| 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?
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?
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:
1. Strength and endurance, and
2. 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.
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 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.
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.
This article was contributed by Sylvia Ho, Physiotherapist
(Masters in Physiotherapy) from Core Concepts www.coreconcepts.com.sg
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