Core Stability – Research Update – May 2015

I have posted previously regarding the “Core Stability Problem“.

One of the first articles I reviewed this year in relation to this topic was:

An update of stabilisation exercises for low back pain: a systematic review with meta-analysis by Smith et al (2014).

I think this systematic review quite clearly demonstrates where we are now at with the “Core Stability” and the “Stabilisation” approach. Key conclusions by the authors being:

There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.

The other key conclusions from the authors, which were unfortunately not included in the abstract, were:

The results of this current systematic review suggest that stabilisation exercises improves low back pain symptoms, but no better than any other form of active exercise in the long term. The low levels of heterogeneity and large num- ber of high methodological quality of available studies, at long term follow-up, strengthen our current findings. There is a trend of worse fear avoidance scores.

This review cannot recommend stabilisation exercises for low back pain in preference to other forms of general exercise, and further research is unlikely to considerably alter this conclusion.

Repeating the key points:

Core stability training is not superior to other forms of active exercise. It is not the “magic” fix or “key factor” that people need to work on the improve their back pain.

Core stability training programs demonstrate a trend for worse/higher fear avoidance.

I think the Fear aspect is a really critical factor to reflect upon. When I reflect on my past clinical practice of prescribing core stability exercises I recall using phrases along the lines of:

Your back is unstable.

Your core muscles are not working correctly hence your spine is at risk of damage and deterioration.

You need to contract your core muscles before you lift so that your back is supported. If you don’t contract these muscles your back will be more likely to be injured.

You need to retrain your core muscles to “switch on” automatically, or else your back is vulnerable to injury.

You need to improve your core muscle activation to support your damaged disc.

I can now quite clearly see why a core stability program might elevate fear in patients versus, for example, a simple graded exercise/gym program incorporating education about pain within a biopsychosocial framework.

Surely our rehabilitation programs should not be promoting fear? They should be promoting confidence and self-efficacy!

So I am having a hard time seeing any relevance in sending people down a core stability training program, in particularly the types of core stability training I have done in the past (the isolated deep muscle contractions and training people to contract these muscles pre and during tasks).

By the way I don’t think that “planks” are a problem…..

I just see too many patients that think that their back needs to “move like a plank”.