Episode 17: The myth of core stability, Peter O’Sullivan’s personal story for Low back pain fact 7


Low back pain is still the world’s most disabling health condition and costs more than cancer and diabetes combined. A scientific journal article covering 10 facts about low back pain was recently published in the British Journal of Sports Medicine (http://dx.doi.org/10.1136/bjsports-2019-101611). The origins and motivations for that paper, as well as patient stories, were covered in episodes 4 and 5 of the podcast. In this episode, Professor Peter O’Sullivan joins Kevin Wernli to discuss low back pain fact number 7: back pain is not caused by a ‘weak core’. Pete is well-positioned to talk about this topic;

  • he has the lived experience of trying to fix his debilitating back pain by doing core exercises,
  • as an early career researcher, he then researched core stabilising exercises for low back pain,
  • and now as an internationally-renowned, distinguished Professor of Musculoskeletal pain, and specialist clinician has a mountain of wisdom to share.

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Episode Show Notes:

O’Sullivan PBCaneiro JO’Sullivan K, et al
Back to basics: 10 facts every person should know about back pain
low back pain infographic

Lederman E. The myth of core stability. J Bodyw Mov Ther. 2010 Jan;14(1):84-98. doi: 10.1016/j.jbmt.2009.08.001. PMID: 20006294.


Augeard N, Carroll SP. Core stability and low-back pain: a causal fallacy. J Exerc Rehabil. 2019 Jun 30;15(3):493-495. doi: 10.12965/jer.1938198.099. PMID: 31316947; PMCID: PMC6614774.


Smith, B.E., Littlewood, C. & May, S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord 15, 416 (2014). https://doi.org/10.1186/1471-2474-15-416


May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. 2008. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK75203/


Geisser, M. E., M. Ranavaya, A. J. Haig, R. S. Roth, R. Zucker, C. Ambroz and M. Caruso (2005). “A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls.” J Pain 6(11): 711-726. https://doi.org/10.1016/j.jpain.2005.06.008


Wong AY, Parent EC, Funabashi M, Kawchuk GN. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain? A systematic review. J Pain. 2014 Apr;15(4):377.e1-35. doi: 10.1016/j.jpain.2013.10.008. Epub 2013 Nov 1. PMID: 24184573.


Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. Eur Spine J. 2012 Jul;21(7):1301-10. doi: 10.1007/s00586-012-2155-9. Epub 2012 Jan 24. PMID: 22270245; PMCID: PMC3389103.

Caneiro JP, Smith A, Rabey M, Moseley GL, O’Sullivan P. Process of Change in Pain-Related Fear: Clinical Insights From a Single Case Report of Persistent Back Pain Managed With Cognitive Functional Therapy. J Orthop Sports Phys Ther. 2017 Sep;47(9):637-651. doi: 10.2519/jospt.2017.7371. Epub 2017 Jul 13. PMID: 28704623.

Caneiro, J. P., A. Smith, S. J. Linton, G. L. Moseley and P. O’Sullivan (2019). “‘How does change unfold?’ an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy: A replicated single-case experimental design study.” Behaviour Research and Therapy 117: 28-39. https://doi.org/10.1016/j.brat.2019.02.007


Dankaerts W, O’Sullivan P, Burnett A, Straker L. Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine (Phila Pa 1976). 2006 Aug 1;31(17):2017-23. doi: 10.1097/01.brs.0000228728.11076.82. PMID: 16924221.


Dankaerts W, O’Sullivan P, Burnett A, Straker L, Davey P, Gupta R. Discriminating healthy controls and two clinical subgroups of nonspecific chronic low back pain patients using trunk muscle activation and lumbosacral kinematics of postures and movements: a statistical classification model. Spine (Phila Pa 1976). 2009 Jul 1;34(15):1610-8. doi: 10.1097/BRS.0b013e3181aa6175. PMID: 19564772.


Kevin WernliJay-Shian TanPeter O’SullivanAnne SmithAmity Campbell, and Peter Kent. Journal of Orthopaedic & Sports Physical Therapy 2020 0:01-48
The posture and pain infographic discussed in the podcast:
Posture infographic

From this paper: 

Slater D, Korakakis V, O’Sullivan P, Nolan D, O’Sullivan K. “Sit Up Straight”: Time to Re-evaluate. J Orthop Sports Phys Ther. 2019 Aug;49(8):562-564. doi: 10.2519/jospt.2019.0610. PMID: 31366294.

Other Supporting references:

Nic SaraceniPeter KentLeo NgAmity CampbellLeon Straker, and Peter O’Sullivan

Journal of Orthopaedic & Sports Physical Therapy 2020 50:3121-130

Lifting position low back pain


Nolan D, O’Sullivan K, Newton C, Singh G, Smith BE. Are there differences in lifting technique between those with and without low back pain? A systematic review. Scand J Pain. 2020 Apr 28;20(2):215-227. doi: 10.1515/sjpain-2019-0089. PMID: 31730537.

Heneweer, H., Staes, F., Aufdemkampe, G., van Rijn, M., & Vanhees, L. (2011). Physical activity and low back pain: a systematic review of recent literature. Eur Spine J, 20(6), 826-845. doi:10.1007/s00586-010-1680-7

Mitchell, T., O’Sullivan, P. B., Burnett, A., Straker, L., Smith, A., Thornton, J., & Rudd, C. J. (2010). Identification of modifiable personal factors that predict new-onset low back pain: a prospective study of female nursing students. Clin J Pain, 26(4), 275-283. doi:10.1097/AJP.0b013e3181cd16e1

Machado, G. C., et al. (2016). “Transient physical and psychosocial activities increase the risk of nonpersistent and persistent low back pain: a case-crossover study with 12 months follow-up.” Spine Journal 16(12): 1445-1452.

Inability to perform because of pain/injury in elite adult Irish dance: A prospective investigation of contributing factors.

Cahalan R, O’Sullivan P, Purtill H, Bargary N, Ni Bhriain O, O’Sullivan K.Scand J Med Sci Sports. 2016 Jun;26(6):694-702. doi: 10.1111/sms.12492. Epub 2015 Jun 3.PMID: 26040202
Coenen, P., et al. (2017). “Abdominal bracing during lifting alters trunk muscle activity and body kinematics.” Appl Ergon 63: 91-98.
Wernli, KO’Sullivan, PSmith, ACampbell, AKent, PMovement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back painEur J Pain2020241831– 1849https://doi.org/10.1002/ejp.1631


coming soon.