Core Stability: A Call to Action James G. Garrick, MD
tuber et al1 have undertaken a prodigious task—looking at some aspect of core stability —albeit just that associated with low-back pain. Their search revealed 753 appropriate references. Had they just sorted on “core stability” (Medline) they would have found over 7000 citations, or had they used a general database (Google) they would have found over 2 250 000 citations. Core stability is indeed a topic to be reckoned with. “Core stability” came to my attention some 30 plus years ago with the popularization of Pilates-type exercises. It seemed logical that a stronger “core” (trunk) would provide a more stable platform for the use of muscles of the extremities and those supporting the spine. Who knew, or cared, exactly what structures made up the “core.” More strength and better ﬁtness seemed unassailable goals. Then core stability took on a life of its own. In slightly more than a decade, the enhancement of core stability as treatment for, or prevention of, a myriad of problems became not only a mainstay of musculoskeletal injury management but also an accepted preventive strategy. It also became a successful business model. Virtually, every ﬁtness and physical therapy facility offers “core stability” programs. Given that there is little or no evidence that such programs actually “cause” problems, few have questioned their legitimacy or efﬁcacy. However, by offering and supporting “core strengthening programs” in our medical facilities we tacitly acknowledge their efﬁcacy in the ﬁtness world. Thus, it seems that it is totally appropriate to examine the legitimacy of the many claims associated with core strengthening. Frustrating is the fact that there is not much there —as Stuber et al have documented. If nothing else, this review should serve as a “call to action” to researchers of this topic. At the very least, we must agree on just what “core stability” is and the speciﬁc populations appropriate for study. Earlier, the sports medicine community had embraced “stretching” as both a preventive and therapeutic “modality,” although it too had little true scientiﬁc support. Indeed, when that support was sought, the result was much like Stuber et al report—not much there. REFERENCE 1. Stuber KJ, Bruno P, Sajko S, et al. Core stability exercises for low back pain in athletes: a systematic review of the literature. Clin J Sport Med. 2014;24:448–456.
From the St. Francis Memorial Hospital, Center for Sports Medicine, San Francisco, California. The author reports no conﬂicts of interest. Corresponding Author: James G. Garrick, MD, St. Francis Memorial Hospital, Center for Sports Medicine, 900 Hyde St, San Francisco, CA 94109 (jggarrick@ mac.com). Copyright © 2014 by Lippincott Williams & Wilkins
Clin J Sport Med Volume 24, Number 6, November 2014