- “I need to strengthen my core!” What is the role of core stability training?
“Working the core” has become a huge focus of rehabilitation of athletes and non athletes in recent years. The belief that the spines stabilising muscles become inhibited with back pain rendering the spine ‘unstable’ and ‘vulnerable’ drives this. Yet growing evidence tells us that disabling persistent back pain disorders are often associated with increased trunk muscle co-contraction, earlier activation of the transverse abdominal wall and an inability to relax the spines stabilising muscles such as lumbar multifidus (Geisser, Haig et al. 2004, Dankaerts, O’Sullivan et al. 2009, Gubler, Mannion et al. 2010). This increase in co-contraction can increase spine stiffness and alter biomechanical loading reinforcing pain.
A number of high quality randomised controlled trials have compared stabilisation training to various forms of exercise, manual therapy and placebo. These studies highlight that this approach is not superior to the other active therapies and only marginally superior to a poor placebo, with only minimal changes in pain and moderate reductions in disability (Ferreira, Ferreira et al. 2006, Ferreira, Ferreira et al. 2007, Costa, Maher et al. 2009). Recent studies have also demonstrated that positive outcomes associated with stabilisation training are best predicted by
reductions in catastrophising rather than changes in muscle patterning (Mannion, Caporaso et al. 2012 ), highlighting that non-specific factors such as therapeutic alliance and therapist confidence may be the active ingredient in the treatment – rather than the desired change in muscle.