80% of the general population will suffer at least one back pain episode in their lives. There are many causes of low back pain, such as age-related changes, poor foot mechanics, muscle imbalance or poor posture. Regardless of mechanical cause, core stabilization plays an important role in both treating low back pain and decreasing the chance of recurrent back pain.
What are the core stabilizers?
The core stabilizers consist of 4 muscles that surround the trunk: the diaphragm from above, the pelvic floor from underneath, the transversus abdominis from the front, and multifidus from behind. These structures act like a corset or capsule that surround the trunk in all directions when these muscles are contracted.
The effect of back pain on the core stabilizers:
Literature has reported that the core stabilizers of people with pain back are too weak or do not activate to provide the stability that the body needs. Possible complications that may arise include:
- Weakness of the pelvic floor muscles.
- Weakness and decreased size of the multifidus specific to the level of back pain.
- Altered timing of the transversus abdominis muscle. Recent studies have shown that the transversus abdominus in people with low back pain turns on, but the problem is the timing of the muscle- instead of turning on before the onset of a movement (e.g. the arm), the transversus abdominis turns on after the arm movement, hence not providing the stability the body needs.
Training the core stabilizers- the early stages
Once you have been assessed by your physiotherapist and it is believed that your core stabilizers needs work, he or she will start you off by teaching you how to turn on your core muscles in a variety of positions (lying on your tummy, lying on your back, 4 point kneeling, etc). Be warned: these exercises are not your typical exercises- they require concentration and subtle, precise movements. Once you have mastered isolating the muscles, then you are ready for the next phase of the exercise.
Training the core stabilizers- the advanced stages
Once you have grasped the concept of activating the core stabilizers, it is time to challenge them. There are progressive exercises your physiotherapist can teach you, from adding arm and leg movements while maintaining your core muscles to doing advanced balance and strengthening training on the exercise ball. The goal is to train your core stabilizers to work properly during your specific functional goals, whether it be carrying your grandchildren or competing in a sport.
So, if you suffer from low back pain, come visit us at SEMI. We will diagnose your back pain, order appropriate tests and recommend state of the art treatment. This can include consultations with a variety of our specialists including physiotherapists, massage therapists, chiropractors and podiatrists, to suit your particular situation. Our staff will determine whether core stabilization will be beneficial to you and guide you through the appropriate exercises.
Hides J, Stokes M, Jull G, Cooper D. (1994). Evidence of multifidus wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine: Jan 15;19(2):165-72
Hodges P, Richardson C (1997): Feedforward contraction of transversus abdominus is not influenced by the direction of arm movement. Experimental Bain Research. Apr;114(2):362-70
Richardson C, Hodges P, Hides J (2004)- Therapeutic exercise for Lumbo-pelvic Stabilization: A Motor Control Approach to the Treatment and Prevention of Low Back Pain. 2nd Edition Churchill Livingstone, Edinburgh.