Core strength and back pain

What is the core?

  • The “core” refers to the group of muscles around the trunk that help stabilize and move the trunk. It is actually made up of 2 layers of muscles, known as the “inner unit” and “outer unit”.
    • The inner unit refers to the deeper layer of muscles that are closest to the spine and inner organs of the body. These muscles are not visible to the human eye and are not easily felt. When these muscles contract, they generate little to no movement as their purpose is to provide stabilization of the spine at each segment.
    • The outer unit is the more superficial layer that can be visibly seen when contracting (i.e. 6 pack abs). These muscles generate trunk movement, help to control trunk range of motion, and provide general stability of the spine.
  • Importantly, the inner and outer unit must work together in a coordinated manner to create stability in the core.

How is this related to back pain?

  • Back pain often begins with weakness in the core muscles. Often, it is due weakness specifically in the inner unit, or poor coordination of the inner and outer unit.
  • When one part of the stabilizer is weak, when you increase the load on the spine, there is a greater risk of injury
  • Strengthening the core can help to lower the risk of injuring the spine, and can help improve the posture of your spine which can decrease back pain

How can I strengthen the core to prevent/treat back pain?

Transverse abdominus activation

  • Start by lying on your back on a flat, firm surface with your knees bent to 90 degrees. Place your fingers on the bony prominences at the front of your pelvic bone (near the hip).
  • Imagine if you had a string between these 2 prominences, and you are trying to tighten the string to pull them together. You should feel a small muscle contractionwhere your fingers are placed.
  • Hold this contraction for 10 s and repeat 10 times.
  • Pelvic tilts
  • Start by lying on your back on a flat, firm surface with your knees bent to 90 degrees. Imagine yourself wearing a belt around your waist.
  • Rotate your pelvis upwards so that the belt buckle rolls inwards into your stomach, and your back is completely flat against the floor. Then rotate your pelvis downwards so that the belt buckle rolls down toward your tailbone, and your back is arched.
  • Perform 2 sets of 10.
  • Dead bugs
  • Start by lying on your back on a flat, firm surface with your arms and knees pointed straight up towards the ceiling (see picture).
  • At the same time, extend one leg and the opposite arm without them touching the floor. Bring your arm and leg back to the starting position and repeat with the other arm and leg. Perform 2 sets of 10. Note: Be sure to keep your back flat against the floor and prevent from arching

Bird dogs

  • Start in a 4 point kneeling position (on your hands and knees).
  • At the same time, extend one leg and the opposite arm while keeping your hips and shoulders parallel to the floor. Bring your arm and leg back to the starting position and repeat with the other arm and leg. Perform 2 sets of 10. Note: Be sure to keep your spine straight throughout the exercise and don’t let it sag down towards the ground.

By Rebecca Chow
Physiotherapy Resident