A guest post from Dave Renfrew of Newcastle Performance Physio
Before we get started, just some things to get out there first.
Things I am not saying include the following –
1. “Core” exercises are bad
2. Strong trunk muscles are a waste of time.
3. People who run exercises classes or teach exercises based on the concept of “core stability” are dickheads
4. Strengthening doesn’t help
5. Pilates is shit
6. Pain Science fixes everything
Right, I reckon that covers it. Let’s get started shall we?
Core stability, as a concept, is bullshit.
Ask anyone who is able to process a question and respond with an audible and discernible response and you will get an entirely different answer each time. Especially if that person is a health professional.
Answer it yourself. Now. Go. I’ll give you a few minutes.
Right, what was your answer – BULLSHIT!!!! Ha, just joking.
You’ll normally use words like control, stabilise, protect, whatever. All of which give the impression of stiffness, immobility and the lack of variation in movement of which the back is capable, and actually really good at.
Let’s even just pause and remember for a second that there is no core. Where is your core? What is in it? Abdominal cavity? Does it include your back?
I get the idea. It’s in the middle.
Gymnasts and Surfers – bend themselves over into positions the rest of us are regularly told we shouldn’t do. Do they have good “core stability”?
What about if you lack “core stability”, do you have “core instability”? Bad things happen with unstable cores – like nuclear power plant bad. Is this what we are really saying?
So, let’s not say it.
The concept of core stability came out of research in the early 90s by Panjabi and friends here
The concept, while groundbreaking at the time, has since been shown to be oversimplified and based on incorrect assumptions. While it speaks of segmental spinal movement being associated with pain and injury, it also speaks of feedback mechanisms, central control and faulty firing and dampening reactions. This sounds more like non-human science right?
In Engineering, the stability of a system is also pretty complex, but is related to the relative relationship between input and output. An input, within a certain magnitude, results in an output also bound within a certain magnitude. Input and output are consistently linked, ie does it do what you want it to do. A stable system is also one which remains in a constant state unless acted on by an external stimulus, but then returns to that state once that stimulus is removed.
Stability in the spine is exactly the same. It is the consistency of its performance with varying inputs.
It does not mean DON’T MOVE. Moving and instability aren’t the same thing. Stability is not the lack of physical instability.
Stability is not about how strongly you can contract your abdominal muscles.
Now, as previously mentioned, I am not saying that doing these exercises is bad, stupid or whatever. There is evidence that learning to use certain muscles is extremely effective – postnatal pelvic floor and abdominal muscle activity for instance.
I am just trying to get you to think about what you are saying, thinking and why. The core stability concept was picked and run off with and hasn’t stopped to think if the game has changed.
A runner or weightlifter doesn’t need to do “core exercise”
People in pain don’t need to improve their “core stability”
Improving your “core” does not help with weight loss, athletic performance or pain relief.
Exercise can help with all of that. But there are lots of exercises that can do that. Exercise needs to be specific for the person and what they want to achieve. They do not need to be upside down on a BOSU ball trying to not move.
My definition is as follows – “Efficient load transmission between the upper and lower limb in the desired and specified direction and nature of your intended task for sufficient duration and at the desired level of intensity”. Try putting that in front of “..x..class” and selling it.
Which brings me to my next ranty point. Money and health. Always linked and not for everyone’s benefit. Now before you get all high and mighty again, i’ll say it first. I get paid for selling health services to people. I’m not saying people should do it for free, just that what they sell shouldn’t stink.
Health and fitness pick up on research, straw man the shit out of it, and sell it to the public on the basis of “if you don’t do this you will be fat”.
Tone your abs, Get core fit, Stability training, whatever they call it is generally boring, easy or a waste of time. I don’t care how many crunches you can do and neither does your back pain.
I am an advocate for exercise. Exercise is magic. We all need it, and harder and for longer than most people think. But misrepresentation of what people need to do and guilting them into doing it by making them feel inherently broken is bullshit. Saying every human needs to do a certain type of exercise is ridiculous.
The most important exercise to do is the one that will get done. There are generally 4 or 5 barriers to exercise
The best exercise to do is the hardest one possible that ticks as many boxes as you can.
I hate swimming. I am terrible at it and it bores me. I can swim to save my life (I think, let’s not test that out) and I can paddle with a board under me. But if you told me that swimming laps everyday would prolong my life from 85 to 105, i’d be smoking a fat cigar on the eve of my 85th birthday with a smile on my face. Not going to happen.
Swimming is patently good for you, cheap or free, relatively time efficient and we live in Newcastle FFS. Still, don’t care.
You do not need to do any exercise in particular. You do need to exercise. Hard.
Crunches may make your abs hurt, planks may make you want to throw up. But that just means you are getting better at ab crunches and planks.
I agree that if someone is not strong enough they can run into problems. But pain and injury are so much more complicated than a lack of “core stability”. It is a bullshit diagnosis.
The thing that most people lack is capacity. Load tolerance and ability to negotiate movement. We are sedentary, more overweight and doing less physically demanding things. That means we get worse at them over time.
Or we are coming back from an event that has decreased our capacity and we need to build some physical resilience.
Current recommendations sit at 300 minutes of moderate or 150 minutes of vigorous exercise a week with 2 resistance training/strengthening sessions. What percentage of the population hit that?
When we decide to get up and get moving things can hurt and get injured. That doesn’t mean that we have a “weak core”. It means that we have gotten crap at things because we are doing them less and our nervous system has decided that if we kept going bad things could happen.
The core stability model is too simplistic, makes people waste time on useless exercise and gives people false hope that because they can plank for a minute they are strong and healthy.
It is also very unhelpful for people that have been in pain for a long time.
Low back pain in particular is associated with an increase in hypervigilance, a process whereby, given the regularity and severity of pain, a person will either consciously or subconsciously “stabilise” or brace muscles in the back, pelvis, everywhere to make sure they are prepared for the upcoming task. But that could be picking up their toothbrush.
The constant overactivity is a big driver of neural signal to the central nervous system and can result in an increase in pain.
Imagine what happens when you tell that person that their core is weak, that they lack stability.
So what next then, Dave? Just whinge about how everyone is wrong??
For non health professionals.
Make exercise a priority. Do more of it, make it harder and continue until you die, or most likely you will die sooner than you need to.
If you are really strong and fit, well done, but stop putting images of your abs on social media. Old people like me think you are a wanker and young people feel they need to look like that.
If you find exercise hard, find what motivates you. For me, I have 3 young kids that are the reason I do anything. They currently think I am the biggest legend on the planet. I know this will change, but I want them to think i’m lame because i’m old and tell bad jokes and embarrass them, not because I can’t run around with them any more. The day i’m not their hero will break my heart and so i’m doing everything I can to make sure that won’t be my fault. Find what will make you do it and if you can’t – ask for help.
For health and fitness professionals.
Adapt. We treat humans, the most adaptable thing on the planet. We live in a time where the best information is available at your FINGERTIPS. What a time to be alive!!
Get better. Realise that what you say to people has an effect. Learn more about what you do, all the time. No excuses.
Work together. Thinking that you are the only person that can help someone is ridiculous and often dangerous.
Exercise yourself you lazy buggers!!
Advocate for strengthening, exercise, self efficacy and increasing capacity at every possible point. Build Weapons of Mass Function capable of having greater influence on their own health and being role models for their descendants.
Recognise you will have biases towards what you like and what you are good at.
Exercise people however you want but make it about them, not you. Make them fantastic in what they want to do. Make their trunk strong, but make their legs strong, arms strong, make their coordination and speed fantastic. Give them good balance, agility and reactions.
And stop calling it core stability. It’s illogical and it pisses me off. Clearly.
Until next time.