Is core stability as important as we think?

As healthcare practitioners we hear about many common beliefs and questions that people have around the core, these include things like:

I’ve been told my core is weak, how can I strengthen it?

What is the best exercise to strengthen my core?

Will core strength improve my back pain?

Do I need to brace/engage my core when doing [blank] exercise?

We see and hear about it everywhere in the healthcare and exercise industry - the importance of having a strong and stable core, engaging it, training it. But why is that?

People may want to engage in core-focused exercise for many reasons, the most common reason is to protect the spine as a means of treating pain or injury, or preventing pain or injury.

It is likely that this belief came from some research that was conducted in the late 1990’s (Hodges PW 2003) which had a significant influence on how we came to use core stability strategies to manage and treat musculoskeletal pain like low back pain. Hodges (2003) included subjects who had low back pain and subjects who did not and they were required to lift their arm whilst the researchers measured the timing of the activation of trunk (core) muscles. It was found that the subjects with back pain had a delay in the onset of the activation of trunk musculature, compared to those without back pain, by roughly 20milliseconds - one fifteenth of a second difference (Hodges PW 2003). This doesn’t seem overly significant right?

It appears as though the information regarding the timing difference has been extrapolated into the belief that our spines are unstable and we must stabilise to protect them. As a result, the findings of this research have been utilized within the healthcare and exercise industries by promoting core exercise and cueing to engage or brace the core to treat or prevent back pain (Wang et al 2012).

Adding different exercises to our tool belt is great, as long as the messaging about why these exercises are important is not nocebic and doesn’t come with fear mongering. Unfortunately most people seek out (client) or prescribe (practitioner) this mode of exercise due to the inherent belief that our spines are unstable and must be stabilised and strengthened to treat or prevent pain.

So what does the current research say?

There is a lot of research out there that does show that core exercise can be effective in improving low back pain, which is fantastic. However, there is a lot of recent research that shows core exercise is no more effective than any other form of exercise to treat back pain in the long term (Benjamin E Smith et al 2014, Wang et al 2012).

Sounds crazy right? This suggests that core exercises may not be effective in treating pain for the reasons we perceive them to be effective (Reeves et al 2019). I.e. if we truly need core exercises to strengthen, stabilise and protect our spine in order to be out of pain, then why does any other form of exercise help as well? You would think only exercise that is focused on improving those aspects of the core would be helpful.

If we take strengthening, stabilising and protecting the spine out of the equation we are left with something a lot simpler, engaging in movement or activity. There are many aspects as to why someone experiences pain, pain is multifactorial (read more about it here!), and to assume it is only due to a lack of core strength and stability would be over simplifying something that is actually quite complicated and unique to each person.

We know that pain can be ‘turned up’ by being stressed or anxious, feeling low or depressed, avoiding activity, being unwell or not sleeping well, previous experiences, life/work pressures. However, we also know things that can ‘turn down’ our pain, like regular movement or exercise, reducing stress, eating and sleeping well, socializing, working with a supportive healthcare clinician, taking control of your recovery and engaging in everyday activities (Karran et al 2018). Often partaking in regular exercise or movement can have a wider impact than just the physical changes. This may be why any form of exercise can help, as it can also address the other factors that can ‘turn down’ our pain.

If we take the whole picture into account then the way we address these factors can look really different from individual to individual. This means we don’t necessarily have to do bulk 'core' or 'stabilising' exercises. We can use lots of different strategies to improve our own or someone else’s pain situation and we can adapt the strategy to your wants and needs. Now this is empowering!

If you’d like some more information or assistance on how to manage your pain and apply some of the above strategies to you, our allied health team is here for you, book now through the button above!

References

1.    Hodges,PW. 2003. Core stability exercise in chronic low back pain. Orthopedic Clinics of North America, 34,pp.245-254.

2.    Karran,EL., Hillier, SL., Yau, Y., McAuley, JH., Moseley, GL. 2018. Aquasi-randomised, controlled, feasibility trial of GLITtER (green light imaging interpretation to enhance recovery) – a psycho education intervention for adults with low back pain attending secondary care. Peer J, pp. 1-20.

3.    Reeves,NP., Cholewicki, J., Van Dieen, JH., Kawchuk, G., Hodges, PW. 2019. Are stability and instability relevant concepts for back pain? Journal of Orthopaedic and Sports Physical Therapy, 49(6), pp.415-425.

4.    Smith,BE., Littlewood, C., May, S. 2014. An update of stabilization exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders, 15(416), pp. 2-21.

5.    Wang,X., Zheng, J., Yu, Z., Bi, X., Lou, S., Liu, J., Cai, B., Hua, Y., Wu, M., Wei,M., Shen, H., Chen, Y., Pan, Y., Xu, G., Chen, P. 2021. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. Plos One, 7(12), pp. 2-7.