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Posted on 09-07-2017

Core Strengthening and Stability for Low Back Pain


While chiropractic spinal manipulation is very effective at helping people with low back pain, exercise, specifically core stability and strengthening, significantly improves outcomes and helps to prevent recurrence of symptoms. "Core" has become a buzz word in the exercise and health community, often referring to anything between the shoulders and hips; but, the "core" is much more specific than such a broad anatomical reference.

Individuals often feel like they are core strengthening when they do piles of sit-ups, crunches and engaged twisting type motions; though, if this is the focus of exercises, they are missing the true core stabilization muscles all together. In the motions mentioned, the rectus abdominus and abdominal obliques are strengthened, providing that sought after 6-pack. While there is benefit to strengthening these muscles, they are major body movers, not core stabilizer muscles.

So, what is the "core"?

At a minimum, the "core" is a cylinder created by several structures through the abdomen, namely, the diaphragm, the transverse abdominus (TVA), the thoracolumbar fascia, the multifidi and the pelvic floor muscles. None of these muscles require a sit-up or crunch to activate and strengthen.
Many movement therapists and health care providers are inclined to include all of the muscles and fascia of the "Deep Front Line", outlined in research by Tom Myers and published in his book Anatomy Trains. This view expands the focus of the core to include deep muscles of the legs, neck and ribs with a focus on fascial connections and patterns through the body. This is a very functional perspective for core stabilization; however, this blog will focus on the core cylinder of the body that is critical for low back stabilization.

Core stabilization exercises are most effective in engaged, spine neutral positions.  In plain English, “engaged, spine neutral” positions are exercises that actively engage muscles without bringing the spine into any curved or bent positions, as close as possible to ideal posture is maintained throughout the exercise. Planks and bridge pose exercises are examples.

Specific breathing exercises that focus on “belly breathing" patterns are effective at engaging/re-training the diaphragm as the primary muscle of respiration. Belly breathing, also, helps to relax secondary muscles of respiration, which contribute to poor posture, poor breathing patterns, fascial tension, anxiety and chronic pain. An activity that can be performed at home is to place a hand on the belly and the chest and observe the breathing pattern. After making some initial observations, try to bring your attention to and maintain a breathing pattern that keeps the rib cage and chest completely still while allowing the belly to expand and contract with the breath; hand placement helps to keep awareness on our patterns. Try to maintain focus on this activity for 5 or 10 minutes, if your mind wanders, try to bring your attention back to breath focus without self-criticism. This activity is simple; yet, it can be very challenging and therapeutic.

Pelvic floor exercises are important core strengthening activities that are typically overlooked except during pregnancy; but, we can all benefit.  These exercises active muscle engagement in the perineum, creating a lifting sensation. Kegel exercises are the classic pelvic floor exercises that were described and instructed by Dr. Arnold Kegel in 1948.  To perform these exercises, a person creates an internal lifting action that is experienced between the anus and scrotum in men or vulva in women. The exercise is not a clenching of the anus nor is it a cutting off urination; it is a unique lifting action that does not involve clenching or activating of the rectal region or the urinary sphincters but a lifting muscle engagement between the anus and the urinary muscles. Men and women, alike, benefit significantly with these exercises for core stability and these exercises are not limited to pregnancy and recovery from pregnancy.

Core strengthening and stability through abdominal region focuses intention on the TVA muscle, the deepest abdominal muscle layer.  The TVA muscle fibers run in a horizontal direction, wrapping from the back around the sides of our abdominal region to make fascial connections at mid-line in the front side body.  It extends from the pubic bone to the lowest front ribs. Activation of this muscle is felt as an abdominal "hugging" toward mid-line in front. This muscle activation can be felt and taught by placing the hands on the abdomen and activating abdominal muscles.  The TVA will create motion toward mid-line in the abdominal region on both the left and right side of the abdomen.  Other abdominal muscles create a forward bending, crunch type motion that should be avoided when specifically targeting the TVA.

If you have questions about core stability exercises, whether they were discussed in this article or elsewhere, your doctor at Gallatin Valley Chiropractic will be happy to have a conversation with you or to instruct core stabilization exercises and activities to promote low back health and overall wellness.  


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