Core Stability Training

It's really annoying when you invest yourself in an idea which later proves to be invalid. Although I try to not marry any particular theory or technique, I typically find myself extolling its virtues and developing constructs to support my belief system.



It's probably acceptable to wed as long as you don't mind going through the pains of divorce. With biomedical research moving at such a swift pace, it's dangerous to strongly embrace any belief too passionately. With that in mind, I've decided to fully accept Tom Myers' advice and "cling by my fingernails" (his statement made to our 2007 Costa Rica class when discussing the validity of the thixotropy theory) and to endorse the popular concept of core stability (CS).



Studies by Hodges and Richardson in the late 1990s demonstrated a change in onset timing of the trunk muscles in patients with chronic low back pain, and led to the current rage in manual therapy and fitness programs regarding core-stability training.1 As a consequence of this research, a whole industry blossomed with clinics and gyms worldwide teaching the tummy tuck and trunk-bracing exercises aimed at curing or preventing low back pain. Then core stability grew into a cult with the transverses abdominis (TrA) as its mantra (Fig. 1). In this and future "Toolbox of Touch" columns, I wish to re-examine some basic CS assumptions, recommend support, critical observations and practical treatment options.

What Is Core Stability?

A primary goal of CS training is teaching clients how to recruit identifiable deep trunk muscles to effectively control lumbar spine positioning during dynamic movements. Core training is intended to provide essential joint stiffness and stability, allowing the body's large prime movers (global muscles) a solid working foundation. Carolyn Richardson, describing her research on core stability affirms, "Thus, conceptually, the transversus abdominis forms the walls of a cylinder while the muscles of the pelvic floor and diaphragm form its base and lid, respectively. There is some initialoriginal evidence that these four muscles act in synergy to provide a spinal support mechanism. Functionally, the nervous system could be expected continuously to modulate activity in these muscles in order to control joint position, irrespective of the direction of movement. In this way, such muscles could provide concentrated joint support, while, alone, the larger torque-producing muscles control the acceleration and braking movements of the joint."



Richardson's studies also reveal that arm and leg movements also might elicit pubococcygeus contraction concurrent with that of the TrA. This presupposes a link may exist linking these two muscles. In the CS model, the client's deep support system (TrA, obliques, multifidus, pelvic floor, diaphragm, lumbar erectors and thoracolumbar fascia) works to brace vulnerable spinal structures, therefore allowing superficial global muscles (and fascia) to engage in acts such as walking and lifting. Proponents consider repetitive co-contraction of specific, deep postural muscles results in greater spinal stabilization and the reduction and/or prevention of back pain.



When working synergistically, core trunk muscles sense orientation in the gravitational field and supply the central nervous system with proprioceptive input important in synchronizing appropriate responses for the global muscles of movement. Since intrinsic postural (core) muscles consist of red slow-twitch fibers and burn oxygen for fuel (oxidative metabolism), they're more resilient to fatigue. However, when subjected to high levels of prolonged activity, they tend to lose some of their red slow-twitch fiber content as white fast-twitch fibers are more often recruited. In a sense, as the larger global muscles become stronger and tighter (i.e., resistance weight training), the delicate balance among the inner and outer units becomes disrupted. Before delving into theories on possible recruitment patterns and firing order sequencing during gait, let's discuss a few studies refuting specific aspects of core stability training.



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