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Thanks very much everyone for an interesting discussion.
Yes, John. That is one of my fears with core stability. Research has shown that patients treated within a purely biomedical model of pain do have worse fear avoidance. O’Sullivan, for example, has done lot of work. We know that patients with long term persistent pain show signs of higher levels of EMG activity, and increased trunk muscle activation. They often show an inability to relax. These maladaptive movements/beliefs/behaviours often make the pain worse. This coupled with the large emotional factors that coincide with LBP, fear/anxiety/ catastrophizing, fear of movement hyper vigilance further enhancing the pain and disability levels. Core stability could increase these features, not help.
Perhaps. But who’s to say we actually need to ‘strengthen’ any muscles at all. There’s a lot of uncertainty surrounding the therapeutic effect of exercise intervention; graded exposure, impact on the nervous system, the use of exercise to promote self-efficacy expectations, or adherence. It’s difficult to say why an exercise regime works. It’s likely not to work in the way we traditionally think it does, I would say.
John, there was a very small statistical difference in favour of core stability at short term. About 7 points on a scale of 0-100. However this is demonstrated as clinically insignificant.
Personally; no not really. I think there are far better entry levels exercises that can be used. There are some potential iatrogenic effects with core stability exercises that aren’t yet fully understood.
That said, if someone really enjoys these type of exercises, pilates or gym ball exercise classes for example, then I certainly wouldn’t tell someone not to do them. The best form of exercise is the one the patient is more likely to follow.
Hi HannahM. Yes, that’s correct. It’s not saying core stability isn’t beneficial .It’s saying it’s as beneficial as any other form of active, supervised activity. E.G a progressive walking programme, spin classes, mat based exercises etc etc.
What it is saying is that core stability is the great cure as was initially thought.
Good question.
Yes, I think this information hasn’t filtered fully down to clinical practice. My experience is that core stability training is still the default position that young graduates seem to take, and many experienced therapists seem to take.Hi All
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