The Myth of Core Stability

The Myth of Core Stability Blog

If you have a problem with pain in your back, you may have been told to do exercises to make your core muscles stronger. Performing a quick search for the correlation between weak core muscles and back pain turns up a long list of possible solutions, most involving exercise to improve stability around the midsection. However, this advice may not be as helpful as it sounds.

Examining the Core of the Problem

Where did the idea of a weak core causing pain in your back come from? Eyal Lederman examined the assumptions driving this idea in a review in the Journal of Bodywork and Movement Therapies. He discovered a disproportionate focus on the strength of the transverse abdominis, spurred on by an assumed correlation between back pain and weak muscles deep in the abdomen. Lederman’s review suggested the core muscles are seen as more important than any other muscle in regards to stability and pain prevention.

The Transverse Abdominis: A Key Player?

The transverse muscles are situated deep inside your abdominal area, but there doesn’t seem to be any direct correlation between transverse abdominis strength and the presence of pain in the back. Pregnant women, mentioning a study in which their ability to do a sit-up was measured as a sign of transverse abdominis function and strength. Those unable to perform the exercise didn’t necessarily suffer from back pain. Other findings show individuals with back pain tend to wait to engage their transverse muscles, but this shows an adaptation rather than direct causation.

Simplifying Pain Management

Narrow focus on core strength in treating back pain. Stripping treatment down to one group of muscles may prevent proper diagnosis and rehabilitation, and it can leave patients with the fear of a “weak back” for life. This fear can cause the body to react in ways it normally wouldn’t, contacting muscles at the wrong times or overcompensating with other muscle groups to avoid anticipated discomfort. Focusing too much on core stability and abdominal strengthening can intensify the psychological factor by making individuals already suffering from back pain think about their problems even more and become fixated on doing whatever they can to prevent symptoms from worsening.

The Reality of Movement

Learning to move without fear of hurting yourself may actually be a better way to prevent back pain than doing a series of core-specific exercises. True back problems are best addressed by a doctor or physical therapist, but using common sense and paying attention to your personal patterns of movement can help prevent pain in the first place. Lederman notes everyone learns different patterns of movement and has different levels of motor skill development, and variations between individuals aren’t indicative of back pain prevalence.

Having a strong and stable core does help with daily movement and can prevent you from hurting yourself during routine tasks. Core stability also reduces the chance of falling so that you don’t wind up in pain from an injury, but it may not be the best solution if you already have pain in your back. While strengthening your core in general is never a bad idea, talk with your doctor before assuming a “bad back” is the cause of your discomfort.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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