The Core
If you're a gamer who has suffered from lower back problems and has consulted with a trainer or physio, or indeed if you've done your own internet research, you're sure to have come across the concept of core stability. This blog post will examine some of the myths that surround this subject so that hopefully the next time you talk to somebody or consult Dr Google you'll be going in aware of some of the misconceptions surrounding this topic.
A lot of researchers credit the popularisation of core stability exercises to a paper from the 90s by Hodges and Richardson (1) in which they looked at the timing of various muscles around the trunk when an arm was moved. The theory was that the muscles should activate in order to stabilise the body and allow the arm to move and what they found was a delayed activation of the transverse abdominis (TrA) muscle in patients who were suffering from lower back pain. The problem with this finding is that they didn't really establish if the differing timing of muscle activation is what caused the pain or if it was caused by the pain. There are plenty of other unanswered questions around this theory as well, for example:
- Even if it was true that delayed TrA activation was a problem how would it physically have caused the pain?
- Is the timing of activation found in the tests whilst standing still correct when you're sat at your desk in a DX Racer? How does TrA activation timing alter when you have one hand on a mouse and one on a keyboard compared to to hands an a controller?
- If the timing is faulty how can we consciously retrain the nervous system's activation when we are talking about differences of milliseconds and we don't know what normal is in every situation?
What is the core?
So what is the core? That's a very good question as there isn't really a good definition. A lot of people will talk about 'deep' muscles which act as stabilisers, but the truth is a lot of the big superficial muscles will also act to stabilise the body. Your latissimus dorsi (lat) muscles are the big muscles that run up the side of your body from your lower back to under your arms, they're what you feel when trying to do a pull-up and have a big role to play in controlling your trunk, but how often have you heard somebody say that you should do pull-ups in order to improve your core stability? I've got personal experience for this working though - a young lady lost a leg when a lorry tipped on top of her and the surgeons harvested a lot of her back muscles in order to reconstruct enough of a stump for her to use a prosthetic leg. She struggled to balance on the new leg and one of the things we trained to improve this were her lat muscles. I honestly don't believe that any amount of TrA bracing would have helped to compensate for a lack of strength in the bigger muscles.
I think that maybe trunk stability is a better term than core stability, because your body is a very complex a machine and I can't see any point in differentiaiting muscle groups based on arbitrary factors that people can't agree on, but even this term has problems - if you have poor hip control or strength then you'll struggle to controll your trunk movement no matter how good your core is becuase it's built on a weak foundation, which leads us on to the next point:
Are pull-ups a core stability exercise? They’re definitely a good exercise for muscles which affect trunk stability, can this be practically differentiated from ‘the core’?
You're only as strong as your weakest link.
It's certainly true that you are only as strong as your weakest link when you're trying to run/jump/throw/carry, but the problem with the core stability theory is that it implies that the back is always the weak link, that it's inherently weak and fragile and without the TrA applying it's compressive force quick enough something will break. This just isn't true, the vertebrae are strong, the ligaments are super strong and, as discussed above, there are lots of other muscles working hard. Of course injuries can occur if the forces experienced are above those with which your body can cope, but the human body is amazingly capable and you as a gamer are not going to cause structural damage your back by standing up to get a drink without consciously pre-activating a certain muscle.
Core training.
We are all familiar with core exercises such as those in the video below, they teach you to maintain a level of tension around the abdomen and consciously control every movement. The problem with this is that it discourages movement and reinforces the image of fragility which is exactly the opposite of what people need (2,3).
So should we stop doing the classic core exercises? No. They are not bad exercises, it's just that they are no better than any other form of exercise for back problems (4) and the explanations surrounding them are poor. The movements themselves are not bad and can help (especially if you are very sedentary) as long as you don't use them to reinforce the concept of constant tension. If you are more physically capable, then we know that deadlifting is great for lower back pain (5), but what if you find the gym boring or don't have access to heavy weights? It really doesn't matter. The majority of research says that what's important is for you consistently do some form of exercise and if you enjoy the exercise you are more likely to do it regularly, so if you enjoy core stability exercises and will do them regularly then by all means do them, but if you prefer swimming then go and do that. Personally I like picking up very heavy weights, believe me you will find your weakest link when you have 300kg on your back.
Core stability? You certainly can’t be weak in the middle when shifting heavy loads, so will lying on your back and drawing your belly button in actually make you strong enough for this?
If you find the classic core exercises work for you then keep going, but please don't buy into the hype. Consciously continuously bracing is the exact opposite of what people with non-specific lower back pain need to do (2,3) so relax, move more, don't worry about bad movements or bad postures, try to find an exercise or sport that you enjoy then get out and do it. Having fun really is the key to beating back pain.
References
1. Hodges, C., & Richardson, C. (1996). Inefficient muscular stabilization of the lumber spine associated with low back pain. SPINE, 21(22), 2640-2650. (Link)
2. Lederman, E. (2010). The myth of core stability. Journal of Bodywork and Movement Therapies. 14 (1), 84-98. (Link)
3. O'Sullivan, P. (2011). It's time for a change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 46 (4), 224-227. (Link)
4. Gomes-Neto, M., Moura Lopes, J., Sena Conceição, C., Araujo, A., Brasileiro, A., Sousa, C., Oliveira Carvalho, V., & Luciano Arcanjo, F. (2017). Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Physical Therapy in Sport, 23 136-142. (Link)
5. Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., Falvey, E., & Franklyn-Miller, A. (2015). The effects of free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ Open Sport & Exercise Medicine, 1, 000050. (Link)