'The Core' in exercise

We delve into the concept and understanding of 'The Core' and it's use in exercise before looking at a more holistic understanding through the lens of IMMT.

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Why did the transverse abdominis break up with the spine? Because it felt that the spine was just using it for support and never gave anything back. Hello, greetings. As they say here in Sujo, China, and a very warm welcome to the IMMT channel, where we talk about all things mind-body health related with an emphasis on Pilates, functional movement, filden Christ, and manual therapy. Because here at Sino British Academy, that's what we do. Hello and welcome. Today we're tackling a massive topic in the world of fitness, health, and rehabilitation, which is the concept of the core. So, the core, is it fact? Is it fiction? What exactly is it? And do we really need to strengthen it? And why are some people still training their bodies like they're building a Lego set instead of a living, breathing organism? Hmm. What has this to do with the core? On June the 23rd, 2016, the UK voted to leave the European Union in what was known as Brexit. On June the 24th, a map was circulated in the media and on the internet showing the distribution of the people that voted for Brexit versus the geographics of bovine, spongyphone, and sepalapathy, otherwise known as mad cow disease. People were amazed how the prevalence of mad cow disease exactly matched the distribution for people who voted for Brexit. It was only later that someone questioned this correlation, and we found out that some smart Alec, presumably named Michael von Freising, had made a grey version of exactly the same map showing the geographic disbursement of Brexit voters, and added a new year and a new title to it, proposing it to be the Magal distribution of 1992. So, although seemingly funnier than my core joke earlier, what's it got to do with today's subject matter? Well, let's start by seeing if there are any theoretical models that may have an influence on what is popular teaching these days for the core. In 1987, Dr. Sergi Grachovetsky proposed the spinal engine theory, which was based on three fundamental principles of the torsional spring, how the curves of the spine store and release the elastic energy, what he called the power amplifier, which was to do with the global muscles of the trunk, like the latissimus dorsi, the gluteus maximus, how they weave together through the thoracolumbar fascia, and then scale up this rotational power generated by the spine. The hydraulic amplifier, which is how the intraabdominal pressure stabilizes the spine under heavy loads. Hydraulic amplification may also refer to the manner in which the muscle pushes out into the wall of surrounding fascia to create this force. So this certainly contains the elements of intraabdominal pressure, which is a cornerstone of the concept of the core with the diaphragm, pelvic floor, TA, and moltifidius forming the roof floor and wall of the container. Then in 1992, Punjabi introduced his spinal stability model of the passive, active, and neural subsystems. Now he didn't use the word core, but again, possibly this work may lay some of the theoretical groundwork. And then of course, 1996 came the biggie. This was Hodges and Richardson. They published their uh influential paper on the delayed firing of the transverse abdominus muscle or TA muscle. And they looked at just 15 people with low back pain and 15 people without. They had then moved their arms around and used the EMG, the electromyography, to measure the muscle activity. And what did they find? Well, they found that the contraction of the TA was significantly delayed in the group with people with low back pain. And a conclusion from this was that the delay indicated a deficit in motor control, which was then hypothesized, resulted in inefficient muscle stabilization of the spine. Then in the early 2000s, Stuart McGill translated this research into practical exercises and shifted the focus from movement more to stability, and hence the concept of the core was born. And more specifically, that the retraining of the transverse abdominus muscle was essential for spinal health. Now, fast forward to today, and the term core stability has become incredibly popular. It's presented as the key for preventing injuries, especially for the lower back, and as a must-go-to treatment for all sorts of musculoskeletal issues. How many times as a teacher have you heard someone say, Oh, I've got low back pain. I need to train my core. And this concept is now so infused in marketing hype that not many people have stopped to question where it actually comes from. In other words, people have started correlating back pain, mad cow disease, with the dysfunctional TA, Brexit, without questioning the validity or the rationale of it first. So here's some questions on that. First of all, Grakovetsky himself in 2005 stated that his work had been misinterpreted. In 2005, he produced a paper in which he argued against the standard idea of this rigid core, proposing instead a concept of controlled stability. He believed the torso shouldn't be locked down like a stiff braced cylinder, and it needs to dynamically flex, bend, and rotate to efficiently drive the human engine. The opposite to that, which a lot of people have nowadays, is my core is a rock. Yeah, great, your core is a rock, and rocks don't move. Secondly, Hodges apparently also said his work had been misinterpreted by saying that although he had stated there was a correlation between the pain uh dysfunction of the TA, he never said that the TA was the cause. So here we go. And then in fact, he later did some research and in 2003 published uh a paper that kind of solved this issue of does the back pain create the misfire in TA or does the TA create the misfire in uh does the misfire in TA create the pain? So to answer this question, Hodges took uh uh healthy people and injected them with some hypertonic saline or salt solution deep into the lower back. And this created a temporary pain, which perfectly mimicked the acute low back pain. The researchers then connected the electrodes directly to the TA, and then they could measure when and how it was firing. So these subjects were told to move their arms around in a map manner similar to his previous 1996 study, and they found that the subjects that were originally pain-free and had the TA firing flawlessly after they'd been given the injection to create the pain, the TA muscle began misfiring. Even more so, when the TA was inhibited and delayed, the superficial trunk muscles, like the rectus abdominis, the external obliques, started to overcompensate and they overactivated and changed their firing patterns. So this in itself seemed to clearly establish a rationale to treat pain quickly to avoid misfiring motor patterns that stick around long after the initial tissue damage is healed. Hence, this could be a very good explanation of chronic pain as the body enters into this chicken and egg cycle of muscle dysfunction and pain. However, let's go back to the year 2000 when a perfect storm was brewing. So, around about the same time that the ideas from the original research from Hodges were gaining traction. In the year 2000, a major legal dispute over the Pilates trademark was finally settled. Before this, at about, let's say, 1998, there were probably only around a couple of hundred Pilates studios in the whole world. But just two years after the trademark was cancelled for Pilates, the number of people practicing Pilates exploded by millions. So classical Pilates is always talked about the powerhouse. And contemporary Pilates, which is more, I suppose, fitness and rehab focused, somehow renamed or returned this term the core. Thus, the Pilates boom and the core research boom both happened at exactly the same time, feeding into each other perfectly. So, what's with all the isolated stability exercises that we see with the drawing in, the hollowing, and the bracing? I remember a while ago talking with Pilates master, teacher, and podcaster, Darion Gold, who told me a great story she heard. I think it was from Kathy Grant. Apparently, Kathy was on the trapeze table one day doing an exercise that Josie Pilates had not taught her. And Joe walked past. And he asked her, What are you doing? And she after she replied, he said, Well, so long as you are using the whole body. And this story always stuck with me. So I think it's a wonderful example of how the classical Pilates system also sees movement as being whole body movement and not in isolated parts. But at the same time, it's kind of an example of how some of the original teachings and philosophy from Josie Pilates may have been lost or distorted through this more contemporary fitness or rehabilitative approach, which becomes more segmental. When you tell someone to engage their core before they even move, realistically, you're basically telling their nervous system to go on high, hello. You're creating a bracing pattern, and it's kind of like trying to drive the car by putting the brakes on first. Yeah, sure, you're gonna move, but you're gonna be smelling burning rubber pretty soon. Now, in the last 15 years or more, there's been loads of uh large-scale systematic reviews and randomized controlled trials that have proven that isolated core stability training is no more effective at reducing low back pain than general exercise like weight lifting, walking, or swimming. So, in other words, spinal stability doesn't rely on a single muscle in terms of the TA, it's a system. As Ido Patel says, I think in patterns, therefore I move in patterns. And to back this up, in 2010, an English osteopath uh named Dr. A. L. Liedemann published, which is basically a mustery paper, he published something called the Myth of Core Stability, in which he systematically dismantles the idea that you need a strong core to avoid back pain. And he points out many things, such as things uh uh tilted pelvis, asymmetrical spine, these are just normal variations and rarely the direct cause of chronic pain. So, how many courses have you been on to correct anterior pelvic tilt? Think about it. When you watch these incredible break dances in the dance competitions on TV, or do you think, wow, I bet they have a strong core? No, you just see an amazing fluid dynamic movement, and the brain coordinates movement into patterns. It doesn't isolate the core from the rest of the body. Forcing a rigid trunk is actually non-functional. So if the core, as many people know it, is a myth, what should we be focusing on? And where or what is the real center? Well, a good start, I think, is just to think about integration. It's the fact that your diaphragm and your pelvic floor, for instance, they have to dance together. And if one of them has lead boots, the other one's gonna get its toes stepped on. And now comes what I think is a very important concept that we teach about here at Sino British Academy, at least, and that's when people talk about the core, they're usually implying that it's the body's center. But the body's actual center is located just in front of the second sacral vertebra, S2. So that's at the level of the SI joint, and the SI joint is where the forces from the ground are transmitted from up through the body and from uh from up, down through the body, and from down and up through the body. And this isn't a new idea. In Chinese philosophy, the Dantian is at this level, S2, it's the center of the energy. In Japanese martial arts, it's your hara, and in yoga, it's the seat of the kundalini. So all of these practices identify the same area, not some muscle on the abdominal wall, as the true center of movement and energy. And they see it as a system of interconnectiveness, and this goes all the way up into the cranial structures. So next time someone tells you to strengthen your core to fix your back pain, remember this mad cow disease and the Brexit vote are not the same thing. Isolated core exercises are no better than any other form of general movement and may indeed be detrimental or worse for your condition. And the concept of a rigid embraced core is really a myth. What seems to help is the movement itself, not some magical core stability. Instead of obsessing over a single group of muscles, start to think about your body as a dynamic interconnected system. Going back to 1992 with put with uh Panjabi when he proposed the concept of this integrated passive, active, and neural subsystems. We need to stop thinking about strengthening and start thinking about responsiveness. I don't want a core that's a brick wall, I want a core that's a suspension bridge that can give, it can take, it vibrate, can handle the wind. And I want to be able to focus on fluid, adaptable movement that involves your whole body. And if we go back to a previous uh podcast, you may want to think about the IMT approach with the three intrinsic pillars and the three extrinsic influences as an example. And also think about this as an example. Imagine next time you're at a workshop and the teacher starts talking about activating the glutes with some resistance bands, and they start to put resistance bands on someone, and now you observe that the person they put the resistance bands on, she or he can't put their weight back into their heel, which is needed to rotate the pelvis. Well, you know, wrapping bands around the knees is not going to change anything. So integrated movement is about geometry, not just firing single muscles. And your your brain doesn't care about your six-pack, it cares about survival. So if your brain feels that your spine is unstable, it will create stiffness to protect you. It's like an automatic parking brake. So you can stretch your hamstrings until you're blowing the face, but if the brain thinks you're gonna fall over, if it lets those go, those hamstrings are gonna stay tight. So this is the integrated movement piece. You have to convince the nervous system that it's safe to move, and thus the movement becomes the medicine.