“My core is rubbish”
“I have a weak core.”
“I need to strengthen my core.”
I hear comments like these every day. They make me wonder:
“Do you know exactly what you mean by core? How do you know this to be true? Do you feel this or did someone tell you so?”
You may not be aware that movement professionals, from physiotherapists over strength and conditioning coaches to pilates teachers all have very different opinions about what the core is, what is wrong with it, how to fix it or whether to fix it at all. The difference in opinion is not necessarily based on the job title, but on whatever they have learned to be the truth and whatever works for them personally.
I admit it here and now, at the start of my career, like many, I worked on the bases of just one school of thought, because it was taught to me as the truth. When I embarked on further training I was told that in fact what I thought to be true was very flawed. I was angry and annoyed at the challenging thought that I may have been doing it wrong. Like many others I insisted that they were the ones who were wrong. I continued to seek more professional development and the more I studied the more often this happened. Repeatedly I was confronted with a completely different idea of what the core is and how it works. I started to wonder, if so many people are convinced of so many different things, how do I know what is true? I realised how religious we movement professionals can be about the theory we choose to follow and how dismissive we are of other ideas. I realised what this complete diversity of believe means. If we look around and read all the research done in the area of movement science and spine stability we realise that this subject is anything but clear and it is very unlikely that only one approach out of all of them is the right one. If there was one right way of doing it we would all get fixed instantly. You may have found it is often not that easy.
I want to give you a taster of the core chaos out there so you have a more realistic image of your core and what it means. Here are some of the different ideas of what the core is and how to treat it.
A popular believe is that we have deep/local muscles making up our core. These muscles have the main function of stabilizing the spine. We also have superficial/global muscles, with the job to create movement. The local core muscles always tend to include pelvic floor, diaphram, transverse abdominus (TVA) and multifidus. The global muscles in the core area always include rectus abdominus, erector spinae and the external obliques. There are a fair few muscles in between. Experts like to argue about which group they belong to. Unfortunately muscles do not come with labels that state their purpose.
Those who work based on this idea of the inner unit and outer unit, as they are also called, might tell you that your inner unit or core is weak and that you need to do core isolation/strengthening exercises with the purpose of targeting those local muscles.
This practice is based on research conducted by Australian physiotherapy and neuroscience professor Paul Hodges. He has researched the area of spine stabilization and motor control since the 1980ies. While it is widely accepted that indeed the deep muscles differ in many ways from the superficial ones there has been a lot of misinterpretation of his work. The reason why there are core conditioning classes in every gym, we believe to be plagued by a world wide epidemic of weak cores and that those with back pain particularly need to strengthen their core, is based on one of Hodges early research projects. He tested the performance of the deep core muscle transverse abdominus in people with chronic back pain compared to people without back pain. In people without back pain transverse abdominus contracted earlier in relation to other muscles and the performed movement. In people with back pain TVA contracted slightly later in comparison. So there is something interesting to be said about the difference in behaviour of the TVA in people with back pain, compared to the one in those without back pain.
When the results were published many rushed to the conclusion that our societies epidemic of back pain is due to the fact that we have weak or sluggish TVAs. This was the point when Pilates became all about the core. Joseph Pilates, the founder of the method never mentioned the word in his life. It may sound like a logical conclusion, yet we have no idea if the delayed TVA contraction caused the back pain, or if it was caused by the back pain. We simply do not know what the effect of the different behaviour of TVA is. It also is a whole other story to assume that we all have a faulty TVA and therefore we all need to strengthen our core. Yes we have an epidemic of back pain but remember, the ten individuals who were tested, who did not have back pain had a perfectly normal TVA contraction (if we assume their TVA performance is the normal one). Hodges study was a small one, only involving 20 people in total who were only tested on one arm movement. It was too small a study to assume chronic pain or poor physical performance is due to a weak set of deep core muscles. Hodges himself never made this conclusion from his work. He still works on getting his message through, that his research was misinterpreted. In an interview with the British Journal of Sports Medicine in 2015 he addressed the issue that the fact that he has studied muscles such as TVA in great detail does not mean that he believes these muscles to be more important than any other muscle in the body and that stability of the spine is provided by an orchestra of muscles. (link: https://www.youtube.com/watch?v=hplw6Lg95SY)
The believe that the TVA can be isolated and retrained or strengthened in isolation has also been highly disputed. The TVA is deep inside our body fully networked via connective tissue with other structures and muscles. Because of this complication, those who believe in the local core isolation approach make core contraction quite an art from. The contraction has to be so slight that other muscles are recruited as little as possible alongside it. Some speak of a 25% contraction in order to make their clients understand that the effort they are to put into it is way less than a thorough pull of the navel to the spine. Some suggest the mere thought of contraction is enough. The degree of subtlety is difficult to get right and requires experimentation with a variety of different visualisations. Core isolation is a difficult skill if it can be mastered at all. Its purpose is questionable, yet some therapists have had good results with it. Although we also do not know what about the procedure really helped the client. Is their core really stronger and fixing the problem, or perhaps it was just slowing down and gaining body awareness that took their pain away and made them feel better. We do not know.
“PELVIC FLOOR ISOLATION”
There are many practitioners out there, particularly in the fitness world, who consider all trunk muscles to be the core, which is strengthened by drawing the navel to the spine. Recent research has shown that there is a huge issue with sucking the stomach in all the time. Whenever we draw the stomach in we can cause dysfunction and prolapsing of the pelvic floor. This can also happen with the TVA isolation approach when not enough emphasis is placed on the subtlety of the contraction.
When we draw our stomach in this creates something called intra abdominal pressure, which facilitates stability to the spine. It was found that this pressure also causes us to bear down on the pelvic floor which literally buckles under the pressure. Imagine creating pressure in a balloon by squeezing it and how an area in the balloon’s skin starts to bulge. This discovery has caused many who previously attempted TVA isolation directly to now access it via the pelvic floor instead, as the pelvic floor will always also engage TVA with it. This way it can be more or less insured that the pelvic floor will not bulge during core contraction.
This sounds like a great idea, it just became problematic when we learned recently, that in many people who were suspected of having a weak pelvic floor, the pelvic floor is in fact hypertonic (tight/in spasm/not functioning) and the last thing it needs is more pulling and tensing up. (you can read more about it here, and how pilates teachers themselves are particularly at risk of developing hypertonic pelvic floors due to their focus on repetitive pelvic floor contraction: http://www.mypelvichealth.ca/causes-pelvic-floor-pain/hypertonic-pelvic-floor-muscle-dysfunction/).
This does not mean that everyone who is currently doing kegel exercises should stop doing so. It just means the problem with the pelvic floor is not always that it is baggy and weak, it may be the opposite. And too much focus on pelvic floor contraction can cause problems. It is possible for an experienced movement professional to get an idea of someone's pelvic floor health by looking at the person’s quality of movement. If in doubt ultrasound imaging would reveal the truth. In any case it would make sense to practice pelvic floor releases as well as strengthening exercises. Unfortunately that is usually not part of core training.
The world of core was basically fine, mainly following Paul Hodges idea of what it was and how it works. Then suddenly a man named Stuart McGill, professor of spine biomechanics from Canada dropped a bombshell. He claimed that drawing your stomach in and isolating the deep core muscles was harmful to our core stability. He said that the global muscles of the trunk, such as the rectus abdominus, external obliques and erector spinae are all just as vital to help with spinal stability as the deep, local muscles. He said that drawing our stomach in meant that we inhibit the proper function of the rectus abdominus, which means we do not get the full stability for our spine that we should get. He suggested we should use abdominal bracing (tensing your stomach as though you expect to get punched in the stomach) to engage our core. He dismissed the idea that the performance of the TVA had much to do with onset of back pain. Instead he believed that spinal flexion under load (forward bending in abdominal exercises such as sit ups or crunches) causes spinal disk degeneration, which then causes back issues. He suggested we should strengthen our core in isometric contractions only. This means with the spine in a lengthened form such as in a plank or squat with a straight back to minimise disk degeneration.
McGill came to this conclusion by testing the pressure that spinal disks had to endure during certain movements and positions, such as bending down, lying, sitting and so on. He found that by bending forward we put a lot of load through the vertebral disks and wear them out over time. To proof his believe that we only have a set number of movements within our spinal disks before they break he put the spines of dead pigs through massive repetitive bending tests. The spinal disks eventually broke. McGill concluded that we must minimise flexion of our spine and work on core stability in a way that strengthens our trunk into an erect shape. So brace your abs and don’t bend down if you can help it.
McGill found out a lot of stuff about the human body that is worth considering and it is thanks to his discoveries that we have moved on a fair bit from old school gym training. There is one thing that bothers me though. My spine, right now inside me, as I type this, is not dead. There is still constant repair going on in my body. Yes I age, yes time starts to show in the lines of my skin and in areas in my body that have suffered over the years and simply are not as fresh as they used to be. Yet if I injure myself I heal. Even in 40 years time, if I break my leg, the bone will grow back together. Even if I bulge a disk, if I look after myself sensibly the bulge can disappear with time. Does this happen in a dead pig spine? No it does not. There is no more repair happening there. So while of course time and repetitive movement wears out parts of our body McGill’s research does not proof that it is necessary to keep ourselves upright all the time because we do not have enough flexion in our spine to last us a lifetime. McGill’s theory also doesn’t explain why I have had many clients under the age of 35 with upright posture suffering disk problems. Yet many of my clients over 60 have no back problems at all. I suspect that the amount of disk degeneration through spinal flexion is somewhat dependent on the segmental quality of movement through the spine and the functionality of the surrounding tissue.
As with most things, the truth is probably somewhere in the middle. Do I want to flex someone forward with an acute disk injury? Probably not. Do I suggest we put your healthy spine through 100 sit ups at a time? I certainly do not. Should we ban people from flexing forward? It just doesn't sound natural or realistic to me. Not only would this be a serious limitation for people’s ability to move, we also know that the vertebral disks need movement in order to remain healthy and repair themselves. Maintaining an even movement quality through each spinal disk is also supposed to prevent hinging repetitively from the same areas in the spine which indeed could cause problems. If we stop teaching clients how to flex their spines well their vertebral disks will start to dry out due to a lack of use. Soft tissue around the spine would become less adaptable. Further down the line when they bend down to put on a shoe their body may not be able to cope very well with this basic task any more.
A problem I have with the idea of exessive bracing of the abdominals is that it was found that such forceful contraction of the global muscles of the trunk will actually compress the spine. In pilates we work a lot on elongating the spine and improving posture and movement in order to prevent spinal compression. Spinal compression can speed up disk degeneration, reduces shock absorption and by extend therefore can cause harm to other weight bearing joints. Contracting my trunk muscles that forcefully may make my spine more stable in the immediate term, however it may cause it to become more compressed in the long term.
Still there are times when abdominal bracing may be the best strategy for us to achieve what we are wanting to do. And McGill's discoveries about the pressure placed on spinal disks during particular movements is very valuable and influencing what we choose to ask our clients to do in classes. My dispute is with the generalisations based on the results of the research and the often blunt and categorical actions taken.
“THERE IS NO CORE”
While the McGill supporters quarrel with the Hodges believers about what the core is and how to contract it there is a whole other group of movement professionals who challenge both of them by basically saying: “There is no core.”, and the idea of improving physical ability by tensing up individual muscles is not functional or helpful.
They tend to say that western movement science has gone about it the wrong way by attempting to make sense of the human body by applying mechanical ideas (biomechanics) to it. The idea of “switching the core on and off” is part of this as well as the text book image of dissected bodies in general. Our body is seen as the casing of the muscular system, skeletal system, nervous system and so on. The muscular system is broken down into different muscles with different purposes. It is argued that seeing the whole, living, moving body as an arrangement of separate parts is not helpful, because we are not machines and science is still far away from understanding how we human beings work. Connective tissue (fascia) has been discovered to line the inside of our bones as much as it wraps around and through our muscles and into the deep layers of our skin. We are beginning to understand, that it is of huge importance for our stability in movement and biomechanical health. Separating the body into different systems means breaking down the fascia and disregarding anything interconnecting that may be of value. This may just hinder us in discovering how the body really works, as a very organic interconnected universe of its own, where for example the feet may hold the key to spinal stability as well as many other factors such as balance, breath and soft tissue health.
People who believe that our bodies, including our mind, are one organic whole, where everything effects everything tend to argue that the martial arts masters and yogis in the far east have astounding physical abilities even at very old age without injuries, and most importantly without applying any of our western methods of training and treatments. Our western athletes however tend to retire in their 30ies due to injuries, regardless of all the expert support, coaching and treatments they receive.
There are many different strands of this general rejection of the idea that there is a core we need to engage or strengthen. Some simply argue that the chronic tension and stiffening that many of us experience as we grow older is worsened by the constant focus on muscular strength and deliberate contraction and flexing of our muscles. They say that the key is in getting in touch with our body and our instincts and trusting in our natural ability to move again. It is in learning to find strength in a very different way by balancing the body well, letting gravity help us as supposed to fighting it, and letting go of excessive tension as much as possible.
Thomas Myers was perhaps the first to draw our attention to the value of connective tissue inside the body when he published his book “The Anatomy Trains” just after the millennium. His work was new and ground breaking in the western world. He saw the body and its movements based on myofacial meridians. He identified the forces of pull that our connective tissue develops over the years. In dissection these can be seen in the alignment of the fascial fibres, which look like paths or lines. They indicate that muscles work in a sort of chain reaction in long and spiralling lines up and down and through the depth of the body. The health of the fasica is absolutely vital in making these chain reactions work.. In the past fascia was merely regarded as packaging material for our muscles. Myers and others working in his field have now demonstrated the huge role fascia plays in our body and the impact its health has on our ability to move well and avoid injury.
Others who have also recognised the importance of connective tissue see the body more as a trensegrity model and developed the idea of biotensegrity. If the structure is completely balanced with an equal amount of tension and length in all parts the overall tension and expansion allows the whole system to be buoyant, light, balanced and effortless without any structures wearing away. Tensing up a set of muscles such as the core would disturb the over all balance and cause compression.
Those who believe in biotensegrity blame our epidemic of compressive joints such as knees, hips and vertebral disks causing pain, injury, replacements and spinal rods to some degree on the way we exercise our muscles with deliberate contractions (flexing them, tightening and shortening them).
Part of all these new discoveries that were made about the connective tissue in the body was that 80% of our nerves are located in our connective tissue and therefore there is a strong relationship between the nervous system and the fascial system. Neuroscience and the role the brain plays in the struggles we have with our body is the new area of exploration. The brain is constantly communicating with our body via the nervous and endocrine system in ways we are not even aware of. A simple example of this would be that our posture suffers when we are depressed. There are many much more mind blowing examples of this close relationship between the two. Biomechanist Stephen Braybrook is one of many current experts exploring this connection. He wrote “The Evolution of Biomechanics” to share his ideas of the direction movement science should go into while Caroline Sutherland’s book “The Body Knows” also explores the effect of the mind on the body, by saying that our physicality is ease-dropping on our state of mind and is affected by it.
While a faulty or weak core seems like a much more tangible issue to tackle when we seek improvement or relief from pain there is now a much wider spectrum of possible causes for our problems from connective tissue damage to our mental state.
It is possible to have some consideration for the research around the core and yet be able to see the body as a much more interconnected whole. Many who regard both develop a much more interconnected idea or abstract image of the core or even say that we have many cores. We may have a core around our spine but we also have a core in our shoulder for example and not one is more important than the other. Alternatively they may suggest that spinal stability is gained by engaging well with gravity and moving with a quality of expansion within us that provides supportive tension in our connective tissue. This way we avoid constant joint and spinal compression through deliberate muscle contraction.
What is certain is that each one of us is a complex individual and the more strategies and approaches we have available to us to make positive changes the more likely it is that we will find the one that will help us.
So when you say your core is rubbish, are you still sure you know what exactly that means and if this is actually true?
So your core is weak and needs strengthening. How do you know this?
And in what way do you want to strengthen it now?
I think we can safely say that we have no idea what the reality about our core is. I have spend enough time in the past believing religiously in one thing and opposing everything else. I am over that. I am proud to say that I have learned an awful lot from all the different approaches out there. The more I have learned the less I know., and believe it or not, I am very comfortable with that as it keeps me on my toes and it keeps me exploring and becoming better at what I do every day. I have studied and applied all the techniques and concepts above. All of them have helped some people, and some they have not helped. It is easy to stick to a "one fits all" approach and preech ones ability to "fix people". I can not fix you because you are not a machine.
When you come to see me I see you as an individual with a unique problem or goal. I want to know more about it and how it affects you, because although it may seem similar to the goal or problem many others have, I am sure it is not the same.. The direction we take together is determined by the nature of your problem or goal and how you speak about it within the context of your life. It is determined by what you tell me, how you tell me and what I see when I see you move. It is determined by the changes you experience with my guidance. I will draw from many theories and ways of working to find the thing that helps you best.
I see you and your body as a whole living person with the potential to be most amazing, with fascial meridians, a clinical history, movement habits, a mind that affects the body and a body that affects the mind, a spine affected by its life so far and muscles supporting it in the centre of your body. I can support you with neuro-linguistic programming, manual fascial and deep tissue release techniques and a flexible approach of movement therapy, biomechanics and pilates.
Being open and valuing all sorts of different expertise, theories and methods gives us more flexibility. The more flexible we are, the more choices we have. The more choices we have, the more likely we are to find the right way for you to resolve your problems and to reach your goal. There may be a core, but there are many possibilities of what it is and how it works. There are also many other things about you and your body that are worth some attention. I like to give my attention to all that is you and choose our course of action based on you, rather than the latest theory.
If you would like to speak to me about how I may be able to help you feel free to get in touch. You can book a session with me in Edinburgh, Southend or London. For those elsewhere in the world I offer sessions online via skype.
“Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain” by Carolyn Richardson PhD BPhty(Hons) and Paul W. Hodges PhD MedDr DSc BPhty(Hons) FACP
“Low Back Dissorders” by Stuart McGill
“Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists” by Thomas Myers