The Core Stability Myth / Go Go Physio / Sydney

I have been practising and teaching pilates for years now. As a Physio I really do feel it can help my clients, but is this an evidence based decision? There has been little criticism of the Pilates method and whether this can actually prevent or rehabilitate injury. There are many advocates for core stability with Fredericson and Moore (2005) describing it as “essential”. Clinically I have seen first hand clients get better doing pilates. Even the indie rockers are doing it!  

PilatesForIndieRockers

 

 

However, a recent critical review challenges many of the principles of Pilates and how clinicians use this as a form of rehabilitation.

The main points that I feel should be mentioned are highlighted below:

 
  • Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.

 

  • Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise or physical therapy.

 

  • Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain. Any therapeutic influence is related to the exercise effects rather than stability issues.

 

  • There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities.

 

  • Patients who have been trained to use complex abdominal hollowing and bracing manoeuvres should be discouraged from using them.
 

Some of the points above may not sit comfortably with clinicians who emphasis the switching on of the transverses abdominus muscle. Clinically I feel that if this muscle has been shown to be weak, then strengthening it will help if pelvic stability has shown to be ta problem on assessment. I have had some great results using Pilates based exercises on clients with hyper-mobility, athletes,  through pregnancy and with post natal women.

The problem with Pilates is there is little or no evidence specific to athletes but it's widely recommended and even described as a 'must do' based on very little. I think Pilates has role in rehabilitation but it's not clear what yet. Like most things there is minimal good quality evidence to guide us. What seems most like is that there are subgroups of people who will benefit from either approach.

So if Pilates is working for you keep doing it! Maybe just with a little less squeezing of the abdominal muscles.