Core Stability, a neuroscience approach

[Calvin27]

I remember a conversation a while ago with my trainer (freebie for signing up haha). Went something along the lines of 'people only have to do core because they do too much isolation these days'.

 

[pharmaboy]

"For those unfamiliar, McGill is generally considered the leading authority on Lower Back Disorders."

That's an awfully big claim, that a bit of googling doesn't seem to uphold. McGill is a prof of a middling degree from a secondary university that few would have heard of. As DK notes, he uses no references to support his assertions, has also published on his own website, and for the trifecta, seems to be selling a book.

To me, that's the sort of article that reduces my belief in the topic, it doesn't improve things. I am sure McGill believes it wholeheartedly, but I know people who believe the month they were born determines their personality, their futures , and what life partner they will be compatible with.........

 

[Mywifesirrational]

Firstly, can we agree that this ‘article’ is a thinly disguised advertorial article for his side business of selling books and seminars?

I am thinking that being a professor doesn’t pay well enough.

And while he certainly is a well published in the field of biomechanics (although most of it is not on core stability), this article would not pass peer review, some of his statements go directly against current evidence. I would be really interested to see a date on this article, won’t be surprised if it was more than a few years old (?). Or alternatively, his vested interested is selling books with his name on them, he’s not going to suddenly do a 180 turn and cease this income and look like a twit at the same time.

The problem is he has a financial investment in the research favoring his ‘views’, this is considered a very strong bias in science. There is quite a few respected experts in this area who have the opposite view to him, but they aren’t selling books and seminar seats. Although in science conflicting views are a good thing, as they elicit discussion and further and better quality research.

I’ll just highlight three main things; I've only cited systematic reviews here as they pool all the studies in the topic they are looking at rank them on quality and dismiss the ones which fail at scientific rigor.

Sports performance, he highlights the importance of targeted core stability training, the current research does not support this approach, it never did.
The effects of isolated and integrated 'core stability' training on athletic performance measures: a systematic review
http://www.ncbi.nlm.nih.gov/pubmed/22784233

LBP in athletes is common, he claims that a targeted core stability program can remove symptoms due to spine dysfunction, the current evidence also does not support this and highlights the quality of evidence is actually very poor and the risk of bias in results high – a common theme in core stability research.
Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature.
http://www.ncbi.nlm.nih.gov/pubmed/24662572

Or in chronic LBP, same thing, the evidence does not support a targeted core stability approach.
A meta-analysis of core stability exercise versus general exercise for chronic low back pain.
http://www.ncbi.nlm.nih.gov/pubmed/23284879

I have to agree with pharma completely, articles like this aren't helping with zero evidence, statements that go against current and overwhelming evidence, all this achieves is to confuse and muddy an already tediously understood topic... all for his personal gain.

When they talk about the core ane sports like MMA, I sometime question if they understand how you throw a punch, punching power comes from the planted leg and then the torque (twist) generated through the body its not really a matter of punching from the core like it would suggest. But that's a bit off topic.

MMA is definitely a sport where you need a very strong trunk to deal with impact, but perhaps more importantly grappling and wrestle demand it. From the training stuff I have watched they generally do quiet complex and challenging activities to strengthen the mid section, things like barrel throws and the like. From what I have seen it's quite smart as having a strong trunk helps the summation of forces from the feet to the hand.

While I doubt the trainers put everything on youtube for me and others to see, they seems to have a pretty solid approach to their training practices which make a lot of sense from a motor control perspective.

 

[my02]

Just to reiterate, I put the article up for those who have an interest in the area of training, conditioning and rehab. I wasn't trying to put forward an argument for or against core training.

And yes, it is certainly an advert for his book however for those who may not yet have come across his work, I thought it might act as a catalyst for them to do their own research.

That aside, MWI, I might have missed where it was stated but do you know what exercises were being used / tested in the the studies that you listed above?

 

[steve job's pancreas]

I would have titled this thread

"Core, what is it good for ?"

 

[Mywifesirrational]

Just to reiterate, I put the article up for those who have an interest in the area of training, conditioning and rehab. I wasn't trying to put forward an argument for or against core training.

And yes, it is certainly an advert for his book however for those who may not yet have come across his work, I thought it might act as a catalyst for them to do their own research.

That aside, MWI, I might have missed where it was stated but do you know what exercises were being used / tested in the the studies that you listed above?

Thanks for putting it up, I have put in a request for works library to procure me one or two of his books, always interested in reading differing views, I am a bit worried his books will be outdated (the science is moving quite fast in this topic) or simply based on opinion and not evidence.

Those studies pretty much include all common approaches and some less utilized or novel approaches. Typically they will be isolation type exercises, typically targeting the deeper abdominal muscles and paraspinals, such is multifidus, erector spinae... Unfortunately many studies don't directly measure against conventional rehab/strength training, I think there is a certain reason for that, as this would directly show up substandard results.

The three reviews cover more than two hundred studies, although many were deemed not good enough quality to be included. Says a lot about this area of research, at least in the last decade.

 

[Pastavore]

Just a few points to throw in.


The main reading I got from the metanalysis MWI linked to is that the research in this area is pretty poor. The conclusion that "research doesn't support core stability training" is correct, but that may be because adequate and appropriate research hasn't yet been done.

Secondly, if you ask 3 different professionals to define "core", you will get six different answers. And then if you get them to give you a core stability program , you will get 60 different exercises.

My view on the matter is that paying LOTS of attention to posture ( particularly spinal alignment and pelvic positioning) and correct movement patterns in multi-joint movements, including rotational and anti-rotational exercises will give you great results.

If you want a six pack then starve yourself, do sit ups, take drugs and get fucked.

 

[my02]

I have put in a request for works library to procure me one or two of his books, always interested in reading differing views, I am a bit worried his books will be outdated (the science is moving quite fast in this topic).....

I have his Low Back Disorder book if you are interested. Happy post it down on a long term loan if that is of any benefit. Same with "Movement" by Gray Cook.

 

[driftking]

MMA is definitely a sport where you need a very strong trunk to deal with impact, but perhaps more importantly grappling and wrestle demand it. From the training stuff I have watched they generally do quiet complex and challenging activities to strengthen the mid section, things like barrel throws and the like. From what I have seen it's quite smart as having a strong trunk helps the summation of forces from the feet to the hand.

While I doubt the trainers put everything on youtube for me and others to see, they seems to have a pretty solid approach to their training practices which make a lot of sense from a motor control perspective.

No doubt but there is more to technique and leverage than just the trunk. That was my main point, there is more to it than just having a solid trunk and punching or moving from the trunk the trunk itself is involved in movements as well. The article seems to indicate that punching power comes from a stable trunk which allows the arm to exert maximum force, we we know punching come from the ground up through the body and rotation. I was not saying having a solid trunk is wrong just the article sort of skewed the functional way to punch to help sell their few.

grappling, wrestling and impact is a different story however for sports that are very high on the trunk strength I would have to wonder if there is research on these particular athletes and core training, fighters spend a lot of time training the core and rotational movement strength.

I am still on the fence with core training, but its more that I feel it can help depending on the applied area, gymnast need to have a crazy strong core due to their demands equally strengthening the core allows the body to no longer use other muscles to compensate for weaknesses so therefore it may improve performance for some sports and if not improves performance will it lower injury rates?

 

[my02]

Just a few points to throw in.



Secondly, if you ask 3 different professionals to define "core", you will get six different answers. And then if you get them to give you a core stability program , you will get 60 different exercises.

My view on the matter is that paying LOTS of attention to posture ( particularly spinal alignment and pelvic positioning) and correct movement patterns in multi-joint movements, including rotational and anti-rotational exercises will give you great results.

I agree and i think your view on the approach (assuming structural integrity) is a good one to follow (certainly one that I have been addressing).

Despite having a physio drill home the importance of core stability (in her words, "isolate and engage my TA") to help with my ongoing SIJ pain, Ive just recently found that stretching my RA has caused almost instantaneous relief. 10 mins of modest stretching seems to have rectified 6 years of pain and poor function!

 

[rsquared]

Seriously MWI, I do really enjoy your posts/replies and respect that you know your stuff but your 'all PT's are useless oxygen thieves that should never be listened to' attitude is pretty annoying. Yes, there are plenty of shit PT's out there and plenty more coming out of the fitness qualification system everyday but that doesn't mean we are all useless.

I am definitely pro core and I think the argument of whether core strength is important for athletic performance is silly. Whether someone sitting in a lab somewhere has written it on a piece of paper yet or not, I tend to look towards what a lot of the top sporting teams/coaches use for their strength and conditioning. Maybe it's just my stupid PT brain thinking here but when there is so much money tied up in sponsorship and sporting team performance at the top level, I don't believe they would be using training techniques that aren't going to give them the best chance of winning. If they are then those super genius people sitting in the lab saying core strength is useless and training it is a waste of time could probably stand to make a massive amount of money by getting out of the lab and advising those said teams on how much better their lab proven system is.

That said, I think 'core training' is a massively generic phrase and what constitutes 'core training' isn't defined which causes some of the arguments. I also think constantly relating or linking core strength/training and swiss balls is a pretty narrow view of it. While i'm pretty new to Personal Training as a profession (I've had a career change at 30yrs old and have been training myself for 12+ yrs), I struggle to remember a single session I've taken with my clients that has had sit-ups on a swiss ball or actually any form of sit up programmed into it but I consider my training style to be heavily focused on core strength and yes I use swiss balls. Once you can do a plank properly - rotating and holding your pelvis posteriorly to activate your core (lots of people don't do them correctly, and their pelvis is rotated anteriorly which has little core activation and a lot of pressure through the lower back), try doing it with your arms resting on a swiss ball and make circular rotations with your elbows but maintain perfect form and stability through your hips and lower back or even try the mountain climber exercise using trx/crankit suspension straps. In terms of mountain bike specific exercises, try doing a freestanding (not supported on a bench or wall) alternating single arm bent over row with a DB or KB in each hand (so your body position should be similar to that when on the bike). Keep doing this exercise with correct back position and no movement through the hips and tell me this doesn't improve your core strength and would not help on the bike. Up the weight only when you can maintain shoulder retraction and hip stability or even try it in a split stance to decrease your stability base.

So rant over but basically I think I'm with Drift King, I will remain pro core and continue to do 'core training' with my clients because it makes functional sense in terms of performance and it's what a lot of top sports and conditioning coaches or athletes recommend. Whether it's right or wrong, for the reasons stated above, I will listen to a professional athlete/coach who's living is based on out performing their competitors, over a theorist in a lab writing articles.

Thanks as always MWI for taking the time to write all of these replies and posts though!

 

[my02]

Once you can do a plank properly - rotating and holding your pelvis posteriorly to activate your core (lots of people don't do them correctly...

Whereas post rot of the pelvis would activate the RA, I thought the "correct" or optimal method was to perform the plank with a neutral spine. A post rot pelvis means that it isn't neutral and is less likely to be functional (as its re-enforcing potentially incorrect spinal positioning).

Mind you I've also heard that correct technique should involve strong contraction of the gluteus, lats, lower traps etc.

Very happy to be corrected.

Edit: I think that if someone can clearly state which muscles constitute the "core" then opinions on exercising those muscles can be given far better context.

 

[driftking]

Whereas post rot of the pelvis would activate the RA, I thought the "correct" or optimal method was to perform the plank with a neutral spine. A post rot pelvis means that it isn't neutral and is less likely to be functional (as its re-enforcing potentially incorrect spinal positioning).

Mind you I've also heard that correct technique should involve strong contraction of the gluteus, lats, lower traps etc.

Very happy to be corrected.

Edit: I think that if someone can clearly state which muscles constitute the "core" then opinions on exercising those muscles can be given far better context.

Planks definitely involve activation of more muscles than just holing yourself up, as mentioned this is why most people tend to strain the back more, even with good technique though you may not be using the right muscles. By activating the glutes and your inner abdominals (the whole pulling the belly button inwards) you are supporting the spine and it helps keep it in that neutral position while activating the right muscles and not overloading another one. The traps and upper body is to prevent any issue with shoulder weighting. Like most exercises its not just a matter of going through the motions its also about the activation of the right muscles and support systems.

The core
The core is the entire body that is not an extremity.

The issue is the fitness industry has focused on core been just the abs or just the abs and wrap around to the lower back.
Unfortunately you don't need to go far to find out why these issue exist, sit down and watch any fitness infomercial its full of wrong information and bullshit.

Couple this with the PT courses around its no wonder the miss information is been throw everywhere.
I know people who have done PT courses at tafe and proper places AIF and while they have taken i think 6months to a year to do the course I still question their ability to train people safely, they seem to learn the minimal and even some of the teachings there are wrong.
I had a good old rant a while ago about the concept of tabata and how personal training industries are using this name in the wrong way.
It may be a moot issue but ultimately its still pushing misinformation, they are training people in a way that is not tabata but then claiming the improvements that tabata offers. You cannot do this, ultimately most people are just doing HIIT not tabata.

I actually told my friend about it and they said "well everyone knows it as tabata", im sorry It doesn't matter, its still wrong and contributing to misinformation is not something PT's should do.

But to the point, its these things that are destroying industry. The misinterpretation of data leading to incorrect implementation.
I think they also lack learning in bio-mechanics, I wonder how many people know the bio-mechanics and the reasons behind how you exercise.
it seems like many people get taught how to do things right but don't understand the reasons why this is right or are not taught how to correct poor form. Instead they are given this cookie cutter "right form" that they have to then try to fit everyone in.

 

[my02]

Planks definitely involve activation of more muscles than just holing yourself up, as mentioned this is why most people tend to strain the back more, even with good technique though you may not be using the right muscles. By activating the glutes and your inner abdominals (the whole pulling the belly button inwards) you are supporting the spine and it helps keep it in that neutral position while activating the right muscles and not overloading another one. The traps and upper body is to prevent any issue with shoulder weighting. Like most exercises its not just a matter of going through the motions its also about the activation of the right muscles and support systems.

Abdominal hollowing or just consciously engaging the TA?

And rather that just supporting the spine, I thought engagement of the lats went a long way to increasing the lumbar spine stability, through stiffening the thoacolumbar fascia. Hence why you're told to engage the lats in things like DL and squats etc.

 

[driftking]

Abdominal hollowing or just consciously engaging the TA?

And rather that just supporting the spine, I thought engagement of the lats went a long way to increasing the lumbar spine, through stiffening the thoacolumbar fascia. Hence why you're tole to engage the lats in things like DL and squats etc.

First Up I will say i am not qualified so please take this as my own personal research and experience.

Personally when I do planks I do abdominal hollowing as it engages the TA prior to the plank and it supports the spine.
By hollowing I am referring to just pulling it in to engage the supporting muscles not pulling it right back to the spine.

You mean increases the curve in the lumbar spine or increase the support?

You should contract the lats for support but not pull them right back you want to aim for a neutral position. If you exaggerate the lumbar curve by pulling the lats right back you load the spine more from my experience. You want to aim for neutral and engaged.
For support I breath in to increase intra abdominal pressure to support the spine.

Because deadlifts require higher intra abdominal pressure you usually breath in and lift and start releasing breath at the half way point or even at the top of the lift than take a full breath to breath and again hold than pressure as you lower the bar again.

I like these two videos. proper good information.
http://www.youtube.com/watch?v=vue17RjRhwM
http://www.youtube.com/watch?v=uu3-64C7JEY

The second video really I think is key, I question if todays PT courses are teaching this sort of detail, or are they giving a basic form guide than getting PTs to force clients into that form which as explained is not right.

As per usually i am happy to be corrected or pointed to a different method.

 

[my02]

Whoops - edited to add stability.

Not sure how strong contraction of the lats would curve the lower back (assuming abs are equally braced)…?

 

[driftking]

Whoops - edited to add stability.

Not sure how strong contraction of the lats would curve the lower back (assuming abs are equally braced)…?

It shouldn't really but sometime people contract the lats by pulling back which may pull the upper back back. Some people also push the lumbar forward.

 

[rsquared]

Whereas post rot of the pelvis would activate the RA, I thought the "correct" or optimal method was to perform the plank with a neutral spine. A post rot pelvis means that it isn't neutral and is less likely to be functional (as its re-enforcing potentially incorrect spinal positioning).

Mind you I've also heard that correct technique should involve strong contraction of the gluteus, lats, lower traps etc.

Very happy to be corrected.

Edit: I think that if someone can clearly state which muscles constitute the "core" then opinions on exercising those muscles can be given far better context.

My02, I could be wrong and I'm sure there are many different 'correct' plank techniques out there but the way I think of it is the correct plank position is maintaining the correct standing posture alignment but in a horizontal plane. Therefore, the pelvis should be slightly anteriorly rotated and held in that position which will involve correct activation or deactivation of all the muscles with attachments to pelvis (lats, glutes etc). To achieve this, as most people with weak cores will automatically go into excessive anterior pelvic tilt (The 'I'm feeling it in my lower back' position) when doing a plank, I cue my clients to rotate their hips under them (rotate them posteriorly), which effectively gets them to flex the pelvis slightly which activates the RA (but don't go into excessive posterior tilt).

All good discussion and while there may not be an academic paper linking performance and core strength, I'm sure having a strong core paired with correct muscular balance and mobility won't be damaging people so I for one won't be telling anyone to stop doing any core strength work just yet.

 

[Mywifesirrational]

Sorry about being annoying, I assure you in person I am the most charming and warm individual! I do enjoy the discussion and differing views.

To be fair I never used the term oxygen thief (at least I don’t recall?), I have also highlighted that there are very good PT’s out there, although they are the minority. I base this on having taught cert 3-4 and diplomas in fitness and having first-hand experience with what is taught by the other staff (who perpetuate myths and crap on the students as the staff only have certs themselves) and many years working in gyms. To be fair I have also critised physios, chiros have copped more than most from me, natural medicines, alternative therapy, nutritionists, professional athletes (dumber than potatoes a lot of the time - just gifted physically), exercise physiologists, my own lack of knowledge and my own biases. I feel I am fairly equal opportunity when it comes to criticism.

If I was in charge of fitness Australia, I would require ALL PT’s / fitness instructors to have exercise science degrees (3 years minimum)! Dealing with real people and prescribing exercise, when done wrong can permanently maim or kill people. There’s actually a push in government (Lobbied by ESSA and SMA) to require all PT’s to be supervised by accredited exercise physiologists at fitness facilities.

I don’t mind if you believe differently to me, the only thing that makes me concerned is your rationale is wrong, in regards to where you get your knowledge from.

I will listen to a professional athlete/coach who's living is based on out performing their competitors, over a theorist in a lab writing articles.

Your approach is fundamentally flawed, scientific evidence is ranked in quality,

(1) systematic reviews and meta-analysis
(2) randomised control trials
(3) Cohort studies (although the intervention can be randomised)
(4) Cross sectional servays
(5) Case studies
(6) Expert opinion (athletes/coaches)

You are relying on the lowest form of evidence for you approach and practices, I myself rely on the highest levels, much of my work is peer reviewed (and grumpy professors really like destroying substandard work) and I typically only work with people either prior to or immediately following major orthopedic surgery, I am not allowed to base my decisions off my or someone else's opinion - I must base it off the best quality, up to date and peer reviewed evidence. An excellent PT would take my approach and ensure their clients get the best possible outcomes for their money and effort put in.

If they are then those super genius people sitting in the lab saying core strength is useless and training it is a waste of time could probably stand to make a massive amount of money by getting out of the lab and advising those said teams on how much better their lab proven system is.

This already happens, most professional clubs will require strength staff to have PhD's, myself and others (I know quite a few AFL, NRL, Cricket, VIS, AIS strength coaches) don't think core stability is a waste of time, we think directly training for it is a waste of time, you'll find many clubs over the last few years have gone away from isolating it - basically they stopped listening to physio's. You gain all the core strength you need by using heavy loading that challenges posture and general training specific to a given sport, the evidence strongly supports this, you have given an example very much the same as this, professional clubs are doing this... yet the fitness industry still is following fads and ignoring evidence, basically misleading paying clients.

Secondly, there is NO MONEY in athletic training, smart people avoid this area and go into medical research or academia, better money (job security) better hours, less hassles of dealing with idiots. Some do it part time, I do, most don't.

I will remain pro core and continue to do 'core training' with my clients because it makes functional sense in terms of performance

This is the problem, I started this thread because it does not make sense that core stability helps function or performance. Since then some quality high level evidence has come out that fully supports my earlier posts, core stability training has no meaningful effect on functional or sports performance.

The main reading I got from the metanalysis MWI linked to is that the research in this area is pretty poor. The conclusion that "research doesn't support core stability training" is correct, but that may be because adequate and appropriate research hasn't yet been done.

I agree with Pastavore, it may be because of poor quality research is resulting in a false negative in the findings, but a lot of different approaches have been used and still nothing significant has been found.

I am still on the fence with core training, but its more that I feel it can help depending on the applied area, gymnast need to have a crazy strong core due to their demands equally strengthening the core allows the body to no longer use other muscles to compensate for weaknesses so therefore it may improve performance for some sports and if not improves performance will it lower injury rates?

Being on the fence is a pretty good place to be, it means you haven't made a decision one way or the other, as long as it;s quality evidence that sways you one way or the other.

Gymnasts dont do core specific work, as their regular training is more than adequate to stimulate positive adaptation. In regards to injury rates, nothing has been shown in regards to core stability as a 'pre'hab or preventive exercise as fair as I am aware. It certainly has been shown in feild sports in regards to lower limb training (strength and balance) reducing injury rates, just not core... might suggest that core has very little to do with injury?

 

[driftking]

If I was in charge of fitness Australia, I would require ALL PT’s / fitness instructors to have exercise science degrees (3 years minimum)! Dealing with real people and prescribing exercise, when done wrong can permanently maim or kill people. There’s actually a push in government (Lobbied by ESSA and SMA) to require all PT’s to be supervised by accredited exercise physiologists at fitness facilities.
I think that is a great idea, id be all for that.


Being on the fence is a pretty good place to be, it means you haven't made a decision one way or the other, as long as it;s quality evidence that sways you one way or the other.

Gymnasts dont do core specific work, as their regular training is more than adequate to stimulate positive adaptation. In regards to injury rates, nothing has been shown in regards to core stability as a 'pre'hab or preventive exercise as fair as I am aware. It certainly has been shown in feild sports in regards to lower limb training (strength and balance) reducing injury rates, just not core... might suggest that core has very little to do with injury?

Yeah for sure I would argue that most their training movements are very core dependent though which I think is the point we are getting at.
I think some users are thinking you're anti core, but you seem to be anti specific core, in that through training you develop what is necessary anyway without the need for specifically targeting the core.

I'm glad you brought up balance, I think there has to be one a point where the core assists balance. If we look at gymnast for instance their bodies are able to remain balanced and stable while doing some very complex and straining movements. For instance.

[video=youtube;WnLhTBebZSE]http://www.youtube.com/watch?v=WnLhTBebZSE[/video]

The ability for the core to remain stable means the athletes range of balance is improved and they can remain balanced at a higher leverage and at awkward angles. Where the core can take some load of the extremities it would improve its ability to perform. Now clearly this comes down to specificity. There is little reason why a xc rider would need to train for extreme range of balance, where a dh rider where the body frequently is very separate from the bike may be more arguable and further than gymnast obviously need that core.

Commonly the extremities are used to compensate for weak cores, by freeing this up we in theory should be able to perform better.
I think as we have stated many times its going to be very sport or hobby specific. I would like to see studies on gymnast or those sports where core strength is at a crazy high level of development and see if direct training does improve their speed of development or performance.

On a side note I think we need to take more from gymnast, they have managed to create a very high level of flexibility, controlled range of motion, strength, endurance and power all without specific training. Even as an adult now I have considered doing gymnastics, partly because learning how to flip around like a ninja is impressive aha, but because the adaptions are quite universal. It seems like a very ideal sport for overall development.

Of course i understand the argument here is core specific training, not the role of the core, but does specifically training the core have a benefit and again I still sit on the fence and I believe it is specific to needs and level of athlete. Although I will say my abs have been getting stronger and larger from doing deadlifts.