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 a pelvic health clinician.
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! (reference, reference). 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. (reference, reference, reference, reference)
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 (reference, reference, reference) 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.
The Naked Physio / The curiouser 
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