The Myth of Core Stability Professor Eyal Lederman CPDO Ltd

The Myth of Core Stability Professor Eyal Lederman CPDO Ltd., 15 Harberton Road, London N19 3JS, UK E-mail: [email protected] Tel: 0044 207 263 8551 KEYWORDS Core stability, transverses abdominis, chronic lower back and neuromuscular rehabilitation Introduction Abstract The principle of core stability has gained wide acceptance in training for prevention of injury and as a treatment modality for rehabilitation of various musculoskeletal conditions in particular the lower back. There has been surprising little criticism of this approach up to date. This article will reexamine the original findings and the principles of core stability and how well they fare within the wider knowledge of motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal systems following injury. Core stability (CS) arrived in the latter part of the 1990’s. It was largely derived from studies that demonstrated a change in onset timing of the trunk muscles in back injury and chronic lower back pain (CLBP) patients 1, 2. The research in trunk control has been an important contribution to the understanding of neuromuscular reorganisation in back pain and injury. As long as four decades ago it was shown that motor strategies change in injury and pain 3. The CS studies confirmed that such changes take place in the trunk muscles of patients who suffer from back injury and pain. However, these findings combined with general beliefs about the importance of abdominal muscles for a strong back and influences from Pilates have promoted several assumptions prevalent in CS training: 1 That certain muscles are more important for stabilisation of the spine, in particular transverses abdominis (TrA). 2 That weak abdominal muscles lead to back pain 3 That strengthening abdominal or trunk muscles can reduce back pain 4 That there is a unique group of “core” muscles working independently of other trunk muscles 5 That a strong core will prevent injury. 6 That there is a relationship between stability and back pain As a consequence of these assumptions, a whole industry grew out of these studies with gyms and clinics worldwide teaching the “tummy tuck” and trunk bracing exercise to athletes for prevention of injury and to patients as a cure for lower back pain 4, 5. At that point core stability became a cult and TrA its mantra. In this article some of these basic assumption will be re-examined. In particular, it will examine: