Does a weak core = back pain?
Since opening my own practice earlier this year, I’ve seen more than a handful of low back pain patients. During the subjective portion of their initial exam, they consistently express the assumption that their core is “weak and probably the cause of pain”.
This is interesting.
I am excited to set the record straight on this widely overused blanket statement about the relationship between core strength and lumbar pain.
First, let’s solidify the fact that back pain arises from a myriad of factors.
I have seen back pain in patients that sit too long, stand too long, smoke too much, don’t sleep enough, drink too much, are overweight, are underweight, lift too much, and don’t lift enough, just to name a few.
If we’re getting anatomical structure specific, I’ve seen back pain arise from disc herniations, facet joints, vertebral compression fractures, nerve root compromise, hypertonic musculature, myofascial trigger point referral, osteoarthritic changes, and the list goes on.
Now, having acknowledged that low back pain is complex in both the anatomical and lifestyle factors that can contribute, let’s talk about where the “core” comes into play.
When I say core, what I’m envisioning is the muscle bound cylindrical powerhouse that is your torso. You have the obliques, transverse abdominus, rectus abdominus, thick lumbar erectors, lumbar multifidus, and diaphragm. To be clear, the pelvic floor, hip, and shoulder muscles could be lumped into this category as well, but for the sake of simplicity and your time, we’ll focus on the previously mentioned muscles.
These muscles work in coordination with each other to create a stiffening around the vertebral column which is necessary in times of heavy lifting (think max back squat day, moving day). They also guide movement throughout motions of the flexible spine as it twists, flexes, and extends. They support the normal curvature of the spine.
If these muscles are weak and not functioning optimally, one could argue that when demands are then placed on the spine (as in lifting, bending, twisting) there are less dynamic stabilizing forces available to protect the vertebral column and it’s surrounding joints and ligaments, thus injury and pain occur.
I think this mechanism of injury is where the majority of patients draw their conclusions regarding the root cause of their pain.
In some cases, they absolutely have a point. There’s actually been research to support that patients with chronic low back pain also have inhibition (disruption of the neural connection between brain and muscle) of core muscles like the multifidus and rotatores in the spine. Inhibition can lead to weakness which can lead to poor movement mechanics which can result in injury over time.
But a weak core won’t capture the full picture.
I want to touch on two things: motor control and prolonged postures.
Motor control is defined as the process of initiating, directing, and grading purposeful voluntary movement.
Why is this relevant?
In my clinic I see plenty of patients with great brute force strength. Their core is strong, their legs are powerhouses, and they’re benching more than their body weight on a regular basis.
But when it comes to fine tuning a compound movement such as a deadlift, their muscle recruitment patterns and joint proprioception are often all out of whack. They lack the ability to properly hinge from the hips, engage the correct muscles, and keep their feet grounded.
Ensuring smooth, controlled movement while maintaining proper posture and minimizing strain on the body by efficiently engaging the necessary muscles at the right time and intensity is what will help lead to pain free lifting and bending. And I’m not just talking about in the gym! This applies to someone who regularly lifts their child, carries objects at work, or just transitions from sit to stand a few times a day.
Next up: prolonged postures.
Most Americans sit for 6-7 hours a day on average.
There’s nothing inherently wrong with sitting. But what you might not know is that extended periods of sitting in a slightly flexed lumbar position can lead to tissue creep (stretching and elongation) of the posterior longitudinal ligament. This, in turn, can decrease reinforcements on the posterior side of your lumbar discs and increase the chance of a disc herniation. Long periods of sitting can inhibit blood flow to joints and muscles around the spine, increase pressure on the discs everyone is afraid of herniating, and lead to mobility restrictions over time.
The point here is not to instill a great fear in my readers of the perils of sitting, but rather to inform that regular position changes throughout the day will literally save your ass.
Sitting for too long, standing for too long, and even lying down for too long will pose a threat to the health of your spine. Be diligent about taking a walk break, a stretch break, or whatever it is that will remove you from your current posture and promote blood flow and a little therapeutic exercise to your spine.
It’s important to note here that I’m just brushing over the surface of general concepts I see with low back pain clients. The complexity of each case will vary and no single patient is ever dealing with the exact same injury. I could probably write a novel on lumbar pain and the way each case manifests differently. Lucky for you, someone already has!
If you’re a non-medical person who is interested in delving a little deeper into the anatomy of their spine and how to gain independence in self-treatment, read this book.
If you’re a physical therapist, personal trainer, chiropractor, MD, or really any reader who wants a much more in-depth discussion on low back disorders, read this book.
Hopefully you learned a little something.
Love,
Roni
