Core Stability: Myths debunked

“Fire your core”, “engage your core”, “strengthen your core”

These are terms that you may have come across or heard over recent years, the focus being…. for all your injury, related problems then look to the core to fix it!

But is this really true? And what is the core?

The core, that is being related to is a group of muscles which are positioned around the trunk, tummy and back, which form a natural girdle for the body. These muscles it was believed, and has subsequently been shown, work together as a team, to provide a steady, solid support from which the rest of the body can function from. The belief being, that without a solid and balanced base to work from, the activities of the body can become more laboured, more compensatory and, if repetitive, more risk of injury, anyone who has tried their normal gym routine whilst stood on a bosu ball will know this feeling of increased work. It is in essence like balancing on a jelly!

The core is made up of the key core muscles i.e.

tranversus abdominis,

multifidus,

pelvic floor muscles

diaphragm.

The other core muscles identified as having a key supporting

role in stability are:

internal and external obliques

rectus abdominis

erector spinae

gluteals

and to a lesser degree trapezius and latissimus dorsi.

These may be the names you have heard in the gym or from your physiotherapist.

Why is a girdle needed?

For every action there is an equal and opposite reaction, so said sir Issac Newton, and this is a great way to view how the muscular system of the body works in action. For one muscle to shorten and contract another lengthens (with control) to counter this action and help stabilise the movement on an individual joint basis. On a larger mass body picture, as a limb moves to function, the core could be said to be completing the opposite stabilising action. As physiotherapists we know and understand that when a muscle or group of muscles has a problem another group will often over compensate and over dominate to allow the body to fulfil its functional role, but over the longer term this imbalance can be the precursor to injury or problems.

But what about my back pain?

The spine is a marvelous feat of engineering! 33 vertebrae (bones) of varying size depending on their role, 23 inter-vertebral disc (the cushiony bit) for distributing the loads, forces and shocks away from the vertebrae and supporting the movement of the spine.

The joints between the bones themselves ensure that each joint has a fairly small amount of movement, but together as a spine, great variety and size of movement is possible. Although there are ligaments between each vertebra providing an initial stability, it is the action of the stabilising muscles i.e. the core which then allow controlled movement from the larger global muscles of the body and the solid powerhouse stabilisers, keeping the base firm and stable and balanced.

Physiologists through studies believe that maintaining the strength in these supporting muscles is integral to spine integrity and the supportive muscular structure may be key in prevention of disc herniation. It is also recognised by the recent NICE guidelines, that strengthening of muscles is an integral part of the management of low back pain.

But my back isn’t my problem, its my………

As a physiotherapist, treating people for problems other than direct back related problems, I will always check core strength and control. This is because the whole body does work as one, the toe bone really is connected to the foot bone and so on! If you sit down now and slump down into a proper TV watching posture, get comfy. Now try and raise your arms as high as you can, surprised? Now sit up tall, with a “normal” spine posture and again reach your arms up, you should find your arms reach a lot higher. This is not magic, but by correcting the position your body is in it aligns itself more anatomically and can achieve more movement and function.

However, if this position is not maintained in activity, because the posture slumps, or relaxes (probably due to core muscle fatigue or switch off) then suddenly those limb muscles don’t have their supporting hand from the posture, have more of a demand on themselves and become more prone to overuse and injury. This is why most professional sportsmen and women include a degree of core control work into their training, athletes, runners, rowers, cricketers, footballers and rugby to name a few.

But I read it’s all a myth?

About 10 years ago, clinicians from many professions started questioning how integral the core really was to prevention of injury, specifically back injury. Debates and discussions were had amongst predominantly the fields of musculoskeletal medicine. Interestingly at this time within the field of neurology, this was being taken up positively as it aligned with many of the concepts used in neurophysiotherapy rehab specifically around gaining central control to allow the body to re learn and work most effectively.

Research has been conducted and analysed and the general consensus remains that for prevention of injury and imbalance related problems to the spine specifically, the need for a stable and strong control at the core is vital.

It is also the opinion of Mike Stamp physio that not only from the research available, and theoretical premise of core stability, from our own clinical practice, we have and continue to see the benefits of training, strengthening and maintaining a good core control for both normal daily function, and improved sporting ability.

As the story goes…..the wise man built his house upon the rocks, and it stood firm, the foolish man built his house on the sand, and it couldn’t withstand the demands.