Core Stability has been a popular phrase that is used by a multitude of professions for decades. Though many of these professions teach the importance of a stable core, there has been a discrepancy in understanding exactly what the science says about it. What structures are a part of the core? If you ask an MD or a personal trainer, chances are they will have different answers. As a chiropractor, it is essential to understand what exactly the core consists of, and how it is important to our patients and the health of their spine. Though we seek to help our patients understand the vitality chiropractic can bring through whole-body health, dysfunction in the core can lead to the most common problem among adults: back pain. Pain disrupts the life of an individual and is important to address, yet important not to focus on.
Rebekka Kuzichev
Before having a “strong core” meant a set of glistening six-pack abs, it was defined as two systems working together to maintain biomechanical integrity throughout the body. These two muscle systems were known as the intrinsic muscles or the “inner being” muscles, and the extrinsic muscles known as the doing muscles or the “sleeve” to the intrinsic muscles.1 Imbalances can occur with inappropriate substitution by the extrinsic muscles for the intrinsic muscles. These muscles work efficiently when the nervous system responds appropriately on how to stabilize the spine with movement. This, however, isn’t as simple as it sounds. Along with gross motor movements of the muscles in everyday life, the nervous system is also responsible for coordinating postural control and breathing at the same time.1 Since the core muscles have more than one responsibility, it is easy for the mechanics to suffer when imbalances are present. Let’s look at breathing and spinal stability. If the muscles of the core are weak and inhibited, what is more important for basic survival: stability or breathing?
Breathing is obviously going to affect the survival of the body directly and quickly. However, it is extremely common for normal breathing mechanics to be off as well with the sedentary lifestyle most people live, spending their lives in one position: sitting. When sitting, significant changes in core muscle activation occur. Unless adequate posture is maintained while sitting for prolonged periods of time, muscle activity is reduced, resulting in passive postures.2 From the time we are 5 years old, we spend hours each day sitting. Children are not necessarily concerned with low back pain, but after spending 20 years of sitting for hours in school, the stabilizing muscles of the back are no longer active. Without the protection of the core muscles, the spine becomes more and more susceptible to injury and pain, especially for the low back. Low back pain is among the top 10 high-burden diseases and injuries, with the average number of years being affected by disability higher than that of HIV, road injuries, COPD, lung cancer and tuberculosis. Low back pain has also been ranked as the greatest contributor to global disability. It has been postulated that a major contributor to low back pain is lumbar instability.3
There is no doubt that the most important aspect of chiropractic is the adjustment and how innate heals through the facilitation of it. We live in a world full of pain and are the frontrunners to facilitating the best avenue of healing for it. This can be accomplished by becoming experts at our craft, educating our patients about the importance of muscular function, teaching exercise and proper biomechanics, and understanding ourselves the importance of balancing the two muscular systems.
References
- Key, Josephine. ‘The Core’: Understanding it and retraining its dysfunction. Journal of Bodywork and Movement Therapies. 2013. March: 17 (4): 541-559 [Oct 14, 2019.] https://www.sciencedirect.com/science/article/pii/S1360859213001162?via%3Dihub
- Ko, M. Jung, E. Kim, M. Oh, J. Effects of deep breathing on internal oblique and multifidus muscle activity in three sitting postures. Journal of Physical Therapy. 2018 April. 30 (4): 504-506.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908991/ - Finta, R. Nagy, E. Bender, T. The effect of diaphragm training on lumbar stabilizer muscles: a new concept for improving segmental stability in the case of low back pain. Journal of pain Research. 2018 Nov: 28 (11): 3031 – 3045 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276912/
This article first appeared in the November 2019 issue of Lifelines, the Life West student magazine.