Weak Core, Pilates and Back Pain.

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There is usually not a week goes by where I am seeing a back pain client for the first time and they tell me they think their pain is because of a “weak core”. The fact is, the whole concept of a weak core and its relationship to back pain is dubious to say the least. It mainly stems from research done in the 1990’s by Australian physiotherapists which showed a delayed onset to the firing of the core muscles namely the transverse abdominus (Tra) in people with low back pain. This has spawned a massive industry of mainly physiotherapists, Pilates instructors, personal trainers telling their clients to brace their core by, “pulling the belly button towards the spine”, or “sucking the stomach in”, in an attempt to prevent or relieve back pain.

The idea of the core being a corset of muscles that stabalise the spine is anatomically incorrect, as the body is integrated with a 3D movement system that involves a large variety of muscles and connective tissue that span many parts of the body to control movement of the spine. The biggest issue with the idea of bracing or tensing the spine is the vast majority of people I treat already have quite tense/overworked back muscles, stiff spines, poor movement patterns and heightened fear avoidance behaviors I’m not sure what the goal of bracing the spine actually is. Stuart McGill a Canadian world leader in spinal biomechanics research say’s pulling the stomach in/hollowing may actually weaken the spine.

Another thing to note is most people feel back pain and stiffness first thing in the morning or when sitting for extended periods of time. There is no reason why a weak core would cause back pain under these circumstances as there is very little force on the spine, whether a core is strong or weak is not an issue. Also sitting while bracing your core would feel extremely unnatural and potentially aggravate the problem.

More than likely the delayed onset of firing of the core muscles found in the research the original research has more to do with the response of pain as a neurological coping mechanism to avoid low back pain rather than the other way around. Pilates is probably the biggest proponent of bracing the core or sucking in the stomach with instructors and physiotherapist a like charging exorbitant fee’s for classes when in fact you would more likely benefit just as much if not more from general exercise such as resistance training, swimming, yoga etc… With a recent systematic review finding; There is low- to moderate-quality evidence that Pilates is more effective than minimal intervention with most of the effect sizes being considered medium. However, there is no conclusive evidence that Pilates is superior to other forms of exercises. When you consider you can do other forms of exercise for free or comparably at very low costs with similar if not better results for lower back pain, pilates or doing endless plank exercises may not be the best choice.

kieranfWeak Core, Pilates and Back Pain.