A Scientific Response to the Article- The core stability myth
By Jackie Snell | 14th August 2010
A Scientific Response to the Article:
The Core Stability Myth.
Published in the Times Newspaper, Tuesday, 10th of August.
Response written by:
Mr. Glenn Withers
Founder of the Australian Physiotherapy and Pilates Institute
All rights reserved.
I am writing in response to the published article in the Times newspaper on Tuesday, August 10th, entitled 'The core stability myth', written by journalist Peta Bee. This article is a continuation from the 'myth of core stability' paper published by osteopath Mr. Eyal Lederman
This was a fascinating and thought provoking article that puts forward the idea that all exercise related to core stability, including, and specifically that of Pilates, is a myth. In fact the article goes further to state not only is Pilates not helpful for people with back pain, but can indeed make back pain worse. I feel it is necessary to respond to this article as it is very misguided, in my opinion dangerous, and sadly in parts completely factually void!
I would like to analyse the article with you over the course of this correspondence.
The idea that this article may be misinformed begins on the very front paragraph. Peta states that few gym workouts "are conducted without the cues to engage your 'core' by pulling in the belly button and sucking in the stomach ''. As you will all know the two exact cues that we have been advocating for years are completely incorrect. Pulling in the belly button will cause the upper abdominals to activate rather than the lower abdominals, the exact incorrect patterning that Urquhart, et.al, (2005 ) showed with their highly regarded, empirical research, published in the Journal of Manual Therapy is not optimal in back pain sufferers. Urquhart showed that the upper and lower abdominals have different functional patterning, and that it is the lower abdominals that are affected by back pain. Sadly this vital bit of research has been ignored. Secondly, the cue to 'suck in the stomach' once again has not been used for years in anyone truly managing back pain, once again missing the relevance of Hodges et.al 1996 ) that showed the link between the activity of the diaphragm and Transversus Abdominis (Tr.A).
Peta has, in her defence, referenced Hodges early research of 1996, 1997 and 1998 in relation to the timing of activity between healthy and non-healthy backs in his ground breaking early research. Sadly, this concept has moved on, it is now 14 years since this publication and Hodges (2008) more up to date research, acknowledges that Tr.A alone is not enough for rehabilitating the spine after injury, but that it is still a vital component of re-training correct spinal mechanics after back pain. A concept we have been teaching for over 9 years now. Indeed, Hodges has now been able to map the cortical response of Transversus Abdominis and its actual change in the motor cortex that occurs after back pain, this motor cortex change is specific to the Transversus Abdominis.
Peta then moves on to proclaim that this research, the 14 year old research, was adapted by gyms to prevent back pain, along with a washboard stomach. An interesting link, as a washboard stomach has a lot more to do with rectus abdominis, a muscle that has absolutely no attachment to the spine itself, and what Hodges and many fellow researches, acknowledges has no link to the occurrence of or the prevention of back pain.
A large part of the article then discusses Stuart McGill's article that this notion of Transversus Abdominis activity actually reduces the spinal support by bringing the muscles closer in to the spine. Now Stuart has some relevance in his article, but the misguided concept that this is relevant to all components of core stability is widely acknowledged. Stuart proposes that bracing the abdominals is a more complete strategy to achieving support for the lumbar spine. In doing this movement one increases the intra-abdominal pressure and braces the spine. Now, this can be appropriate in one of two ways, either with high load tasks or with unpredictable movements such as falling off the sidewalk. This bracing movement is however an automatic reaction to that perturbation.
As a training tool it is rather misguided. If I was planning to lift 100 kg from a standing position, I would agree with Stuart. However, if I am sitting at a desk, bracing of the abdominals is not relevant to functional task. In deed, the way we activate, and therefore the way we train the abdominals is load dependant. The training should be specific for the functional task. As we know, the 'bracing' concept makes muscles work at close to, or at, their maximal capacity (MVC). In this instance muscle fatigue will set in and therefore leave the spine even more vulnerable. In fact, if we looked at this scientifically, we know that the stabilising muscles of the spine, Transversus Abdominis, multifidus, pelvic floor and the diaphragm, are actually predominately type 1 (endurance) fibres, not type 2 (fast acting) fibres. This concept would actually only recruit the type 2 fibres, and these are fatigable. We know that APPI advocates a sub-maximal lower abdominal recruitment initially, and then when load is added, the other abdominals are activated in their normal load bearing capacity, a task they are specifically designed for.
The article then moves on to report that physiotherapists have seen a growing number of people who have back problems as a result of poor Pilates technique. "They tighten their lower backs, stop breathing, or drop their pelvic floor muscles when attempting to 'engage the core'. All of which can potentially make the back pain worse". This is reported by Pete Gladwell, a pain specialist with Bristol NHS, and a well known advocate against the growth of core stability exercises. I highly value Pete's opinion, and agree with much of what he has said. However, we all know that what Pete has described is not Pilates at all. Pete has effectively described exactly what Stuart McGill proposes, therefore leading to a large contradiction in this article. Pete has actually described abdominal bracing(tightening the lower backs, holding your breath and therefore causing a depression of the pelvic floor). This is the exact opposite of what is actually taught in Pilates, and specifically in the APPI approach.
You will see in this ultrasound evidence below the difference between the concept of 'centre' as we propose it, and the concept of 'abdominal bracing'.