For People With Back Pain

By Dylan Bartley, MSPT

Back pain is the most common condition we see in physical therapy, with some studies reporting that 84% of adults will suffer from it at some point during their life. Strengthening your core and learning how to use it to stabilize your back can be one of the best ways to treat back pain. Also, our center of gravity is in the core and all movement begins here. If the extremity muscles are strong but the core is weak, not enough force will be created to produce efficient movements. So even if you’re not worried about pain, but you want to be a better athlete, the core is the best place to start building strength.

If you look at the anatomy of the human spine, it’s not hard to imagine why the lumbar spine is so vulnerable. The thoracic spine is surrounded by your ribs and is fairly well protected. The pelvis is a stable ring of several bones coming together with little mobility happening there. But in between the thoracic spine and the pelvis lives 5 lumbar vertebrae that can be very mobile and flexible with not much bony architecture to stabilize it. Our abdominals have a big responsibility to protect us from high loads and forces that can lead to disc bulges, degenerating joints, and eventually painful pinched nerves.

There are 4 different abdominal layers that surround the lumbar spine and they are not all created equal. The outermost layer is called the rectus abdominus and it is the one that forms the six pack and helps us when we sit up. Below that we have the external and internal obliques and those are involved in rotational and diagonal movements of the body. The deepest layer is the transversus abdominus and this is the most important for our purposes because it is the abdominal muscle that actually connects the most into the fascia that connects the vertebrae of the spine. It provides the deep support that we need to reduce excessive movement of the lumbar vertebrae. So when we say, “core,” we are referring mostly to this transversus abdominus layer.

So how do you isolate the core with your exercises? First of all, understand that the outer abdominals move the spine when they contract. So when you are flexing the trunk during a sit up you are working the rectus abdominus. When you twist the spine with a wood chopper type exercise, you are working the obliques. When just the transversus abdominus contracts, the spine doesn’t move, it is just stabilized. So you should focus on exercises where you are moving the arms or legs, but trying to keep your back in a neutral position. Just as in Martial Arts, breathing out just as you initiate the movement is crucial and often the most challenging part. A suggested progression is detailed below, but these are just the basics to get started. Come on in for a consultation for more guidance and to learn more challenging core exercises and ones that are specific to your sport or injury needs.

1. Abdominal Bracing
   1. Lie on your back with the knees bent and 2 fingers placed on the side of your belly, between your ribs and pelvis
   2. Exhale and draw your navel towards your spine, knitting your ribs inwards
   3. Try to tighten the muscles under your fingers without the belly pooching outward.
   4. Inhale and relax
2. Abdominal Marching
   1. Lie on your back with knees bent
   2. Exhale and tighten the core
   3. Lift one leg up to a tabletop position without allowing the back to move
   4. Lower the leg, inhale and relax. Repeat, alternating sides
3. Heel Taps
   1. Lie on your back with both legs up in a tabletop position
   2. Exhale and tighten the core
   3. Lower one leg and tap your heel on the floor without allowing the back to move
   4. Return the leg to the tabletop potion, inhale and relax. Repeat, alternating sides.