This post I would like to address the fundamental rationale for core stability training, as it relates to back pain. Also, I intend to explain how muscular imbalances contribute to low back pain, specifically. As a PT, my objective is always to give individuals exercise prescription that relates to his/her intended functional demands – walk, sit, stand, lift/carry, household demands, or athletic endeavors (to name a few) without pain or compensation. So, exercise and movement technique is the foundation of any rehabilitation approach.
As such, I cannot reiterate enough the importance of correct biomechanics. Quality over quantity ALWAYS! The human body moves dynamically into a variety of spinal positions. That being said, if your muscles or surrounding tissues are not working optimally, this can lead to an imbalance, and is the first concern that should be addressed.1,2
Muscular imbalance, specifically across the pelvis, can be problematic for your entire body. The diagram above illustrates the pathological positioning and alignment that I see very often…and from all ages and abilities. Most notably, the weakness on opposite diagonals – abs and butt! In the general population, these muscles are chronically UNDERused.
First, let’s start with the gluteal issue before tackling the abdominals. Gluteal muscles help decrease the load on the back.2 If you have low back pain, the gluteal muscles can virtually forget how and when to work. Whenever you walk, sit, stand, or lift odds are, you are OVERusing your back musculature. In essence, you may even have a “strong back” simply by way of using it all of the time; however, using your back muscles causes significant increases in spinal load, and leads to fatigue and breakdown. Continuing to move with these poor mechanics doesn’t allow your overworked muscles to relax, recover, and heal. Adding exercises with the intent of strengthening back muscles is also just perpetuating the cumulative damage and overworking, instead of addressing the underlying problem.
So, rather than continuing to “strengthen” the back muscles, I suggest exercising for core “stability.” Stability training involves resisting motion at the lumbar spine. To do this, you will use not only abdominal muscles, but gluteal and surrounding trunk musculature as well. The emphasis of core stabilizing movements is to teach how to maintain a neutral position/brace while holding a more challenging position. The plank and side plank are examples of core stabilizing exercises. Overall spinal stability is achieved when the correct muscles allow you to obtain/maintain this neutral position for the necessary duration required to carry out a task. This post’s focus on core stabilization hopes to address the foundation that all movement begins with first achieving stability. Try holding the side plank for 5-10 seconds each and the plank for 20-30 seconds. Do 5 reps of each to start. Remember, technique is key and never push into pain…difficulty and muscle fatigue is okay, though! Increase your hold time & reps as you improve your stability. Keep an eye out for additional stabilization exercises in future posts.