Core Strength and Stability for a Healthy Back

Low back pain is the #1 cause of disability and the most common diagnosis treated by physical therapists. We see it every day both inside and outside of work. Most people in their lives experience low back pain, and most people have reoccurring low back pain. In many cases, the pain comes and goes on its own. However, there are several steps you can take to speed up the healing process and minimize repeat injuries. Core strength and stability is the #1 way to conservatively treat and prevent low back pain. Simply staying active and moving is #2. Other management strategies include utilizing proper lifting techniques (lift by bending your knees not your back and keep objects close to your body), maintaining upright posture (sit and stand as tall as you can), and keeping your weight in an appropriate range (a bulging belly increases stress to the low back). 

Low back pain can be caused by arthritis, muscle strains, degenerative disc disease (when the discs between our vertebrae flatten), herniated discs (when the discs tear and leak outside their normal space), spinal stenosis (narrowing of the space around the spinal cord putting pressure on the nerves), or fractures. Other factors leading to low back pain can include prolonged sitting, too much exertion, weight gain, deconditioning and lack of exercise, or new/unusual activities. Any and all of these causes can be treated with core strengthening and stabilization!

Your core involves the muscles between the bottom of your ribs and your hips. The most important of these is the lower abdominals, which lay directly over the low back. When your lower abdominals are strong, they provide a stable support structure for the low back. The lower abdominals minimize abnormal forces and shear that break down the low back and lead to pain.

Below are my top core strengthening/stabilization exercises and progressions. These are also what I call "forever" exercises. Even if you don't have low back pain or the pain has gone away, you should continue to do these a couple times a week to maintain strength and stability for prevention of future injury. These exercises are also great postpartum. 

Abdominal Bracing: Laying on your back with your knees bent and feet flat on the floor, tighten your lower abdominals and flatten your low back into the floor. Hold for 5-10 seconds then relax. This can be a hard exercise to treat some people, but it will come with practice. Other cues that are helpful include tightening your glutes, pulling your belly button down into the floor, putting your hand under your low back to feel for your back pressing down into the floor, and/or putting your hand on your lower abs (just above the hip bone) to feel for the contraction. Don't forget to breathe!

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This exercise (abdominal bracing) is the base for the rest of the exercises below. Make sure you do not let your back or belly pop up - that simply means you have done too many or the exercise is too hard for you and you have to work up to it. As you get better at abdominal bracing, you'll find you can do it throughout the day and incorporate it into activities that used to strain your back, i.e. when lifting heavy objects or shoveling.  

Abdominal Brace with Single Leg Extension: Perform the abdominal brace as above and hold while extending one leg out. Bring it back in and set the foot down, then perform with the other leg. Continue alternating until you cannot hold your abdominal brace anymore. Make sure you keep your core tight the whole time. The lower your leg/foot is to the ground, the harder the exercise will be. 

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Abdominal Brace with Bent Knee Fall Out: Perform the abdominal brace and then slowly lower one knee out towards the side. Bring the knee back up, and then perform with the other leg. Continue alternating till you cannot hold the abdominal brace and your form falters. Only lower the leg as far as you can while maintaining a tight core with level hips. You do not want to rotate your whole body to the side. 

Abdominal Brace with 90/90 Single Leg Extension: Perform the abdominal brace and bring your knees up to a 90/90 position (hips bent to 90 degrees and knees bent to 90 degrees). Slowly extend one knee/foot out, and then bring it back to the starting position. Alternate sides. You can also put a band around our feet to make the exercise harder with the added resistance. 

Abdominal Brace with Alternate Arm and Leg Extension (also known as "Dead Bug"): Perform the exercise above, but add your arms. Start with your arms straight up towards the ceiling, and then lower the arm opposite from the leg your are extending. Once again, you can add the band around your feet to make this harder.

Bridges: Perform the abdominal brace, contract the glutes, and push through your heels to lift your hips up off the floor. Slowly lower and repeat. Try to create a straight line from your shoulders to your hips to your knees. Your arms can be above your head or by your sides. With your arms down, you get a little more stability from your upper body so it is a bit easier. For bridge progressions, click here

Quadruped Alternate Arm and Leg Extension: On your hands and knees, perform the abdominal brace and extend alternate arms and legs. It is important to maintain your abdominal brace throughout the exercise and not let your hips or body tilt side to side. Even though you are no longer laying on your back, you still want to keep your core engaged the whole time. To advance the exercise, tie a band around your foot and hold the other end with your hand. 

Here is quick review of all the exercises above:

  • Abdominal bracing
  • Abdominal bracing with single leg extension
  • Abdominal bracing with bent knee fall out
  • Abdominal bracing with 90/90 single leg extension
  • Abdominal bracing with alternate arm and leg extension
  • Bridges
  • Quadruped alternate arm and leg extensions

Planks are another great core strengthening exercise, but make sure you do not arch your back and keep your core tight throughout the plank. The exercises above are much more controlled and less likely to provoke pain. Click here for ideas and variations of planks.

Finally, it is important to note low back pain is rarely life threatening, but it can be dangerous. Red flags requiring immediate medical attention include loss of bowel/bladder control and numbness in the saddle region (inner thighs/groin). This could indicate cauda equine syndrome, which means the end of the spinal cord is being compressed and surgery is required to prevent permeant damage. Other red flags include low back pain associated with weight loss, night sweats, chills, fever, and nausea. This could indicate a tumor in the spine and cancer. Just want to keep everyone safe!