One of the first things I wanted to talk about are the ideas surrounding “Core”. What is it, what is it’s relationship to pain especially in the low back, and is it as important as we believe for reducing injury and enhancing performance?

So what is it? In it’s simplest form, core refers to a lot of the smaller muscles that attach to the spine and help to control movement and provide support. We have lots of other muscles that attach to the spine that are designed for power and large movements, like our “6 pack ab” muscles in the front or our Lats in the back.

Some of the biggest issues I find clinically that I want to try to touch on is that for one, conceptually, patients and practitioners really don’t have a good understanding for what it is. Providers like PT’s, Chiros, Trainers, Doctors can often recite some of the textbook definitions of what muscles are a part of the core, but do a poor job with the application -or training part, which is ultimately the most important part. It doesn’t matter how well you know what muscles make up the core if you can’t train them appropriately. And on the patient or athlete side, they typically think that it means you need strong abs. I’ll touch on that in a minute. The second part that I wanted to address is the core’s relationship to pain and injury. There are some really outdated philosophies that continue to be perpetuated in the clinic and in the mainstream media platforms that are really not true.

So first, how do we train “core muscles” and how can we maybe do a better job of training them effectively. One of the biggest problems with our current philosophy is that we train core muscles in isolation. Over and over again, I see clients being trained in spinal neutral. Exercises like dead bugs, bird dogs, planks…these are very good exercises for a lot of reasons that I will still use in my practice. They all have a purpose, especially for the novice movers that need introduction, the sedentary clients who don’t do a lot of moving, or the patients who are suffering from extreme and debilitating pain. But we are doing our clients a disservice if they are used to moving even a moderate amount. People who run, go to classes, or use the gym regularly need more. For the elite movers, athletes, and gym goers I’d argue that we really shouldn’t be using these much at all.

Core muscles are designed to work during movement, not in isolation. They also turn on and off when they are supposed to. We don’t have to bring that out of them by trying to train certain muscles to “turn on”. These muscles don’t just shut off when we are injured or weak. We would fall apart if that were true. We need to spend more time focusing on movement based core strengthening. I would argue that our perception of people like trainers with these ripped abs do not have the strongest core. Some of them maybe, depending on how they train, but I’d argue that the individuals who have really strong core muscles might be athletes you don’t typically think of because they don’t have a six pack. Powerlifters and olympic lifters, for example, tend to have some fat on them but they handle extreme amounts of load when pushing them, pulling them, lifting them from the floor or catching them overhead. Golfers or baseball players aren’t always shredded, but they can rotate extremely powerfully and accelerate and decelerate very quickly. Dancers or Gymnasts who can control their bodies through extremely large ranges of motion. Core is far more complex than our current basic understanding of “strong abs”.

The next part I wanted to address is the core’s relationship to pain. I still see providers in mine and related fields talking about a weak core and it’s correlation to low back pain. Lots of this stems from studies in the late 90s and early 2000’s that linked weak transverse abdominis muscles to individuals with low back pain. But so many more recent and quality studies disprove what we once believed to be true. Even one of the pioneers of this concept retracted his opinions of it’s relationship! A STRONG CORE WILL NOT FIX LOW BACK PAIN AND IS VERY RARELY THE CAUSE OF IT.

A strong core is important for many different reasons, but very little of it has to do with preventing or solving low back pain. Low back pain can come from so many different sources and reasons, physiological reasons, genetic reasons, even emotional or psychological reasons. So saying or assuming that all of these sources for low back pain can be fixed with stronger core muscles is a joke and needs to be thrown out. 

The average, every day person needs to understand that core is really not related to back pain and that it needs to be trained differently than how we often think it does. And PT’s, chiros, trainers and doctors, people in my field, need to stop perpetuating false concepts and links to low back pain and outdated methods for fixing them. Everybody is built differently, and a good practitioner understands that back pain, and pain in general, is incredibly complex and individualized. We are all unique. We need to stop being part of the problem and start being part of the solution. Don’t give lazy diagnoses and treatment plans centered around core. Hopefully, we all can continue to grow in our understanding of the core and how we can use it more effectively.   

• Core is poorly understood, even by experts!
• Core muscles are NOT your six pack ab muscles
• Traditional Core exercises are great for novices or when in large amounts of pain, but often poor for regular exercisers and athletes
• Core muscles REQUIRE MOVEMENT to be effective
• Core is very poorly linked to low back pain and injury
• A stronger core, by itself, is NOT very likely to fix back pain
• Low back pain can come from physiological, environmental, genetic, emotional or psychological reasons (to name a few) – stop using a weak core to define something so complex!