By Natalie Marshall, Registered Kinesiologist

What is your core? Your core is like a “muscular box” composed of abdominals like your transversus and rectus abdominus in the front and back; glute muscles in back, the obliques on the sides, the diaphragm at the top, and the pelvic floor and hip girdle muscles at the bottom. These muscles can be split up into two groups: the local stabilizers and the global mobilizers. The local stabilizers are attached to the vertebrae in your lumbar spine (low back) and are equipped to stabilize the trunk and respond to changes in posture. The global mobilizers are attached to your pelvis and thoracic cage and are equipped to produce rotational trunk movements and gross movements of your limbs. For your limbs to move, the local muscles must first contract to stabilize the spine. 

Back pain is among the most common chronic conditions in Canada and 80% of all adults will experience an episode of back pain in their lives. While back pain can occur as a result of injury or trauma to the back, around 85-90% of cases of low back pain have no specific cause. However, clinical findings of people with chronic low back pain show trunk and abdominal muscle weakening, reduced lumbar mobility, and insufficient recruitment of appropriate core muscles. Several studies have been done to support this idea, concluding that weakness in the superficial and/or deep trunk and abdominal muscles are significant risk factors for low back pain. 

But there is good news! While core strengthening can reduce the risk of low back pain in the first place, it can also alleviate low back pain should it occur. Several studies looking at the efficacy of core strengthening have shown that core strengthening programs are not only effective in alleviating low back pain, but they are superior to general strength training. Core strengthening can also be an effective rehabilitation technique regardless of how long you have experienced back pain, whether it be one month or one year. Exercises that focus on segmental stability, meaning the strengthening and recruitment of deep trunk muscles like the transversus abdominus and multifidus, are more effective than exercises aimed at strengthening the superficial or global muscles. Segmental stability exercises have proven to decrease pain (MyTopCare), increase functional capacity, and improve the ability to recruit appropriate deep trunk and abdominal muscles. 

Examples of exercises would be to first teach the how to engage the deep core muscles without with global muscles, often by using tactile cues such as palpating the lower abdomen and using verbal cues such as “drawinging in,” “holding your pee,” or “belly button to spine.” Once the patient is able to hold the contraction in various positions (quadruped, supine, prone, standing), more complex exercises that include movement of the limbs could be added. For example, once the patient has mastered the contraction of the transversus abdominus in supine, they will then try the contraction with a heel slide, and can later progress to several variations of the dead-bug (shown below). 

About the Author

I am a practising Kinesiologist working at Allan McGavin Sports Medicine Clinic in the North Shore Winter Club location. I primarily work with ICBC patients who are doing active rehab to recover from an MVA. I am passionate about prescribing exercises that not only help the patient recover from the MVA but are also applicable to the patients daily life and activities that they may enjoy. I also work with private kinesiology patients who may be recovering from injury or who want education on how to do exercises properly. With all patients, I aim to emphasize the importance of exercise and physical activity in daily life even after the injury has been treated. My sports growing up were volleyball and soccer, and now I enjoy exploring the North Shore by hiking or road biking. 

References in APA 

Akuthota, V., Ferreiro, A., Moore, T., & Fredericson, M. (2008). Core Stability Exercise Principles. Current Sports Medicine Reports,7(1), 39-44. doi:10.1097/01.csmr.0000308663.13278.69

Back pain. (2006, August 15). Retrieved July 5, 2021, from https://www150.statcan.gc.ca/n1/pub/82-619-m/2006003/4053542-eng.htm

Chang, W., Lin, H., & Lai, P. (2015). Core strength training for patients with chronic low back pain. Journal of Physical Therapy Science,27(3), 619-622. doi:10.1589/jpts.27.619

França, F. R., Burke, T. N., Hanada, E. S., & Marques, A. P. (2010). Segmental stabilization and muscular strengthening in chronic low back pain: A comparative study. Clinics,65(10), 1013-1017. doi:10.1590/s1807-59322010001000015

Kim, B., & Yim, J. (2020). Core Stability and Hip Exercises Improve Physical Function and Activity in Patients with Non-Specific Low Back Pain: A Randomized Controlled Trial. The Tohoku Journal of Experimental Medicine,251(3), 193-206. doi:10.1620/tjem.251.193

Kumar, T., Kumar, S., Nezamuddin, M., & Sharma, V. (2015). Efficacy of core muscle strengthening exercise in chronic low back pain patients. Journal of Back and Musculoskeletal Rehabilitation,28(4), 699-707. doi:10.3233/bmr-140572

Richardson, C., & Jull, G. (1995). Muscle control–pain control. What exercises would you prescribe? Manual Therapy,1(1), 2-10. doi:10.1054/math.1995.0243