Wednesday, September 30, 2009

Mythical Methods?

The Myth of Core Stability.
By Eyal Lederman

A critical review of core/spinal stability practices and claims. Great article.

The conclusions from the article:

-Weak trunk muscles, weak abdominals and imbalances
between trunk muscles groups are not a pathology just
a normal variation.


-The division of the trunk into core and global muscle
system is a reductionist fantasy, which serves only to
promote CS.


-Weak or dysfunctional abdominal muscles will not lead
to back pain.


-Tensing the trunk muscles is unlikely to provide any
protection against back pain or reduce the recurrence
of back pain.


-Core stability exercises are no more effective than, and
will not prevent injury more than, any other forms of
exercise or physical therapy.


-Core stability exercises are no better than other forms
of exercise in reducing chronic lower back pain. Any
therapeutic influence is related to the exercise effects
rather than stability issues.


-There may be potential danger of damaging the spine
with continuous tensing of the trunk muscles during
daily and sports activities.


-Patients who have been trained to use complex
abdominal hollowing and bracing manoeuvres should be
discouraged from using them.


Move.
AS

Reference:
Lederman, E. The myth of core stability. Journal of Bodywork & Movement Therapies (2009).
doi:10.1016/j.jbmt.2009.08.001.

8 comments:

Patrick Ward said...

I have read the paper and it offers some interesting arguments.

One problem I have with it is that the author simply says "Don't do this", but then he doesn't really offer a solution. It is one thing to make criticism and then offer your idea of a better way. But, taking the rug out from under someones feet and not giving them something else to stand on is usually not the best way to approach things.

One thing Gray Cook said at a seminar awhile back was "If our training programs are so good, why do we have to supplement them with all this extra core work and flexibility work?"

I think there is something to that statement. However, the reality of it is that people don't move well to begin with. That is why we have the supplemental core work and flexibility/mobility work. We need to create some awareness that wasn't there before. Once you can get them to do that, you can move away from a lot of the supplemental stuff and begin to do more dynamic training. However, just moving around and "hoping for the best" (as it would seem the author of that paper is suggesting) doesn't gaurantee us results.

At least that is how I think about it.

Patrick

Mike T Nelson said...

Cool paper and I am giving it the closer read early next week.

The parts I did read, I do agree with so far.

I will have a huge blog post at some point on all the "core stuff" going on.

Time to do some moving planks now (aka push ups).

Rock on
Mike T Nelson PhD(c)
Extreme Human Performance

Aaron Schwenzfeier said...

Patrick,

I appreciate the comments.

What I do like about the paper is that it gives another perspective, to hopefully get people thinking beyond certain belief systems.

Regarding the Gray Cook statement, whose training programs was he referring to?

I completely agree that most people don't move very well and that we need many methods to get them to move better. Each person will be different, with unique issues, and coming from entirely different contexts. Some will respond to movement change, some to contextual change, some to perceptual change, and/or some to biochemical change, or a combination of these.

The questions to be asked:
Does the person subjectively feel better, and does the person objectively perform better?

Look forward to the blog post Mike.

AS

Patrick Ward said...

Aaron,

I think he was referring to the way people train in general.

"I need to do CORE work"

or

"Don't forget to stretch"

etc...

People are always supplementing their program with that stuff because maybe the program isn't getting them what they need in the first place.

patrick

L. Wu said...

I looked through the associated PPT slidedeck and the PDF which I found elsewhere. As Patrick said, interesting arguments.

"Weak or dysfunctional abdominal muscles will not lead
to back pain."

What I found interesting is that Lederman doesn't distinguish between max-strength and strength-endurance when it comes to the anterior & posterior core. My understanding was that it was strength-endurance that was protective, not generally strength.

(But will have to re-review McGill to check that.)

"Core stability exercises are no more effective than, and
will not prevent injury more than, any other forms of
exercise or physical therapy"

Okay... might be possible, but for athletes and folks who suffer from a bit more LBP, that doesn't imply that for them we couldn't do both?

"There may be potential danger of damaging the spine
with continuous tensing of the trunk muscles during
daily and sports activities."

Appropriate level of tensions needed, yes.

One interesting point with one of the studies cited, the Nadler 2002 LBP collegiate athlete one is that they actually did find an effect (LBP incidence 4% rather than 8%) but that they didn't have n great enough for this statistic to be significant.

This report seems to play the devil's advocate role pretty well, and makes some plausible arguments about why CS work may not always be necessary. That said, there are counterarguments to some of the claims--CS work has been found to be beneficial (slide 54 of the author's presentation), it is just not clear whether or not CS by itself is better than general exercise by itself.

I didn't see an argument I really bought as to why you wouldn't combine CS and general exercise, especially if you understand the SAID principle and use an appropriate level of tension under load.

Training on a Swiss ball is very different from running, but one would hope that one progresses and uses the CS training to improve proprioception / movement patterns. Does CS by itself improve them? No, but a good trainer can use CS work as a way to coach some of these--interestingly the author doesn't talk about glutes at all, just abs/TVa, and the anterior core is just half the picture, no?

Basically, I agree with Patrick, and note that the author doesn't distinguish max-strength from strength-endurance, focuses on the anterior core musculature rather than glutes, AFAICT, and focuses more on a general population rather than on educated trainers who know who to use CS strength-endurance work as a way to coach movement/strength/endurance skill, in a way that involves progression to more functional movements, and as a way to improve performance of athletes that could still learn to better "pulse" as McGill talks about.

jleeger said...

I love the article, because it debunks a myth that is extremely popular and over-worked in personal training (my field) these days. Paul Chek, to me, is the biggest promoter of this bad practice...recommending innumerable bizarre assessments for core strength and stability, strange progressions (that take years to complete), and odd exercise choices (anyone have a sphygmomanometer handy?) that are usually only appropriate for people who are severely injured...which brings me to what I don't like about the article...

Aside from the training/coaching aspects, which I think Patrick covered well, I have a big problem with blanket statements about anything having to do with the body. Every body is different, presents with different structure and function, and different pathologies.

For me, the future of "training" is educating people about how their bodies work. Then they can become, as they should be, the boss of themselves...self-responsible.

How does a human body work, in general? What are the mechanisms at work? Chek doesn't teach his people that...probably because he's afraid that, if he did, they wouldn't need him anymore.

That's really sad, though. True coaching isn't about telling people what to do all the time. It's about being an artist. It's about accumulating the time in the field, researching your field, seeing what works and what doesn't, so that you can effectively help the individuals you work with in a faster and faster manner...

Coaching is an art.

More education. Less admonishment, less prescription, less arguing about "what's right for everyone" (it doesn't exist...every one individual is different), less "guru-ism."

IMHO

Aaron Schwenzfeier said...

L. Wu,

Good points and thanks for your comments.

Josh,

Also great points and appreciate the comments.

To reiterate,
I think the article is important because it raises questions and hopefully challenges thought processes enough to lead to more thoughts and ideas.

Stand-alone, I don't think CS exercise does much, but in agreement with everyone else, CS work can make those aware of issues which can hopefully lead to resolving gross motor pattern problems.

And again with regard to whatever methods chooses to do; the questions to be asked:
Does the person subjectively feel better, and does the person objectively perform better?

I like Josh's statement here:
"Coaching is an art.

More education. Less admonishment, less prescription, less arguing about "what's right for everyone" (it doesn't exist...every one individual is different), less "guru-ism.""

Patrick Ward said...

Aaron,

Great stuff. I agree with yout stance. Especially about "awareeness" and the idea that we hope to improve gross patterns. It really is an individual thing and the one size fits all mentality wont work.

I also agree with, "Is the person feeling better? Are they performing better?"

In the end, it isn't really about core exercises, not doing front or back squats, or what is "right or wrong". It is more about having your own metholdogy and believing 100% that what you are doing for that client/athlete is what they need at that time. Putting your faith in your own methodology/philosophy and believing that it puts you in the position to get the best results possible. Have a good reason for what you are doing and be able to explain why you are doing it. Don't just do "stuff".

patrick