“That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.”

“That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.” Is a great line from one of my favorite YouTube short film clips: It’s Not About the Nail. But the phrase also applies to my own worries about our constant attempt to so easily blame a weak core as the source of back pain. Some researchers and clinicians have been working to debunk this commonly held misbelief for some time, see Eyal Lederman’s The Myth of Core Stability or Peter O’Sullivan’s Core Stability: separating facts from fiction as a couple examples. One would think that we could move past this illusive search for the weak core impairment that needs fixed to eliminate back pain.

That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.

I get an email feed from Pain Week as one of many sources to stay current with pain research and current topics around pain. The most recent headline was: AVOIDING RUNNER’S CHRONIC BACK PAIN: IT’S ALL IN THE CORE. Needless to say, it perked my interest so I read the story. I’m guessing the opening few lines sounded very convincing to many, especially when they referred to the high-level technology (force place, motion detection, and computer simulation) used in the research. The results have to be good if they used high-level technology, right?

Then you get to the results:  “When your deep core is weak, your body is able to compensate in a way that allows you to essentially run the same way. But that increases the load on your spine in a way that may lead to low back pain.” I have to do is a few planks and my pain will go away, right?

That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.

I dug a bit deeper into results by following the links to another news story. It came from Newswise, so the information should be wise, right? The title of this press release: “Study Uncovers Potential Key to Preventing Back Pain in Runners” and it provide the findings summary in the second paragraph. “The study, published in the Journal of Biomechanics, suggests that runners with weak deep core muscles are at higher risk of developing low back pain. And, unfortunately, most people’s deep core muscles aren’t nearly as strong as they should be.”

That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.

Trying to figure out how the authors came to this conclusion, I decided not to take the news media’s slant on the research and went straight to the paper, found here. So how was the study done? They used datoma fr 3 people that had consented to a previously published study. They took that data and made computer simulations of running and then ran various computer simulations of what would happen if you weakened some of the core muscles. Their findings showed that taking away some of the muscles lead to increased axial load onto the spine. Their findings suggest that all deep core muscles contribute to maintaining stability of the spine. I can agree with all of these. I struggle with how these findings suggest that just getting your core strong enough is all that needs to be done to prevent back pain.

That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.

One limitation listed in the study that never made it to the news media reports listed by the authors was that because it was a computer simulation running kinematics were forced to stay the same after the muscle weakness was simulated into the model and thus it is unknown if people may alter kinematics to compensate for muscle weakness. Oh, and one more limitation provided by the authors: “It is unknown if this phenomenon is entirely realistic clinically.”

Once again, we see the public being feed a story that isn’t accurate about back pain and the dreaded core weakness as the cause by twisting up research to make inaccurate claims.

That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.

 

 

2 responses to ““That’s the thing that scares me the most, is that I don’t know if it’s ever going to stop.”

  1. Brian D'Orazio DPT, MS, OCS says:

    I like the post. When will the concept of a weak TA as the cause of all ills go away? Thanks for sharing some really bad ” research “.

    Brian

  2. Ina Diener says:

    Although the ‘core’ is proposed as the reason for many spinal problems, and clinicians cling to this concept despite evidence against it, there are also many other ‘myths’ that we cling to in musculoskeletal health. Fortunately we see a lot of evidence busting these myths, but is is scary to think that it takes sooo long for clinicians to move on from concepts that were in fashion and demonstrated not to be what they were proposed to be! Even thought the clinicians who have done the research [Hodges, O’Sullivan ets] have now moved away from their initial findings as the final answer!

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