Getting to the “core” of low back pain

Ryan LaCorte Kathleen Groome, Publications

What is a “core?”

Your abdominals or “core” as some people like to call them are actually a group of muscles known as the rectus abdominis, external and internal obliques, transverse abdominis, multifidi, diaphragm, and pelvic floor muscles. The easiest way to think of your “core” is to think of a box: the roof is the diaphragm, the walls are multifidi and transverse abdominis and the floor is the pelvic floor muscles.

Why are they important?

Without having a strong base of support or “core,” the body must rely more heavily on other muscles due to imbalances. For this reason these muscles are often known as your stabilizers as they allow the rest of your body to move properly. Simple everyday activities such as walking, lifting, bending over to tie your shoes or playing sports may become painful to complete.

I have a six pack so doesn’t that mean I have a strong core?

Not exactly. A six pack looks aesthetically pleasing, however, unless you train your inner abdominal muscles, it is only a matter of time before you end up with an injury; in fact the six pack does not involve the entire “core” it is mostly comprised of the rectus abdominis. The rectus is unable to support itself without assistance from other muscles located in your abdominal cavity. It can even compress your spine and cause pain if over worked.

I suffer from back pain, can I still work on my core?

Yes, you can. If you suffer from back pain, your doctor may recommend you see a physical therapist. Physical therapists are licensed professionals who are medically trained to help patients decrease pain, improve strength, increase mobility, and improve function. A physical therapist can evaluate your symptoms and design a program for you, which will allow you to strengthen your “core” without causing back pain, while preventing injury.

I want to start a core exercise program, but I don’t know where to start?

It is recommended that you consult a professional before beginning any exercise program. If you would like to strengthen your “core” or inner abdominal stabilizers, let’s first start with the basics by strengthening two important muscles: the transverse abdominis (TA) and diaphragm. Lying down on your back with your knees bent, gently tighten your stomach in towards your belly button. Hold for 5 seconds without holding your breath. You can repeat this 10 times. This exercise isn’t easy however it is extremely important as these muscles are being contracted when we lift or move. You should be able to hold a conversation and contract your abdomen at the same time. Another exercise is called diaphragmatic breathing. As with the exercise mentioned above it is designed to strengthen your inner stabilizers. To start the exercise you can either lie down or sit upright in a chair with your feet planted firmly on the floor. Place one hand on your abdomen and the other on your chest. Breathe in slowly and deeply through your nose and allow your stomach to rise, then blow the air out of your mouth as if you are blowing out a candle. Do NOT hold your breath. Diaphragmatic breathing is very relaxing, and easy to complete with practice.

In conclusion, back pain can result from weakness of the abdominals and back muscles. This weakness causes the back to work harder which results in back pain. As a result of “core” strengthening, the back is able to increase its flexibility which it needs to support the spine.

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