What exactly is core stability? This term gets thrown around pretty often these days in both the fitness world and the PT world. You ask five different practitioners, and well you might get five different answers. In the gym you may see people walking around looking like Greek gods, but as a physical therapist I get to treat these same gods for back and joint pain just the same. They will always ask me “why did this happen? I am in great shape.” So I tell them. You have a weak core. And well this usually doesn’t go over very well and I typically get a response like. “What do you mean a weak core?! I run marathons, go to the gym, do pilates, do yoga, crossfit, and spin!” And I will repeat to them… well you have a weak core. Just because someone looks like they are in good shape or is very active doesn’t necessarily mean that they have a strong core.
So what exactly is core stability? In an easy way to define this core stability refers to muscular control of the spine and pelvis to provide functional movement through a range of motion. Read that line again. I said nothing about strength. The strength of these stabilizing muscles is not so much as important as their timing and ability to fire. The research actually shows that your stabilizing muscles (your core) activate milliseconds before movement actually occurs. This means that as your body anticipates movement. Those intrinsic muscles fire and stabilize the spine and pelvic girdle just before all of those attractive primary movers spring you into action. Most people think about exercising your core by working your abs, doing planks, side planks, bridging, Russian twists, pikes, you name it the list goes on. Sure these can be very viable exercises for training, but you must make sure that your core is engaged and that the body is supporting what it is naturally intending to do.
When I am examining a patient with back or buttock pain I always try to see where their motion is coming from. For example, when looking at hip extension does my patient extend his/her hip solely from the hip joint through the function of the gluteal muscles or is there also movement from the lumbar spine. Often you will see the lumbar spine go through extension and possibly even rotation. Think about that on a functional level. Take for instance someone walking, or someone running. How does this compensation affect these activities? When your core does not have the ability to stabilize the spine, your hip cannot fully extend for propulsion. Because of this, the low back will hyperextend to assist with the lack of hip extension. This is only one representation of poor timing and lack of movement disassociation, and sometimes there can be multiple reasons why this occurs.
This is what we mean when it comes to having a weak core. It just means that although your muscles are strong, your body is not working in a coordinated manner. That’s where we as physical therapists come into play pre or post injury. I always assess a patient in terms of functional assessment of their motion and of their coordinated movements looking for compensations. I’m happy to help patients realize their maximum potential while rehabbing their injury so they can achieve a higher level of function than ever before they were hurt.
Francesco P. Gallaro MPT