Does Core Stability Help With Back Pain?
If you’re here, you are probably dealing with low back pain. Why wait to start feeling better?
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What do most people with low back pain think they need to work on?
Core stability.
We have all been told that “instability” of the spine is a major cause of low back pain. This seems to make sense logically. But what if I told you that might not be true?
The research actually doesn’t support the idea that low back pain is caused by core weakness or instability. Let’s go over some of the issues with this line of thinking and talk about how we’ve had success treating patients with low back pain.
What Is Core Stability?
Core stability is one of those concepts that everyone talks about, but nobody ever defines clearly.
One definition of “stability” on its own when applied to physical systems is:
“The property of a body that causes it when disturbed from a condition of equilibrium or steady motion to develop forces or moments that restore the original condition.”
What!?
Basically, if a system (in this case the human spine) is disturbed by an outside force, can it come back to its original and balanced state?
So if a toddler is trying to ride a unicycle…unstable. Easily knocked off balance and difficult to regain control.
If the same toddler tries to tackle Shaquille O’Neal…stable.
So, core stability is really less about being brutally strong and more about being strong, balanced and adaptive.
Do People With Low Back Pain Have Unstable Spines?
Research studies have shown that many people experiencing low back pain actually have MORE core activation than someone who is not in pain. This tends to be because of muscle tensing, guarding and fear.
They may, in a general sense, have a “strong core,” but according to the definition above they may not have a lot of stability. Over-bracing and constantly holding the spine rigid does not allow for normal movement and physical function.
In fact, stiffening and bracing the spine is not always the best strategy. Sometimes it is basically the opposite of what is needed.
If you are going to pick up something really heavy, it might make sense to brace your spine more. But if you are doing something like running, jumping or generally being athletic you need to be more fluid and natural.
We need adaptability, not rigidity.
What Kind of Exercise Helps Low Back Pain?
There has been quite a bit of research around exercise and low back pain.
For a long time, the common narrative was that low back pain patients needed to work on “activating” and stabilizing the smaller muscles surrounding the spine in order to relieve pain.
The theory was that abnormal/excess movement of spinal segments was causing pain, so stabilization training targeting the small muscles around the spine should reduce this. There really is no good evidence to support this idea.
Some research articles have shown a benefit of this kind of training, but they are mostly poorly executed studies or compare these exercises to no treatment at all.
Other studies have found just as much (or more) pain reduction in other forms of exercise such as lifting weights, walking, yoga, etc.
This is actually a good thing. It suggests that there is no “special” form of exercise everyone with back pain needs to do. Do what you need to do to get moving. General movement and exercise are the best tools we have against both acute and chronic back pain.
Just get moving.
Exercises that help with low back pain:
Basically, movement in general helps reduce low back pain. Each individual patient will have different tolerance for specific kinds of movements. Our job as PTs is to help patients understand what options might be best for them.
Stability Should Be Like Breathing
This idea comes from a great PT and researcher named Greg Lehman.
Think of it this way: the vast majority of the time, we are not thinking about our breathing. It happens automatically (even when we are sleeping) because it is vital to life itself.
Yes, there can be a lot of value in consciously controlling breathing. But most of the time, our minds are engaged in something else.
The same can be said about spine stability. If you are thinking about it too much, it actually becomes problematic. The systems of the body that stabilize and move the spine are very complex and innate.
Don’t over complicate things.
How Do We Treat Back Pain?
So, how do we approach treatment for back pain at Wagner PT & Performance?
How we treat low back pain:
Rule out red flags
Relieve pain with dry needling, manual therapy and modalities as needed
Get patients moving in any way that feels good
Customized mobility and strength exercises
General lifestyle and recovery support
Build a great routine to keep patients feeling their best
First and most importantly, we rule out any red flags. The statements and research above apply to the vast majority of back pain, but there are very rare cases that are caused by something serious (fracture, cancer, systemic disease, etc.). We screen and rule these things out before doing anything else.
The next thing we think about is giving patients some relief from their acute pain. Most people come to us because their pain has gotten out of hand and/or is affecting their lives.
Being in pain sucks! So we use modalities like manual therapy, dry needling, taping and patient education to reduce their pain. The important thing to realize is that these modalities don’t really “solve the problem.” They just allow us to get a patient moving, which is the most important part.
Next, we focus on getting patients moving however we need to. This often includes some of the basic exercises discussed above. There is nothing wrong with these exercises, they just aren’t enough to treat back pain on their own.
In this stage, we are using low level exercises, basic strengthening, walking programs and more to get patients moving. This lets us take advantage of the wonderful pain relieving effects of exercise in an appropriate way for each patient.
Once pain is under control and patients are moving, we progress their strengthening, conditioning and sport specific exercises until they are back to the level they want to be at.
This seems like a pretty simple process and in some cases it is. Treating back pain is really a “simple, not easy” sort of thing. The challenging part is helping a patient understand what is going on, finding the right combination of treatments for them and helping them stay on track.
An Empowering Message About Back Pain
Overall, we want you to understand that a lot of people experience back pain (including us). Back pain sucks, but it is rarely due to something really serious and there are a lot of ways to successfully treat it.
Our profession has created a lot of fear around the spine and back pain in general. This is based on bad research and faulty logic.
For example, check out this episode of our podcast discussing how to interpret MRI and imaging results.
We want you to know that your spine is inherently strong and stable. Your body has amazing ways of moving and protecting itself. You don’t need magic core stability exercises to help with your back pain.
This narrative of “weak core” becomes problematic long term because it makes people feel like their spine is inherently unstable (it’s not) and that they need to spend a lot of time on these low level exercises to keep their back healthy (they don’t).
Pain doesn’t mean you are broken or damaged, it just may mean you need some help. If you’re struggling with back pain and want to work with us, reach out.
We help patients with low back pain all the time and we can help you get back to your life without pain.
Also, if you’re interested in learning more, check out the references below for some great videos and articles.
References:
Bodylogicphysio. (2013 April 4). Peter O’Sullivan and core stability [video]. https://www.youtube.com/watch?v=YezBG_NdLgs
Charlie Dickson. (2021 February 19). Core stability: does it matter? Barbell Medicine. https://www.barbellmedicine.com/blog/core-stability-does-it-matter/
Greg Lehman-Movement Optimism. (2020 June 6). 10 issues with core stability and low back pain [video]. YouTube. https://www.youtube.com/watch?v=tolxdFQ35j8
Haladay DE et al. Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain. 2013 JOSPT 43(4): 242-250