'The Core' A Reductionist Fantasy
Sitting comfortably? Grab your favourite cuppa or cold drink and get ready for some possibly thought provoking reading. :)
Every few months or so I like to write a blog about a topic which I find compelling. The topic this year is referring to something we are used to hearing a lot about namely; The 'Core'. It is a widely used concept both in the fitness industry as well as amongst our physios, doctors and so on. I've been meaning to write something on this topic for a long time as there are so many common misconceptions floating around us which are merely assumptions based on this whole concept of a 'Core' .
Here are some examples of those misconceptions I hear on a regular basis in my classes:
'I get back pain, so I Need to strengthen my core'
'I haven't done exercise in a while, my back (spine) is stiff and probably weak so I should strengthen my core'
'I want to improve my posture so I need to work my core'
'My abdominals are doming when I do certain exercises so there must be something I can do about my core'
'Pilates strengthens your core so that is why I'm here'
The Core. Does. Not. Exist.
It is a Reductionist Fantasy.
In fact, the core concept was invalidated over 15 years ago now.
Have I got your attention yet? :)
The concept of core does not reflect how we learn to move let alone how we move day to day as human beings whether we are playing tennis, skiing, walking or working out in the gym. The core concept is not a functional one but our bodies on the other hand are.
It would be nice if the concept of a core was true. It is such a simple formula and an easy one to understand. Yes, wouldn't it be great if we could just eat broccoli everyday and not get cancer...This is what the analogy versus the concept of the promises of a strong core looks like. It sounds so good it must be true!! But unfortunately (or fortunately, depending on which way you look at it) the body is much more complex than that yet very simple in how it actually operates.
There is no actual conclusive research that shows us that the core does what we have been told it does. None. In fact, there is plenty of research proving the opposite of what we have been told so far.
The core concept was born from research in the late 90's by a group of Australian physios, (Richardson, Hodges*, Joel and their team. )What the research showed was that there was a change in the anticipatory timing of the trunk muscles in those people with a back injury or with chronic back pain.
(This research timed itself with the emergence of Pilates in the everyday market. You see, in the 2000's we saw the last court case relating to the use of the trademark of 'Pilates'. And with that we had a huge explosion of Pilates and Pilates training companies throughout the world. This tied in with what came out of the research in Australia which all fitted very nicely together at the time. )
What they found in this research was that in a normal patient the Transverse Abdominis (TVA), (your oblique muscles ) were recruited 50 milliseconds prior to the Deltoid (shoulder) when they lifted their arm. They found that with a patient with back pain or a back injury, this anticipatory recruitment was not consistent or didn't happen at all.
From that, there were huge assumptions made about the implications of training the TVA and the other musculature that were pulled into this definition of 'core' and their relationship. (TVA, Lumbar Multifidus, Pelvic Floor, & Diaphragm)
These assumptions pulled together this whole industry that said that if we train these muscles this will lead to a decrease in lower back pain.
Other assumptions made during this study was that:
1.Certain muscles are more important in Spinal Stability than others, in particular the TVA
2. Weak abs lead to back pain
3.Strengthening the abdominal wall will decrease back pain
4.There are a group of trunk muscles called the 'core' which can work independently of other trunk muscles
5.There is a relationship between the stability of the Spine and lower back pain. i.e , if the spinal column is unstable you will automatically have lower back pain.
All these assumptions tied in with the emergence of Pilates. Jumping on board this were also physios, GP's, and pretty much the rest of the whole fitness industry. This created this industry in itself of 'core stability strength & training', of cuing the core, of 'activating' it and of constantly trying to isolate muscle contractions etc...
Eyal Lederman (clinical researcher and a lecturer with a phd in Physiotheraphy..) breaks all this down in his fantastic paper: 'The myth about core stability.' All the studies are listed there and there is a lot more which is deeply explained and detailed if you wish to know more about the subject.
So, what about the role of TVA in spinal stability. Is it essential ? What happens if it's not functioning well? According to the core programming it is such that if we have a weak TVA, we should therefore have spinal instability which may and does lead to back pain. That is the assumption that was made and this is why it is simply not true:
1. In Grey's Anatomy (not the series :) but the English Medical Textbook) they show that The TVA is either absent or fused to the internal obliques as a normal variation in some people, i.e some individuals don't actually have a TVA! Does that lead to lower back pain, or an unstable spine? No.
2. Pregnancy. A brilliant example. Here we have a dramatic elongation (lengthening) of the abdominals (due to a growing baby) The TVA are put under a huge stretch/strain and therefore not functioning optimally. Do we have an epidemic of back pain? No.
Eyal Lederman talks about pregnancy in his paper where after birth , 98% of pregnant women who had back pain during pregnancy in a research programme, once the baby was out, their back pain had diminished completely. This also kills the assumption that weak abdominals lead to back pain. Why do pregnant women often suffer from back pain? It could be due to a number of reasons. Hormones for example. But it certainly is not due to 'weak abdominals'.
It takes between 4-6 weeks for the abdominal wall to reverse the effects of this elongation during pregnancy and there is no increase in back pain either during that period.
We can look at people that are obese or suffer a massive weight gain. Studies have shown that increased weight gain and weak abdominals are only really weakly associated. You can be incredibly slim and still suffer with back pain. Weight has not been shown to be a back pain trigger. That stress of the extra weight on the abdominal wall does not equal back pain.
Another area is breast reconstruction in ladies who have suffered from breast cancer. Surgeons sometimes create a new breast from one of the pieces of the Rectus Abdominis (your six pack). One of the pieces is cut away to form a new breast. In these cases there has been no relationship shown between this and lower back pain, neither impaired movement in that area after the surgery.
The argument that the TVA is very important in the stability of the spine simply does not work as we can see. With all these cases mentioned above, if these assumptions were true, we would have an EPIDEMIC of back pain within these groups. But we don't.
Another very important thing to bring into this conversation is that it's simply impossible to work one set of muscles independently of others. Impossible. Our musculature is so closely intertwined and connected, you would struggle to split them apart even with a really sharp knife. The TVA is just one muscle in a whole list of structures within the body which gives us postural control and other things. To think that we can isolate it consciously in a contraction is just a load of nonsense. If you are exercising with a method where you are 'activating' or 'bracing' your 'core' you are adding way too much compression to the spine which can be really really damaging. After all, we're not competitive weightlifters, lifting 210 kg in weight!
(weightlifters have a technique where they need to hold their breath and brace the abdominals to freeze the spine at some point during a 'snatch'. Otherwise they won't be able to lift it)
In Pilates or any other exercise we're merely lifting a head, a leg or a set of weights. Putting pressure on top of the already perfectly balanced pressure your nervous system is automatically giving you is asking for trouble. And in terms of abdominal doming, guess what? Your doming will only get worse if you create even more rigidity than you had in the first place. The intra abdominal pressure from consciously 'bracing' your trunk is going to push the Linea Alba (thin sheath behind the abdominal wall) out, creating more doming. If you brace, you can't breathe down into the body so your bones will also have limited range of movement as a result.
If your problem is doming, we need to start with:
1. Breathing Technique. Does your diaphragm have sufficient space to move? Are you breathing down into the body or does your breath just stay in your jaws? 2. Spinal range of movement. How is your positioning in those exercises where doming is present? Are you bracing? 3. Muscles imbalances. Are your muscles more dominant in your lower back? i.e do they take over in exercises involving things such as Thoracic spinal extensions?
All of these can contribute to abdominal doming. We need to find out the 'why' so we can get to the 'how'. And all this without basing our strategy on assumptions, especially on the concept of 'core' which nowadays is a red zone. The overall movement pattern and breathing technique are key components to solving any physical issues or discomfort we might struggle with.
Let's go back to the initial study and why there was a delay in activation of the TVA in the patient when raising an arm. This is called an 'injury response'. Basically, we knew for a long time that when a person injures themselves, the body goes into some kind of protection strategy to prevent further damage occurring. For example with an ankle instability, when people sprain their ankles, we know that something happens to the motor control so they become unstable when they are standing on one leg etc.. In this research by Hodges and his team of people from Australia- they were able to show that the same protection strategy is actually universal. It also appears in the lower back when people have back pain, back injury, or even have the feeling of pain in the lower back. So in a way, the information is important, but it wasn’t this new, revolutionary idea. We knew that it was happening elsewhere in the body.
What is hugely significant is the way we learn to move. This is when we need to look at the nervous system. We need to consider how we actually learn to move from the beginning. We learn to move by practise. Our brain anticipate what we need to do to move, what we need to do to stabilise the spine against movement, and that anticipation, is based on experience. This all happens on a unconscious level. If we consider how learn to walk, it takes us a long time as little toddlers. We try and stand up, we fall over, we get back up, we might fall backwards. We gradually learn to walk by doing it, by practising walking. Same thing with for example.. skiing. Do you remember the first time you stood on a pair of skis? When we're trying something new we tend to tense up and over recruit, working far too hard. Eventually, we get the rythm of it by allowing our nervous system the time and the practise to anticipate what we need to do to ski down a hill. Eventually we learn to use less and less effort until we are working at an optimal rate. We certainly do not consider; 'I'm going to activate this muscle or that muscle, bend this knee and squeeze this...' we just keep doing it, keep practising it until it becomes smooth. The nervous system recruits the muscles and divides the job between them according to the task performed. Always. It does not split the body into 'core' and global muscles. Each and every muscle in your body serves an important function.
Our nervous system is there to teach us new movement patterns and how to move. We are likely going to start off using too much effort but gradually we'll move to that optimal load and optimal function where the nervous system has learned just enough to perform the movement.
It is the Propriorceptive system (a message system) that tells us that there is an anticipatory load. A message kicks into place, like connections throughout the body. All these connections work at a:
1. Subconscious (no thought) 2. Spontaneous (a natural movement) and 3. Subthreshold (just enough) level
Going back to what we've been told about the 'core', it just doesn't fit into how we move as human beings. How we naturally, spontaneously and subconsciously move!
If we consciously try to do something, try to 'activate' our core or draw up the pelvic floor, we're not working naturally and functionally.
The conscious 'activation' we're trying to do is too slow anyway for the movement.
During Subconscious activation of the muscles in the Australian research it took about 50 milliseconds. So if we think about the fastest thing we can do consciously ,( probably something like winking,) it will take about 250 milliseconds ( a quarter of a second). If we were to move from this conscious activation of muscles we need to switch things on so much quicker than that. 50 milliseconds to be precise, but we consciously can't do that! By the time you have 'activated your muscles', your body is already way ahead of you, thanks to your fabulous nervous system.
If I go to close my front door I don't first think: 'hold on, I need to activate my core, raise my arm a little,'... it's just not how we move! It is useless thinking that training this in a class or in the gym is somehow going to transfer onto my sport or real life. We're basically too slow when we try and activate something consciously. This type of training does not transfer and make the body's subconscious timing quicker and we will never consciously be able to better our activation timing to 50 milliseconds. :)
In other words, conscious activation of muscles is useless both inside and outside the gym. We're too slow. A waste of time. If you want to make your tennis better, guess what? You need to play tennis!
Our nervous system is so much more clever than we can possibly imagine. So we need to create an environment where the body learns. Where our nervous system learns to anticipate. We need to create the right environment for that to be happening.
Another thing is, consciously thinking of a movement (as mentioned already in relation to abdominal doming above) is far too much recruitment. It creates way too much tension which can be counter productive to movement and lead to rigidity.
You're not consciously thinking about holding your head up. But if you hear or read the instructions right now from me: 'hold your head up! ' Can you feel the rigidity in your neck from the instructions?( on something so simple as holding your head up. )
If I ask you to sit down, hold your hands out in front of you, palms up, elbows down by your sides, now you twist from side to side.
Imagine now your have a can of beans in each hand and then twist again. Now I'm replacing that by a bottle of wine in each hand, feel with happens to your body, you may feel the movement stiffening slightly, muscles switching on ...
Next, loose the bottles of wine and go back to empty hands, twisting from side to side. Now I'm going to ask you to: 'switch on your core' and twist.
When I asked you to just twist loosely without anything imaginary in your hands, possibly your movement was nice and loose. When I asked you to hold the beans and bottles of wine, you had a natural anticipatory action because you knew roughly how much beans and a bottle of wine weighs. Your Spine thought, 'ah I know how to keep myself safe here while we keep twisting' This was all happening without thought i.e you didn't have to think about 'stabilising or activating' anything.
How did you feel when I asked you to 'switch on your core'. Likely much more rigid right? Stiffer, because it is simply too much.
If you have pain or discomfort, consciously tightening up even more is a downward slope. Your body is already tight due to the co- contraction of the muscles within the injury response. Tightening muscles on this level will have a massive downward impact on our mobility throughout the body.
If anything we need to let go and allow the subconscious, subthreshold, and Spontaneous action happen. Allowing the nervous system to do its job.
What about posture and the core?
(Do I still have to go on? :))
Ok. If your trunk muscles were truly 'weak' well, you wouldn't be able to hold yourself upright for a start! The topic of posture deserves its on Blog so I'm not going to go into it too much. But generally we need to look at muscle imbalances throughout the body and the range of movement within your bones along with, what activities you do on a daily basis. I'll give you a clue to posture though by saying: Pilates has your back....
Why do we think we need to improve our posture? Is there an ideal posture? One for the blog I think...
Joseph Pilates never said that some muscles were more important than others. He talked about the Powerhouse but this is not the same as our concept of the core. The Powerhouse includes all the muscles in your trunk plus your glutes, your inner thighs... and within that powerhouse lies what to him was the holy grail-The Diaphragm.
Pilates works THE WHOLE body in every move. It is a functional movement system which allows us to lengthen and strengthen at the same time while we create space in the body and learn to breathe properly and fully. This is the reason Joe invented his technique. To oxygenate the body.
He was a genius. Way ahead of his time.
*Paul Hodges has later retracted the assumptions that were made in the 90's study about 'The Core' which some PT's and Physios are still holding onto today despite evidence on how the body actually works. You can watch the interview with Paul Hodges here: https://www.youtube.com/watch?v=hplw6Lg95SY
*The source for this blog has come from Eyal Lederman, 'The Myth About Core Stability'