Low Back Pain is the leading cause of activity limitation and work absence throughout much of the world and is associated with an enormous economic burden. Even worse chronic low back pain has increased form 3.9% in 1992 to 10.2 % in 1996 and only seems to be increasing according to Freburger et al. With prevalence of 60-65 % of people having back pain at some point of their lives (Hillman, Prevelance of Back pain, 1996). Inadequate Core muscle function and low back pain has been correlated in the literature. This article will demonstrate how you can improve your Core to potentially reduce risk of you being just another statistic!
What does poor Core endurance tell us?
Is back extensor endurance linked to common low back pain? Whether we are exercising, walking, or even standing, we should always be engaging our low back musclulature. When the endurance of these muscles are compromised, one may rely on passive structures such as their joints and ligaments to hold them upright, which is NOT ideal. . There are multiple studies that have shown that back extensor fatigability is associated with Low Back Pain (Crossman, spine, 2004 & Bourbakhsh, JOSPT 2002) in addition to being a potential risk factor for Low Back Pain (Adams, spine, 1999 & Biering-Sorensen, spine, 1984).
Here I show the Sorensen test, which is the most widely used test evaluating endurance of the trunk extensor muscles. To properly execute this; keep your arms bent grabbing your opposing shoulder, and allow your Iliac crest of your pelvis to be right at the edge of the table. Sorensen & Holmstrom et al. found a mean holding position of 198 seconds in healthy men and 171.5 seconds in healthy women. They found when someone had low back pain, the hold time was 163 seconds in men and 137.5 seconds in women.
The important statistic is that with a holding time of less than 176 seconds, there was PREDICTED low back pain within the next year in males, whereas greater than 198 seconds predicted ABSENCE of low back pain. There were no predictive validity for females, sorry girls.
3 Planes of motion to train your core
Low Level Dead Bugs
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Finding just the right challenge and determining your target tissue should always be considered. . When targeting the core, you could argue this should always be engaged in every exercise. However, when people are trying to bounce back from an injury or surgery, the body needs to re-learn how to move. Here are some modifications and progressions of lower level core exercises for patients and clients you may be having difficulty with in regards to activating their core, and finding just the right challenge.
1. knee bend to chest using a physioball *push feet into ball*
2. alternating marches *cue person to push other leg into table*
3. 90/90 hold with arm press *push hands into ball*
4. Hand-ball-knee holds with knee extension *don’t arch your back* *
Here are a few progressions using only the lower extremity for the traditional Dead Bug Exercise.
The goal of the roll is the maintain an COMPLETELY STABLE AND NEUTRAL SPINE THROUGHOUT. The rolling motion should occur STRICTLY FROM THE HIPS AND SHOULDERS, and there should be absolutely NO SPINAL TWISTING. Mind you, this is extremely hard to do!
In a study by McGill and Karpowics in 2009, they looked at this exercise performed under the guidance of a normal clinician, and then an expert clinician. They wanted to see if muscle activation patterns could be improved by fine-tuning exercise technique as a result of verbal and manual cueing. With this particular exercise, they found that clinician correction significantly increased activity in both obliques and the latissimus dorsi (18% to 35% MVIC in lats). Even more importantly, torso twisting was reduced from 11 degrees to 4 degrees with corrected instruction. The main verbal cue they used was to emphasize “locking the ribcage to the pelvis” to eliminate spinal twist. The decrease in spinal twist is HUGE, because often times its those little MICROMOVEMENTS that’s the difference between doing an exercise PAIN FREE vs HAVING PAIN. . This goes to show that a MOVEMENT EXPERT can facilitate not only greater muscle activity, but potentially ELIMINATE pain during exercises. Like all of our posts, if you’re going to exercise, do it right!
Planking is an easy to perform isometric core exercise.
🔑 Key here is to keep a neutral spine throughout this exercise. . Here are a couple ways to regress and progress the traditional planks:
Level 1: Modified Plank – on your knees
Level 2: Plank – keeping your ankle, knee, hips, and shoulders all in alignment
Level 3A: Plank + Arm Raise – try to keep your pelvis level here, AVOID any pelvic rotation
Level 3B: Plank + Leg Raise
Level 4: Bird-Dog Plank
🔥 Alternative: Plank + Military Press = An ultimate Core/Shoulder combination exercise.
Rotational Core Strength
Anti-rotational exercise should be a staple of every core program, and it is well documented in the research to support its ability in increasing core stiffness. . The exercises shown here are 4 great ways in which you can improve your rotational core strength:
1️⃣ Anti-Rotational Plate Push-Away
2️⃣ Standing Pallof Press
3️⃣ Dead Bug Pallof Press
4️⃣ TRX Anti-Rotation
Proximal Stability Promotes Distal Mobility.
Make sure to move in a slow and controlled fashion with all of these exercises. You have an option to hold at the end position for a certain amount of time. Parameters we recommend is beginning with a 30 second hold or 15 repetitions for 3 sets.
🔑 Maintain an absolute stable and still pelvis/spine…only your arms should be moving in this exercise. The further you bring your arms out in front of you = longer moment arm = greater demand.
Ball Toss’s are great way to strengthen the core– build some stiffness in low back region. Shown here I am left rotating, which will target my Right Multifidus, Right External Oblique, and Left Internal Oblique. You can progress this exercise by walking out further or rotating further away from the throwing target.
Note: Initiate the rotational force from your core, and let your arms just go along for the ride.
It is shown that the Multifidus volume (at the L5-S1 area) is actually decreased bilaterally about 18% when comparing individuals with chronic low back pain to those without back pain (Beneck & Kulig, APM&R, 2012) .
Note: The further you bring your arm away from you, the increase in EMG activity will be placed on the core (Calatayud et al, 2015)
The spinal stabilizing system consists of 3 components:
1️⃣Neuromuscular control (Neural elements)
2️⃣Passive Subsystem (osseous/ligamentous elements)
3️⃣Active subsystem (muscular elements)
Muscle strength isn’t the only factor when it comes to spinal stability. It is imperative to have proper sensory input to alert the central nervous system about interaction between the body and environment and to allow for refinement of movement. These exercises will help with the first and third of these components of spinal stability.
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The Reverse salamander is a great way to improve muscle function of the core in a rotational manner. As shown here when I drop my hips to the left; my torso is in left rotation in relationship to my lower extremity. To get my hips back up to my starting position, I must use my trunk right rotators which includes primarily the right internal Oblique, left External oblique, and left Multifidus. This exercise will work on the anterior, posterior, lateral, and spiral movement slings.
I initially show this exercise demonstrated with support of the foot. This is a regressed version of the exercise and will decrease the demand placed on the core. I progress this exercise by elevating my entire leg to allow myself to ONLY make contact to the floor with my hips. (This is harder than it looks!) This requires adequate mobility in the transverse plane; if mobility/tightness is limiting you form lowering your leg all the way down, just work within your given range of motion.
NOTE: Try this exercise! It is more difficult than it looks! Make sure to do this exercise slow and controlled.
Lee, B. C., and S. M. McGill. Effect of long-term isometric training on core/torso stiffness. 2015.
Core Stability Exercise Principles By: Venu Akuthota et al. 2008.