There is no doubting back pain is a big problem in the modern world. It is not limited to people who don’t exercise and can cut down even the fittest people. The good news is I believe many people recognize that exercise is invaluable for treating back pain and also preventing it. Unfortunately the understanding of what type of exercise is best is where it all goes wrong. For many years now we have been convinced to believe that strong abs means a strong core, and will prevent back pain. Even therapists and Doctors have been known to prescribe planks and abdominal exercises to treat back pain with this same type of thinking. We must realize that strength of the abdominal muscles WILL NOT change the faulty movement that leads to injury and pain. Your body will instantly sacrifice any strength if it only knows how to move with the same dysfunctional movement it has always used. You must identify and change the faulty movement patterns linked to the injury to have any chance. In this article we will explain why learning to move better is more important to you than strength of your abdominal muscles if you have back pain.
Strength Cannot Over-ride Poor Movement
Back pain does not limit itself to unfit or untrained people. It can break down a professional athlete who can squat 200kg as much as the 65 year old retired office worker who does nothing! It can even affect teenagers and I have seen several teenagers with bulging discs in recent years! Rarely is this injury created from one incident or from lifting heavy objects but a build up of many poor ones and repetitive bad movement.
This is where the popularity of Pilates and Core Strength exercises have grown rapidly as we have been convinced the solution is to build a stronger core. However, what people fail to see is that the strength of the core is of no value if you continue to move poorly or with inefficient movement. Performing endless abdominal activation exercises lying on the floor will not be able to change the way you move standing up. More on this shortly but first it is important to define what core training really is.
What Core Training Should Involve
The main thing to understand is that the core is not just the muscles around the abdominal area.
The Core is a complex integration of small stabilizer muscles (the INNER UNIT) working together with large prime moving muscles (the OUTER UNIT) to produce movement.
These inner unit muscles attach to the body at the spine only, meaning that when they activate they generate little or no movement. They can only stabilize not move you.
These muscles, TVA, Pelvic Floor, Diaphragm, and Multifidus are often the focus of clinical Pilates training with many researchers showing there is a delayed response with back pain sufferers. The TVA is classified as an “anticipatory muscle” meaning it is programmed to fire when it senses you are about to move, in order to stabilize the body.
A bit like a construction crane being bolted to the ground before it goes to pick something up.
Often with back pain this automatic sensory program is either delayed or does not occur at all leaving the person’s spine vulnerable to problems. So you can see how people would come to the conclusion that all they need to do is work these muscles to become stronger and everything is fixed!”
However, there are several problems with this type of thinking!
Usually the body is hurt in a standing position, not a lying on your back position. Meaning that it is also using the outer unit muscles within complex motor programs all within a split second. But even more important than all of this is one huge player – The Brain!
Remember the crane scenario. By training the abdominal muscles on their own and ignoring the value of teaching your brain how to move correctly is like forgetting to teach the crane driver how to use the crane. If the driver is not skilled enough or trained how to use the crane correctly it does not matter how good the base is or how well the stabilizers are, disaster is always just a small step away. The brain is everything.
The picture shown below is a classic example of a person who may be great at holding planks and doing sit-ups but the minute they bend they lose all control of the abdominal muscles as they know no other way to bend over. Their abs are not weak, they are simply sacrificed when they need to bend over because she does not use her hips to take the load and her spine is forced to pick up the workload. Back pain in inevitable in this situation and more ab work will be pointless. If anything working on hip mobility will do more good.
The outer unit are the larger and more powerful muscles more concerned with providing movement of the body. However these muscles help to control the range of motion and provides stability on a much bigger scale. These muscles do a very poor job of stabilizing the pelvis and spine but they do play a part..
The key here is one cannot work without the other. Both units need each other and they must learn how to sequence together perfectly in order to function efficiently.
The stabilizer muscles are not designed or know how to produce movement. And the large global muscles are not designed to provide stability. To focus solely on only one area is a waste of time and potentially could ruin you. This is where the trick is, identifying which one is the main contributor to your problem, and secondly working out how to correct it WITHIN A FUNCTIONAL MOVEMENT!
Usually the movement that creates your pain is the one you need to work with the most!
True core strength can only be developed using both inner unit and outer unit together in a standing position. This is where you will now be training the inner unit, the outer unit but more importantly the brain and the neuromuscular system who drive the crane!
You Must Identify the Faulty Movement Creating The Pain
Below is a great video to watch about how easily back pain can be created from simple daily movements we think nothing of.
It is easy to see how we fall into the trap of thinking well if there is a problem with my stabilizers I will fix that and it should all be okay. The question you should be asking is, “why are my stabilizers broken in the first place?”
When you find the answer to this question is when you really make some progress and some significant changes that will last forever!
Dr Stuart McGill calls this identifying the injury mechanism and if you fail to find it you risk causing more pain. By understanding your pain trigger you can begin to understand how to get rid of it for good or even avoiding more damage to begin with. But how do you find your trigger?
The simple answer is to you must complete an assessment.
Finding The Injury Mechanism is more Important Than Strength
Something I say to my clients all the time is bones and muscles do whatever they are told to do. They don’t question if a movement is wrong or right, they just do what they are told by the brain and nervous system. If the brain and nervous system only know dysfunctional movement then it will continue to cause pain and more harm for it knows no other way to move! Any strength you develop with isolated exercises are useless for it goes back to what it was doing beforehand that caused the problem.
It is up to you to find out what is the optimal movement and develop that skill enough times that the brain takes this new pattern and makes it automatic!
Exercises like crunches, planks, and all the endless isolated abdominal exercises cannot change the motor programs like bending poorly where the injury mechanism is found.
Poor bending actions are where we see someone constantly flexing their spine instead of using their hips as seen in the picture earlier in the article.
Sometimes it may be your job or sport that requires constant bending that may contribute to this problem. However it is not the job or the sport that is the problem, it is HOW YOU BEND that is. If it was the job or the sport then 100% of the people in this job would have the same problem. There is no problem with bending if you use your hips and maintain a neutral lumbar curve most of the time.
Big problems arise when you use your spine to do the bending repetitively, especially with load.
I get a lot of idiot trolls on social media commenting on articles like this saying that it is fine to bend the spine and it is normal. I would say yes it is normal to be able to do this and you do not need to be stiff as a board all the time. However, where bending the spine repeatedly with deliberate movements that force the body to remain in a curved position with loads will inevitably lead to disc problems and chronic pain. These trolls would know this if they worked with hundreds, or over a thousand cases of bulging discs like I have.
Learning To Hip-hinge Is Critical For Getting Rid Of Back Pain
People are very surprised when I say to them – “this is going to be the best core exercise you ever learn”. They think it is going to be a great way to make their abs burn but as I am sure you understand by now it is not about the abs burning it is about them working as they are designed.
Before jumping straight into the exercise you may need to mobilize the hips. Without adequate hip mobility your lumbar spine has no choice but to bend and flex during movements that it should remain stable and in neutral. Some of my favourite drills for this are shown below. By the way mobility work can also be some of the greatest core training someone with back pain can do. Releasing areas like the thoracic region and hips with mobility work might be the catalyst for improving movement and finally allowing the stabiliser muscles to do their work.
The simplest method I find to teach someone how to bend correctly is to use a kettlebell.
The kettlebell provides great visual feedback cues to help the person see where it is they are moving poorly. The Romanian Deadlift is more about moving the hip and bending from the top-down instead of from the bottom up! The person with mobility restrictions will often feel this as a massive hamstring stretch!
The most important part here is to maintain the natural curve of the lumbar spine by keeping an anterior tilt of the pelvis. Again critical for anyone who has back pain.
Instructions:
- Position the kettlebell on the floor between your legs so that you cannot see your shins in a mirror from the side.
- Standing with feet a comfortable width apart. Reach down keeping the natural arch in your low back, and neck tucked. Touch the kettlebell keeping good posture.
- Inhale and engage your core before you begin to stand to the top position, exhaling and when at the top and gently rolling your shoulder down and scapula apart
- At the top repeat the inhaling process before lowering to the ground.
Sets / Reps: 2-3 sets of 10-15 reps with control tempo
- TIP: If you are struggling to keep the curve in your lower back you can also add some tape to your lower back. We use this very effectively with disc bulge clients to teach them how to keep the extension in their back muscles. This is a critical point in getting the glutes to fire.
Activating The Inner Unit
Training conscious core control is never the best solution and a poor strategy over the long term, however it serves a great purpose in the early days of corrective training. If you have spent enough time learning correct positioning and alignment you will give your body a great chance at getting this right. It will work best the minute you add load.
But…….. you must be very careful about doing this too soon.
There are three important parts to creating good stiffness in the deadlift and they are
1.Breathing
2.Grip strength
3.Activating the lats.
The breath is the real key as this will activate your inner unit prior to the lift and protect your lumbar spine from damage.
Read the article – How to correctly brace the core to see more detail on this.
You will see a good example of this in the video below.
The heavier the load this stabilization method will usually happen automatically. This is why you will find that you hold your breath just as you begin to lift the load because as the nervous system senses the threat to the spinal cord.
This is when the diaphragm switches from a respiratory role to a stabilizer role. The diaphragm creates what is known as intra-abdominal pressure. As much as your other stabilizer muscles like the TVA are involved, they are very dependent on the diaphragm for creating pressure. This muscle also connects to most of your ribs and helps to stabilize the body which is why grip strength and lat strength are a crucial part in assisting this to work.
You will see a good example of how to take the isolated learning and apply it to a functional movement in the video below.
Does That Mean Isolating The Abdominal Muscles Is Pointless?
No, the isolated exercises such as breathing, TVA activation, lower abdominal training and even oblique training all have their place in your rehabilitation program. They are extremely useful in the beginning when inflammation is chronic and it is hard to move efficiently standing up.
However, they just must be looked at as a stepping stone to learning how to move in a standing position. If you are able to walk around, go to work, do things at home such as gardening, sports lifting shopping bags you MUST learn how to move. Just isolating your abdominal wall to feel the burn will do nothing to save your back!
Video of some of our simple activation drills for the abdominal muscles are shown below.
Training The Core During Functional Movement
If you are truly serious about learning how to develop incredible core strength then you will need to learn how to apply SLING TRAINING.
This is also where you teach the body how to effectively use the core within a functional movement pattern that you will use during the day. The strength of individual muscles is not the main concern with these it is the synchronization and efficient interaction of multiple joints and muscles that is.
This is where the body combines the inner unit and outer unit together perfectly to create efficient movement via myofascial slings. There are four slings you need to learn and they are all effectively trained and strengthened using exercises in a standing position.
They are:
1.The Anterior Sling
2.The Posterior Sling
3.The Lateral Sling
4.The Deep Longitudinal Sling
Exercises that develop these include single cable push or pull, lunges, wood-chops and even step-up exercises. Any person that can learn to bend correctly and master the deadlift and also be able to effectively master these slings has incredible core strength that will go a long way to protecting their back.
It is with these exercises that many core strengthening programs and Pilates methods fail for they do not teach people how to do this. They just hope by strengthening individual muscles that the body will automatically know how to use them which is very rarely the case. The longer the person has been in pain or compensating the more difficult it is to correct faulty movement patterns so the sooner you start the better.
Do You Need More Help?
Before you attempt to complete any exercises shown in this article make sure you have seen a qualified Health professional for an accurate diagnosis and assessment of your condition. I cannot stress this enough as self diagnosing can potentially lead to more problems. We often refer out to Doctors, Chiropractors and Physiotherapists before implementing our program. Being certain on where to start is crucial to the success of the program.
If you have seen a health professional and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program called Back Pain Secrets that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process!
Click here or on the image below to get a copy.
Summary
I hope this article shares some light on what core strength really means and that you grasp the concept of learning to move is more important than just trying to work your abs!
We must stop trying to train the stabilizer muscles like they are biceps and trying to feel the burn. They are not designed to work this way and more reliant on providing a stable base to assist the larger muscles with moving. The movement that hurts you is the one you must learn to master and where your core training begins. Failure to do this will mean you are always one small poor movement away from hurting yourself again. Surgery, pain medication and relying on health professionals to treat you is merely treating your symptoms and not addressing your real reason you are in pain.
Remember, strength is useless to your body if you continue to move poorly. The abdominal muscles will sacrifice their strength and stability in order to execute the movement you desire. If you improve how you move, you improve your core.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Functional Anatomy of the Pelvis and the Sacroiliac Joint – By John Gibbons
•The Vital Glutes – By John Gibbons
•Movement – By Gray Cook
•Corrective Exercise Solutions – by Evan Osar
•Back Pain Mechanic – by Dr Stuart McGill
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Low Back Disorders – by Dr Stuart McGill
•Ultimate Back Fitness & Performance – by Dr Stuart McGill
•Core Stability – by Peak Performance
•Anatomy Trains – by Thomas Meyers
•Motor Learning and Performance – By Richard A Schmidt and Timothy D Lee
•Assessment & Treatment Of Muscle Imbalance – By Vladimir Janda
•How To Eat, Move & Be Healthy by Paul Chek
•Scientific Core Conditioning Correspondence Course – By Paul Chek
•Advanced Program Design – By Paul Chek