I Was Told I Don’t Have a Core:(I Am Doing Planks but I Still Have Back Pain.

Most days at least one patient will advise me that they do not have a “core”, and someone; their trainer, their physiotherapist, their spouse has told them that and THAT being the reason for their pain.

The reality is that most people do not understand what this implies except some vague concept that they must be missing a muscle somewhere in their abdomen! The ‘core strength’ concept is everywhere – in fitness studios, in physiotherapy clinics, in health centres, on the internet……… despite being trendy – the term core is overused and abused!

The ‘core’ is commonly thought of to involve muscles of the trunk, largely the abdominal and back muscles and efforts to train the core is usually via high load exercises using either the body’s weight (planks), unstable surfaces (BOSU, balls) and resistance (bands, weights). It is implied that by loading up the trunk for example, in the plank position will by default, result in a strong core. I would argue however that most people doing THE plank are overworking the outer muscles of the trunk and under-using the inner muscles -making their condition worse and negating the purpose of the exercise.

Why would I say that? What is not well understood is that the ‘core’ should be conceptualised to comprise of many layers of muscular networks and synergies; each layer building off the foundation of a deeper layer. Therefore, we could think of having an ‘inner core’ and an ‘outer core’ with the inner core being less responsive to general stability exercises like the plank. This is especially the case if there is any pain or if the posture is poor.

The deeper, inner ‘core’ muscles have different physiological characteristics and need a different training approach than the outer core muscles. In these muscles it is important to consider the brain to nerve to muscle link and to re-educate this connection. Once the inner network of muscles and their neural connections are synergised, we can think of moving outward into traditional ‘core exercise’.

In over 30 years as a physiotherapist I have never found that targeting the outer core with planks and balls and so on to be helpful in correcting the underlying muscle imbalances that are so common with many musculoskeletal injuries. In fact I have received many cases of injuries or worsening conditions as a result of ‘core’ exercise prescription.