Getting to the Core of the Core

Getting to the Core of the Core Anthony Lett and Dr. Amit Abraham Master’s House An interview with Pilates writer Anthony Lett and specialist clinician and researcher Dr. Amit Abraham

Anthony

Musculoskeletal Physical Therapy from the University of

First, thank you Amit for making the time to share your

Queensland (Brisbane, Australia), and a P.hD in Physical

knowledge with the Pilates community. We are greatly

Therapy from the Haifa University (Haifa, Israel). Currently,

appreciative. I know I can speak for the 34 000 followers

I’m a post-doctoral research fellow at the Emory School of

of Pilates Kinesiology Facebook group who have an

Medicine (Atlanta, GA, USA). My involvement and interest

interest in anything movement, Pilates and fascia related.

in core stability has begun during my studies in Australia, under the supervision of professors Hodges and Jull, who

Amit It is my pleasure. Thanks for giving me this opportunity.

are among the pioneers of core stability research in the 20th century. The reason I decided to make such an effort and move to Australia was my understanding that this

Anthony

would be the best place to learn the science and practice

First, can you tell us about your background, your

of core stability (and other topics) from experts in both

involvement with the “core stability” research, your

research and clinical fields. Moving to Australia was part

workshops and what you are doing currently? What

of my quest to purchase academic and clinical education

intrigued you enough about it initially to make you pack

and expertise with a true, naïve thought of doing whatever

up and head to the “core” of it in Australia?

I could to provide my patients and clients with the best possible treatment and advice.

Amit Sure. I’m a musculoskeletal physical therapist specializing

Since my graduation from the Masters program, I’ve been

in imagery training and dance injuries and rehabilitation.

involved in teaching and lecturing on core stability in a

I have a Bachelor degree in Physical Therapy from Tel-

variety of frameworks, including physical therapy schools,

Aviv University (Tel-Aviv, Israel), a Masters degree in

pilates academies and teachers trainings, etc. I was

curious about core stability since day one of pt school.

various populations, including dancers and people with

When graduating from my first pilates teachers training,

Parkinson’s Disease.

during 2nd year of pt school, I felt a whole new world was opened in front of my eyes. And yet, I felt I knew nothing.

Today, I know how much I was right.

Anthony Could you talk about the history of the core strength idea and where we are currently at in terms of our

In the past 11 years, I have taught, worked with, and

understanding of the notion of core strength? I’m sure it

treated hundreds of pilates teachers and did not lose

has evolved over since the initial research.

my passion to this topic. I truly think, even today, that thoroughly teaching the concept of core stability is among

Amit

the core elements of pilates teachers training. Whether

I will begin with that: I’m not sure that “core strength” is

or not this is being done properly and adequately, is not

the ultimate term I would pick when it comes to core.. My

for me to answer. From my experience as a pt working

second comment is that the core is most probably more

with pilates teachers, I have noticed that pilates teachers

complex and diverse than describing it as a uni-modal

comprise a unique population of amazing people who are

concept (i.e., “weak” vs. “strong”, or “on” vs. “off”). All

desperately in need for such knowledge and experience.

that makes the task of summarizing the history of core

As we know, pilates people come from different

idea and its related research pretty challenging..

backgrounds and are doing an extremely important job in training a variety of populations, ranging from athletes to

That being said, and in order not to avoid an answer,

people with neuro-degenerative conditions. This is a real

I will share with you a few of my understandings and

challenge and it is our responsibility to provide them with

insights, based on reading current literature and years

adequate knowledge and skills, so they can keep the great

of clinical expertise: the first is that we have to be very

job they’re doing out there, providing opportunities for a

careful and accurate when we discuss the core and

better well-being for so many humans. Seriously, it is our

its activation. My experience showed me that there is

job!! And that what keeps me passionate and enthusiastic

sometimes a lack of understanding (and knowledge)

about my work and teaching. I’m trying to do my tiny

regarding the core- both its definition and concept-

share in the big picture.

which may lead to significant misinterpretations and misperceptions. In a study I conducted a few years ago

In my clinical workshops around the world, I put an

(which was not published), I assessed more more than

emphasis on providing participants with theoretical-

75 certified pilates teachers over 14 months and over

scientific knowledge combined with practical-clinical

62% were not able to identify and activate correctly the

knowledge about core stability. Thus, participants gain

core (i.e., Transversus Abdominis, in this case). So my

ability and skills to use such knowledge wisely and

point is that we must make sure that the teachers get

accommodate it to various clinical scenarios, while

adequate training and EXPERIENCE in identifying the

acknowledging the challenges this topic provides.

core muscles, understanding its relevance, and being able to teach it correctly.

In addition, my current path of research focuses on understanding the beneficial effect of imagery

Now, the next point is that you shouldn’t think that it’s

training (e.g., Dynamic neuro-Cognitive Imagery and

all crystal clear and straight forward... Not at all! There is

Motor Imagery) on motor and non-motor aspects of

some body of evidence published over the years to doubt

performance, including body awareness and schema, in

the clinical relevance of the core activation concept.

Or in other words: there is no need for isolating these

I warn us all not to take research for granted. If a study

muscles or even spending time on teaching clients/

failed to show such an ability- we should ask ourselves

patients to use the core correctly. So what is the right

first- was it logical to expect the participants to be

answer? As always, when it comes to a lot of information

able to do it? Were they given enough training? were

and complex cases- there is no easy one. If you carefully

they experienced enough ? what were the cues and

read the literature, you may notice a few major gaps and

instructions they were given ? etc. etc.

differences in approaches (e.g., operational definitions of

So, again, as you can see- there are no simple answers

the core, measurement methods, different populations)

here! And I don’t like to overcomplicate things, but it

as well as interventions assessed (e.g., the exact type of

would be unprofessional to try and give a simple answer

exercises, length of classes and intervention, intensity,

to such a complex topic..

etc.) which, at least in my opinion, makes it very difficult to draw the $1 million question: whether we should continue teach it or not?

Anthony Many Pilates teachers working in a wellbeing context i.e. teaching clients without identified pathologies

Yet, my personal, professional thought is that we should

focus on notions of “body balance,” “good posture” and

definitely keep doing so because of many reasons, among

“alignment.” What are your views on these concepts?

them are: 1. the existing body of evidence is enough to support it; 2) over the years, I have noticed the many

Amit

positive effect of teaching the core on movement quality

As I mentioned before, these are all great notions

and control in a variety of patients and pilates teachers;

as long as the teacher has a thorough and detailed

and 3) it is most probably associated with improving body

understanding about these terms and how to efficiently

schema (i.e., the mental representation of one’s body

transfer the information to the client. Otherwise, it just

and body parts). I’m sure other people may come up with

becomes another slogan with no meaning.. It’s almost

additional reasons.

like a pilates teacher telling me, after 5 repetitions of an exercise, “yes, that’s it! You got it now” and honestly, I

Anthony

have no clue what I’ve done differently and I’m left with a

Perhaps you could comment on our understanding about

vague feeling that I understand what she meant... In this

the division of muscles and their functional roles, and our

case, again, my understanding is that these domains of

ability to tap into or access and engage individual muscles.

knowledge should be included and emphasized within all pilates teachers trainings.

Amit I hope my previous (long) answer partially addressed this question. But in addition: yes, it is obvious that we can

Anthony Can you help us to define these notions?

access, engage, and control individual muscles in some cases, and the core is one example. Now, again, if you

Amit

want to be 100% accurate, I should ask you “what do you

This topic, along with being so interesting, complex,

mean by ‘access’ or ‘engage’? Do you mean activating

and popular, is also a bit misleading and vague. The

a sole, individual muscle without any hint of additional

concepts of “balance” and good posture have changed

activity?” Then my answer would be probably NO. But,

and transformed quite a bit in the past two decades, and

for sure you can focus on engaging one muscle more

what used to be considered as ‘absolute truth’ is being

than others (e.g., the TA and not the Internal Oblique

thoroughly questions nowadays. This is not to say that

or Extenrnal Oblique). And in this case, as a researcher,

everything we thought was wrong. Not at all.

However, it sheds light on the diversity of the topic.

is not good enough evidence (in my opinion, of course)

For example, the concept of ‘neutral pelvis’ used to be

to suggest that “correcting pelvic alignment” reuslts in

strictly taught and ‘enforced’ by clinicians, educators, and

better function of pain reduction. The above does not

pilates teachers. I can’t tell what drove the shift in our

include ‘extreme’ cases, where significant malalignments

understanding, but nowadays it is much more common

or dysfunctions are evident (e.g., a complete kyphotic

to use this term within the ‘individualized’ concept- that

posture). In these cases, which are the ‘easy to detect’

is, each and every one of us has his/her own ‘neutral’

ones, a postural/alignment change will most probably

position (which is determined and influenced by a

benefit the individual.

variety of factors, such as anatomy, motor habits, mental status, etc.) and there is not mcuh evidence to support

To sum, today, more than ever, I think we can conclude

an accurate way to assess what is the ‘neutral’ or ‘best’

that “there is not right or wrong, there is a whole

pelvic alignment for an individual person. Moreover, there

spectrum of possiblities”.

For more details on workshops and trainings, please contact Dr. Abraham at amitabr@gmail.com.

For information on Anthony’s books search “Anthony Lett” on Amazon books.