Pain Science is evolving. The belief in the importance of core strength for reducing back pain is mainstream, and it will probably take 15 years or more for these new and more correct ideas to become mainstream.
“The popularity of core stability training is based on the following assumptions (taken directly from Lederman 1):
- That certain muscles are more important for stabilisation of the spine, in particular transverses abdominis (TrA).
- That weak abdominal muscles lead to back pain.
- That strengthening abdominal or trunk muscles can reduce back pain.
- That there is a unique group of “core” muscles working independently of other trunk muscles.
- That a strong core will prevent injury.
- That there is a relationship between stability and back pain.
Admittedly, these assumptions pass the “it sounds right” test for someone who isn’t up to date with the pain literature. But “it sounds right” is far from a scientific basis and as a proponent of evidence based practice, I prefer to make clinical decisions based on the best available evidence. In the case of low back pain and core stability, we have a good deal of scientific evidence that we can consult for answers. The literature suggests the following (taken directly from Lederman 1):
- Weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not pathological, just a normal variation.
- The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote CS.
- Weak or dysfunctional abdominal muscles will not lead to back pain.
- Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.
- Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise.
- Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain.
- Any therapeutic influence is related to the exercise effects rather than CS issues.
- There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities.
- Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them.
In short, the assumptions that core stability reasoning are built upon are no longer tenable. The evidence clearly demonstrates that core stability as a single solution to low back pain is no more than a reductionist fantasy. If a thorough review of the literature on the topic is desired, the reader is encouraged to read Lederman’s well referenced paper The Myth of Core Stability 1.”