There are camps in physical therapy that like to bash each other about their treatment styles, beliefs, gurus, etc. I think some of that is warranted, some seems a little on the rude side. One topic that tends to drive people to their camps to sling poo at the other camp is core stability. 

I have gone back and forth between camps on this one. On one side is the “activate transverse abdominous 64% while sitting on the toilet” camp and on the other is the “just make them strong humans” camp. The first would take a patient through a somewhat elaborate sequence of motor control activities to try to get the patient to independently and volitionally active their deep core muscles. The other side, championed by Stuart McGill among others, would advocate for a more general core strengthening program, including: planks, “McGill curl-ups”, bird-dogs, etc. while not necessarily giving a rip if the TA is activated or not.

I started in camp TA and have moved to camp get strong, for the most part, BUT I recently had an interesting patient that made me step back towards the middle of the camps…no man’s land, if you will. Long story short, she was a weak, middle-aged women with low back pain. No red flag scary business. After taking her through my “normal” low back assessment system, I was a little stumped. So I started to see if I could change her symptoms any other way. The only way we could decrease (and actually abolish) her symptoms was to activate her TA specifically. Now, I know team “get people strong” may be grumbling right now, saying “it’s not even possible to isolate…blah blah blah.” I get that because I usually am the one saying that. But in this particular case for this particular women for some particular reason, when she contracted her TA (or tried to) and performed a previously painful movement she had no pain. 

So what do I do with that? I didn’t just throw that tid bit of information out and continue telling myself that TA activation doesn’t matter, I ran with it. I had her activate her TA with other movements that hurt during the assessment, no pain. Then I loaded those movements and challenged her in novel movement patterns all while contracting her TA. She didn’t have any pain and she was moving her skeleton around…a win in my book.

So does core stability matter? I would say this: if doing something changes a patient’s pain, especially if it completely removes their pain, it matters. I know this is a slippery slope, but if we don’t skillfully navigate slippery slopes as physical therapists patients like her don’t have the same level of success, right? Let’s navigate the slippery slopes, the muddy waters, the no man’s land between camps well so that people don’t slip through the cracks all because our camp wouldn’t agree.