Treatment: 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:

• Strength and endurance, and
• 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.

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.