We can get into a lengthy discussion as to which is more important, strength or stability. The reality is, it depends (as I often say in my courses). It depends on the needs of the person and what our goals are for them. My goal with this blog post isn’t so much to argue for one or the other. Rather, I would prefer to clarify the verbiage that we use when we talk among each other as professionals, as well as with our patients or clients.
The main reason that I bring this is up is that I continue to hear from people over and over that the reason that can’t do a specific movement is because their “core is weak.” Or, if I am teaching a course and we discover that a diaphragm taping technique is working well for someone, I typically ask the question…”now that we know that up-regulating their deep front chain improves their movement, what do we need to do to make it stick?” The answer I usually get is, “core strengthening.”
I don’t want to make too big of a deal out of something that isn’t a big deal, because at the end of the day, usually when people say that they need to perform “core strengthening”, they are really talking about performing some sort of core stabilization exercises, but they are using the wrong terminology. But, using the right terminology is important.
What’s the big deal?
So, really, what is the big deal? If we’re talking about the same movements, why does it matter whether we use the term strength or stability? I’ve thought about it a lot, and honestly, I think the terms we use matter a lot.
First off, they matter because at the end of the day, for most of our clients, it is pretty rare that they don’t have enough strength in their abdominals to perform activities of daily living. I know that I primarily work with a young, active population and many of you do not, but I can’t recall the last time I saw or heard of an individual who actually didn’t have enough strength to stay upright (with the exception of chronically ill, disabled individuals). Even one of our athletes who has had multiple fasciotomies through his abdomen and will soon have his entire abdominal wall reconstructed, is strong enough to perform his ADLs. If we aren’t strong enough, we should be prescribing weighted sit-ups to everyone, but most of us stopped that a long time ago.
The exception to this situation is the athlete (I’m also including industrial athletes here) who is trying to accomplish a very specific task that would necessitate a great deal of strength and power to handle a large load while creating movement with their trunk. High level Crossfit Athletes come to mind here because of some of the movements they perform as part of their competitions. I can see an argument for high level football players who need to be able to withstand a high anti flexion load during contact. I would also imagine that athletes who perform in high level outdoor events (I’m thinking the Highland games) need to be able to move heavy loads through their trunk and core at times (although I don’t work with them personally so I can’t say for sure).
With all of that being said, I also have to acknowledge that these are not the people that most of us work with every day and even if they are, there is a solid argument that if these athletes properly stabilize the way that they are supposed to in their trunk, the rest of the body should be taking on the task of being the primary mover.
What most people don’t have (especially those in pain) is stability and motor control in their core and trunk. Their timing is off. Their sequencing is out of order. They don’t “flow” with their movement patterns. Quality movement patterns require proper timing, sequencing and the ability to fine tune our primary stabilizers.
So, when we are talking about training the trunk and the core, with only a few exceptions, we are really talking about improving their stability and motor control to get the various layers of tissue to turn on and off at the right time and in the right sequence to create efficient movement.
Back to the original question, do semantics matter?
Yes they do. Using the correct words not only relays to those around us as to what we are doing, but it also trains our own brain to look at things a little bit differently. If I constantly tell myself to make someone strong, at some point, my exercise prescription is going to transition from stabilization to more strength based movements over time. Knowing and stating that I am working on stabilization interventions with my client, will eventually lead to me not only sticking to stabilization interventions and eventually encouraging me to think outside the box and improve my strategies.
It is also very important that we properly educate our patients and clients. Most of my patients who struggle with trunk stability are unhappy when I tell them that because they can typically perform tons of crunches without any problem. This is because they have come to understand that improving their “core” means lots of strengthening. Unfortunately, that strengthening is probably feeding their dysfunction, making our jobs harder. I think we can all agree that when our patients are better educated, their likelihood of improving is also better. Part of that education is using proper terminology.
Our words matter. It seems like a little thing, but to me, the words we use with our colleagues, clients, patients, and coworkers matter. They help us improve our train of thought and they ensure those who we are helping get the best care possible.