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Core Stability – Is it time for a re-think?

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 “When my information changes, I alter my conclusions. What do you do, sir?” - John Maynard Keynes, economist

Core stability is one of those phrases that so many patients have heard about, but have little real understanding of what it means, how to get it – and whether any of us need it anyway?

A typical example of the confusion:  A while ago I suggested a patient work on his core.  He was obviously a bit confused by this and when I asked him what he thought I meant by ‘core’.  He proceeded to describe that he thought the core was like a ball or a sphere inside his stomach that would either be loose or tough.  He felt his was tough and so he assumed his ‘core’ was strong and not the issue.

When manual therapists say ‘core’ we mean a set of muscles that are deep inside us and attach to the spine and pelvis from the front and the back. These provide movement and protection to the spine.  It refers to a deep layer, rather than something like the earth’s core, or an apple core. It’s not a place – it’s a concept.

Anyway.  The idea is that if you have weakness in these muscles, or that they don’t contract when they’re supposed to then it will lead to back pain.  And so logically if these muscles are strong and toned then you will bulletproof your spine.  Brilliant. But…One of the most important studies done in 1996 which really drove the belief that a weak or inefficient core was to blame was a very, very small study (only 30 people) – which is hardly enough to base a global healthcare movement upon.

However – the concept of core stability went stratospheric.  Viral, if you will.

The thing is, it’s a really, really persuasive and convincing solution to back pain.  It seems to make such perfect sense and it works enough of the time for some people that it will take a long time for this trend to die out.  I jumped on the core stability bandwagon in a big way in 2007 after becoming interested (obsessed) with Professor Stuart McGill’s work.  When I say jumped on the bandwagon I mean I ran like a lunatic to the top of Pen Dinas and jet packed myself head first at 200 mph onto it.

But here’s the thing.  I’ve changed my mind. Big style. And here’s why:

Most of us hurt when there are factors in our lives which make us more susceptible to pain, like stress, poor sleep and lack of exercise (not because a disc is slipped, or a joint is arthritic or a nerve is pinched).  These are things that wind up our nervous system, making our whole body tense – meaning that simple aches, pains and strains can become amplified into agony.

Increasing muscle tension on an already turbo-charged nervous system seems like a pretty daft thing to do, doesn’t  it?  If you’re already wound up, tense as a drum and ramped up for pain, what do you think is going to help?  Doing loads of core strengthening? Pilates? Bracing your back and keeping it stiff at all times?  Well, probably not.  Maybe what’s really going to help is to chill out, unwind, relax, breathe, get a good nights’ sleep, do some exercise and eat well – In a nutshell; be good to yourself.  It surely explains why so many people can overcome pain by getting into things like meditation and mindfulness.  It probably explains why some get benefit from Yoga.  It explains why so many patients stop hurting when they've left a job they hated. It really adds to the fact that regular exercise is an amazing therapy for chronic pain. 

So maybe it’s time to look at pain from a different angle: 95% of back pain is not coming from damaged or diseased structures in our spines, so by attending to our sleep quality, stress levels and exercise levels then our sensitive nervous systems can wind down to a level where pain needn’t become a fearsome catastrophe.

It’s common sense really isn’t it? 

Thanks for reading.

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