Unstable Core or Unstable Theories?

Low back pain is one of the most prevalent, costly, and complex issues we face in rehab and medicine as a whole. It has been proposed that a large portion of back pain cases are due to core weakness or, as it’s commonly referred to, instability. This idea originated from the work of Paul Hodges and Peter O’Sullivan in the early 1990s. The idea caught like wild fire, infiltrating university level classes, continuing professional education courses, and subsequently shaping societal beliefs about backs and back pain causes. Fitness, rehabilitation, and medical professionals frequently blame back pain on an unstable or weak core. Consequentially, patients believe that, if they experience back pain, they must be weak and unstable in their spines. Yet, what does the current best evidence tell us about this topic? Has this theory strengthened, or has it failed to keep up with more rigorous investigation? Finally, what implications could this clinical framework have on patient outcomes and resilience surrounding the most common musculoskeletal complaint in the world? (Recorded at PAINWeek 2018)