Paul in Hobart
07-08-2009, 09:27 PM
http://www.cpdo.net/myth_of_core_stability.doc
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Continuous and abnormal patterns of use of the trunk muscles could also be a source of potential damage for spinal or pelvic pain conditions. It is known that when trunk muscles contract they exert a compressive force on the lumbar spine [45] and that CLBP patients tend to increase their co-contraction force during movement [44]. This results in further increases of spinal compression. The advice in CS for patients to increase their co-contraction is likely to come at a cost of increasing compression on the already sensitised spinal joints and discs [33, 63]. Another recent study examined the effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations [117]. The abdominal stabilization maneuvers were - abdominal hollowing, abdominal bracing and a “natural” strategy. Abdominal hollowing was the most ineffective and did not increase stability. Abdominal bracing did improve stability but came at a cost of increasing spinal compression. The natural strategy group seems to employ the best strategy – ideal stability without excessive spinal compression. <o></o>
An increase in intra-abdominal pressure could be a further complication of tensing the trunk muscles [118]. It has been estimated that in patients with pelvic girdle pain, increased intra-abdominal pressure could exert potentially damaging forces on various pelvic ligaments [119]. This study for example recommends teaching the patients to reduce their intra-abdominal pressure, i.e. no CS. <o></o>
Maybe our patients should be encouraged to relax their trunk muscle rather than hold them rigid? In a study of the effects of psychological stress during lifting it was found that mental processing / stress had a large impact on the spine. It resulted in a dramatic increase in spinal compression associated with increases in trunk muscle co-contraction and less controlled movements [120]. <o></o>
Psychological factors such as catastrophising and somatisation are often observed in patients suffering from CLBP. One wonders if CS training colludes with these factors, encouraging excessive focusing on back pain and re-enforcing the patient’s notion that there is something seriously wrong with their back. Perhaps we should be shifting the patient’s focus away from their back. (I often stop patients doing specific back exercise).<o></o>
Furthermore, CS training may shift the therapeutic focus away from the real issues that maintain the patient in their chronic state. It offers a simplistic solution to a condition that may have complex biopsychosocial factors. The issues that underline the patient’s condition may be neglected, with the patient remaining uninformed about the real causes of their condition. Under such circumstance CS training may promote chronicity.[I]<o></o>
[I]Conclusion<o></o>
Weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not pathological, just a normal variation. The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote CS.<o></o>
Weak or dysfunctional abdominal muscles will not lead to back pain. <o></o>
Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.<o></o>
Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise. Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain. Any therapeutic influence is related to the exercise effects rather than CS issues.<o></o>
There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities. Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them.<o></o>
Epilogue<o></o>
Many of the issue raised in this article were known well before the emergence of CS training. It is surprising that the researchers and proponents of this method ignored such important issues. Despite a decade of extensive research in this area, it is difficult to see what contribution CS had to the understanding and care of patients suffering from back pain.<o></o>
<o></o>
Not being an expert in the field I can't comment. Other than to say if I had a $ for every situp I haven't done in my life I could've retired 5 years ago!
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Continuous and abnormal patterns of use of the trunk muscles could also be a source of potential damage for spinal or pelvic pain conditions. It is known that when trunk muscles contract they exert a compressive force on the lumbar spine [45] and that CLBP patients tend to increase their co-contraction force during movement [44]. This results in further increases of spinal compression. The advice in CS for patients to increase their co-contraction is likely to come at a cost of increasing compression on the already sensitised spinal joints and discs [33, 63]. Another recent study examined the effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations [117]. The abdominal stabilization maneuvers were - abdominal hollowing, abdominal bracing and a “natural” strategy. Abdominal hollowing was the most ineffective and did not increase stability. Abdominal bracing did improve stability but came at a cost of increasing spinal compression. The natural strategy group seems to employ the best strategy – ideal stability without excessive spinal compression. <o></o>
An increase in intra-abdominal pressure could be a further complication of tensing the trunk muscles [118]. It has been estimated that in patients with pelvic girdle pain, increased intra-abdominal pressure could exert potentially damaging forces on various pelvic ligaments [119]. This study for example recommends teaching the patients to reduce their intra-abdominal pressure, i.e. no CS. <o></o>
Maybe our patients should be encouraged to relax their trunk muscle rather than hold them rigid? In a study of the effects of psychological stress during lifting it was found that mental processing / stress had a large impact on the spine. It resulted in a dramatic increase in spinal compression associated with increases in trunk muscle co-contraction and less controlled movements [120]. <o></o>
Psychological factors such as catastrophising and somatisation are often observed in patients suffering from CLBP. One wonders if CS training colludes with these factors, encouraging excessive focusing on back pain and re-enforcing the patient’s notion that there is something seriously wrong with their back. Perhaps we should be shifting the patient’s focus away from their back. (I often stop patients doing specific back exercise).<o></o>
Furthermore, CS training may shift the therapeutic focus away from the real issues that maintain the patient in their chronic state. It offers a simplistic solution to a condition that may have complex biopsychosocial factors. The issues that underline the patient’s condition may be neglected, with the patient remaining uninformed about the real causes of their condition. Under such circumstance CS training may promote chronicity.[I]<o></o>
[I]Conclusion<o></o>
Weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not pathological, just a normal variation. The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote CS.<o></o>
Weak or dysfunctional abdominal muscles will not lead to back pain. <o></o>
Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.<o></o>
Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise. Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain. Any therapeutic influence is related to the exercise effects rather than CS issues.<o></o>
There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities. Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them.<o></o>
Epilogue<o></o>
Many of the issue raised in this article were known well before the emergence of CS training. It is surprising that the researchers and proponents of this method ignored such important issues. Despite a decade of extensive research in this area, it is difficult to see what contribution CS had to the understanding and care of patients suffering from back pain.<o></o>
<o></o>
Not being an expert in the field I can't comment. Other than to say if I had a $ for every situp I haven't done in my life I could've retired 5 years ago!