One of the most common reasons people require physiotherapy is for low back pain. Treating low back pain usually centers on the common goals of decreasing pain, increasing range of motion and improving function. For the majority of low back injuries a core stability exercise program is beneficial for improving function and returning to activities of daily living, work and sports. Core stability exercises are a common and often successful treatment in physiotherapy for recovering from an injury, preventing a further injury, improving general health and optimizing athletic performance.
So what exactly is core stability?
We have three different systems that aid in the stabilization of our spine. One is the passive system which includes non-contractile tissues such as bones and ligaments. The second is the active system which includes contractile tissues such as muscles and tendons. This active system of muscles that attach to the spine and pelvis is necessary for stabilizing the spine and producing motion. The third is the motor control system. This can be thought of as our ability to turn on and off the required muscles to the correct degree at the appropriate time.
What causes someone to have poor core stability?
A lack of stability is often seen when one of the above three systems is affected. This could include factors such as: an injury to the tissue itself, insufficient muscle endurance, muscle imbalance or poor motor control. In fact, in many people with low back pain it is common to see atrophy of the spine stabilization muscles, poor muscle endurance, a muscle imbalance or delayed activation of the stabilization muscles. Physiotherapy focuses primarily on motor re-learning, or learning to activate the correct muscles at the appropriate time, and improving the endurance of these muscles.
What exercises should I be doing to improve core stability?
It is important to begin by understanding what exercises to avoid, exercises that may be doing you more harm than good. We determine the quality of a core stability exercise not only by how well it turns on the correct muscles but also by the amount of stress it puts through the spine, known as compression and shear forces. For example, while a sit up may be a great exercise to strengthen the core, specifically the rectus abdominis muscle, it requires excessive bending (or flexion) of the low back and results in a high compression force on the spine. Repeated bending of the back and high compression forces on the spine is a common mechanism of injury for tissue damage to the vertebral disc. This would make it a poor choice when designing a core stability program. It would also be unwise to do this exercise alone, as it will most likely result in a muscle imbalance which could potentially lead to injury. It is advisable to start a core stability program with exercises that keep the spine in a neutral position and avoiding excessive bending and twisting. Common exercises that I often teach to improve core stability include a front plank, a side plank and a squat. Along with other exercises, these three challenge different muscle groups and have lower compression and shear forces through the spine which minimizes the risk of injury.
When designing a core stability exercise program it is important to focus on improving motor control and muscle endurance rather than trying to improve muscle strength at higher loads. It would also be beneficial to include a cardiovascular exercise, such as walking, to your program. The exercises you include should be comfortable and should not cause any low back pain. One exercise program is not appropriate for everyone. Exercises should consider your training goals (injury rehabilitation, injury prevention, general health or improving athletic performance) and your past medical history (including general health and specific history of low back injury).
Krista Smith is a registered physiotherapist and associate at Sun City’s downtown, St. Paul Street location. She can be contacted at firstname.lastname@example.org