A strong and flexible core is needed to perform all tasks. And, as a conduit between the hips and upper body, the core or trunk has a massive job to perform. What is concerning is the lack of understanding about the core and what makes it function effectively.
The newly found importance of the core has now made it a “go to” remedy when dealing with problems in and around the trunk, especially in the low back area. Although a variety of issues can cause low back pain, many healthcare professionals prescribe core training as a cure all for symptomatic pain in this area. This generic prescription is concerning as it does not take into account the multitude of different causes that may be contributing to issues regarding the low back area.
The assumed generic nature and explanation of the lower back pain by trusted health care professionals, and its remedy through generic “core” exercises can lead to chronic pain and many ineffective trips for inadequate help. This problem has been highlighted through the witnessing of the prescription of a TV` doctor during a phone-in on low back pain. His answer to nearly all back problems was to work the core muscles without understanding the individual movement dysfunctions of the people phoning in. Although he was following the protocol used by many doctors when addressing this issue, this demonstrates the poor institutional understanding of cause and remedy of pain in this area. Adequate assessment is vital to diagnosis and this would be pretty hard over the phone for a start. Additionally, the doctor did not give any examples of how to go about working the core. This again, displayed the assumed generic nature and understanding of core stability and exercise that will work the core.
Later, when the functional perspective of lower back pain (LBP) is addressed, the highlight can be placed on reasons why working the core may not be the cure for LBP. The classic core exercises, which nearly all seem to be floor based, supposedly, will improve running, lifting and sporting performance according to nearly all the information available today. However, in light of modern research, those exercise recommendations may not actually have the right components to effectively train the core.
This is where two very important questions should be posed:
- How can isolated and stabilized movements improve dynamic function?
- How does isolated and stabilized exercise deal with dynamic and possibly distal dysfunction that causes LBP?
To make the muscles of the core function, input must be provided in all three planes of motion. In function, this is done by using the arms and legs. Muscular reactions at the trunk are caused by movement and also help facilitate movement. Input feeds up from the hips to the spine and also back down into the hips from the spine. Exercises such as the plank or sit up, in any of their variations, seem to fail, fairly dismally, at providing the variety of muscular phases, e.g. eccentric, isometric and concentric and the transformation between them, that helps to create effective function and pain free movement. Many of the traditional core exercises fail to utilize all of the three planes of motion.
A higher focus should be placed on creating a better relationship between the core and the rest of the body. Instead, there tends to be a regression in the understanding regarding the inter-dependence between different areas of the body back to a more isolated approach when training the core. This isolation methodology should be considered outdated in this modern era of training, especially in relation to the trunk and lower back. Now, there should be a better understanding of the neuromuscular and skeletal mechanisms that make human bodies and muscles function.
Muscular inter-relations are also function related. This means that to effectively train the core, functional positioning of the trunk and extremities must be taken into account. This will create the appropriate core reactions for different functions. Rotating the pelvis and spine in the same direction (in-sync), a movement consistent with a golfer or boxer, will cause a certain reaction at the core. If the pelvis and spine rotate in opposite reactions (out of-sync), as can be seen in gait, a different reaction is created. Most of the reactions created at the lumbar spine are relative joint motions that occur because of the distal drive of the arms and legs. In a leg driven exercise such as running, most movement will happen at the inferior sections of the spine. The superior segment will provide more motion with an arm driven function such as golf or throwing. We must understand this to get the applicable core reaction for our client’s function.
An upright body position and a stride stance is also a demand of many functions. The pelvic tilt caused by a stride stance is vital to facilitating healthy and correct core activation. This will have a significant impact during training of the core but is rarely used as a posture in core training.
One of the most interesting subjects for many fitness professionals is the approach to stability or core stability. A more correct terminology would be “lumbar spine stability created by the core muscles” as has been explored by most research. Core stability implies the core generates the body’s stability. This disregards the interaction of core and other area’s of the body and the resultant muscular responses that truly create stability of the body and core.
A great question is “when do we most need stability?” The most appropriate answer seems to be “when we are dynamic” or “unstable” such as during sport or movement. However, we have taken the approach of becoming predominantly floor based. This actually increases stability and reduces the input needed to enhance the body’s ability to reach a higher level of stabilization ability through overload and adaptation.
Movement must be decelerated to create stability, but is this the role of the core? Try to jump and land without bending the ankle, knee or hip. The landing will not be stable because of the lack of ability to decelerate with the core alone. In fact, this will create increased stress through excessive flexion at the lumbar spine.
It is the relationship between the core and the legs that provide this stability and it is this relationship that should be when training. The force of ground reaction cannot be attenuated through the core alone. Unmitigated, these forces could be a cause of lower back pain. The ankle, knee and hip have a huge role to play in protecting the lumbar spine, as well as the muscles of the trunk. They all have a symbiotic relationship, protecting each other from damaging excessive movement by their bend equality. In addition, the triplane action of the leg starts the proprioceptive reaction that causes the majority of the function related activation of the trunk muscles. For example, hip flexion causes the anterior rotation of the pelvis that eccentrically activates the core. This motion allows the superficial trunk muscles to concentrically operate successfully in the manner that most people expect them to. Could it be said that training the ankle, knee and hip to effectively flex in a functional position is a more constructive way of protecting or generating lumbar spine stability? Instead, many floor based, so-called core exercise which are unrelated to a client’s function or cause of pain are used by trainers around the world.
When running, there is a lengthening of the rectus abdominis on the side of the trail leg, while there is a shortening of the external oblique on the ipsilateral side. The ipsilateral internal oblique and transversus abdominis are both lengthening. This occurs because of the reaction of the hip to a stride stance and the rotation of the spine to the side of the front leg. The question to ask as a responsible trainer is whether or not this ecconcentric (both eccentric and concentric activation of the muscles involved within a given function) muscular pattern and transformational zones (point of change from eccentric to concentric) has been recreated with current training recommendations. If these movements are dysfunctional, will a floor based exercise with incorrect input from the extremities in a single plane or isometrically contracted, improve performance or create a pain free environment? Maybe, the true power of the core is allowing the proper relative motions to occur between the pelvis and ribcage, which are vital to the healthy operation of all parts of the body. Perhaps, the power is in the ability to allow the oppositional movement of the superior and inferior rings, the ribcage and pelvis, to feed the authentic motions at the proper places at the correct times.
The Tools To Use
Tools such as the BOSU or stability ball do create unstable surfaces. They also increase co-contraction and rigidity of muscles, thus not allowing effective eccentric loading and concentric unloading and reducing effective range of movement.
To improve stabilizing mechanisms and neuromuscular and skeletal relationships, take functional positions and movements and destabilize them through reduced floor contact such as a single leg. This creates more proprioceptive input. Using a narrow base could also be a strategy to improve stabilizing mechanisms.
A great starting place would be to create an unstable situation simply by standing on one leg. Instability can be increased or decreased by adding or subtracting eccentric stabilizing tension through positioning of the arms and trunk rotation.
As seen in Image 1, with the single leg stand, internal rotation provides eccentric stabilizing tension. The external rotation takes away eccentric stabilizing tension.
This single leg stand can be evolved into a single leg squat. Again, try using the arms for planar emphasis. Finally, the triplane hop, demonstrated in Image 2 below, would give the instability of one-leg coupled with the momentous force of moving and decelerating through different planes. Progression can be graduated by the size, force and directionality of the hop. Use of feedback tools such as a ball can create great organic variation in variables. This possibly could be used for the function of a wide receiver in American football as an example, especially moving in the transverse plane.
On ground function is hugely important for those that need it. For example, The Special Forces and gymnasts both have a need for ability and stability on the floor. They still remain very dynamic whether prone or supine, although a greater case can be made for the isometric holding of positions in gymnastics. However, these are not positions that would relate to the general populace or resemble classic core exercises.
This approach to gaining “core stability” and reduction in LBP seems to go against the evidence of the available scientific research. Dynamic, functionally three-dimensional and progressively increasing muscular load movements that relate to client function have been shunned in favor of single plane movements, attempted isolation and permanently low muscular load exercises. This reduces the proprioceptive input that creates effective neuromuscular and skeletal relationships within the body, as well as the surrounding environment. This input is vital to functional success that also includes the core or trunk area.