• Experts Divided Over Back’s Core Issue

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  • You roll around on your Swiss ball like a grizzly with a back itch. You do crunches and work your obliques like a champ. So you must have good core stability, right? And core stability will reduce back pain and prevent injury, right?
    Yes, no, maybe. Research on back pain, experts say, is spotty and the subject of debate.
    Research suggests that, yes, exercises that target core muscles might reduce back pain and prevent future injury, but whether these exercises are substantially better than other structured exercise programs for chronic back pain has not been proved. And not all researchers agree on which components of the body’s core muscles are most crucial to preventing a back injury and reducing pain after suffering an injury.
    A seminar on the role of core stability in reducing and preventing back pain attracted a full house last week at the American College of Sports Medicine’s Health and Fitness Summit and Exposition in Long Beach, Calif. Presenter Marjorie King, director of the graduate athletic training program at Plymouth State University, in Plymouth, N.H., outlined the current state of the field: a need for more research and moderate support for the use of core stabilization exercises to decrease low-back pain and increase low-back function.
    King thinks that some who practice core stability are missing at least part of the boat. “One of the biggest misconceptions people have about core stability is that by doing crunches, they’re getting at core stability,” she says.
    Crunches address the trunk, or “global” muscles, which exercisers more commonly work. But to really target core stability, she says, exercisers need to attend to the often-ignored spinal, or “local” muscles.
    Local muscles include the little intersegmental muscles, the multifidi, that run along the vertebrae. These muscles don’t move a lot but are thought to play a role in keeping the spine stable during movement.
    Other musculature involved in local stabilization include pelvic floor muscles and the transversus abdominis muscle, the deepest of the abdominal muscles. This muscle is horizontal in design, King says, and functions like a corset, stabilizing the spine.
    Core stability training “is the standard of care, it’s what people do, in my field anyway,” says Dr. Christopher Standaert, a physiatrist (a physician specializing in physical medicine and rehabilitation) and clinical associate professor of rehabilitation medicine at the University of Washington in Seattle. But, he adds, “There’s never even been a uniform agreement on the definition.”
    Among those who think — based on their clinical experience — that core training works, there are two schools of thought on exactly how it works. Some think, as King does, that local muscles such as the multifidi and the transverse abdominis are critically important.
    But, Standaert says, “there are other people who ... think it’s more about training movement patterns and broader motions and coordination of multiple muscles through your trunk to help your spine move more effectively. ... So it’s about the whole system.”
    In fact, Standaert adds, whether one is talking about local or global core stabilization, the rush to embrace core training has moved ahead of the science. “People need to know that the scientific clinical foundation, the research, doesn’t match the extent of emphasis that trainers and therapists and all sorts of people put on it,” he says.
    As back experts continue their debates and research, those who want to prevent or deal with their back pain need solutions now.
    Those with persistent, chronic back pain should see a physician and get a proper diagnosis, says Dr. Robert S. Bray Jr., a neurological spinal surgeon and founding director of D.I.S.C. Spine and Sports Center in suburban Los Angeles. A sports-medicine physician or physiatrist is a good place to start.
    In addition, anyone who is doing exercises to reduce back pain should do so with guidance from an exercise or back-care professional, such as a physical therapist, chiropractor or certified athletic trainer.
    Regardless of the state of the science, working the core’s local stabilizers won’t hurt and probably will help, King says. The best way to stabilize the spine, she says, is to stand up straight (stomach in while still breathing, equal weight on both feet, feet straight ahead, glutes flexed, pulling up through the pelvic floor) and sit up straight (stomach in, both feet on the ground, again, pulling up through the pelvic floor).
    “Any time you sit or stand, in the line at the grocery store, stuck in traffic, brushing your teeth” is an opportunity to correct your posture, she says. “You don’t necessarily need a huge difference; you just need a bit of a difference.”