Why is core strength so important for improving and preventing back pain?

Your core muscles are the primary stabilizers of not just your trunk, but your entire body.  Your core provides an anchor that all of your muscles use as a base to generate force.  Anatomically, a lot of your core muscles actually wrap all the way around your trunk and attach to your spine. The core muscles are designed to stabilize your joints with lifting, reaching, and even just with sitting.  When they are not properly strengthened, this leads to excessive compressive forces being placed through your low back.  It also results in poor mechanics and posture, which over time wears on your lumbar spine and leads to chronic pain.   Low back pain is the most common complaint we treat our patients for, and a lot of it is preventable with proper core maintenance. 

How can I strengthen my core to improve my back pain/prevent future back pain?

The goals with a majority of the core exercises we do in physical therapy are to improve posture, both sitting and standing, and to improve core activation with activity.  The stronger your core is, the stronger the muscle-to-brain connection is.  All that means is that your core will naturally engage when performing activities without you having to think about it.  Listed below are three great exercises that are easy on your joints and improve core strength and stability.

A) Posterior Pelvic Tilting

This is a great exercise to wake up your abdominal muscles and begin establishing that strong brain-to-muscle connection. 

Starting position: Laying flat on your back with your knees bent and feet down flat.

Action: Engaging just your core muscles, you will tilt your pelvis back towards your nose.  Think about flattening your low back curve into the surface you are laying on.  Hold the tilt for 3 seconds and perform 2 sets of 10 repetitions.

Make sure you keep your head and shoulders down flat and not use your buttock muscles to tilt your hips.

B) Plank

This is a great exercise that engages all your core muscles and improves the entire stability of your body.

Starting position: Laying flat on your stomach.

Action: Pressing up onto your elbow and your toes, hold your back completely flat for 20 seconds, then relax and lay back down on your stomach.  Repeat 5 times.

If you are feeling it in your lower back, think about holding your stomach in to while you hold to keep the core engaged.

C) Side plank

Similar concept to the plank, but this will work more of your deeper abdominal muscles and the sides of your hips.

Starting position: Laying on your side

Action: Pushing up onto your elbow and knee, try to hold your shoulders-hips-knees in a straight line for 20 seconds.  Perform 3 times on each side.

Are there any core exercises I should avoid doing that may hurt my back?

 Any exercise when performed incorrectly can potentially cause pain, but there are some exercises that place excessive and unnecessary stress through your back that can be avoided. 

The first exercise we recommend avoiding is crunches.  Most people lead with crunches by flexing their neck and throwing their head/shoulders forward and using momentum to hoist themselves up.  First off, this can lead to chronic neck pain and headaches due to over activity of the surrounding neck muscles, but secondly it also puts a lot of stress on the discs in your low back with the repetitive forward bending.

Another exercise we recommend avoiding is swimmer kicks/scissor kicks.  With this, patients arch their back off the table and hyperextend their back in an attempt to stabilize the hips so they can kick either up and down or side to side.  This leads to poor core muscle recruitment and leads to compressive forces through the low back, which may potentially lead to injuring your back.

The last core exercise we recommend you avoid is the classic sit up.  This is similar to the crunch.  A lot of people with low back pain will have their symptoms worsened by this repetitive forward bending of the low back.  It puts a significant amount of stress on the structures within the spine and can potentially lead to an injury of the low back.

It is much easier to perform 10 minutes a day of core maintenance exercises than to deal with 10+ years of low back pain! The earlier you get ahead of it, the easier it will be to manage your low back pain. Incorporating these recommendations into your daily routine, in conjunction with practicing good posture and body mechanics, will help you in continuing to do the things you love!

Mohammad “Mo” Abuhmud, PT, DPT, and Tanner Simmons, PT, DPT are physical therapists at the OrthoSouth Germantown clinic. Appointments can be made directly by calling (901)522-6440.