Low back pain: the role of core muscles

When it comes to back pain, and specifically the most common one in the lumbar area defined as low back pain, many are aware of the importance that exercise has, both as a prevention but also as a cure. Extremely important thing to consider and not to underestimate is: timing.

Low back pains exercises

Generally when we talk about exercises for low back pain we tend to use the term postural exercises, but usually means a technique or a different approach that can go from the Pilates method, to the Back School, to the McKenzie Method or more simply to the strengthening of the abdominal and lumbar muscles.

The latter constitute the muscles of the so-called abdominal and lumbar regions or, to put it in a term widely used today, the core muscles.

When to avoid core muscles strengthening exercises

Very often the abdominal and lumbar muscles of those suffering from back pain are already very fatigued, continuing to overwork them with strengthening exercises only increases their fatigue levels and causes them to be unable to carry out the most important work they are required to do: stabilize the spine by contracting when needed and with the right intensity.

So, when you suffer from back pain you do not necessarily have weak abdominals and lumbar muscles. What correlates with low back pain, therefore, is not the muscles lack of strength in absolute terms but being fatigued and not being efficient when needed.

It is true that our body must be mobile, flexible, strong and have good posture, but all of this is not enough. The maintenance of the upright position, requires us to manage the gravity force that pushes us downwards, generating compression loads on the spine.

Hence the importance of having muscles that function as shock absorbers that are activated automatically to stabilize and protect the spine. They act like the active suspension of a car managed by an electronic control unit. It is therefore essential that the muscles dedicated to stabilizing and protecting the spine are activated automatically and at a precise time.

These automated responses are easily lost. For example, an initial back pain event, or a forced rest like what is occurring currently, and the effect of these are accentuated if accompanied by long periods in a seated position. Therefore, if you suffer from low back pain, these muscles must be reprogrammed through a precise sequence of exercises before you can safely move on to all the activities that your daily life or sport requires.

Recent scientific literature
A 2018 study (ref. 1) reports how: "The exercises that intend to restore control of movement through a Cognitive and Kinesiological approach (awareness of movement errors, understanding of movement changes and then performing the correct movement ) have proven to be superior in the treatment of back pain compared to other approaches."

Low back pain and breathing

We must also not forget to also perform breathing exercises using the diaphragm, which is, the muscle that divides the lungs from the viscera and helps us to let the air in and out of our lungs.

If it is position is too high and is rigid with reduced range of movement, as well as reducing the ability to perform aerobic activities (walking and especially running and cycling) it predisposes us to the onset of back pain.
As for the abdominal and spinal erector muscles, the reduced ability to maintain a valid contraction over time correlates with back pain similar to the diaphragm.

How to maintain the correct functioning of core muscles

to improve back pain. It is essential to proceed following a gradual progression of exercises which includes:

  1. Research and learning of the "Neutral Position"
  2. Correct "diaphragm breathing"
  3. "Consciousness" phase to focus on the movement of some muscles that have not been used for some time and learn how to use them
  4. "Automation" phase. Whereby repeatedly and correctly performing the previously learned exercises will get the stabilizing and protective muscles of the back to activate themselves automatically at the right time, generating a stable and secure base with respect to the various movements that will be performed in everyday life and in motor or sports activities.
  5. stabilization in complex movement (from supine, from prone, from standing)
Pratical tips when at home
We all take seemingly comfortable positions when we sit on the sofa and watch television or chat on the phone. In reality, these positions are not beneficial for our spine.
The sofa, in fact, obliges us to assume a position with the spine taking on a C shape when the spine normally has a S physiological shape. In a nutshell, the sofa alters the so-called physiological curves of the spine and leads us to take on a single curve. This leads to a reduced ability to counteract the force of gravity - already reduced in the sitting position compared to the standing position - by the vertebrae and intervertebral discs and requires higher activity of the muscle structures which will end up fatiguing and losing efficiency.
How to sit correctly?
Do not sink into the sofa, trying to maintain the physiological curves, perhaps even with the help of some pillows placed behind the lumbar and cervical area.
Be careful though: do not sit too long and try to get up often to take a walk or to do some specific exercise.
Luomajoki HA, Bonet Beltran MB, Careddu S, Bauer CM. Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2018;36:1-11
Stuge B. Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review. Braz J Phys Ther. 2019; 23(2):181-186.
Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014 Dec 9;15:416.
Thomas K, Lee RYW. Fatigue of abdominal and paraspinal muscles during sustained loading of the trunk in the coronal plane. Arch Phys Med Rehabil. 2000;81:916-20.
Arokoski JP, Valta T, Airaksinen O, Kankaanpaa M. Back and abdominal muscle function during stabilization exercise. Arch Phys Med Rehabil. 2001;82(8):1089-98.
Chok B, Lee R, Latimer J, Tan SB. Endurance training of trunk extensor muscles in people with subacute low back pain. Phys Ther. 1999;79:1032-42.
Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42:352-62.
Janssens L, Brumagne S, McConnell AK, Hermans G, Troosters T, Gayan-Ramirez G. Greater diaphragm fatigability in individuals with recurrent low back pain. Respir Physiol Neurobiol. 2013;188:119-23.
Anderson BE, Bliven KCH. The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain. J Sport Rehabil. 2017;26:452-458.

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