April 28, 2010
Please note that the comments in this blog come from many years of clinical experience and practice, combined with details and opinions taken from various sources, including open-source internet articles. Where relevant, links are provided.
The term ‘core stability’ has gone in to popular culture and is widely used in fitness, training and health circles. However, I do believe that the very popularity of the term’s use often means that people are unclear exactly what ‘the core’ is. I ask many patients to tell me what their understanding is and it is clear that there is a huge range of interpretation and advice being given.
Now it should be said that there is no substantial danger in exercising and strengthening ‘the wrong muscles’, but I believe it is a matter of accuracy and you may not get the result that you want or expect . There may be some risk of aggravating lower back problems is the exerciser if overzealous.
Exercises range from gentle, subtle pelvic floor and lower abdominal contractions to highly taxing and often aerobic dynamic exercises such as Kettlebell and advanced Pilates routines. So, who needs what? That, of course depends on what your specific needs, physical condition and ambitions are. However, I generally like my patients to start off at the bottom, (sorry!), even if they are otherwise fit and able. This is because the technique is very important and running before walking is what leads to the confusion about what core strength and stability really is.
For example, I have scanned some very fit professional footballers and they have wonderful external and internal oblique muscles – well defined, strong and capable. But, their Transverse abdominis muscle, (the really important one), is thin and poorly defined. Why? I think that it is partly training-specific and partly because they can see fantastic abs and six packs, (so therefore they are worth the effort), and partly culturally-driven within football – pelvic floor stuff, “is a bit girlie”. I do point out that ignoring this area is partly why they are on my treatment couch in the first place and it my responsibility to educate them of the importance. Give people the right reasons to do something and they will usually do it, even if they do need a good push to get started! Let’s face it, the most valuable, basic structural exercises are also pretty dull – but see them as the base for the more glamorous stuff.
What then, can real-time dynamic ultrasound scanning offer, and why bother? It is all about feedback, a sort of visual carrot and stick – perform an exercise or muscle contraction and see the result there and then, able to visualize what is going on beneath the skin – a quick peek inside at how things work. Action and result before your eyes. (more…)