Lower back pain is probably one of the most common medical conditions in Australia, which can effect individuals of all ages. Lower back pain is often a very complex issue, with no shortage of different causes. It can also be a very frustrating condition for patients to manage, especially when scans may not reveal a cause of the pain or the various treatments may not completely resolve the issue. However when we look at the majority of causes of ‘non-specific lower back pain’ (e.g. pain without a definite cause), this can often, in part, be attributed to weakness in the muscles of the core which are responsible for stabilising the spine. Subsequently, improving this core strength with exercise and rehabilitation is an important therapeutic option for managing lower back pain that is often overlooked.
So what does it mean when we talk about ‘the core’ and ‘core strength’? Core strength refers to our ability to maintain a stable spine. You can think of the spine as being a pole in the centre of a cylinder. The cylinder in this case is made up a range of muscles that work together to help stabilise the spine. At the back there are a range of muscles that help to move and stabilise the spine itself (the erector spinae muscles), with a muscle known as the transversus abdominis which runs around from the back to the front and works in a very similar way to an old-fashioned corset. At the bottom we have the muscles of the pelvic floor, which also have a big role in maintaining continence. Rounding off the cylinder as the roof is our primary breathing muscle, the diaphragm. When each of these 4 components contract and become shorter, this causes the volume of the cylinder to decrease and therefore the pressure increases within the cylinder. This increase in pressure helps to keep the spine strong and stable. A weakness in any of these 4 areas can lead to poor core strength and subsequently an unstable spine.
Much like building a house, where the foundation is fundamental to a successful build, a strong and stable core (spine) is necessary to allow us to perform any type of movement with our arms or legs. Research shows that whenever we perform and activity with our limbs, the core muscles activate milliseconds before we begin to move, in order to stabilise the spine in preparation for movement. Often for people with poor core strength, which often coincides with back pain, have a delay in activating these core muscles, meaning that any type of movement will cause more disruption to an unstable spine, and can potentially lead to injury or pain.
A strong and stable core (spine) is necessary to allow us to perform any type of movement with our arms or legs
Developing core strength is not the end of the story when it comes to managing back pain. Going back to the idea of building a house on solid foundations, what comes next is ensuring the supports are also strong and durable so that the framework for the house is set. In the context of back pain, this means ensuring that the larger muscle groups that move the important joints around the spine (e.g. hips, knees, shoulders, neck) are sufficiently strong but also flexible so that they can do their job properly. When a muscle is not strong enough to do its job properly, other muscles have to compensate to help out. This can lead to these muscles becoming excessively shortened or ‘tight’, which can lead to poor postures that can worsen pain. A classic example of this is at the hip joint. Often with back pain, the gluteal muscles are weak and can’t do their job properly. The hamstring muscles on the back of the leg often compensate for this to help out, but as a side effect can become very tight and cause additional issues. This is one of the important things that our Exercise Physiologists and Physiotherapists assess and then address when looking at causes of back pain.
This approach of improving core stability as well as strength and flexibility of the muscles that move the limbs is what we specialise in at Functional Health. Our purpose-built exercise machines are specifically designed to target the muscles of the core as well as the larger muscles of the limbs. Our equipment is not something you will find in a routine gym; it is unique because they target muscles so specifically, meaning that we can identify what muscles are not working properly, and then specifically train them to reduce this deficit to address your individual cause of pain. If you are suffering from lower back pain, improving the function of the core and your overall strength may go a long way to helping improve your symptoms.