The Myth of Core Stability

This is my opinion / summary on a paper that I recently read:
The Myth of Core Stability, by Professor Eyal Lederman. Available here: http://www.cpdo.net/Lederman_The_myth_of_core_stability.pdf

As you can probably guess from the title of the paper itself, Prof. Lederman addresses the mis-information surrounding Core Stability (CS) and Chronic Lower Back Pain (CLBP). Injuries are grouped into two categories, acute and behavioral. Where acute injuries occur from trauma e.g., getting into a car accident, trauma to the back. Behavioral injuries are more chronic in nature and have a wide variety of causes.

The TL:DR of the paper, is that having a ‘strong’ core doesn’t protect your back from injuries nor does having a ‘weak’ back make you more susceptible to injuries. CLBP is a complex problem that some trunk exercises won’t fix. There are a wide variety of successful treatments, none of which included CS strengthening exercises.

What is the Core?

Defining the core as the abdomen and the included area is a common way to define the ‘core’. One could raise the question, is the back part of the core? Since the back contains musculature that stabilizes the spinal column too. Some specialists even go so far as to isolate the transverse abdominis as the keystone to CS. This is akin to saying the vastus lateralis is the most important muscle in the quadriceps group. This is a too simplified approach to the complex organism that is the human body.

Studies were conducted on women who, due to pregnancy suffered ruptured abdominal muscles and found no statistical evidence to show that a broken core led to an increase in lower back pain.

For there to be a link between core strength and back pain, then a strong core would show statistical significance in reduction with back pain and vice versa. Clinical studies show that this isn’t the case, there is no link in any study every conducted to show that core strength and back pain have any correlated or causal relationship.

Most people don’t consciously contract ‘core muslces’ when engaging in regular activities, outside of the need of a coordinated body. During walking or standing, an EMG shows that the ‘core muscles’ are actually minimally activated. So strengthening the core to improve movement outcomes is a misnomer. The body adapts to specific stress, e.g., playing piano doesn’t directly lead to a better trumpet player. So why would we treat the musculature any differently, holding a plank will have no carry over to the golf swing. On a more basic level, it is near impossible to perform a purely isolated exercise for any muscle group, let alone the ‘core’. In almost any typical ab exercise, other muscles in the body are being engaged and moved. The body is a complex organism and trying to simply increasing the strength of the core – which is dubious at best – can’t protect the back. The studies show that increasing core strength doesn’t lead to positive outcomes in sport performance.

Improvement [of chronic lower back pain] appeared to be mainly due to changes in neural activation of the lumbar muscles and psychological changes concerning, for example, motivation or pain tolerance

Prof. Lederman

When comparing core specific exercise with general exercise – both showed similar improvements in back pain symptoms. The one thing that the studies concluded, was that physical activity was a good way to treat lower back pain. Movement is better than non movement for human beings in general. One of the best things an animal can do is move as soon as possible after an injury.

The paper cites a lot of articles that I have neither the time nor knowledge to read and fully comprehend. All the claims made by the article are backed up by research papers and references, so I believe that what has been written is grounded in solid scientific evidence. At first, we don’t want to believe the conclusions of the article, however this is probably because we have heard it so many times. However, upon further logical thought and especially when presented with statistical and scientific data it is easy to see that the fix for CLBP is neither simple nor easy. We’re just an a complex machine that can be fixed relatively easy. We’re complicated organisms that not only consist of muscle and bones, but a brain that can create sensations and panic.

To ignore the psychological and social factors that lead to back pain misses a huge part of the picture. To claim that strengthening one part of the body will help protect another part of the body is too simplistic.

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