“I have a lower back problem, it’s because of my weak core and I need some exercises to strengthen it”. A statement I hear on a regular basis as I treat patients with lumbar-pelvic pain. Rumour on the street is that a strong core is the ‘cure-all’ for back pain! So I thought I would take the time to dispel the myths that surround our understanding of core stability system and how it may (or may not) assist you in managing your back pain. Is your core all it’s cracked up to be?
If we start with some anatomy basics- our core stability system for our lumbar spine consists of a group of muscles that wrap around the lumbar pelvic region to provide support. These muscles include a low deep layer in our abdominals, called our transversus (named as the fibres run horizontally). Also included in this stability system are the muscles of our pelvic floor at the base, the deepest layer of back muscles (called multifidis) and our diaphragm at the top. These muscles form the walls, the top and the base of the canister that contains our abdominal organs and spine. Tension in this system is required to prevent our pelvic joints and our low back joints from excessive movement which is thought to contribute to pain.
I often use the analogy of the tension required in your shoelaces to hold your shoe on. If you don’t tie your shoelaces, your shoe can slip off and lead to trouble. Likewise if you tie your shoelace up too tight or in the wrong place, that can be uncomfortable too! Your core system works in a similar manner to support your lumbar spine. A small amount of tension to support the spine, in the right place and not too much!
Many years ago physiotherapy researchers in Australia discovered a link between the presence of lower back pain and reduced timing and activation of this stability muscle system. And soon a growing trend was born! Strengthening the ‘core’ was the answer we were all looking for to solve the nationwide problem of low back pain!
And what is the outcome of all of this diligent core strengthening? Is lower back pain any less prevalent now tens years later? Sadly it is not. Were we wrong? Did the research lead us in the wrong direction? Is the core not really all it’s cracked up to be? The answer to those questions is both yes and no.
Let me explain, and I will use an analogy I like to use, in that your body is like any machine. If you imagine your body a little bit like a car. Like your car, you need the correct fuel (nutrition) to run the engine. You need your tyres pumped up and enough suspension for shock absorbing through the feet, knees and thorax. You need enough cylinders firing to power the engine and provide force, just like your muscles need to move you around. You need an electrical system, like your nervous system, working well to conduct messages. You need your wheel alignment centred so to avoid excessive wear in the wrong places, just like you need your posture to be optimal for certain activities. And finally you need the nuts and bolts that hold the car together to be working, just like your core.
So if you took your car to a mechanic to report a problem, his job is to check all car systems to see what might be contributing to the problem. Is it the electrics? The fuel? The wheel alignment? The shock absorbers? The answer to fix your car’s problem might be different for each and every person that walks through his door.
Similarly, for each and every person that presents to me with low back pain, a full check needs to be performed to determine the cause of the problem. Is it a neural problem? A postural alignment issue? A joint mobility and shock absorber problem? Or are the nuts and bolts that support the system just not functioning well? It could be a combination of problems contributing to symptoms.
So the answer to resolving someone’s lower back pain might be different for each and every person that walks through my door.
So is ‘the core’ the answer? Sometimes yes. Sometimes no. And there are many tests that I will do to determine that answer for each individual.
Is it time to ditch pilates and move onto the next fad? No I don’t think so. Pilates and core stability work can be a fantastic way of improving the control of your lumbar-pelvic joints. But we do need to lose the unrealistic expectation that it is the solution to all lower back pain, because without a thorough analysis of the whole integrated system we could be missing many components contributing to your pain!