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Does poor core stability put you at higher risk for lower extremity injuries?

Most people have come to believe that it is important to improve their core stability. This study went through the literature to see if poor core stability is a risk factor for lower extremity injuries.

Core Exercises For Back Pain | Poor Core Stability | National Spine CareHow did they do the research on Poor Core Stability?

The authors did a systematic review, meaning they combed the literature and systematically narrowed it down to the good research studies examining this topic. They then went on to summarize the conclusions. Here is how it broke down:

Although almost 1600 citations, titles, and abstracts were initially identified, only nine studies met the rigorous quality control standards and ended up being included in the final review.

  • Three studies investigated the relationship between core endurance and lower extremity injuries (4, 10, 12)
  • One study investigated the relationship between core muscle strength and ACL injuries specifically (3)
  • One study investigated the role of proprioception, measured by active and passive repositioning of the lumbar spine (9)
  • Four studies investigated movement control by studying the movement of the lumbopelvic region during specific tasks (8, 11, 13, 14)

What did they find?

This evidence suggests that core endurance strength, proprioception, and movement control may be risk factors in the development of lower extremity injuries, particularly in females. The wild card, which will require future research is to identify the role anterior (front) core muscle endurance may play in these injuries.

Although this review specifically studied the athletic population, the results may be more profound in the general population. Although this concept needs further exploration, it is generally accepted that the general population has decreased levels of overall fitness, conditioning and movement control than the amateur and professional athletes included in these studies.


Before you rush out and draw firm conclusions, understand that the nature of the studies included in this review were what is called observational cohort. That means they were designed to observe trends rather than establish firm cause-and-effect relationship conclusions. Having said that, wouldn’t it be nice to think that by working with your clinician and exercise professional to improve your core strength, core endurance, proprioception and movement control, you may reduce your risk of suffering a hip, knee, ankle or foot injury. Stranger things have happened…

A quick shout out to Shawn Thistle and his team at Research Review Service. They do a great job of summarizing topical and relevant research so if you want to learn more check them out.


  1. Bahr R and Krosshaug T. Understanding injury mechanisms: A key component of preventing injuries in sport. Br J Sports Med 2005; 39(6): 324-329.
  2. Chuter VH and Janse de Jonghe XA. Proximal and distal contributions to lower extremity injury: A review of the literature. Gait Posture 2012; 36(1): 7-15.
  3. Raschner C, Platzner H, Patterson C, et al. The relationship between ACL injuries and physical fitness in young competitive ski racers: A 10-year longitudinal study. Br J Sports Med 2012; 46(15): 1065-1071.
  4. Wilkerson GB and Colstan MA. A refined prediction model for core and lower extremity sprains and strains among collegiate football players. J Athl Train 2015; 50(6): 643-650.
  5. Ireland ML, Willson JD, Ballantyne BT et al. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 2003; 33(11): 671-676.
  6. Kibler WB, Press J and Sciascia A. The role of core stability in athletic function. Sports Med 2006; 36(3): 189-198.
  7. Borghuis J, Hof A, and Lemmink KAPM. The importance of sensory-motor control in providing core stability: Implications for measurement and training. Sports Med 2008; 38(11): 893-916.
  8. Zazulak BT, Hewett TE, Reeves NP et al. Deficits in neuromuscular control of the trunk predict knee injury risk. The Am J Sports Med 2007a; 35(7): 1123-1130.
  9. Zazulak BT, Hewett TE, Reeves NP, et al. The effects of core proprioception on the knee injury. AJ Sports Med 2007b; 35(3): 368-373.
  10. Leetun DT, Ireland ML, Willson JD et al. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Ex 2004; 36(6): 926-934.
  11. Roussel NA, Nijs J, Mottram S et al. Altered lumbopelvic movement control but not generalized joint hypermobility is associated with increased injury in dancers. A prospective study. Man Ther 2009; 14(6): 630-635.
  12. Wilkerson GB, Giles JL, and Seibel DK. Prediction of core and lower extremity strains and sprains in collegiate football players: A preliminary study. J Athl Train 2012; 47(30): 264-272.
  13. Verrelst R, De Clerq D, Vanrenterghem J et al. The role of proximal dynamic joint stability in the development of exertional medial tibial pain: A prospective study. Br J Sports Med 2013; 48(5): 388-393.
  14. Verrelst R, De Clerq D, Willems TM et al. Contralateral risk factors associated with exertional medial tibial pain in women. Med Sci Sports Ex 2014; 46(8): 1546-1553.
  15. Wong JJ, Cote P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain 2017; 21(2): 201-216.

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