The Importance of Core Strengthening: Understanding Motor Control vs. Strength Training

The terms "core training" and "core strengthening" have been used interchangeably in both physiotherapy and the fitness industry for years. Often, the same exercises are given indiscriminately to everyone, regardless of how their core is functioning. But here's the critical question: Is core training the same as core strengthening?

The short answer is no. There's a fundamental difference between motor control training and strengthening exercises for your core—and understanding this difference can make or break your recovery from back pain.

What Is Your Core, Really?

The word "core" refers to the area of your body between your diaphragm (the breathing muscle that separates your chest from your abdomen) and your pelvic floor. It includes all the joints of the lumbar spine as well as those of the low thorax (chest) and the pelvis.

There are many muscles that support this region, and in addition to the pelvic floor and breathing diaphragm, the transversus abdominis (deepest abdominal muscle) and the multifidus (deepest back muscle) are known to be critically important.

How Should Your Core Function?

Recent research has shown that the deep muscles function differently from the superficial muscles (oblique abdominals, rectus abdominis, and long back muscles). The deep core muscles:

• Prepare your body for movement before it happens
• Work continuously, regardless of the direction you're moving
• Function like a harmonious chord, working in synergy with one another
• Vary their levels of activation as they anticipate impending loads on the trunk

The timing and amplitude of their contraction is vitally important if they are to provide control to the joints of the back and pelvis.

"Exercises for the core that focus on timing and co-activation with other muscles are called motor control training exercises. Exercises that then take a well-timed and co-activated core and load it are called core strengthening exercises."

Why Timing and Co-Activation Matter

Research has shown that it's the timing, or synergy, of co-contraction of the core muscles that is affected by back or pelvic pain—or even by the fear of back pain. Clinically, visceral pain (from the bowel, uterus, and/or bladder) can also inhibit optimal function of the core.

Current motor control theory suggests that the problem stems from a disruption in communication between your brain and the core muscles—a motor planning problem.

Here's the critical insight: Since you cannot strengthen a muscle that your brain is not using properly, your current core strengthening exercises may merely be reinforcing a non-optimal pattern of muscle activation that you already have.

The Problem Doesn't Resolve on Its Own

This inhibition or delay in timing of contraction does NOT improve once the pain has resolved. One landmark study followed people from their very first episode of acute low back pain for several years and found that some people still had discordant or non-synergistic muscle patterns. In addition, they continued to have frequent episodes of acute low back pain.

Motor Control Training: The Missing Foundation

Motor control training exercises focus on restoring the timing and sequencing of your deep muscles of the core. For the lumbopelvic region, these include:

• Transversus abdominis
• Multifidus
• Pelvic floor muscles
• Breathing diaphragm

Since this system is anticipatory and prepares you for movement, we cannot give you traditional "doing" exercises—your brain will fire the big superficial muscles meant for movement. Instead, we use:

• Preparatory cues and imagery where you imagine connections to increase the activation of deep muscles before you move
• Hands-on feedback to feel for the right contractions
• Self-palpation techniques to teach you how to feel the correct contraction yourself
• Internal awareness to develop a sense of the right contraction without external feedback

The Role of Assessment and Biofeedback

Ultrasound imaging is a powerful biofeedback tool that we use to help you engage the right muscles at the right time. You can visually see whether you're activating your deep core muscles correctly or compensating with superficial muscles.

Efficiency of movement is also a useful indicator. You can easily feel the difference in the effort it takes to lift your leg when you compare an optimal sequencing strategy with a non-optimal one.

Common Compensation Patterns to Watch For

It's not uncommon for other muscles to co-contract in an attempt to compensate for a dysfunctional core. Watch for these substitution strategies:

• Posterior tilting of the pelvis
• Bulging of the abdomen
• Depression of the rib cage
• Breath holding
• Fingertips being pressed out by a strong muscular contraction (internal oblique)
• Gripping with the big buttock muscles

The Three Stages of Core Rehabilitation

Stage 1: Motor Control Training

This is where you learn to activate the deep core muscles with proper timing and sequencing. Think of this more like learning a language rather than exercising. You're retraining your nervous system to use muscles it has "forgotten" how to recruit properly.

This stage is often missed at the gym or in yoga and Pilates studios unless you're working with an evidence-informed trainer who understands the neuromuscular aspects of core function.

Stage 2: Strength Training

Once you can activate the deep core muscles synergistically, it's time to strengthen and build endurance. By adding loads through the trunk, legs, or arms, you will functionally strengthen an optimal pattern for stabilization that gives you stability without limiting your mobility.

This is where traditional core strengthening exercises come in—but only after the motor control foundation has been established.

Stage 3: Functional Integration

The final stage involves integrating the co-activation of the deep system into functional tasks such as squats, lunges, arm work, and sport-specific movements. This pattern of muscle activation should be incorporated into every exercise you do.

Why Continuing with Non-Optimal Strategies Is Harmful

If you continue to use non-optimal strategies, such as inappropriate core strengthening exercises, while an underlying deep core muscle deficit is present, you may end up reinforcing the non-optimal pattern.

Over time, this can lead to:

• Tissue breakdown
• Chronic or recurring pain
• Inability to function at the level you used to
• Compensatory pain in other areas (knee pain, plantar fasciitis, shoulder pain)

For some people, the clue that their body isn't working well is the onset of low back pain. For others, the pain can be remote—everything ultimately connects to your core.

The Bottom Line

Training the deep muscles of your core without having had a proper assessment can be very difficult and frustrating. The difference between motor control training and strengthening matters—and it will make a difference in your outcomes.

At Bedford Health Centre, our physiotherapists are trained to assess core function using evidence-based techniques, identify motor control deficits, and guide you through the appropriate stages of rehabilitation. We don't just give you exercises—we ensure your nervous system is using the right muscles at the right time before we progress to strengthening.

Because you can't strengthen what your brain isn't activating.