Core Stability, a neuroscience approach

[rsquared]

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.



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.



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.



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.



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.



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?

MWI, thanks again for the reply, couple of points:
- I added in the 'oxygen thief' remark to add emphasis to your continued bashing of everything PT but thank you for assuming I'm warm and charming. Don't worry, I come from a career in Human Resources in the mining industry so am used to people not liking me or my opinion. Water and ducks back and all that.
- When I say I listen to professional teams/athletes re: training, I do that because I make the assumption that they would be getting the best scientifically and performance proven advice from a team of professionals such as physioligists etc. When so much money is on the line for them, why would they not be getting the best people's advice.
- I think we agree on the core stability being fundamentally important but I think this argument is getting confused because no one has clarified exactly what 'core stability' or 'core training' is. As someone has said previously, it means vastly different things to different people but I think I agree with you. It is important and best trained by completing weighted compound exercises with correct posture that are specific to your sport.
- Definitely don't agree that having a PT sit in a classroom for 3 years to get a certificate is required or will make them a good PT (I've got a number of bachelor degrees as well as Cert qualifications and I know most of what I learnt about doing my jobs well was learnt on the job). For most of the general public, the biggest skill required to be a good PT is being able to unlock their clients reasons for not exercising previously and being able to keep them motivated and exercising regularly. Taking someone from a couch to keeping them motivated for training is going to require variety and fun in workouts at times so if this is taking them from a bench onto a swiss ball to change things up, then that's what you do. Does the general client care that the change isn't maximising their strength gains or athletic performance? No! Is it causing them damage if still performed with good form and posture - no! Are they still at the gym training rather than sitting at home on a couch - yes. Now I agree that PT's with Cert III & IV don't have the experience or qualification to train special populations though (rehab, high risk clients, etc) but this is why you guys are specialists and why a good PT would refer those clients to a qualified professional. Making every single PT do this level of qualification is over the top though.

 

[BakerFitness]

MWI not all PTs are bad, only 99% of them... I've just read this whole thread and agree, practice and preach to my clients everything you've said. Good work!

It's very refreshing to hear someone that's not delusional regarding core work. I've been a pt for 10 years and there was a stage when I put a lot more emphasis on core specific work as it's something that gets constantly drilled into all PTs.

Cheers

 

[shirtz]

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.

great thread.

how do i put your comment in my signature

 

[Mywifesirrational]

Just spent a handful of days in Adelaide at the Exercise and Sports Science Australia conference, presented some of my work, but more importantly got to listen to people with more knowledge than myself.

Perhaps unsurprisingly there was a keynote speaker that talked about core stability for one hour, it gave me an academic erection. He spent the hour presenting the lack of evidence for core stability and the evidence for non-core approaches to both LBP and sports performance.

His summary slide was at the start - which stated that a targeted core stability intervention is a waste of time, no better (and often worse) than conventional training and rehab methods, the science doesn't support it's use, the definition is ambiguous at best (much like what a few Rb'ers on here have highlighted) and even if you get a core better by improving your testing results it doesn't translate to decreasing LBP or increased sports performance. He also took time to rubbish pilates and both clinicians and trainers that should know better.

Tim Mitchell, well worth going to see speak on this topic for those that are both pro and against core propaganda.

 

[driftking]

Just spent a handful of days in Adelaide at the Exercise and Sports Science Australia conference, presented some of my work, but more importantly got to listen to people with more knowledge than myself.

Perhaps unsurprisingly there was a keynote speaker that talked about core stability for one hour, it gave me an academic erection. He spent the hour presenting the lack of evidence for core stability and the evidence for non-core approaches to both LBP and sports performance.

His summary slide was at the start - which stated that a targeted core stability intervention is a waste of time, no better (and often worse) than conventional training and rehab methods, the science doesn't support it's use, the definition is ambiguous at best (much like what a few Rb'ers on here have highlighted) and even if you get a core better by improving your testing results it doesn't translate to decreasing LBP or increased sports performance. He also took time to rubbish pilates and both clinicians and trainers that should know better.

Tim Mitchell, well worth going to see speak on this topic for those that are both pro and against core propaganda.

Thanks for the head up I might have a google and see if any of his talks are online. Sounds good.

 

[my02]

Thanks for the head up I might have a google and see if any of his talks are online. Sounds good.

I couldn't find 'owt with a very quick search. Let us know if you have better luck.

 

[Mywifesirrational]

This is him, I very much liked his approach very holistic for what is more often than not a complex problem.

http://www.bodylogicphysiotherapy.c...list-physiotherapists/23-dr-tim-mitchell.html
http://healthsciences.curtin.edu.au/teaching/physiotherapy_people.cfm/T.Mitchell2

This is an interesting read - I cut out and highlighted the most interesting bit.

http://www.bodylogicphysiotherapy.com.au/images/pdf/Low_Back_Pain_case_study_Feb2012 InMotion_1.pdf

At the initial consultation, Tara was
given a home program of gentle bending
and postural relaxation exercises, daily
cardiovascular exercise out of extension
(cycling), and instruction to cease all
core stability exercises. Tara’s underlying
anxiety issues were a potential barrier.
Communication with her GP resulted
in Tara taking anti-anxiety medication,
which also helped her pain.

 

[shakes]

I'm far from educated enough to be posting in this thread but I'd like to hear your thoughts.

Assuming your average desk jockey that hits the gym a couple nights a week with poor technique. Good arm and leg strength, but low-med 'core' Starts getting some back pain.

Aside from making sure he improves his technique, do you then also ad in some basic core work to balance him out so to speak?

 

[dontfeelcold]

I'm far from educated enough to be posting in this thread but I'd like to hear your thoughts.

Assuming your average desk jockey that hits the gym a couple nights a week with poor technique. Good arm and leg strength, but low-med 'core' Starts getting some back pain.

Aside from making sure he improves his technique, do you then also ad in some basic core work to balance him out so to speak?

Taken from Mywifesirrational

You gain all the core strength you need by using heavy loading that challenges posture

 

[my02]

But he is a confirmed desk jockey. His posture might be knackered from excessive sitting...?

 

[driftking]

I'm far from educated enough to be posting in this thread but I'd like to hear your thoughts.

Assuming your average desk jockey that hits the gym a couple nights a week with poor technique. Good arm and leg strength, but low-med 'core' Starts getting some back pain.

Aside from making sure he improves his technique, do you then also ad in some basic core work to balance him out so to speak?

My unqualified opinion that has no weight haha

Stop all exercises until assessment

First I would find if there is a psecifc cause of the pain and check flexibility and movement to make sure there are not any structural or functional issues. If he has been using bad form on big lifts there is a higher chance of injury somewhere. I would also asses daily posture.

Daily posture must be fixed and addressed as you spend most your time in these positions.

Once addressed I move onto the weights.
I would drop his weights and Fix his form and stick him on a pure compound routine with lighter weights for a few sessions to nail and cement form.
Get him to add a stretching routine daily as well.

conclusion
-daily posture
-exercise form
-compound lifts
-stretching

Done

If the lower back is very weak he would need to start with a weight that is comfortable for the back, he would need to leave the ego at the door and lift to his weakest link. eg. Don't go in dead lifting what his legs can drive if his back cannot support itself. If he is so weak that he cannot even do the lightest weight than there would be some reason to do some back strengthening work but only specific exercises that keep the back stable. So situps are out, knee raises also tend to round the lower back, planks and plank variations are in.

M2c

 

[shakes]

I was baiting a little with that question.

The next one is that the idea of a weight belt gives you something to brace against so you live heavier.

To me between those two things, it would be fair to say that 'core' work has gained its reputation as being essential?

I know climbing and yoga have helped my riding no end, both have increased my flexibility and core strength massively. Making bike control and balance much easier. Can't say that I've done isolated core work and if that will help as much. And body awareness that also comes from those activities. But to me its a good argument towards it.

 

[B.utters]

I was baiting a little with that question.

The next one is that the idea of a weight belt gives you something to brace against so you live heavier.

To me between those two things, it would be fair to say that 'core' work has gained its reputation as being essential?

I know climbing and yoga have helped my riding no end, both have increased my flexibility and core strength massively. Making bike control and balance much easier. Can't say that I've done isolated core work and if that will help as much. And body awareness that also comes from those activities. But to me its a good argument towards it.

In both of those activities you are using a bunch of muscle groups in the movements you are making and your "core" isn't isolated. The whole argument here (I think?) is that isolated core exercises are a load of crap and they don't produce any performance benefits. `

 

[Pinesheriff]

For what it is worth,

About 10 yrs ago I was experiencing quite sever lower back pain from over exertion. Went through all the normal avenues of treatment...physio etc. but not going anywhere in a hurry. Finally got referred to a specialist. After examination, q'ing etc he said that he wanted me to commence doing Pilates to focus on enhancing my core strength. Do it for 6 months and if things don't start improving come back and see him.

Here I was thinking to myself I have great core strength, well at least I thought I did.
"increase my core strength"? Having been training in Karate for at that stage about 15+ yrs I thought I had great core strength. Given my predicament I was willing to try anything to fix my back.

So started attending the local Pilates classes each Wed nite at the local gym. The core strength I thought I had.........I had nuthin".

To cut a long story short, Pilates was an absolute god send for me. Within 3 months of starting it was truly amazing the advances I had made not in back pain relief but my general improvement in my "Core Strength". I continued with it for pretty much 12 months and taught myself a whole new way of moving and engaging my core strength to support my body movement i.e: from bending over to pick up a pen, to lifting and wheeling a wheel barrow full of concrete to sitting in the drivers seat of my car going around a corner.
If you want to increase your core strength DO PILATES!! It is truly amazing for increasing core strength and eliminating and preventing back problems.
These days I incorporate in every work out I do some form of core strength exercise which I believe has such a great positive result in my XC riding and hill climbing.

 

[faulko]

Are folk confusing core strength and flexibility?

2 very different things but similar at the same time.

Flexibility has help me more then any physio, chiro, massage and even the big needle in the back has ever done individually but combined, man what a difference.

I use chiro too keep joints aligned correctly, especially the spine, hips and sacrum.
I use physio to keep range of motion in check
I use massage to help relax stiff/stuck muscle groups.

So strong core muscles with poor range of motion and of course good range of movement with limited overall strength.

I think this is why yoga/Pilates etc feel like they work as your extending your muscles range of motion. You would be activating muscles with angles and effort not normally seen.

My useless 2c worth is flexibility above strength.

 

[jeremykearns]

I've contacted MWI and been tested in the lab at the uni and worked out progressive training program aimed at increasing 'core stability' I guess, but more so to reduce my lower back symptoms, pain and some issues I had been having with my knee in the 10 years since a full knee reco.

I've been doing pilates for 7 years, whilst i enjoy it, the strength training has vastly improved my lower back pain, pelvis and knee issues. But more importantly I am actually noticing a lot more power during riding, particularly out of the saddle sprints and climbs.

Program is:

Squats - front or standard
Deadlifts
Leg press one leg at a time
some balance work - bosu for knee stability.

All heavy load with form as perfect as possible. Going back for a reassessment in another few months.

 

[driftking]

I've contacted MWI and been tested in the lab at the uni and worked out progressive training program aimed at increasing 'core stability' I guess, but more so to reduce my lower back symptoms, pain and some issues I had been having with my knee in the 10 years since a full knee reco.

I've been doing pilates for 7 years, whilst i enjoy it, the strength training has vastly improved my lower back pain, pelvis and knee issues. But more importantly I am actually noticing a lot more power during riding, particularly out of the saddle sprints and climbs.

Program is:

Squats - front or standard
Deadlifts
Leg press one leg at a time
some balance work - bosu for knee stability.

All heavy load with form as perfect as possible. Going back for a reassessment in another few months.

Curious about this.

Keep in mind we are not debating if core strength is important we are debating if specific core training offer benefits. So while you got great results from Pilates the question is, would those same results be seen with another less specific isolation routine. That is the question.

What I think is great here is that your program with deadlifts and squats are two compound exercises that are not core isolation and this is exactly what the topic of discussion is. That these exercises are as good if not better than doing all the isolation crap, it also takes less time and gives overall better performance in the body.

I would be very curious to see you have a partner undertake this same testing to test, not just overall body fitness and composition but to test your core strength and stability as well to get base lines. However your partner undertakes isolation core exercises. Than re test.

Its the battle between core isolation vs core inclusive compound movements. In no way is anyway suggesting core strength is not important.
Interested to hear how you get along, but ultimately its a bit pointless in terms of evidence unless you have some control or comparison. I have a feeling you will feel much better doing this new routine than you did doing Pilates. Just be sure to get a trainer if you aren't 100% on the lifts, deadlifts done wrong can seriously hurt your back.

Good luck.