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Confused Over Core

If you suffer from back pain, you would have likely been told that exercises are good for you and specifically those that strengthen your core. Unfortunately, these days it is harder to get by a week without reading somewhere in the newspapers, health or fitness magazines, hearing in the gym about core strength, core conditioning and core stability or about some new fitness equipment.

It can all be rather confusing. So, if you are suffering from back pain, what sort of core exercises should you be doing?

What is core?

Before we start discussing which core exercises are relevant for back pain sufferers, what exactly do we mean by the ‘core’ muscles?

The core area relevant for low back pain is the trunk region below your ribs to your pelvis. On this point, both physiotherapists and fitness instructors generally agree.

However, where they begin to diverge is when specifically talking about the ‘core’ muscles. Physiotherapists when referring to core muscles, mean the deep trunk or abdominal muscles with the term ‘core’ meaning “inner” units.

However, when talking to fitness instructors, core muscles mean all the muscles in the trunk area including your obliques, rectus abdominus (‘six-packs’) and deep abdominal muscles.

So since the fitness definition of core muscles cover a larger group of muscles, should you not be focusing on the core strength and core conditioning exercises taught by fitness instructors? Isn’t a “2-for-1” deal better?

Unfortunately, as with all other important questions in life, the answer is ‘it depends’. Are you simply interested in building up the strength of your core for general fitness, for improved sport performance or improving your core stability to stop recurring back pain

Why is core stability important?

If you are looking to improve your core to stop recurring back pain then you should take up the physiotherapist point of view. When back pain sufferers are told to strengthen their core muscles, they are actually being asked to improve the stability of their core. Specifically, this involves improving two aspects of their core muscles or stabilising muscles, namely for improved:

  1. Strength and endurance, and
  2. Muscle control

Core muscles are connected to your spine, unlike your other abdominal muscles. Their primary role is to help stabilise your spine to provide the necessary support. As their primary function is to stabilise, they do not mobilise or move your body such as your obliques (turns your body side-to-side) or your rectus abdominus (helps you do crunches). Therefore, exercises that target your deep core muscles for low back pain sufferers are rarely vigorous but rather focus on holding the lower trunk region stable.

Weak core muscles and back pain

Research has shown that back pain sufferers have two weak areas where the core muscles are concern. Firstly, the core muscles are generally weak and tire easily. Secondly, they are often not able to activate the muscle or have a delayed contraction.

The muscle being weak is easy enough to understand but what do we mean by delayed contraction?

An analogy would like wearing your seat belt in a car. Before you move off in your car, your seat belt should be on so that when an accident occurs, it helps protect you. It would be a little too late to put the seat belt on after the accident.

In the case of your core muscles, the delay is in terms of milliseconds, when your muscles should activate and provide the support in anticipation of movement and not activate when after the movement begins or have occurred.

Training in isolation

Because of these two weak areas, the core stability exercises by fitness instructors are sometimes not appropriate for back pain sufferers. You should look for exercises that allow you to isolate the core muscles and are relatively gentle.

As they are weak to start with, core-conditioning exercises that do not isolate and train the deep core stability muscles on their own but rather, work the entire core will do little to improve the strength of the deep core muscles.

Working a muscle group composed of weak and strong muscles together will naturally favour the stronger muscles that will take up more than their fair share of the work, leaving the weak muscles taking up little of the workload or none at all. This would be fine if the exercise movement is the end goal in itself but not if the goal is to improve the strength of the core muscles.

The gentle approach

The approach taken to improve the strength of core strength has to be relatively gentle at the start. If the exercises are initially too challenging, it is easy to ‘overshoot’ and recruit the non-stabiliser muscles to achieve the movement.

It is not only important to do the movements correctly, (to prevent injury) as also to ensure that the core muscles are challenged to increase its strength and endurance. This is a common mistake for back pain sufferers when first taking up core stability classes.

One common mistake in this regard is to adopt core stability exercises done by athletes to prevent back pain. These are usually inappropriate for your average sufferers of back pain as the exercises are typically too advance and difficult in intensity.

Back pain is a common complaint amongst performance athletes NOT because their core muscles are as weak as your average person who leads a sedentary lifestyle. Rather their core muscles are weak RELATIVE to the demands of their sports, which generate significant loads on their spine and require vigorous dynamic movements of their trunk.

The next step

Once the deep abdominal muscles reach sufficient strength and endurance, harder core conditioning exercises are then appropriate to continue challenging the deep core muscles to the next level of fitness for dynamic stability.

At this stage, back pain sufferers should notice a significant reduction in recurring back pain in both intensity and frequency. If they then take up a more active lifestyle with their improve fitness, they should continue to ensure that the deep core muscle strength and endurance are sufficient to meet the needs to their new lifestyle.

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Theressa Lim
Theressa Lim
I had an excellent sports massage by Wan Ling, which was very different from the usual massage I've tried elsewhere. Wan Ling skillfully and systematically loosened every muscle in my upper back and neck over the course of an hour. If anyone is seeking relief from tense muscles, I would highly recommend making an appointment with Wan Ling.
Rebecca Lim
Rebecca Lim
Came to see Xue Ting with a broken shoulder for the last 6 weeks and was impressed with her attentiveness and ability to make me feel me feel comforted in my condition . Very dedicated and good therapist indeed .
Janet Koh
Janet Koh
They adopt a scientific and personal approach. The therapists put in a lot of effort to diagnose the issue before attending to it. Overall, I would strongly recommend their professionalism and methods.
Varun Sharma
Varun Sharma
Really good sports massage! Booking process was efficient too :)
Charmaine Miranda
Charmaine Miranda
Friendly and really professional service! I immediately felt welcomed the moment I stepped into the clinic! The physio offered me great advice beyond what I had asked, which allowed me to have a deeper understanding as to why I had my issue in the first place. With this kind of service, I would honestly recommend this physio if you are serious about getting better.
Jimmy Allen Poh
Jimmy Allen Poh
Thoughtful and sincere service. Highly recommended!
Benedict Koh
Benedict Koh
My mum received her first Apos treatment. We intend to continue until her hip muscles become strong. We believe in the treatment as we saw how amazing it was. The idea was simple. Really love that she can be herself again, for long term. The hip and knee cap operations offers 15yrs. Hence we reject the cost and short-life. My wish is that the treatment cost can be lowered and more are aware of this treatment. God bless and thank you team.
Victoria Soh
Victoria Soh
Look for Soo, he is a great physiotherapist . Always communicating and always asking for my feedback. I’m on the right path to recovery all thanks to Soo. Two thumbs up.
Daniel Wang
Daniel Wang
Xue Ting has been working on my troublesome QL, hip girdle - basically the whole left lower kinetic chain! She has been patient, strong and cerebral in her approach to my 48 year old compensatory mechanisms. Her strong massage will finish with an assessment of muscle imbalance and poor activation with finally a retraining back to healthy movement.I’m impressed! Thanks Core Concepts!
Brett McLaren
Brett McLaren
I went from barely understanding physical therapy for injuries, to highly recommending Core Concepts to friends and family for their aches and pains. Ken was knowledgeable, patient and explained symptoms and consequences in a simple, relatable manner. I hope more people will come to understand how physio is a much better alternative to short-term painkillers.
Manda Misso
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Ken is really amazing!
Terry Tan
Terry Tan
The physiotherapist here explained the problem very well and provided me with exercises that helped improved my condition.
Ferdinand Mar
Ferdinand Mar
I have been experiencing great pain on my shoulder coupled with occasional numbness on my arm. Thanks to Ken Liew, I felt so much relieved after my first session. He was very patient and knowledgeable and had definitely made my 1st visit to a physiotherapy clinic a very memorable one. Thank you so much Ken
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Bee Choo Gian
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Sandy Toh CH
Sandy Toh CH
Hi I am Sally and I am in my late sixties. I have endured a year of thigh(joint) pains and thought that it must be due to old age. Visited Core Concepts at Novena and after only 2 sessions, my condition improved so much that I was able to climb stairs easily again. THANKS to my Physiotherapist Samuel Ong who is extremely polite, professional and knowledgeable.
Shino Tutu
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I have had several sports related injuries and Core Concepts has saved me and put me "back to new" each times! The therapists are excellent - knowledgeable and professional, and the receptionists (Carol, Adiqah and Rin) are always friendly and helpful. They even give me oreo cookies for my children! :)
Paola Venturini Hubert
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Highly recommended for sports massage
Simon Ray
Simon Ray
Extremely friendly staff and therapists! Folks Novena Square are just simply smiley and happy. Coming here towards the end of the work day always brings up my mood. Therapist and coach are fabulous. My condition improve so much that I can even start to train up some of my predominately unrealized problems. Highly recommended!
Von Ling Wei Hao
Von Ling Wei Hao
I go to Novena and Cheryl is my therapist. She was upfront from the get go about my neck condition. I liked her honesty and said we'll give it a try. I was better after 4 weekly sessions and continued to go to her every 2 weeks. With her help I am in a better condition, had to put in effort on the exercises she taught me as well.
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Pei Yee Wong
Pei Yee Wong
i have tried different physiotherapy sessions with almost 10 physiotherapists in india and in Singapore, my back pain was treated well by CHERYLL, with God's grace , i was pain free only after Cheryll attended to me. Thank you Cheryll and core concepts for the great experience.
Madiha Sadiq
Madiha Sadiq
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YitKoon Gan
YitKoon Gan
Very friendly and professional physiotherapist as well as receptionists within the clinic. Dr. Issac Wong is easy to approach and came up with alternative ways for me to strengthen my weak thigh muscles and it really helped in reducing my knee pain! Thanks :)
Sam Costanza
Sam Costanza
The best physiotherapist ever. Cheryl is really good. Doesn't shortchange me of time and make sure I feel better before she lets me go. The front desk staff are great too. Very accomodating and friendly. Thank you Carol and Farrah. Only thing if they can give instructions to how to go to their place will be great. Usually only unit number but do give some details like mrt exits and directions to lift and such will be excellent. Coz I almost got lost in 2 different places. Overall still love core concept because of Cheryl! Thank you Cheryl!!
Jeanette Goh
Jeanette Goh
Found out about Core Concepts last year through social media and made an appointment as i was experiencing some neck and shoulder discomfort after a traffic accident. My therapist was evidently experienced and was able to pinpoint the cause of my aches. The one thing i loved about my experience at Core Concepts is that they are not like typical physiotherapists who simply prescribe take home exercises, instead my therapist was extremely hands on, helping me to massage my neck at the right spots to relief the stiffness - best massage ever! Would highly recommend Core Concepts!!
Claire Chia
Claire Chia
Easily the best physio clinic I've been to.
Natarajan Baradwaj
Natarajan Baradwaj
The only physio clinic i trust! A unique approach to treating pains, you simply have to try it out for yourself. Have recommended many friends and family and core concepts has not disappointed. Thumbs up!!!
Claire Chia
Claire Chia
From the reception to the therapist, they are friendly and nice. I was taught on a 2 steps stretching to strengthen my leg muscles that I can do it myself daily and It did help :) Will recommend to anyone who wish to have therapy sessions.
Jaz
Jaz
Knowledgeable and brilliant!
Brenda Chong
Brenda Chong
-emails with advertisement and birthday wishes came, but they didn't think that their customer (with 4/10 sessions remaining in his package) would have expected a reminder of ANY kind if his package was already expiring. I asked the clerk from my last visit how many sessions I had remaining, and she told me 4, with no update on the expiry at all. -assumed I wanted a physiotherapy (PT) appointment when my past SMS have always been for sports massage (SM); whenever I asked for "available slots", they would give me the slots for SM. yet they suddenly gave me the list of available slots for PT ytd. I'm also to blame for not verifying and reading their long SMS carefully.-their masseuse is very good though, skilful and respectful. They ask important questions to understand their client before starting on the SM. I'd still return even though the administrative process is lacking.
Beale Liu JieXiong
Beale Liu JieXiong
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