Reducing the Risk of injury during Core Stability

Only relatively recently did it become the vogue to perform core stability exercises. Part of this initiative came from research and part from commercial exercise companies, but it certainly caught the imagination of the industry and that of the public too. As with any ‘new’ exercise concept, there will always be a variety of ways in which the exercises are prescribed, some less effective than others. But as science has embraced the core stability concept, it has become better taught and applied. In fact, apart from the more overt commercial claims, core stability training has been shown to be a very important part of the patient’s exercise programme(1,2) and studies have indicated that there is no better way of re-programming the motor strategy. In other words, it is very good at getting the muscles to work properly, not only for stabilising the spine, but also to provide the platform upon which the whole body can perform other movements more effectively and safely.
But therein lies the problem. A few years ago, I made a series of presentations at Fit Camp, Lydia Campbell’s excellent annual exercise summit for the fitness industry, on the merits of understanding biomechanics prior to embarking upon an exercise programme. Before the presentation, the audience took part in a Pilate’s class and it looked excellent. But then I asked them how many had back pain and over 75% put up their hands. Whereas prior to the class, only a couple had mentioned any back problems.

I invited some of the audience down and tested their biomechanics and every one of them had marked deficits, which is not uncommon. So, it wasn’t that the class that had caused the pain, it was the fact that they were not biomechanically prepared to perform the exercises properly. Indeed, if there are biomechanical issues with a patient’s spine and pelvis, it is very difficult for them to be able to engage the core, as the global muscles of the spine are in sub-clinical muscle spasm, which actually inhibits core engagement.

I wonder how many of you find it is difficult for patients to engage their core properly? Actually, there are often quite a few who can’t and the reason is usually that their biomechanics are not allowing them. So if you sort out their biomechanics, core engagement is actually remarkably simple. Core stability training teaches patients how to engage their trunk muscles and they stabilise the spine in whatever position that is natural to it at the time, even if its incorrect due to biomechanical issues. So if the pelvis is rotated and they have a leg length discrepancy and a slight scoliosis to compensate for this, do we really want to stabilise clients in this biomechanically incorrect position? Probably not. The likely outcome of stabilising someone in the ‘wrong’ position would be an increased risk of pain. What we need to do instead is the following procedure:

1. Provide the body with the building blocks for ‘normal’ movement, in other words reduce any sub-clinical muscle spasm (Tardieu & Tarbary, Janda 1993),
2. Mobilise any nerve tension (3)
3. Ensure the pelvis is functional, with no leg length discrepancies
4. Once we have the client in proper biomechanical shape, then core stability training provides a high degree of stability in a good biomechanical position. When that stability is refined and becomes functional, you can start working on the functional patterns that are important for achieving many of the client’s goals.

To conclude, core stability training is probably here to stay and rightly so. But let’s just think about how we use it and when. Stuart McGill PhD says that core stability training helps some people and hurts others (2006) and, anecdotally, we know that is correct. With some thought and understanding of biomechanics, however, not only can we understand why there are problems, but also we can help our clients reduce the risk of injury and prepare them more thoroughly than ever before.

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