I agree with the article in general.
However, I think it glosses over a few key
concepts:
- what does the author mean by "the core"
? (I have a more complicated definition than they do),
- healthy back vs. injured back, neutral spine vs. Flexed/extended spine
- strength
training for sport specific activities versus daily activities.
I define the core as the muscles that attach to the spine and
pelvis, which can be broken down into (roughly) 3 parts: the pelvic
floor muscles (as the bottom of a cylinder), the abdominal muscles (the
Transverse Abdominus, Internal Obliques, and External Obliques) and the
Multifidi create the sides of the cylinder, and the scapular
stabilizers (which provide a base of support for the cervical spine and
upper thoracic spine). When all of these groups are balanced in
functional strength and engaged correctly, we should feel a lift in the
crown, providing space for our vertebral discs to be nourished (and not
squished or compressed) during our daily activities.
Some of my clients have current back injuries, most of them have past injuries, and I have some athletes as clients who have never injured their back. In addition to individuals varying with different levels of injury, is a WIDE spectrum of self-body awareness
and every body moves differently. We can present with a spine injury
for a number of reasons. There is no one exercise that I can prescribe
to everyone to prevent or rehabilitate a spine injury. There is merit
in doing exercises in a neutral spine AND doing exercises in the spinal
flexion/posterior pelvic tilt positions. Ultimately, we should move
throughout our days in neutral spine to prevent spinal injury. But, if
we only strengthen our muscles at one range-of-motion, we would create
yet, another muscle imbalance (which could lead to injury). I would
NEVER give someone with a lumbar disc injury a flexion exercise
(hollowed out abdominals with the low back pressed to the floor) in the
initial or intermediate rehabilitation phases (this position places a
lot of stress on the discs and the discs need to be healthy to perform
this motion).
Often, with spinal instability or disc injuries, there is a weak
link in the core and rehabilitation begins with re-training muscles
that have shut down during the inflammation stage of injury. This is
typically begun with neuro-muscular re-education in neutral spine.
Once the muscles are able to work together (on the bottom and sides of
the cylinder) then, we introduce greater ranges of motion in the
strengthening exercises (curl-ups in the flexion plane and, eventually,
including spinal twists and extension when it can be safely performed).
Basically, I assess three things: range of motion, strength, and
function in all 3 movement planes and the balance of strength in
different positions and planes. It is true that "If you concentrate on
strengthening only one set of muscles within the core, you can
destabilize the spine by pulling it out of alignment." This is why the
video shows core exercises in several planes to train the muscles
against the different vectors of gravity (they left out standing).
However, even the woman in the video was not maintaining neutral spine
during the "box kicks" and she is at risk for a disc injury (she was
hyperextending at the thoracic-lumbar junction in the quadruped
position). If someone is injured, and one muscle group is not even
firing, of course I will prescribe an isolated set of exercise for that
muscle group. When that muscle group is firing properly, then we should
introduce, in incrementally increasing levels of difficulty, using the
entire core together. But we shouldn't move like robots either; there
is a beautiful balance of ebb and flow when we flex and bend the spine
throughout the different planes of space. However, our core muscles
should have tone in them and not ever "flap in the wind." This would
also create an imbalance on the tension of the spine as a "rod."
My strengthening rehabilitation approach would be vastly different
for a high level tennis player (who would need to train their obliques
in full range of motion with spinal flexion and rotation just to serve
the ball) versus someone right after a disc injury (who probably can't
even stand up against gravity in a neutral spine without pain).
Please do not perform the exercise shown in the video unless you are pain-free, have excellent self-awareness or your body, and have been trained to this this under supervision.
I hope this clarifies any questions that may have arisen from the article. If not, please feel free to continue this conversation via email.
