I just discovered your blog (bookmarked it), so that’s why I respond to an ‘older’ post.

Although I did not read the version in J of Bodywork, I’ve read this Lederman article in 2006. I think it has not been updated since, and therefor misses a lot of studies. Besides that, Stuart McGill is almost unknown in Europe. Even worse, Janda has almost no value in Europe (go figure).

From a low back point of view, we’re very focused on the Australians and the Netherlands (that’s where I’m from), the so called lumbopelvic stability model and the Waddel bio psychosocial model. The first one is a bio-mechanical perl, especially the force closure part of the SI joints, the latter has no real evidence at all. I’ve been through most literature on the subject and the psychological factors have no convincing correlations. So, maybe a little European perspective helps you interpret the article a bit better.

~ Chi

Here’s a random thought that I was just reminded of when reading all your comments.

I worked along side John Gray for a brief period of time (Mark, he was one of Stu’s PhD candidates) as well as attended a presentation he and Steve Plisk gave. What I came out of it with were these points.

a. The core is like Vitamin C. If you don’t have enough, you need more of it. But once you DO have enough, you’re good to go.

b. You can’t use rehab-type, “core” exercises for training an uninjured/non-dysfunctional athlete. Yes, the low back is exposed to very high loads in specific exercises, however, they are exposed to even HIGHER loads in specific sporting events. As such, we must train these athletes in a way to prepare them to be able to withstand these loads. For example, the traditional squat and deadlift are more effective “core strengthening” exercises for sport X than the plank or dead bug (which for some may be more “core stability” exercises than “strengthening” exercises) HOWEVER, in order to be able to progress to the squat, they should be deemed physically ready to do so.

Just a thought.

I’ll just copy and paste the comments that I made over there to here:

I have read the paper and it offers some interesting arguments.

One problem I have with it is that the author simply says “Don’t do this”, but then he doesn’t really offer a solution. It is one thing to make criticism and then offer your idea of a better way. But, taking the rug out from under someones feet and not giving them something else to stand on is usually not the best way to approach things.

One thing Gray Cook said at a seminar awhile back was “If our training programs are so good, why do we have to supplement them with all this extra core work and flexibility work?”

I think there is something to that statement. However, the reality of it is that people don’t move well to begin with. That is why we have the supplemental core work and flexibility/mobility work. We need to create some awareness that wasn’t there before. Once you can get them to do that, you can move away from a lot of the supplemental stuff and begin to do more dynamic training. However, just moving around and “hoping for the best” (as it would seem the author of that paper is suggesting) doesn’t gaurantee us results.

At least that is how I think about it.

Patrick

Good review. I did have some conflicting thoughts on the paper in regards to rehabilitation and motor learning, but for the most part I agree. My review is at http://mikescottdpt.wordpress.com/2009/10/30/article-review-the-myth-of-core-stability/

Bret makes a great point about the weak glutes and tight HS’s as well.

Mark, psychosocial elements do play a part in some back pain, but clearly not in all back pain, and the author is clearly leaning heavily towards psychosocial elements.

-Mike-

Personally I would like to see core stability defined as something like “the ability to keep the lumbar spine in proper position during exercise.”

I personally believe that back pain is much more related to weak glutes and tight hammies than abdominal/oblique/core strength. Most people have back pain due to the fact that they round their backs when they pick stuff up or they hyperextend their low backs when they lift weights. In both of these instances, it’s a case of the back trying to do a job that the glutes and hamstrings (and hamstring part of the adductor magnus) are supposed to do.

So in essence, core stability in my opinion is synonymous with strong hip extensors.

Talk soon Jeff.

Yuri

It is funny because I had initially planned to review this article for my site when I first picked it up. After reading it, I really didn’t find it that compelling one way or the other.

My main issue is that while the article was supposed to talk about core stability, Lederman failed to provide his working definitely of core stability for the sake of this article. As such, he compared various studies talking about stability when they all had very different definitions and criteria for measuring stability in each paper.

I don’t feel he was very selective in the papers he chose except for the seemingly purposeful exclusion of much of Dr. Stuart McGill’s work. The author did seem to place an emphasis on the psychosocial component of low back pain which, as we know, is part of the issue but it certainly cannot explain all cases.

Frankly, I think the review was a little bit biased towards the author’s belief in psychosocial treatment of lower back pain. I should also note that I did ask the author to be interviewed for my site to discuss these issues and allow my readers to ask questions as well. He declined.