that my spine and discs are not out of place and no pinched nerves? If so, what causes muscle tensions? I often feel stiff everywhere 80% of the time. How can I increase body awareness without tensing the muscles even more and learn to fully relax my muscles?

    As with food, I do personally believe that however and whatever we choose to make ourselves feel better, we must be able to incorporate that in our daily lives and maintain that in the long term. Luckily, I appreciate good food and always eat well and healthy, enjoying everything in moderation and making everything from scratch, knowing where all my ingredients come from. However, with the type of job I have working in the kitchen, I can easily forget to maintain a good posture or balanced body throughout the day!

    Apart from regular massages which leave me feeling better and more relaxed, to help reduce the constant heavy brick feeling and aches in my back/neck/shoulders in the long term (why always there?), would it be more beneficial for me to do exercises to strengthen my core trunk or do something more focused on breathing and energy flow (like Qi Gong or meditation) where my mind/body is more relaxed during the process and my breathing more deep and in control to help release all those tensions? Thanks!

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    1. Hi Sonia

      Thanks for the comment. there are lots of areas you have touched on that I will try and comment on.
      1: Having an awareness of you core is important but to concentrate hard on isolating it for every task you do builds the premise of rigidity. The idea behind activating your core has also built up the illusion that in order to protect your back you need to isolate your core muscles. This is simply not the case. Our bodies are dynamic and we should flow naturally in our movement. If we continue to think about isolating our core when we perform a task it becomes an obsession to the point that if we injure our back we blame it on our poor posture or that we forgot to activate our core before lifting the item that gave us back pain.
      Muscle in our back are the same as muscles anywhere else in our body and we need to train them around task specific movements. i.e. a builder is crawling, lifting, climbing, etc and so there fore requires power endurance, strength – static and dynamic
      2. keeping yourself straight in Pilates why? This also builds up the idea that if you do not stay straight you will be unbalanced. We will assume that having good body alignment is important but over thinking your body alignment may again give the idea of holding yourself very still.
      3. the stiff back can be a result of many things from a mechanical perspective – muscle soreness, bed comfort, deconditioned, endurance of muscle, hydration etc. or a psychological perspective – keeping yourself straight, overthinkning your body position – this can all increase stress levels, which has an effect on muscle tension
      4. Just to nip this in the bud right away, discs being out of place simply does not happen. Explanations from clinicians in the past has built up a consensus of belief that discs slip in and out. This is not the case at all, your discs are surrounded by extremely strong ligaments and some pretty strong muscles as well. Discs do bulge as a result of irritation or accepted understanding between clinicians is from repetitive movement. Muscles and other tissues have nerve endings too and can also give rise to nociceptive pain.
      Muscle tension can be cause by ischameic changes (overusing muscles or holding a contraction in a muscle for a long period of time starves the muscle of oxygen) It can also be caused by increased stress levels. We release adrenalin and cortisol when we are stressed which has an effect on our nervous system and results in increasing muscle tone.
      We expose our bodies to repetitive movements and postures throughout the day which does take it’s toll. Having massages, exercising regularly but also having down time is important to contribute to a healthy balance. This can be difficult in busy times, knowing how to manage our stress levels and understanding what is happening to our bodies throughout the day are all ways to combat the aches and pains that we get. If we get a flare up in our normal aches and pains that we get everyday, having some downtime/relaxation and/or exercising can help with this. You just have to find what works for you…
      Hope that helps?

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      1. Thanks. Very helpful.
        1) For pilates, by saying keeping myself straight, I meant a ‘neutral spine’. (I was struggling to find the technical term for it!) For a lot of movements, the instructor kept reminding us to make sure that we are in the neutral spine position. The hard part is to know if I really did find that correct ‘neutral’ position!
        2) My bed is on the harder side, but I do sleep very well and all through the night everynight, so I imagine that that’s not main source of problem…?
        3) I didn’t realize that there’s a correlation between hydration and back pain. I am definitely guilty of not drinking close to enough water throughout the day!
        4) I am of lately finding more downtime to enjoy my hobbies and exercises, which has helped to switch off completely from work related issues. My husband definitely seems to think that I’ve been more relaxed in the past weeks, so that’s good. Thanks for the advices and the great reads. I’ll just have to keep reminding myself to make that free time to just enjoy, and have a more balanced life. Hopefully there’ll be less and less back aches as I do plan on continuing doing what I do for some time!

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