The Beyond Pain Podcast

Episode 74: The Core Stability Myth: Why a Strong Core Isn’t the Cure for Back Pain

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Summary

In this episode of the Beyond Pain podcast, Joe LaVacca discusses the common misconception that poor core stability is the primary cause of low back pain. 

He emphasizes the need to shift the focus from merely strengthening the core to building confidence and flexibility in movement. Joe explores how traditional approaches to core stability may not effectively address pain management and highlights the importance of adapting movement strategies to promote recovery. 

The conversation encourages listeners to rethink their understanding of core stability and its role in overall spine health and pain management.

Takeaways

  • Poor core stability is often blamed for low back pain.
  • Bracing the core may provide short-term relief but isn't a long-term solution.
  • Building confidence in movement is crucial for recovery.
  • The spine is adaptable and should not be viewed as fragile.
  • Core strength does not directly correlate with pain reduction.
  • Movement should be prioritized over static core exercises.
  • Pain is not always indicative of tissue damage.
  • Strengthening the core should be integrated with overall body movement.
  • It's important to teach patients how to move safely without over-bracing.
  • The ultimate goal is to enhance movement capacity and flexibility.

Joe LaVacca (00:44)
Hello everyone and welcome back to the Beyond Pain podcast. My name is Joe LaVacca I am one and your only host today as Mr. Joe Gambino is sick. He is taking care of his beautiful children and wife and himself. So he will be back joining us next week, but I'm here. I'm ready. And I figured we can have a little chat.

And make this a mini episode based on some of the things I still hear in clinic this week and had conversations of clients over and over again. As always, you can find this podcast on all your major podcast outlets. You can find us on Instagram at Joe Gambino DPT and at strength and motion underscore PT.

And you can also follow the show on Instagram as well at the Beyond Pain podcast. If you are enjoying the show, please, please, write a review, share it with your friends. It will really help the show grow. Now, what is our topic today? And it could probably be our topic every week. That's how often I hear it in the clinic. And that is going to be the idea that poor core stability

causes low back pain and that targeting your core is sort of the key of getting out of back pain. If you have targeted your core and only your core, maybe you were one of the lucky ones that felt better. However, I'm willing to kind of bet my money that a lot of the core stability bracing ideas maybe didn't get you where you wanted to be. So that's what we're going to

talk about today. Now the core stability idea originated around research basically saying that a lot of these deeper muscles around our trunks kind of have a delayed firing with low back pain. However, with all new research that is exciting, it typically just leads us to the next question or at least the next process. The biggest process for confirming a new idea

repeating that idea with different labs, with different researchers, because if it is true it should come up no matter what. Now here's the kicker. Subsequent studies of varying movement patterns and firing muscles don't really show a consistent pattern in people with low back pain. So therefore it becomes a lot harder on knowing what to target.

At the moment then, there's really no clear link between core strength and timing and reducing pain or injury risk, particularly around the spine. So what's the message that we really need to be conveying? That bracing, keeping your core tight may not be the best solution in the long term.

but rather thinking about your spine as mobile, adaptable, resilient could potentially be. So why does bracing or why does keeping my core tight maybe help me in the beginning? Well, let's think about this. When we have acute pain, the main body or the main job of the body is to protect us. That typically means limit motion, play it safe, just

really be on high alert in case something is going wrong so these tissues can heal. And let's just say that for most of us this lasts for maybe anywhere between a couple days to a week or two. Once we move out of the acute pain phase when our tissues should sort of be getting the go ahead or let's resume our normal process, pain can still linger around

However, not moving or moving a little bit less typically makes us feel a little bit more comfortable. This then continues to give us the idea that staying in one position is what we need to do and that maybe other positions are a little bit harmful. So I think that the core stability idea and the posture idea, which we've talked about previously on the show, sort of go hand in hand and probably build from a lot of the same narratives. So should we get rid of it completely?

I don't know. It's, it seems to be a useful metaphor for training. Most people can grab onto it, but I think what we need to do a little bit better as a team, and this is you and I, as provider and patient is realizing that it's not a scientific diagnosis and it does not mean that you are fragile or, you know, unstable. So I think what we want to probably do is shift this idea of

rather than fixing something weak, we just wanna help you build confidence and tolerance in a lot of different modes and lot of different positions. So if that means starting you in a plank and starting you with some breath tools, then so be it. If you're highly irritable, this is where I start a lot of people. When you are ready for more movement though, we need to keep the wheel moving in a forward direction or else we get stuck.

So one of the things we want to think about is eventually using these tools like isometrics or core stability to entry point or gateway back us into some safe movement, but then realize over time it's gonna be more about flexibility, not rigidity. So let's dive into this a bit more. And I think that

What's on my mind is really how the PT or your PT and yourself communicate and build upon these expectations. Because I think it's a delicate dance and I don't think I'm successful with it all the time because it probably depends on the time of the day and what's going on in my life and who I just saw and who I'm seeing. But I try not to invalidate someone who comes in and says,

Well, someone else told me I need to strengthen my core. If I simply just say, well, that's a myth. There's nothing truthful to that. Your previous provider doesn't know what he or she is talking about. Well, I'm going to probably lose your trust and trust and communication really is probably one of the biggest foundations of the show. So if I agree with you.

and say, yeah, well, that's definitely the idea that we need to do here. Well, now maybe it's a little bit more setting you up for failure. Well, maybe I just didn't do the things right. Maybe I didn't do them enough. Maybe this is my fault because my previous PT said I need to get stronger or my core more stable. Joe's saying I need to get my core strong or more stable. So let's maybe think about how we can.

better communicate this idea, how we can start to maybe pivot a little bit in practice. And regardless of if you're a patient of Joe or mine, a clinician yourself or working with someone else, I think that this idea here or maybe these couple of points will help you have better conversations and help direct your care. So first and foremost, I think your clinician should be acknowledging why this makes sense.

Because a lot of people have been told this. would say almost everyone I've treated for low back pain at some point or another said or has heard they just need to get their core stronger. So one way to reiterate that point is yes, working on your core or the muscles around your back definitely means or makes people feel stronger and more confident. If you came in with back pain and I said,

Okay, cool. We're gonna let your back chill. Here's some wrist curls and calf raises. Well, I'm probably leading into the notion that your spine can't handle any load. So I'd much rather start with planks and bird dogs or breath work than giving you motions away from your spine. Cause I actually kind of think that that's probably a little bit more pushing into that idea that you're just too fragile to load. So I'll take course stability over those other things any day of the week.

How we want to maybe pivot gently or think about this from a different standpoint is that newer research or just newer ideas around the profession is sort of letting us believe that your spine really isn't fragile. And once we come out of this protective state, it's not about maintaining perfect core or perfect alignment, but rather helping your body feel safe and capable again. And I think this will start to invite some curiosity.

rather than confrontation. Now that's just sort of point number one. What if, you you just want to strengthen your core a little bit. You've always felt maybe unstable. I think again, this is definitely an opportunity for your clinician to guide you a bit because let's face it, I'm going to train your core with every other movement that we do. So your bicep curls will

actually challenge your core to some degree. Your squats will, your deadlifts will. So yes, we're definitely going to train your core. I don't want to swing the pendulum so far in the other way that says, well, just because core stability might not be linked to your pain, I'm still going to train your core in lots of different ways, but I want to link it with the rest of your body so everything can work together. And then we can get you thinking more about

capacity and Then help you move forward from there now I do understand that to some degree just telling people a lot of these ideas are only going to go so far and Movement always teaches a lot faster. So when people are in pain, they're going to be less likely to want to move

Another reason why these core stability or planks or, you know, heavy isometric exercises make sense. can introduce load without a lot of movement. can even pick and choose the position you're in, the angle you're in. can pick and choose how much tension I can pick and choose how much you're holding your rep for. So can really tailor this idea. However, I also then probably want to mix and match this by teaching you how you can move without over bracing.

or making you feel safe again. And Joe brought up a great point last week. If you listen to that episode, when we were talking about, getting stuck in rehab and doing different things with people, Joe said his child decided to run out of the middle of the street and he had to go after her. Now that's not a core bracing principle that was reacting in the moment that was moving fast.

that was moving limbs wildly, that was doing whatever you could do to get to your goal. In this case, Joe's goal was to protect Olivia from running out into the street. And I think as a parent, or if you have nieces and nephews or baby cousins or things in that, you've probably been there too, where someone's about to fall, someone's about to knock their head on the corner of a table, and then your instincts kick in and you jump up and you scream and you shout and you jump and lunge. So none of that.

going to get better by doing isolated core stabilization ideas. At the same time though, people typically aren't just ready to just jump back into deadlifts and squats and all these high-level approaches when they might be in acute pain or maybe when they're in a flare. So by positioning you on your hands and knees or on your back or sitting versus standing or staggering with one leg or having uneven weight in your hand,

All of these things can sort of trick or teach your body that you don't need to over race with everything. Maybe it's playing a game of catch. I love playing games to catch with people, just kind of throwing balls in different directions. You know, just having to move and kind of like talk to me and you know, maybe I accidentally throw or bounce a ball to them and see how they react. Right. So we do want to teach safety again. We want to teach reaction, but remembering at the same time that there is no right way to

move. So again, this idea of having a perfect core, maybe we need to break that model a little bit more and think your core needs to be flexible. It needs to twist and move and bend and adapt. So if we only continue to progress our planks, our core isometrics and things like that, again, we're not helping people move forward with that idea of healing.

And we're probably not matching what the evidence says anyway. So how about we sort of reframe this idea of instead of fixing an unstable spine, we give people the notion that the goal is to make your spine even more stable than it already is. And if we can make you even more stable or stronger,

Well, now we can increase your capacity. We can build trust in your body again, but we're shifting the narrative away from correcting a deficit and just focusing on improvement or development in an area that's probably already okay. Right. And all you have to do is click back a few episodes to hear Joe and I talk about pain over and over again and how

The longer it lasts, the less reliable of an indicator of tissue damage it is. The changes that happen in the nervous system, the changes that happen in the brain, you these are all real things, but then they all lead to big changes in behavior. So if I'm treating people delicate or you are getting treated delicately, it's going to be really, really hard to move past that. So why do some people get better with coercibility?

could just be time. It could just be the idea that, you told me what hurts and let's think about bending or squatting or running, which, you know, exerts a certain force or energy demand on the tissues around the spine. And if that force level, if we're thinking about a ladder, was on rung number eight, and I gave you a bunch of core stability exercises on rung number three, well, we're not getting anywhere near.

the sensitivity level of these tissues, which again, could be a good thing for building confidence early on. However, if I kept you there and never challenged you, well, now we're leading to tissue D conditioning and you're going to continue to get stronger at level three exercises, but probably weaker at four, five, six, seven, and eight exercises. Just to use this ladder analogy. And I think this is where people get frustrated.

They come in, we meet them where they are. We give them easier motor control exercises that don't trigger pain. They do them for six to eight weeks. Pain typically ebbs and flows or goes down over that time span anyway for most people. Because now pain has gone, people think they're better. They get discharged from physical therapy now potentially in a weaker state than when they came in.

They think that maybe all they need to do in the future is either stay away from high level movement or continue to strengthen their core with lower level things. Now we can maybe see why when I go to run after Olivia, when I go to deadlift again, when I go to press something over my head or get something out of the garage, my back stiffens and tightens again. And then

Again, just like last week, Joe was talking about that rehab loop. We get stuck in the rehab loop. Now I'm back to PT. I'm doing more low level exercises. Now maybe because the pain is recurrent, I'm getting sent for a scan. Now because I'm getting sent for a scan, I have to see a doctor. Now the doctor basically tells me, what am I doing? I'm going to be 40 years old. I have no right just rowing however I want, squatting however I want, deadlifting however I want. And now we're kind of back into this very defeatist disablement.

So what's the wrap up here? If you've been told that you should strengthen your core to alleviate your back pain, go do it. Clinicians, if you tell your clients that they need to strengthen their core to eliminate their back pain, go do it with them. But remember that it is not the end goal we're trying to get to. Most people are already going to come in with stiff

very immobile backs when they have pain. So just because we're meeting them with exercises that don't cause their pain does not mean that we're conditioning them to the point to get over their pain or conquer their pain in the future. So we can use this core stability idea as a way to promote some confidence, get people moving. But then the big picture is going to be promoting safety in all movement.

capacity in different positions and leading people to think it's not only safe to stabilize your spine, but to bend it and twist it and flex it and extend it as well. So that's just my little rant and things that was on my mind from the week, again, inspired by some clients that we just saw in the clinic.

I'm sure I will have this conversation again with people I love or we would love for you to share your experiences with your PT or if you're a PT, how you sort of navigated this conversation. So leave us some comments, drop us some likes, leave us some reviews, let us know how we're doing. Let us know what you want us to talk about. We'll be back next week for another exciting episode of the Beyond Pain podcast.

I will be joined by Joe, but for now, listeners, we love you, and I'm looking forward to chatting again soon.