BACKGROUND: Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered. OBJECTIVES: 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance. DISCUSSION: Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance. CONCLUSIONS: A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes.

Significance: Advances in field-based trauma care, surgical techniques, and protective equipment have collectively facilitated the survival of a historically large number of service members (SMs) following combat trauma, although many sustained significant composite tissue injuries to the extremities, including limb loss (LL) and limb salvage (LS). Beyond the acute surgical and rehabilitative efforts that focus primarily on wound care and restoring mobility, traumatic LL and LS are associated with several debilitating longer term secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], and cardiovascular disease [CVD]) that can adversely impact physical function and quality of life. Recent Advances: Despite recent advancements in prosthetic and orthotic devices, altered movement and mechanical loading patterns have been identified among persons with LL and salvage, which are purported risk factors for the development of longer term secondary musculoskeletal conditions and may limit functional outcomes and/or concomitantly impact cardiovascular health. Critical Issues: The increased prevalence of and risk for LBP, OA, and CVD among the relatively young cohort of SMs with LL and LS significantly impact physiological and psychological well-being, particularly over the next several decades of their lives. Future Directions: Longitudinal studies are needed to characterize the onset, progression, and recurrence of health conditions secondary to LL and salvage. While not a focus of the current review, detailed characterization of physiological biomarkers throughout the rehabilitation process may provide additional insight into the current understanding of disease processes of the musculoskeletal and cardiovascular systems.Keywords: amputation, biomechanics, cardiovascular disease, limb salvage, low back pain, osteoarthritis SCOPE AND SIGNIFICANCEExtremity trauma, including limb loss (LL) and limb salvage (LS), is commonly associated with an elevated risk for secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], cardiovascular disease [CVD]) that can significantly limit physical function, reduce quality of life (QoL), and life expectancy. This review provides an extensive commentary regarding resultant secondary health effects of extremity trauma in service members (SMs), with a particular focus on functional outcomes and quality of movement. TRANSLATIONAL RELEVANCEPhysiologic biomarkers provide an opportunity to enhance translation in future work to examine the pathophysiology of the secondary health conditions associated with traumatic LL from a basic science perspective. While this approach is yet to be fully explored and thus was not a primary focus of this review, such biomarkers may augment traditional analyses and support more comprehensive risk characterization, thereby allowing clinicians and researchers to better mitigate disease onset or progression. CLINICAL RELEVANCEThe increased prevalence of secondary health effects following traumatic extremity injuries places a...

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