Core stability is the current buzz word in the rehabilitation of low back pain, but what is it exactly?

The easiest way to describe it may not be the most technical so for any professionals reading this bear with me. Imagine we have different groups of muscles within the body that do different jobs. If we could isolate these in to two major groups we would list one as those that move us, and the other as those that stabilise us. The former quite simply allow us to bend down, lift an object from the floor, or even twist around. During this process however, the stabilisers work to control how the trunk and spine moves throughout occuring generally at a much finer level. These deep corset like muscles act a little like the big belt you see a weightlifter use. The coupling of these two mechanisms, when both fully operational, makes for a flexible and strong, but also stable spine. The theory of core stability is that the stabilising part of the team becomes lazy and weak, and this muscular imbalance puts more pressure through the spinal anatomy.

This is why some people that appear to be very strong can also have weak spines. It is not uncommon to hear from clients that they have gone to the gym to try and stengthen their backs but unknowingly do exercises that primarily build the strong moving muscles. Theoretically, rather than harmonising the two groups this increases the imbalance with the weak stabilising muscles continuing to struggle against ever increasing forces as you get grossly stronger.

Core Stability is a very widely used concept across many professions however like many areas of rehabilitation, specific evidence from research to support its superiority over other techniques, is vague. There is little doubt that exercise as a complete entity plays an important role in the long term rehabilitation of back pain however it is when different components of exercise therapy, of which core stability is one, are tested in isolation or against one another, that the outcomes become less certain. There does appear however to be a greater role for stability type rehabilitation in chronic (greater than 3 months continuous pain from the same source) rather than acute presentations. This is perhaps not so surprising though with most acute low back pain, without any red flag signs  (indications of serious pathology), generally accepted to be self limiting, settling within 4-12 weeks under their own duress.

Many rehabilitation specialists are now encorporating the theoretics of core stability along side more functional exercise. One area of research has indicated that it is not the weakness pur se of the spinal muscles that causes problems but more the way in which muscle groups, normally found to be working  in unison, become  isolated. Exercise has been shown to help address this muscular asymmetry.

A common problem associated with research in to this area is the acknowledgement that we are all different and we are normally far from perfect. When a specialist practitioner examines you they are going to be looking for abnormalites and to be honest, in most of you, there will be lots of them. The trick is to take all of these findings, stand back and them look a them in a broader light. This enables you to look past the so called red herrings and concentrate on the likley contributors to you problem. It may be of benefit to visit some of them in isolation however viewing them as a whole functional unit is then arguably the best way forward.

The techniques involved in delivering both effective and SAFE core stability regimes can take years of experience and training. Physiotherapists and Pilates instructors are probably the most effective in the use of this technique for back pain sufferers although other exercise professionals who have undergone extensive extra training may also be qualified. Unfortuantely the way in which exercise professionals are graded does not always accurately represent the experience and skill of the trainer so be thorough in your search. Click here for the professionals we utlise in the area most often.

For chronic back pain sufferers the most recent concept of rehabilitation in that of Functional Restoration. This brings together various therapists from different specialist backgrounds and also includes the expertise of a psychologist. This is not to say that its in your head but brings about the possiblity of utilising an effective approach called Cognitive Behavioural Therapy. More information about Functional Restoration can be found here.

 

(Core Stability back pain exercise pilates transversus abdominals gym physiotherapy)