The topic of pain is rife with myths and legends.
One of the biggest is that of core stability, or core strength. In fact this one is sticking around so persistently you could call it a zombie myth.
If you have had back pain you will have had exercises for your core recommended. If not by your doctor or physio, then definitely by one of those helpful people giving out free advice on pain. You know the ones.
Most people who have back pain will have given core strength exercises a good go. But when no improvement in pain has happened, then the prescription always somehow seems to be more core exercise. This is where logic seems to fall over and give up in the face of this strong belief. If you were taking a drug to treat your condition for 6 months, and you had had no improvement, possibly even feeling a bit worse with side effects, would you be prescribed more?
Sometimes underdosing is a problem, true, but after 2 years+ of daily core strength exercises? You would hope that failure of a treatment would at least prompt a think about whether this really is the best strategy for this individual. The underlying theory is that if you have a strong ‘core’ you will have less back pain, have better posture, be less likely injure yourself, and to perform better in sport. BUT none of this is supported by the evidence….
Taking just the back pain claim: Core strength or core stability (a poorly defined thing for a start), seems to have no relationship to someone’s back pain. If you compare a group of people with back pain and matched people without back pain. (same age, sex, activity levels etc) the ones with back pain do not have on average weaker cores. There have been a lot of studies on the subject, so we would expect to have found at least a correlation of back pain with some strength factor by now if this was actually an important thing.
The truth is if you can stand up and walk around you probably have adequate core strength for a happy back. Being strong is a good idea for lots of reasons, but strengthening your core specifically to help your pain probably isn’t going to work.
This is something I feel strongly about because this false belief about the core pushes people into working harder and harder on exercises or bracing themselves in everyday movements in order to get rid of their pain. And not only does that not work very often, it can also be detrimental. It possible to be too switched on. To guard your trunk too much, rather than being too weak, and in that case doing a lot of pilates and ‘core strength exercises’ can actually exacerbate that.
What is needed is to separate exercise, and all its many benefits, from this myth of core strength.
Pilates, lifting weights, yoga, special core or back exercises – all these things can be great, I’m not denigrating any form of exercise, especially when taught by someone who understands how exercise genuinely can help pain.
But when an exercise is making you more painful, or exhausted, or is a form of exercise you find a massive chore, but doesn’t actually help the pain, I would question whether this is the right exercise for you, at this stage. It might be better to choose something gentler such as walking, or just something fun and active, but not worry about whether it specifically engages the core. Any general exercise will strengthen your core (as well as other bits of you) because the core isn’t some special set of muscles. It just means your middle bit. And if you move your whole body your middle bit always needs to get involved.
So are you missing out on fun, social or relaxing activities that would be more beneficial to your back pain and well being because you are pursuing the ‘strong core’ myth?
We need to treat the body (and mind) as a whole. How all the muscles function together, in the context of you as a person, is what is important, not worrying about whether particular parts are stronger or ‘engaged’.
It’s time this zombie myth of the core finally died so we can get on with doing the stuff that actually helps pain.
Ref: there is a body of evidence on this subject but the definitive article on this is still Lederman (2010)
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