Why the big hype about core stability then?

To hear the above statement is very controversial I know.  For years we have been told that a strong core will help prevent low back pain, but the evidence does not stack up quite as well as we hoped.  Yes, working core muscles will help, but why can we not argue that running in fact helps build strength in the back and why does it have to be so ‘core related’ to have ‘better’ results.  Afterall, running has been proven to improve hydration between spinal discs which may in fact be a contributing factor to the pain we feel (slightly off topic from the core subject, I understand).

To solely activate your core muscles is near on impossible.  These muscles are so deep that in order to ‘switch’ these on you must ‘switch’ on a large number of other muscles so what is to say that the actual exercise you are doing is even activating the core muscles as you hoped.  We would only know this with EMG data (these are pads which are attached to the body and detect which muscles are being used predominantly).  Who has the time to do this first?….and second, does it even matter!?

Where does this belief come from then?

This takes me back to my original point at the start of this blog post ‘is core stability really the be all and end all’.  The whole concept of core stability being a defining factor in lower back pain stems from a research paper back in the 1990’s by Hodges et al.  The studies abstract is below;

Methods: While standing, 15 patients with low back pain and 15 matched control subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal muscles, lumbar multifidus, and the surface electrodes.

Results: Movement in each direction resulted in contraction of trunk muscles before or shortly after the deltoid in control subjects. The transversus abdominis was invariably the first muscle active and was not influenced by movement direction, supporting the hypothesized role of this muscle in spinal stiffness generation. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles.

Conclusions: The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.

To the naked eye, this conclusion says that those who had low back pain had a delayed contraction of the core muscles before moving….. therefore the delayed activation must be causing their back pain and if they can rectify this then that would mean we can avoid having low back pain.

Why is this all a myth then?

Now here’s the thing, what if the subjects within this study had actually found a way to move with LESS pain by deactivating their core muscles so that they contract slightly later in order to avoid those painful and sharp moments that they may have been used to before, so in essence the brain is forward thinking before a movement occurs to switch off a muscle to enable the first part of the movement to happen with no constriction before re-engaging the core muscles to help stabilise the remainder of the movement.   This would then disprove the theory of weak core/delayed core because in fact the delayed reaction I actually REDUCING pain, so we could almost argue that a delayed core can reduce low back pain in those who already suffer from back pain.

I know this thought process will challenge your current beliefs and everything you have ever heard before BUT…. What if it is correct?  We couldn’t possibly answer this with the information we have because it would involve going back to the subjects originally tested and asking if their pain was worse currently than it had ever been.

So what should you do instead then?  There is now really good evidence to say that any type of exercise is good for the back, as long as it is within your capability.  For example, going to the gym and lifting 200kg on a squat is likely to be potentially damaging to anyone’s back with or without current back pain symptoms, but to go to the gym and squat with a comfortable weight in a range that is also comfortable is totally fine and safe, and in fact very healthy for the back.  The biggest hurdle usually is overcoming the belief that your back is not ‘weak’ which can often be thrown around with people.

The main take away point here is that just because you have been told your ‘core is weak’ does not mean that you should restrict yourself from any movement or exercises that you enjoy and also, spending hours upon hours in the bird dog position is not necessarily the answer to all your problems (although performing the bird dog is not inherently bad or a waste of time, it is just one exercise to try amongst the millions that are out there).  The key is to find the thing that you enjoy and work out a plan/programme that gets you doing that without aggravating the system.

Here at Bodylogics we treat many patients with back pain every day.  If you are struggling with your back and wanted to get another opinion then feel free to reach out to us and we will have one of our clinicians assess and offer some advice on how you can improve your pain, whilst at the same time getting some much needed treatment on the affected area.