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Special core strengthening prevents no more injuries than ordinary sit-ups

PainSci » bibliography » Childs et al 2010
Tags: radiculopathy, neuropathy, pain, pain problems, spine

Two articles on PainSci cite Childs 2010: 1. The Complete Guide to Low Back Pain2. Your Back Is Not Out of Alignment

PainSci commentary on Childs 2010: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This study of more than 1,100 soldiers found that specialized, “precise” core strengthening did nothing to improve rates of low back pain (or any other injury) compared to good old-fashioned sit-ups.

“But they were all doing some kind of core strengthening!” you might protest. Sure, but the core strengthening “industry” tends to put on airs and act like it’s vital not only that you do core training, but that you do it in a special, technical way for just the right patients (expertly customized). Old-fashioned situps are disparaged as useless and even dangerous. It’s part of the “mystique” of yoga and Pilates that core strengthening must be an “advanced” process. It is one of the main reasons to pay a physical therapist: the patient believes that there must be some reason for paying $80/hour rather than just doing situps at home! This evidence undermines core strengthening dogma by showing that it just doesn’t matter how “technical” your core strengthening is.

See also Steiger, which is also exactly about this problem. Meanwhile, other studies show that no kind of core strengthening is important.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: The US Army has traditionally utilized bent-knee sit-ups as part of physical training and testing. It is unknown whether the short-term effects of a core stabilization exercise program without sit-up training may result in decreased musculoskeletal injury incidence and work restriction compared with traditional training.

OBJECTIVE: The objective of this study was to explore the short-term effects of a core stabilization exercise program (CSEP) without sit-up training and a traditional exercise program (TEP) on musculoskeletal injury incidence and work restriction.

DESIGN: The study was designed as a cluster randomized trial.

SETTING: The setting was a 16-week training program at Fort Sam Houston (San Antonio, Texas).

PARTICIPANTS: The study participants were soldiers with a mean age of 22.9 years (SD=4,7, range=18-35) for whom complete injury data were available for analysis (n=1,141).

INTERVENTION: Twenty companies of soldiers were cluster randomized to complete the CSEP (10 companies of 542 soldiers) or the TEP (10 companies of 599 soldiers). The CSEP included exercises targeting the transversus abdominus and multifidus musculature. The TEP comprised exercises targeting the rectus abdominus, oblique abdominal, and hip flexor musculature.

MEASUREMENTS: Research staff recorded all injuries resulting in the inability to complete full duty responsibilities. Differences in the percentages of musculoskeletal injuries were examined with chi-square analysis; independent sample t tests were used to examine differences in the numbers of days of work restriction.

RESULTS: Of the 1,141 soldiers for whom complete injury data were available for analysis, 511 (44.8%) experienced musculoskeletal injuries during training that resulted in work restrictions. There were no differences in the percentages of soldiers with musculoskeletal injuries. There also were no differences in the numbers of days of work restriction for musculoskeletal injuries overall or specific to the upper extremity. However, soldiers who completed the TEP and experienced a low back injury had more days of work restriction: 8.3 days (SD=14.5) for the TEP group and 4.2 days (SD=8.0) for the CSEP group. Limitations A limitation of this study was the inconsistent reporting of injuries during training. However, the rates of reporting were similar between the groups.

CONCLUSIONS: The incidences of musculoskeletal injuries were similar between the groups. There was marginal evidence that the CSEP resulted in fewer days of work restriction for low back injuries.

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