LOOKING FOR THE CORE PART 1 - WHAT IS CORE STABILITY?
19th November 2015
Back to the future; Part 1
Head of Education and Elite Sport Movement Consultant, Lincoln Blandford offers a refreshed view from his 2013 publication ‘Injury Prevention and Movement Control’
Back in 2013 I was asked to write a book chapter on the much discussed and equally maligned topic - core stability (CST). The chapter finally concludes with the message that there is a need to move on, both in terms concept and terminology. Two years on, I revisit themes from that chapter in a two part blog, presenting a more contemporary perspective on this controversial subject. Ultimately, now, juts as then, the story comes back to the need to assess and retrain movement, employing a multi-joint, multi intensity tool such as ‘The Performance Matrix’ in order to benefit any one individual’s ‘Movement Health’, over their movement lifespan.
I realise now, the chapter’s title, ‘looking for the core, finding movement control’ summarises my own journey as a movement focussed trainer, operating within a performance outcome field and surrounded by conflicting information. This journey/investigation has taken the best part of 15 years and involved many false turns and periods of plateau. Back in 2013, the Movement Health concept (McNeill & Blandford, 2015) was in its early infancy; possessing choice in the achievement of movement outcomes opened new perspectives on the value of movement. Without the CST story that preceded it, this vista may never had appeared. Therefore, the concept should be thanked, as it has taken the importance of movement to a better place, but CST comes with baggage.
Core stability, as a concept, is about twenty years old. In the aim to reinforce this point and illustrate the need to consign it to history I once described CST as ‘yesterday’s pizza’, to Mark Comerford. Mark replied, ‘yes, but everybody knows what it tastes like.’ Mark’s right. Everyone has an opinion, an experience, and exercise when it comes to what started out as a therapeutic application of some research findings performed in the mid-90s. Core stability remains divisive; everybody has heard of it, but opinions can still differ on what it is and if it is worth pursuing, practically or even in a blog.
On the plus side, the original research that spawned the CST ‘revolution’ successfully established links between movement, pain & altered recruitment strategies; for bringing this knowledge to the literature, it should be acknowledged. Yet, the wild-fire success of CST was also somewhat of a curse as it became the answer to all movement questions, no matter in which movement related discipline professionals operated.
Core stability - what’s your style?
From the late 90s onwards CST gained world-wide recognition, adopted on a global scale, with huge variance & incongruence in its application. The original research was adapted to suit the training bias of the specific movement disciplines own cultural take on ‘effective’ training. Strength and performance focussed individuals developed core strength training to match force development focussed profiles. Rehab professionals oversaw the evolution of ‘motor control’, a low intensity version of core stability. Both camps, the high and the low intensity brigade, could mutually discredit their conceptual adversary as neither could achieve goals of the other.
A concept of two halves
So, who was right? Well, everyone, half of the time. Each approach (strength or motor control) could influence specific physiology of the body. Low intensity work could help address low intensity issues. High intensity work helped address high intensity problems. But if the low approach was used with the high problem a fix would not be found; and vice versa. Therefore, it was easy for some authors to say CST didn’t work; half the time, they were right.
‘Brooks (2012) strongly questions the validity of the whole CST approach, stating ‘athletes are probably wasting their valuable training time including core training in their routines’. Although less damning the Reed paper (2012) suggests core training is effective; though only for some. ‘
Function stranger than fiction?
Such literature led to a backlash; CST was more than just old hat, it was portrayed as a time waster. Fitness media and blogs began to replace CST with the term ‘functional training; an equally controversial topic. The strength and conditioning community started to discuss ‘neuromuscular training’; again, a term as non-specific as motor control or functional. Whilst replacing the term CST was necessary, many of the applications/research findings related to pain, movement & recruitment were also disregarded; tarred with the CST brush, useful applications to influence movement quality were considered redundant. The new fashions of functional and neuromuscular training demanded whole body integrated movement, performed at fatiguing intensity. The age of Cross Fit was here. Training approaches not fitting the mould were out; not trending. High intensity held the upper hand.
Allison, G. T., Godfrey, P., & Robinson, G. (1996). EMG signal amplitude assessment during abdominal bracing and hollowing. Electromyogr. Kinesio. 8:51-57.
Briggs, A. M., Greig, A. M., Wark, J. D., Fazzalari, N. L., Bennell, K. L. (2004). A review of anatomical and mechanical factors affecting vertebral body integrity. Int J Med Sci; 1(3):170-180.
Brooks, C. M. (2012). On rethinking core stability exercise programs. Australasian Musculoskeletal Medicine, June: 9-14.
Caraffa, A., G., Cerulli, M., Projetti, G., Aisa, & Rizzu, A. (1996). Prevention of anterior cruciate ligament injuries in soccer: A prospective controlled study of proprioceptive training. Knee Surg. Sports Traumatol. Arthrosc. 4:19–21.
Comerford, M. J. (2013). Personal communication.
Comerford, M. J. & Mottram, S. L. (2012). Kinetic Control: The Management of Uncontrolled Movement. Churchill Livingstone. Elsevier. Australia.
Drysdale, C. L., Earl, J. E., & Hertel, J. (2004). Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises. Journal of Athletic Training. ;39:32–36.
Faries, M. D., & Greenwood, M. (2007). Core Training: stabilizing the confusion. Strength and Conditioning Journal, 29, 10-25.
Fitzgerald, G. K., Ake, M. J., & Snyder-Mackler, L. (2000). The efficacy of perturbation training in nonoperative anterior cruciate ligament rehabilitation programs for physically active individuals. Phys. Ther. 80:128– 140.
Griffın, L. Y., Albohm, M. J., Arendt, E. A., et al. (2006). Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med;34(9):1512–1532.
Hodges, P. W., & Moseley, G. L. (2003). Pain and motor control of the lumbopelvic region: effect and possible mechanismsJournal of Electromyography and Kinesiology 13, 361–370.
Hodges, P. W., & Richardson, C. A. (1996). Inefficient muscular stabilisation of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine;21:2640-2650.
Kavic, N., Grknier, S., & Mcgill, S. M. (2004a). Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine. 29:1254- 1265.
Kibler, W. B., Press, J., & Sciascia, A (2006). The Role of Core Stability in Athletic Function Sports Med; 36 (3): 189-198.
Lederman, E. (2010). The myth of core stability. Journal of Bodywork & Movement Therapies. 14, 84-98.
McGill, S. M. (2001). Low back stability: From formal description to issues for performance and rehabilitation. Exercise Sport Science Review, 29, 26–31.
McGill, S. M., Grenier, S., Kavcic, N., & Cholewicki, J. (2003). Coordination of muscle activity to assure stability of the lumbar spine. J. Electromyogr.Kinesiol. 13:353–359.
Myer, G. D., Ford, K. R. & Hewett. T. E. (2004). Methodological approaches and rationale for training to prevent anterior cruciate ligament injuries in female athletes. Scand. J. Med. Sci. Sports 14:275–285.
Panjabi, M. M. (1992). The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement, Journal of Spinal Disorders 5 (4), 383–389.
Paterno, M. V., Myer, G. D., Ford, K. R., & Hewett. T. E. (2004). Neuromuscular training improves single-limb stability in young female athletes. J.Orthop. Sports Phys. Ther. 34:305–316.
Reed, C. A., Ford, K. R., Myer, G. D., & Hewett, T. E. (2012). The effects of isolated and integrated 'core stability' training on athletic performance measures: a systematic review. Sports Med. 1;42:697-706.
Reeves, N. P., & Cholewicki, J. (2003). Modeling the human lumbar spine for assessing spinal loads, stability, and risk of injury. Crit Rev Biomed Eng;31:73–139.
Reeves, N. P., Narendrac, K. S., & Cholewickia, J. (2007). Spine stability: the six blind men and the elephant. Clin Biomech (Bristol, Avon); 22: 266–274.
Roussel, N. A., Nijs, J., Mottram, S., van Moorsel, A., Truijen, S., & Stassijns, G. (2008). Altered lumbopelvic movement control but not generalised joint hypermobility is associated with increased injury in dancers. A prospective study. Manual Therapy (on line).
Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. Mosby.
Saner, J., Kool, J., de Bie, R. A., Sieben, J. M., & Luomajoki, H. (2011). Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial. BMC Musculoskelet Disord; 12: 207.
STOTT Pilates (2012).
Thacker, S. B., Gilchrist, J., Stroup, D. F., Kimsey, C. D. (2002). The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc;34(1):32– 40.
Thacker, S. B., Stroup, D. F., Branche, C. M., Gilchrist, J., Goodman, R. A., Weitman, E. A. (1999). The prevention of ankle sprains in sports. A systematic review of the literature. Am J Sports Med;27(6):753– 760.
Thacker, S. B, Stroup, D. F., Branche, C. M., Gilchrist, J., Goodman, R. A., Porter Kelling, E. (2003). Prevention of knee injuries in sports. A systematic review of the literature. J Sports Med Phys Fitness; 43:165–79.
Tsao, H., Galea, M. P., & Hodges, P. W. (2008). Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Oxford Journals Medicine Brain; 131, 2161-2171.
Verhagen, E. A., van Mechelen, W., de Vente, W. (2000). The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med;10(4):291– 296.
Wand, B. M., Parkitny, L., O’Connell, N. E., Luomajoki, H., McAuley, J. H., Thacker, M., Moseley, G. L. (2011). Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice. Manual Therapy; 16, 15-20.
White, A. A., Panjabi, M. (1978). Clinical biomechanics of the spine. Philadelphia Toronto: J.B.Lippincott Company.
Willardson, J. M. (2007). Core stability training: applications to sports conditioning programs. J Strength Cond Res. 21:979-985.
Yeung, E. W., Yeung, S. S. (2001). Asystematic review of interventions to prevent lower limb soft tissue running injuries. Br J Sports Med 2001;35(6):383–389.
Zazulak, B. T., Hewett, T. E., Reeves, N. P., Goldberg, B., & Cholewicki, J. (2007). Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med; 35, 1123-1130.