Core stabilization, motor control
'Core stability' , as you probably have heard from patients doing Yoga and Pilate, has been the core advice given by physiotherapists for spinal stability and postural re-education over the last decade. While most therapists are concentrating on the strength of the core muscles, I have always been emphasizing the awareness and endurance or the motor (movement) control of such muscles. Strength and motor control training are two distinctly separate processes. Mark Comerford, a renowned physiotherapist specializing in muscle rehabilitation, has given an interesting analogy for the difference as to think of the musculoskeletal system as a computer. High speed or high load strength training changes muscle structure and can be likened to upgrading the computer's hardware. This can make the computer work faster and run more complex programs. Low threshold motor control training does not change the muscle structure to any great extent, but instead improves the central nervous system's ability to fine tune muscle co-ordination and improve the efficiency of movement. This is like upgrading the software in a computer to perform its tasks more efficiently and to get the most out of the hardware already present. Pain can be likened to a computer virus, which primarily affects the software, causing the computer to run slowly and crash more often. In the human body pain has more consistent effects on the motor control aspects of movement rather than directly affecting muscle structure. Contemporary neurophysiological and clinical research into movement dysfunction associated with musculoskeletal injury, chronicity and recurrence of injury, highlight deficits of low threshold muscle recruitment and motor control inefficiency. These deficits are only clinically and functionally identified with very specific tests of low threshold recruitment efficiency. Recent research on musculoskeletal pain has focused on motor control changes associated with the pain state. Research has provided important new information regarding chronic (long-standing) or recurrent musculoskeletal pain. A large number of independent research groups are reporting a common finding in their studies. They have consistently observed and measured that, in the presence of chronic or recurrent musculoskeletal pain, subjects change the patterns or strategies of synergistic muscle recruitment that are normally used to perform low load functional movements or postures to high load function activities (e.g. lifting, pushing, pulling, throwing, jumping, running etc.). These altered strategies or patterns have been described as 'compensatory movements', 'muscle imbalance' between inhibited/lengthened stabilizers and shortened/overactive mobilizers, 'faulty movements', and 'control impairments' .