Core Training Fundamentals: A Guide to Reducing Back Pain
People with chronic low back pain have inadequate core muscular endurance
Sean Lee, NASM, ACE – CPT, NSCA – CSCS
- The “core” is your body’s center of gravity and includes the lumbo-pelvic-hip complex, thoracic spine, cervical spine, and shoulder girdle.
- Lower back pain commonly occurs between the ages of 30-50 and is often associated with a weak and poorly conditioned core. Having a weak core results in bad postural and ergonomic habits, chronic stiffness and/or pain, and musculoskeletal problems.
- It is estimated that 80% of the population will experience acute or chronic episodes of lower back pain at some point in their lives.
- Research and experience in the field demonstrate a high correlation between the integration of core stability and strengthening exercise programs and a reduction or elimination of lower back pain.
When you hear the word “core” what is the first thing that comes to mind? If you are like most, the answer is probably abs. The abdominals are certainly one segment of the core; however, in biomechanical function these highly publicized yet over-rated muscles have a very limited and specific purpose. The core is actually comprised of many muscles extending the length of the torso. Together, these muscles act to stabilize the spine, pelvis, and shoulder girdle, providing a strong foundation for force production and transfer through the extremities. In addition, the core muscles are responsible for postural control, the distribution of stress while weight bearing, and providing protection from back pain and injury. Weak or poorly conditioned core muscles lead to neuromuscular imbalances often resulting in postural changes, musculoskeletal pain, and/or stiffness due to the improper distribution of force. In fact, most cases of back pain are mechanical or non-organic, meaning they are not caused by serious conditions such as inflammatory arthritis, infection, fracture or disease.
Although back pain is generally mechanical and not caused by serious health conditions, it is one of the most common reasons for missed work and is second only to upper respiratory infections for doctor’s office visits each year. It is estimated that Americans spend 50 billion dollars annually for the medical treatment of back pain. However, recent research indicates that many back pain sufferers are now looking for more natural, conservative care as their first line of pain management. Some of the most popular alternatives include exercise, icing, physical therapy, acupuncture, and chiropractic intervention.
An estimated 31 million Americans will experience low back pain at any given time this year. Those affected are commonly between the ages of 30-50. Pain is often associated with a weak or poorly conditioned core musculature, resulting in bad postural and ergonomic habits. Below are additional risk factors for back pain:
- Prolonged static postures such as sitting
- Stress or depression
- Heavy lifting, pushing or pulling
- Forward bending while twisting
- Inherited diseases (i.e., degenerative disc disease)
- Other conditions and diseases (i.e., osteoarthritis, rheumatoid arthritis, spinal stenosis) Structural spinal changes (i.e., age related or congenital)
- Poor physical fitness
Be proactive and start by identifying or eliminating risk factors such as these, which may lead to further musculoskeletal problems. Preventative care is essential for long term health and maintaining an active lifestyle.
CORE MUSCLE FUNCTION
There are approximately 34 muscles responsible for core stabilization and function, including the pelvic floor. Six of these muscle groups, in particular, frequently become de-conditioned with age. Common symptoms include a feeling of muscular tightness, weakness, and pain in and around the low back and pelvic region.
1. Abdominals: Comprised of four muscle groups
- Rectus Abdominis – Flexes the trunk
- Internal & External Obliques – Flexes, side bends, and rotates the trunk
- Transverse Abdominis – Deepest of all the abdominal muscles and is considered the internal weigh belt. When contracted, it creates hoop tension like a girdle. Provides protection and stability for the back.
2. Multifidus – Small muscles providing postural and segmental stability from vertebrae to vertebrae.
Often very weak and lacks endurance.
3. Erector Spinae – A long set of muscles running from the sacrum attaching to the vertebrae, ribs, and the base of the skull. Responsible for extending the spine and maintaining an upright position. Weakness is com- mon and can lead to an increase in spinal disc pressure.
4. Glutes – Commonly referred to as the power house. Primarily responsible for extending the hip. Very weak and inhibited in back pain sufferers.
5. Hamstrings – Located on the back side of the leg, secondary hip extensors to the larger more powerful glute muscles. Chronically tight in back pain sufferers due to overuse and glute muscle weakness.
6. Psoas – This powerful hip flexing muscle runs from the thoracic and lumbar spine to its attachment on the medial head of the femur near the groin. Frequently tight and weak as a result of prolonged sitting, weak lower abdominals, or internal organ dysfunction. Results in an anterior pelvic tilt and sway back posture.
WHAT THE RESEARCH TELL US
- There is a strong correlation between poor physical conditioning and back pain.
- People with chronic low back pain have inadequate recruitment of the transverse abdominis, internal oblique, multifidus, and deep erector spinae. All are key players in spinal stabilization and back pain reduction.
- Training the abdominals without proper stabilization increases disc pressure and compressive force in the lumbar spine.
- People with chronic low back pain have inadequate core muscular endurance and pelvic control. Crunches could make it worse; the core stabilizers are primarily type I muscle fibers and are best trained using isometric and time under tension training techniques.
- Maintaining a neutral cervical spine during training improves postural control and muscular balance. A protruded head (head forward position) during training can lead to pelvic instability and anterior rotation (sway back).
CORE TRAINING PRINCIPLES
All successful core training programs follow a set of principles which help guide exercise selection and progression. Use the principles below as a blueprint to help direct your core training plan.
Improve Flexibility & Range of Motion
Address flexibility and range of motion first. It provides the foundation from which all movement can occur. The physiological effects of aging, prolonged static postures, and injury can alter joint function and lead to muscle spasm or increased muscular tension, limiting motion and increasing the risk for additional musculoskeletal pain or injury.
Provide a Foundation
Next, add isometric (stability) exercises which require little to no joint movement. This will begin the neuromuscular re-education process in a safe and controlled environment. These exercises will coordinate and build endurance through the deep core stabilizing muscles which are responsible for reducing low back stress.
Example: The Draw in Maneuver
Lie down on your back with knees bent and feet on the floor. Practice drawing your naval to your spine. Breathe in through the nose and out through the mouth while maintaining a neutral pelvic and spinal position.
Once you have established a foundation, you can begin strengthening. At this level of core training, isometric exercises will be replaced with controlled dynamic movements in all planes of motion (flexing, extending, & rotating).
Example: Ball Crunch
Lie down on an exercise ball so that your low to mid back is on the ball and feet are on the floor. Perform slow and controlled crunching movements through a full range of motion.
If you are an athlete, this is where you will enhance performance by adding speed and dynamic sport specific movements to the mix. Power development is considered the most advanced level of core training.
Example: Medicine Ball Rotational Throw
Assume an athletic stance with core and leg muscles strong. Using a weighted ball (medicine ball), rotate through your trunk and throw the ball against a wall; or to a partner.
The underlying factors causing low back pain are not always obvious and often can be quite complex. Recognizing the risk factors for back pain and having a basic understanding of core muscle function will have you well on your way to leading a more active and pain free lifestyle. Use the core training principles and take a proactive approach to the prevention, care, and treatment of low back pain. Consider natural alternative treatments as the first line of defense – exercise, ice, or seek out a qualified fitness or a health care professional for advice on your specific situation.
- Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
- The U.S. Consumer Product safety Commission National Electronic Injury Surveillance System (NEISS) database.
- Hills, E.C. (2006) Mechanical Low Back Pain, E-medicine Online Journal (WebMD) June 28, 2006.
- Lis, A.M. et al. (2007) Association between sitting and occupation low back pain. European Spine Journal, 16, 2, 283-298.
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