There is a wealth of information on the core, spinal loads and biomechanics, and appropriate exercise selection. Despite this, there are no perfect, uniform laws of core training. There are some great principles and guidelines, but there are no unbreakable laws. Perhaps in our desire to communicate the ills of repeated, loaded spine flexion some of us have oversimplified this concept. Such as don’t flex the spine and don’t do crunches. (I know I may be guilty of this, and in doing so failed to follow one of Einstein’s cautions. I admit my bias is due to working with a large population of folks with back pain and a great number of athletes/weekend warriors who spend there days in seated flexion during desk work.) Please note that I am not advocating for or against the crunch, sit up, leg lift, V-up, or any other particular exercise, just a reconsideration of what we know, how we train, and what we say to people about their movements. Perhaps a more complete, reasoned approach is warranted.
Make things as simple as possible, but no simpler. – Albert Einstein
Paraphrasing Stuart McGill, ‘there are no good or bad exercises‘. We need to find the right exercise for the right person at the right time. In my opinion this is best done with a constant monitoring: assess, implement training strategy, reassess (within visit and over time).
I would argue for the novice trainers and clinicians to avoid spine flexion with their patients/clients (particularly loaded or repeated) may be advisable as the yearly and lifetime prevalence of back pain is quite high, 40% and 85% respectively. However, the more seasoned should take a careful look at the individual, their activities and demands, and then weigh the risks and benefits. Below are links to an interesting discussion on this, it is 3 parts of a well reasoned, collegial blog conversation.
Side note: I’d like to applaud both authors for stating their points with their own clinical and scientific understanding, reasoned arguments, and interesting perspectives, rather than sinking to the level where some online disagreements tend to go all to quickly..
Side note #2: The discussion above represent my thoughts and is not intended to summarize the posts below.
Use the links below for a great discussion about appropriate training of youth athletes, the limitations of certain approaches, and finally the multitude of factors that influence appropriate training (particularly in the female athlete).
Take a moment… read it, think about it, challenge your current understanding…
Post #1: by Julie Wiebe, PT “dear coach”
Post #2: by Greg Lehman BKin, MSc, DC, MScPT “Dear Julie”
Post #3: Response to Lehman’s post by Wiebe “Dear Greg”
Things to consider:
- What factors govern your exercise selection? Age? Gender? Injury history? Activity/sport? Frame size? Disc shape? Related mobility (hips/ankles/thoracic)?
- Are there patients/clients who should avoid spine flexion?
- Are there folks who should be encouraged to flex?
- When training flexion how much repetition or load is reasonable?
- Should training recreate the demands of the sport/activity?
- Should training prepare someone to resist the loads of their sport/activity?
- Is core training the same for the male and female athlete?
A bullet list of quality reminders regarding core & pelvic floor. Once again compliments of Dr. Cubos.