Q: What are your thoughts on the right amount of volume, intensity and frequency on core exercises ranging from bridging variations to ab wheel rollouts from the feet for the intermediate to advanced lifter looking to decrease back pain and get out of anterior pelvic tilt? Is it possible to make progress for a while, but overdue it on volume, intensity or frequency and actually have your core get weaker or stop progressing/responding, and start to experience back pain and anterior pelvic tilt again?
A: This is an outstanding question, and I can really go in a number of different directions with it.
First, let me say that the single best way to get out of excessive anterior tilt is training oneself to not live in anterior tilt! No amount of exercise will undo the damage you can do with your daily posture. That’s the easy part of this response, though.
Next, I’ll say that I absolutely believe that we can overdo it with “core-specific” exercises.
As a parallel, just consider the shoulder. The glenohumeral (ball and socket) joint is heavily reliant on both active (muscles/tendons) and passive (capsule/ligaments and labrum) restraints for stability. If you overdo it with rotator cuff exercises and train the cuff to excessive fatigue, individuals lose dynamic stability and can’t maintain the position of the humeral head in the glenoid fossa. Overuse conditions and injuries can occur. I wrote about this in an old series, How Much Rotator Cuff Work is Too Much? - Part 1 and Part 2.
Similarly, the lumbar spine relies heavily on both active and passive restraints. People can overcome lumbar ligament and disc injuries to live pain-free if they maintain adequate soft tissue control. Likewise, many sedentary folks can live pain-free in spite of poor soft tissue function simply because the challenges of their daily activities don’t exceed the tolerance of the passive restraints (these are the folks who often blow out their backs trying move couches).
That said, we have to be careful about overreacting to this realization. Just as the trend of doing thousands of sit-ups in the past few decades created a ton of back pain, you see a lot of completely deconditioned individuals who are hurting, too. There has to be a middle ground between the two. So, you could say:
Optimizing core function is really a delicate balance of exercise selection, volume, frequency, and intensity.
Unfortunately, I don’t know that we have a perfect (or even close to perfect) answer with respect to all of these factors, as everyone is different. Consider the following:
1. Flexion-intolerant backs must be treated differently than extension-intolerant backs.
2. Trained athletes probably need a lower frequency because of their sport participation and neural efficiency, but can handle a greater intensity and more complex exercises – and need to prepare the core for fatigue over an extended period (e.g., soccer game, tennis match, 100-pitch outing).
3. A sedentary individual probably needs a greater frequency of low-intensity exercises.
4. In-season athletes must be careful not to do too much work and pre-fatigue the core before competition.
5. Those with congenital laxity (loose joints) likely need a greater frequency of core work for “neuromuscular reminding.”
6. The general exercises we can do in a weight room or rehab setting must be complemented by sport-specific activities in the appropriate volume. When general volume goes down, specific can go up – and vice versa.
7. Athletes with a previous history of injury – or known diagnostic imaging red flags – may need to do more just to maintain.
8. Everyone’s definitions of “core” is different. I view the core as pretty much everything between the knees and the shoulders – but the truth is that poor core control can also lead to elbow and foot/ankle issues; should we include those joints as part of the equation?
9. Everyone’s definition of and “core stability exercises” is also different. Rollouts – an anterior core stability exercise – were mentioned in the question above, but I’ve never had more soreness in my anterior core than after doing heavy push presses. Simply holding a weight overhead forces our anterior core to work to prevent lumbar hyperextension (the photo below shows what happens when the anterior core isn't properly engaged).
As you can see, the “how much is too much” question is a big, fat, hairy one. Ask 100 fitness professionals and rehabilitation specialists, and they’ll all have different answers – and even then, it will still be dependent on the athlete/client/patient. We can’t even effectively define “core,” let alone “core stability exercises” to answer today’s question.
Taking it a step further, only 15% of low back pain has a definitive diagnosis. One could make the argument, therefore, that only 15% of core function can be adequately assessed/interpreted. We’d like to think that we know exactly what is going on with a spine, but it’s just not reflected in the research.
The good news, though, is that while most people encounter low back pain at some point in their lives, the overwhelming majority of them do get better with rehabilitation. We just don’t know what’s optimal - and I’m not sure we ever will, but we are getting a lot better, thanks to the availability of both research and anecdotal experience of rehabilitation specialists, fitness professionals, and folks who have stayed healthy.
This is one reason why I’m so proud of the Functional Stability Training series from Mike Reinold and me. The two of us collaborated in the past to bridge the gap between rehabilitation and performance training, and we have done it again with project.
Whether you’re a fitness or rehabilitation professional, or exercise enthusiast or athlete looking to learn more about how to effectively prepare the core, train around various lumbo-pelvic injuries/conditions, or learn about developing power in the frontal and transverse planes with medicine ball drills, there is much to be gained from watching Functional Stability Training.
To sweeten the deal, the entire series is on sale for 20% off through the end of the weekend. You can check it out HERE.
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