Positive Health Online

Waiting for a pupil in an osteopathic clinic where I work, I was browsing through a magazine in the waiting room. In this magazine, targeted at macho men, there was a letter from a reader wondering if it could be the abdominal crunches he was practising that were causing his lower backache, and what he could do to cure it.

This perspicacious reader was told that concentrating on his abdominal muscles could indeed cause problems, because if his back was relatively weak, it could create a structural imbalance. In my experience, a man with relatively weak back muscles would be a rarity if not an oddity, but, leaving that aside, the solution, according to the magazine's 'specialist consultant' (whatever that means), was to work on improving the 'core stability'. The cure was in the core and consisted in alternating abdominal crunches with exercises to strengthen the back muscles – which I won't repeat here, as I don't want to be guilty of inflaming the backache statistics. This hard core programme is more a curse than a cure!

This shows that in spite of the new apparels, apparatuses and jargon, there is nothing new under that particular sun that shines above the Fitness World. The new methods are mere variations on the same old theme which could be described as the yo-yo technique: you strengthen the front and then, for good measure, you strengthen the back, or vice versa.

The key word in the solution offered to the reader is 'core'. I don't know when it made its first appearance in this context but it is the dernier cri in fitness circles, and if you want to be trendy and a follower of the latest craze on the gym circuit its use is de rigueur. Now gymnastic goes with semantics. You'd be an illiterate gym-goer if your lexicon didn't include a good dose of the 'c' cord: 'core area', 'core training', 'core stability', 'core muscles', 'inner core' – and as there is always a manufacturer ready to cash in on the universal gullibility of human beings, a 'core board' has been invented. The earth has a core, some fruits have one too, and computers are equipped with core memory or core storage – why not the human body?

The problem is that this so-called core area is a rather vague and foggy entity, and most people don't have a clue of what it comprises. In one article, I read that these core muscles or "…deep stabilizing muscles…" were "…the little muscles that run up the spine – the transverse abdominals and the gluteal muscles." In 16 years of practice, I have never seen these muscles running up the spine! In one book about Yoga Pilates, the core muscles are said to be "…deeper than the surface abdominals and wrap around the lower torso and hips… Core muscles also include the smaller internal muscles that connect the inside of the ribs, and hold the shoulder blades in place." In another book about Pilates, core stability is described as the correct use and control of the deep stabilizing muscles – supposed to be the girdle of muscles around the stomach and back. According to such 'specialists', these deep muscles are the ones that stabilize the lumbar spine: the transversus abdominis, the pelvic floor muscles (?) and the multifidus. And this despite the fact that the main role of the transversus is to support the viscera, so that, according to Cunningham's textbook of Anatomy, "it has virtually no stabilizing effect on the pelvis", and that only its lower portion can decrease the lumbar lordosis (at the level of L4, L5 and S1) while its upper portion can increase it. Apart from these trivial details, one question remains: how deep is deep? If it makes sense to call the multifidus deep, the same does not apply to the transversus which is only deep relative to the other abdominal muscles and of which, since below the navel all of the deep fascia pass anterior to the rectus muscle, it could be said that the latter is at the same level as the transversus. Such a superficial core is a contradiction in term.

Another thing that bothers me about this core concept (yet another phrase you could add to your lexicon) is this stabilizing business. Muscles may act as agonists, antagonists, synergics and fixators. Stabilizers is just another word for fixators. There is no such thing as a fixator, agonist, antagonist or synergist muscle. It is the nature of the movement performed which will determine which role a specific muscle will play. For example, if you wanted to raise your legs from a supine position while maintaining the pelvis tilted backward and keeping the lower back flat on the floor (don't try that at home), it would be the rectus abdominis and external obliques that would be the main stabilizer muscles. Moreover, to explain the role of the stabilizers of the spine it is still common to use the clichéd and irritating, because spurious, analogy of the crane. But the spine is not a straight rod but a sinusoid or, to speak like A Thooris, "not a stick but a snake" and this makes a huge difference to its function. The sooner this comparison is abandoned, the quicker backs will get better.

If you want an encore of the core subject, I will reveal in my next column what I would consider the real two core areas of the human body.