Build a strong core to treat & prevent low back pain
Research shows that a Pilates-based exercise program specifically targeting core stability is effective for preventing & managing low back pain.
Did you know that once you get back pain the chances of getting another episode of back pain in the next year is 80%? This is a scary statistic, but the good news is that you can more than halve this risk by completing a core stabilisation program.
One major reason behind such high recurrence rates for back pain is pain inhibition of the core stabiliser muscles. Basically, we all have a hard-wired reflex called the pain inhibition reflex that switches off our core stabiliser muscles during back pain. Importantly, research shows that these muscles do not automatically turn back on again once our back pain settles.
The fact that your core stabilisers stay switched off even when your pain has settled is critical because it means that even if your pain goes away you are left with a weak spot in your back. This weak spot is much more prone to re-injury, especially when your pain has gone so you think everything is back to normal & you get back into your normal activities & exercise. A classic example would be someone who just takes pain-killers or anti-inflammatories so they feel much better, then goes back to some exercise & then has a much bigger recurrence of pain. Of course getting rid of the pain as fast as possible is good, but you have to make sure your back gets fully strong again once your pain goes.
Another reason for the development of this weak spot is the disruption to the timingof our core muscles, i.e. the muscles don’t fire at the right time. Normally our core stabilisers fire before we begin moving to prepare our spines for taking load. However after an episode of back pain our stabilisers don’t fire until after we begin moving, which means that our spines are left unsupported for the initial part of movement. This puts our joints & discs under much more load & harmful shearing stresses than they are designed for because our core muscles are working reactively rather than proactively.
So what exactly are the core muscles?
A lot of research now shows that re-training our core stabilisers is the most effective way to get rid of that weak spot. But what is “the core”?
Many people think of our core as being our stomach muscles – our abs (six pack) & our obliques. However, this is in fact incorrect. The “core” is a group of deeper muscles including our transversus abdominis, pelvic floor, diaphragm & multifidus. These lie behind our abdominals & obliques, & our multifidus actually extends along the entire length of our spines. Your core is critical for keeping your spine stable, strong, healthy & flexible.
To retrain your core the most important thing you need to do first is to learn how to switch your core on without using your other abdominals to compensate. This is very different to just doing normal abdominal exercises, & this is where many people get into trouble. When you’ve had back pain your core is switched off & your other abdominals become overactive to try & compensate. So if you just do normal abdominal exercises then most of the time you’re just using the wrong muscles & your core stays weak. You have to “wake up” your core first, get it firing, & then gradually integrate it back into higher-level exercises. Think of it like giving you a really stable base to support you as you get back to your normal activities & exercise.
How do I switch on my core?
One of the best cues for you to get the feeling of contracting your core stabilisers is by doing a pelvic floor contraction. Your pelvic floor muscles, as well as working as part of your core stabiliser system, also control your bladder & bowel. To switch them on imagine trying to stop your flow of urine half way through. If you put your fingertips just inside your pelvic bones at the front of your hips you should feel the muscles slightly contract & become firm. You may also notice your belly button draw down towards your spine. This is your transversus abdominus contracting.
The easiest position to feel this contraction is lying on your back with your knees bent up & feet on the floor. You need to make sure your breathing stays relaxed & regular during the contraction. You can put a hand on your ribs to make sure they continue to move in and out just like they do with relaxed regular breathing. Practice keeping this contraction going for 5 breaths in & out, then relax. Repeat this for 2 or 3 minutes at least daily (preferably twice a day) to get the hang of it.
Once you can switch on your core you need to build it’s strength & endurance. You also need to start getting it to co-ordinate properly with the other muscles around your body. This process is critical to your long-term success because you need your core to work effectively with all your other muscles during your every-day activities & exercise. If you sit at a desk for 8 hours a day your core needs to have the endurance to stay active for the whole 8 hours. If you go for a 30 minute run your core needs to be firing & working well with your hip & leg muscles the whole time.
Pilates is a great way to train your core. It can help you train the correct muscles with the correct timing to improve stability, mobility, strength & function. If you have recently had back pain you need to do a Pilates-based re-stabilisation program that is specifically targeted to people recovering from a pain episode to ensure that your fundamental core activation is solid before progressing to more general or higher-level exercises.
What’s the best program for you?
At Central Physio and Performance Fitness we have a great range of Pilates programs tailored to meet the needs of clients ranging from beginners to experienced Pilates devotees.
Core Control is specifically designed for people recovering from back or neck pain or for those who are new to Pilates. It is a gentle, closely-supervised program that gradually activates & strengthens your core. It’s perfect for you if you have had back pain & want to strengthen your spine but are unsure about how to become stronger without stirring up your pain.
Freedom Pilates is the next level of mat Pilates. It brings in more challenging exercises by increasing resistance, speed & complexity of movement. It is great for integrating core stability into more higher-level exercises & is ideal for you if you already have some Pilates experience.
Studio (Equipment) Pilates hugely expands your exercise options by using equipment including the Reformer, Wunda Chair & Barrel. We individually prescribe your exercise program so that it is perfectly matched to your ability & fitness goals. Individual & small group (max 3 people) sessions are available.
Our Pilates services are run by Helen Hathaway, our physiotherapist with formal DMA qualifications in Clinical Pilates. As well as being formally trained in the Pilates method Helen also incorporates newer technology, equipment & research into her sessions. And because she is a registered physiotherapist you may be eligible for private health fund rebates – check with your fund.
References & research
1. Burton AK, McClune TD, Clarke RD, Main CJ. Long-term follow-up of patients with low back pain attending manipulative care: outcomes and predictors. Manual Therapy 2004; 9: 30-35
2. Richardson CA, Snidjers CJ, Hides JA, et al. The relation between the transversus abdominus muscles, sacroiliac joint mechanics, and lower back pain. Spine 2004; 27(4): 399-405
3. La Touche R, Escalante K, Linares M. Treating Non-Specific Lower Back Pain Through the Pilates Method. Journal of Bodywork and Movement Therapies 2008; 12(4): 364-370.