The Core!

The Core!

The Core!

Yep, you guessed it – this week we are biting off a very big subject which I have some fairly strong opinions on. So, please feel free to comment and disagree with me, I do not mind! And please bear in mind that through this blog I mean to empower you, free you from misconceptions, give you my opinion earned through experience, but not knock any other health professionals. In the end, you get to choose!

So…. The Core!! So often discussed and blamed – yet what is it?

Historically when someone discusses the core, they are referring to your ability to contract a muscle at the front of your pelvis. This muscle is called ‘Transverse Abdominis’ (TA) and runs between the two boney bits at the front of your hips. It lies very deep and when isolated supports and locks the front of your pelvis.
I remember when the research on TA came out around 1995, it was a big thing in the Physio community and was utilised widely as it was discovered that contraction of TA caused a simultaneous co-contraction of Multifidus. This muscle (Multifidus) is also deep but lies close to the spine and was found to no longer fire after a lower back injury – firing once more with contraction of TA.
Therefore Physios (myself included) turned their attention en masse to getting TA contractions in the hope of strengthening the under-firing Multifidus. Sometimes what is great in research doesn’t carry over to reality lol.

It seems traditional Physio still builds on this research today, with the focus on ‘Core’ exercises being a large benchmark in treating lower back pain. And though I recognise the need for TA strength, I personally disagree to this approach, even though it is implemented with the best intentions.
In my experience, no amount of strengthening will remove pain / dysfunction or fix a lower back issue. Sure, once the problem is fixed, strengthen your core, but not the other way around. In fact, so many times, premature strengthening worsens an issue – in particular when the sacro-iliac joint is inflamed and hypermobile. In this case, contracting the TA effectively gaps the inflamed and irritated joint, making it worse.
Am I going too deep here? My apologies. My point is that routine prescription of TA exercises is not appropriate – correct diagnosis and specific treatment of the issue presenting is the first priority in every case.

So what do I believe?

For the rest of this blog I will utilise a different expression of what I believe ‘The Core’ really is:
If we are attempting to lock and support the pelvis, then in my opinion the core is not one dimensional (as in TA), but three-dimensional, just as is the pelvic structure…

When discussing the core, I refer to 1/2/3:

‘1’ being contraction of the transverse abdominis (TA) – pulling in the front of the pelvis;
‘2’ being contraction of the pelvic floor – pulling up the base of the pelvis;
and ‘3’ being contraction of the gluteals – pulling in the back of the pelvis.
When we layer 1/2/3, we have effectively locked up and secured the pelvis and its underlying organs against any downward loads, having strengthened our frame and its ability to carry weight incredibly.

Which brings me to when we need to utilise our core (1/2/3)…

To answer this, we need to understand that different muscle groups in our body have different purposes. For instance, our quads (front of the thigh) are power muscles, purposed for movement and strength. We train these accordingly with weights and running etc.
However, our abdominal muscles and pelvic floor are not power muscles – they are skeletal and are created for postural support. Their true function is to support our internal organs, and co-contract to support our pelvis under loads.
Therefore in my opinion, if we would like them to contract appropriately as postural supporters, we are wasting our time training them as power muscles.
Ohhhh, I can feel the steam rising from my PT friends about now!!

But, if we think about it, what do sit-ups really achieve us? We are working skeletal muscles as power muscles, and though we may be able to bulk and define them a little, does this kind of strengthening have any carry-over to life? I can count many patients who presented with impressive 6-pack abs with zilcho core stability or ability to recruit them when needed. Instead of sit-ups we need to train our brains to co-contract our 1/2/3 core at the times we need it – when lifting weights, or children, or groceries etc. I guarantee a 6-pack in the process of correct stabilisation!

So should we therefore be contracting our core at all times? In my opinion – no.
In fact, I have treated a number of issues in women (in particular) who have utilised the ‘constant core contraction’ theory which is vogue at present. There have been a number of dysfunctions linked with this – the pelvic floor developing trigger points due to its over-activity…
Like all skeletal muscles, the core needs to be contracted for a purpose as opposed to constantly. After all, we want our brains to eventually be wired to contract the right muscles for the right occasion – not contract everything constantly!

Well I think I should leave it there for today! I have a bunch more to say, especially with regards to my ‘post-baby’ friends, but this is a whole blog in itself!

Thank you all for your fabulous feedback – and let me know if you would like more specific info on ‘the core’ and how to make it work for you. Message me with any questions you would like discussed, or book in (online or ph 0400284408) if you need to get yourself sorted!
Yours in ‘Solving the Unsolvable’
Elizabeth Orr… 

Elizabeth can be easily contacted via the following:

Website:  physioandacupuncture.com.au 

Email:  [email protected]

Phone:  0400284408

The thoughts of this blog are of the individual writer and not necessarily those of the Nurses for Nurses Network. To read our full disclaimer click here >>

Authored by: Elizabeth Orr

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