Getting to the Core of Low Back Pain!

By Julia Towers, Physiotherapist

The lower back is one of the most common areas that we treat here at Stride Physiotherapy. Low back pain (LBP) is now the most common cause of lost time at work, potentially related to our increasingly sedentary lifestyle and prolonged periods of sitting1 – COVID and working from home hasn’t helped this either! As a Physiotherapist, I often hear of the ways that this limits a patient’s function and quality of life, so feeling better quickly is typically the main goal. Despite the fact that there isn’t a “snap of your fingers fix”, there has been a huge amount of research done on this area of the body, specifically in relation to the core muscles. Let’s take a look at what we can do to treat this nasty pain!

What Is the Core?

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Your core is so much more than just that sought after 6-pack! Looking at the picture below, you can see that our bodies have many layers of muscle at the front, back, and sides. Not pictured are the pelvic floor and diaphragm muscles which are also critical to core stability. Of particular importance is a muscle called “transversus abdominis” (TrA). It is our deepest layer of abdominal muscle – one I like to refer to as our bodies natural back brace. Think of it as a corset that draws inward around the spine.

How Does the Core Relate to Low Back Pain?

The TrA muscle stabilizes the pelvis and lower back prior to movement of the body. Early work by Hodges and Richarson showed that in those with 18+ months of low back pain, there was delayed activation of the TrA muscle compared to those without LBP3, 4. What this means is that after long periods of pain, the deep stabilizers of the back have less control.

What Is the Best Exercise for Treating Low Back Pain?

Many studies have tried to tackle this question over the years and the main conclusion has been that compared to general exercise, core stability training is better for decreasing pain and increasing function in those with longstanding LBP in the short-term5. In the long-term, general exercise (eg. biking, walking, running, weight training, etc) was just as effective.

 

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There are many ways to train core stability and believe me – there is much more to it than just doing a pile of sit-ups and crunches. Actually, doing these typical core exercises will only strengthen the major mover muscles and miss true core stabilization all together. Being able to activate the TrA is the first step. Below is a fantastic exercise to start with!

    1. Lie on your back
    2. Feel for the area about an inch inward from where your hip bones stick out at the front (this is where your TrA muscle lies, deep down)
    3. Breathe in and as you exhale think about drawing your belly button toward your spine and pulling your hip bones inward – this is just a cue (the bones won’t actually move)
    4. As you do this, gently press your low back into the floor
    5. You should feel a gentle, slow activation under your fingers
    6. Work towards holding for ~5-10 seconds without holding your breath

Although this may seem easy, it is very important and sometimes difficult to achieve correct form. I would highly recommend booking in with one of our Physiotherapists at Stride to fully assess, determine a plan, and teach you this exercise. Once you can perform this exercise, we start to add other, more functional movements and change the positions that you’re training in. Eventually this re-teaches the deep core muscles to “kick on” during routine and athletic activities before you move, lift, bend, exercise, etc. To book your appointment online click here.

Final Thoughts

This has been a lot of information, but I want to reassure you that your back is a very robust and resilient structure! Although we can’t blame one muscle for LBP, we do know that there can be some short-term improvements if we train the deep core stabilizers. Ultimately, the best thing for chronic LBP is getting moving. Change up your posture frequently, go for a gentle walk, and if there’s an activity you particularly love let’s talk about getting you back to doing it!

Please consider seeing a Physiotherapist who can help you keep your LBP at bay and assist you on your journey of healthy ageing! We would do this with a combination of hands-on treatment, education, and exercise. Let’s break bad habits of motion, change fear related to movement, and build some self-efficacy!

Resources

    1. Lynders, C. (2019). The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS Journal, 15(3), 214-220. doi:10.1007/s11420-019-09717-8
    2. Build Your Core. (n.d.). Retrieved from https://us.humankinetics.com/blogs/excerpt/build-your-core
    3. Hodges, P. W., & Richardson, C. A. (1998). Delayed Postural Contraction of Transversus Abdominis in Low Back Pain Associated with Movement of the Lower Limb. Journal of Spinal Disorders, 11(1). doi:10.1097/00002517-199802000-00008
    4. Hodges, P. W., & Richardson, C. A. (1996). Inefficient Muscular Stabilization of the Lumbar Spine Associated With Low Back Pain. Spine, 21(22), 2640-2650. doi:10.1097/00007632-199611150-00014
    5. Wang, X., & Chen, P. (2014). Core Stability Exercise Versus General Exercise For Chronic Low Back Pain Meta-analysis. Medicine & Science in Sports & Exercise, 46, 505. doi:10.1249/01.mss.0000494982.79731.79
    6. Physitrack, “Transverse abdominis in hook lying”. https://ca.physitrack.com/exercises