[Exercise Videos] Core Strengthening for Low Back Pain

core strengthening for low back pain

You’ve heard that core strengthening may be an option to help alleviate and even prevent low back pain – so what, you wonder, are the right core exercises for you? You’ve heard sit-ups can damage your back, crunches are old news, the newest ab machines advertised on QVC are just gimmicks, and now you’re just confused…

Let’s demystify the concept of core strengthening once and for all. Let’s talk about why core strengthening is important, how certain core muscles help give you support, and cover some key exercises that can begin to progress you in the right direction toward strengthening your core the right way…

What is the Core?

When you think of the ‘core’ you tend to think mainly of the 6-pack abdominal muscles that we all wish we had.

It turns out that the ‘core’ is much more than just the 6-pack, though.

A deep cylinder of muscles surrounds your spine like a corset. This group of muscles provides stability to your spine in both static postures and during dynamic movement1.

Of course, your spine – consisting of bones and ligaments – has some stability on its own, but the muscles of your core provide it with much more support that help you perform your everyday tasks2.

The good news is: in most situations you come across, only a small amount of core muscle activity is needed to create stiff and stable jointsabout a 10% maximal contraction can provide stability at each segment of your spine3.

This isn’t difficult to achieve and doesn’t require you to go around all day bracing your abdominals as hard as you can.

Endurance of the core muscles is much more important than absolute strength, in most cases.  When it comes to more demanding tasks such as lifting a heavy box or playing a sport, strengthening the core can be beneficial.

Which Core Muscles Are Most Important?

The first muscles that activate when you move an arm or a leg are the Transversus Abdominis and the Lumbar Multifidus – both deep core muscles.

These muscles are also typically active even during static standing positions4. Both of these muscles have direct and indirect attachments with the vertebrae of the spine and increase stiffness5 and stability of the lumbar spine during postural adjustments and whole body movements6,7,8,9.

But spinal stability doesn’t depend only on these two muscles alone. Remember, the ‘core’ is made up of a whole cylinder of deep muscles that provide support to the spine. It is through a co-activation of all of your trunk muscles that you are able to provide the spinal stability10,11,12,13,14.

The Quadratus Lumborum is an important lateral stabilizer, increasing lumbar stiffness on both sides of your spine15,16.

We also can’t forget about the internal and external obliques and, of course, the Rectus Abdominis (6-pack), providing more superficial support.

Also, above the cylinder is the diaphragm, and below are the muscles of the pelvic floor, all of which help contribute to intra-abdominal pressure and spinal stability.

How Does Core Strengthening Help With Low Back Pain?

As it turns out, if you have low back pain, or have had low back pain in the past, you might have decreased core strength and endurance17 – the deep muscles, in particular, can present with atrophy18,19, delayed activation20,21, and a lack of control22,23.

Is this cause for concern?  I wouldn’t say so.  And remember – you’re not alone – most people have had low back pain.

I look at core strengthening as an opportunity to work on improving your function moving forward.

The motor control approach to core strengthening focuses on activating the deep core muscles24, mainly the Transversus Abdominis and the Lumbar Multifidus25.

The initial goal of your core strengthening program is to learn how to activate these deep core muscles in a neutral spine position, then learn to incorporate this into your daily activities.”

Is it possible for your brain to specifically tell only a couple of deep muscles to turn on? Probably not.  But you can perform exercises in certain ways that allow these deep muscles to turn on more readily.

I call this technique ‘bracing’ the core. For some patients, this comes naturally, for others it takes time to learn…

  1. Abdominal Brace:
  • Lie face-up with knees bent and feet flat
  • Gently brace the abdominals by bearing down as if you are going to pass gas or have a bowel movement
  • To make sure you are doing this properly, try poking the side of you abdomen with your finger at rest (it should be soft), then after you brace (it should get harder)
  • We aren’t trying to ‘suck in’ the stomach here. Rather, we’re trying to form a rigid cylinder in your trunk
  • Maintain this brace as you continue to breathe normally
  • As this becomes easier and more natural, practice it in other positions
  • I often instruct patients to see if they can maintain a 10% activation of this brace throughout the day, whenever they think of it

 

Once bracing becomes easily controlled and natural, then – and only then – can exercises be advanced26. The goal is to continue to stabilize the spine with increasing challenges to the muscles.

Exercises in this core strengthening phase include moving the arms and legs simultaneously and through larger ranges of motion to challenge the muscles while still maintaining a strong brace and a neutral spine.

2. Abdominal Brace With Marching:

  • Brace the core as described above
  • Maintain this brace and continue to breathe
  • Lift both knees up to assume the starting position
  • Slowly lower the Right foot down and tap it on the ground, then lift it back up
  • Repeat on the left leg
  • Continue alternating slowly until you fatigue

 

To incorporate the Quadratus Lumborum more, along with other deep core muscles…

3. Side Plank:

  • On your left side
  • Stabilize your upper body with your left forearm directly underneath your shoulder
  • Put the right foot on top of the left or staggered in front
  • Lift the hips up to be in a line with your body
  • There should be a straight line from your head to your toes
  • Maintain this plank as long as you can tolerate
  • Repeat on other side

 

From here, exercises can continue to advance to further challenge the core. Training on unstable surfaces such as a rocker board, a disk, BOSU ball, or swiss ball, has been shown to increase the demand on the core muscles27.

Of course, there are many more great core exercises you can incorporate into your routine based on your specific goals. But the ultimate goal is to train deep and superficial core muscles to contract in sequence to give you support28,29.

Something I should point out is that core strengthening isn’t the only way to improve from low back pain.  It has been shown to be beneficial, but not necessarily more so than other interventions.  Therefore, I urge you not to fixate on your core as being a problem, but rather an opportunity to improve your endurance, strength, and function.  

More than anything else, your ultimate goal should be to get back to what you want to be doing, and core strengthening might play a role in getting you there.  

Question: What is your favorite core strengthening exercise? You can leave a comment by clicking here.

  1. Sahrmann SA: Movement impairment syndromes of the lumbar spine, in: Diagnosis and treatment of movement impairment syndromes. St. Louis, Mosby, 2002, pp 51–119. ↩︎
  2. Crisco JJaMMP: Euler stability of the human ligamentous lumbar spine. Clin Biomech 1992;7:19–32. ↩︎
  3. Barr, KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil 2005;84:473–480. ↩︎
  4. Moseley GL, Hodges PW, Gandevia SC: Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine 2002;27: E29–36. ↩︎
  5. Richardson CA, Snijders CJ, Hides JA, et al: The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine 2002;27:399–405. ↩︎
  6. Behm DG, Anderson K, Curnew RS. Muscle force and activation under stable and unstable conditions. J Strength Cond Res. 2002;16:416-422. ↩︎
  7. Hodges P, Richardson C, Jull G. Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function. Physiother Res Int. 1996;1:30-40. ↩︎
  8. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine. 1996;21:2640-2650. ↩︎
  9. McGill, SM. Low back stability: from formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev. 2001;29:26-31. ↩︎
  10. Axler CT, McGill SM. Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge. Med Sci Sports Exerc. 1997;29:804-811. ↩︎
  11. Butcher SJ, et al. The effect of trunk stability training on a vertical takeoff velocity. JOSPT. 2007;37:223-231. ↩︎
  12. Leetun DT, et al. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004;36:926-934. ↩︎
  13. O’Sullivan PB, et al. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiographic diagnosis of spondyloslysis or spondyloslisthesis. Spine. 1997;22:2959-2967. ↩︎
  14. Rasmussen-Barr E, et al. Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-,12-, and 36-month follow ups. Spine. 2009;34:221-228. ↩︎
  15. Ebenbichler GR, Oddsson LI, Kollmitzer J, et al: Sensorymotor control of the lower back: Implications for rehabilitation. Med Sci Sports Exerc 2001;33:1889–98. ↩︎
  16. McGill S: Developing the exercise program, in: Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL, Human Kinetics, 2002, pp 239–57. ↩︎
  17. Barr, KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil 2005;84:473–480. ↩︎
  18. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine. 2004;29:E515-519. ↩︎
  19. Hides J, et al. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2006 Oct 26: epub ahead of print. ↩︎
  20. Ferreira PH, et al. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine. 2004;29:2560-2566. ↩︎
  21. Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil. 1999;80:1005-1012. ↩︎
  22. Critchley DJ, Coutts FJ. Abdominal muscle function in chronic low back pain patients: measurement with real-time ultrasound scanning. Physiotherapy. 2002;88:322-332. ↩︎
  23. Henry SM, Westervelt KC. The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. J Orthop Sports Phys Ther. 2005;35:338-345. ↩︎
  24. Richardson CA, Hodges PW, Hides J. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. Edinburgh, UK: Churchill Livingstone; 2004. ↩︎
  25. Ferreira PH, et al. Specific stabilization exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006;52:79-88. ↩︎
  26. McGill S: Evaluating the patient. In: Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL, Human Kinetics, 2002, pp 223–38. ↩︎
  27. Atsushi I, et al. Trunk muscle activity during lumbar stabilization exercises on both stable and unstable surface. JOSPT. 2010;40(6):369-375. ↩︎
  28. McGill SM. Low back stability: from formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev. 2001;29:26-31. ↩︎
  29. McGill SM et al. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13:353-359. ↩︎
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  • Josephine Key

    Correct core action isn’t bearing down. This will places undue stress on the pelvic floor. Try widening the ribs and activating IAP.

    • Michael Curtis

      Thanks Josephine. I believe the pelvic floor is actually a vital component to the core and should be utilized and strengthened. I also disagree about widening the ribs. To increase intra-abdominal pressure we should be depressing the ribcage.

  • Gwen Conzemius

    Once ready to advance, I like scooter roll outs for core strengthening. But I agree starting supine for core mm awareness and initial strengthening is key.

    • Michael Curtis

      Roll outs are awesome! There’s a lot of really great exercises to advance with. I believe it’s imperative that we get the basics down first, like you said.