Have you ever been told that you need to work on your “core” by a health professional or fitness instructor? Does your “core” just disappear because you didn’t know it was there in the first place or did you just misplace it one day?
So what does the term core stability mean? Like so many terms related to health, it has various meanings to different health professionals. Some clients with back pain will roll their eyes when I suggest using an exercise approach to low back pain.” I’ve done it all before and it doesn’t work” they lament. What can be difficult, is determining what they have been shown as exercise previously and how this relates to their particular back problem. Whilst no one approach to back pain works for all people, understanding the concepts used to treat low back pain is useful.
The concept of spinal stability has evolved through the 20th century. Joseph Pilates devised his “Pilates” system of exercise , that emphasised control of movement, in the first half of last century. The idea of spinal pain resulting from poor control of spinal stability, developed in the 1970s. This suggested that repetitive microtrauma damages spinal tissue because the spine looses stability. In the 1990s Manohar Panjabi, a researcher in the US described a system of spinal stability that further enhanced this knowledge .
If the spine is considered an unstable stack of bones that buckles without muscle control, Panjabi’s spinal stability theory relies on 3 subsystems that all work together .
The first known as the passive system is the bony and soft tissue structures including the ligaments and discs, and joints of the spine that keep the spine together particularly at the extremes of movement.
The muscles that act on the spine, know as the active system, is the second. Muscles can generate forces that control how the spine moves. This however is only as good as the computer that drives it. Relying on the third system known as the control system, muscles can only work when receiving correct messages from the brain.
Confused? You’re not alone. But essentially, a break down in any one of these three systems can lead to poor spinal control and potential damage and pain. So what can we do to improve this when things go wrong and can exercise help?
One approach is to identify which muscles are not working well and then retrain them so that they return to doing their job of controlling the spine. Because in the “normal” healthy spine these work on automatic pilot without us thinking about them, learning to turn them on during activity is not necessarily easy. It is not a case of just bracing everything and hoping for the best. Too much force and pain can actually increase, and mobility can be lost.
Thorough assessment by a physiotherapist can identify those muscles that have stopped working , and those that may be overworking because the brain has identified an error in the system and has started to recruit the incorrect muscles. Technology such as real time ultrasound can be utilized to accurately visualise how the deep muscles are working. This can assist in prescribing the correct exercise program for each individual.
So for those of you that are lucky enough to not have back pain, breathe a sigh of relief that this wonderful, complex system of motor control continues to work and protect your spine without having to think about it too much.