Pain reduction by strengthening your core

Many people with back pain know that core strength is important and so they promptly start doing a lot of sit-ups with the belief that this will improve their core strength. At best, these sit ups will give some superficial strength to the tummy muscles but they can also compress the lower back which can result in more damage.

The core should actually be viewed as a cube shaped area of your body which includes the lower to middle back, the sides and front of the abdomen, the pelvic floor and the diaphragm. All six sides of the cube need to be strong to stabilise the spine and reduce or prevent back pain. To strengthen these areas, you are best to aim for muscular balance and therefore go for large full body movements rather than lots of isolated movements such as sit-ups.

On the proviso that you are able to do these without pain, here is an exercise routine which can get you started on improving your core strength:

  • Cat/cow movement – in the table top or four point position with your back flat (hands under shoulders and knees under hips on the floor), imagine you have a pen sticking out of your tail bone and you are drawing a line on the wall behind you as you tuck your tail bone under and arch your lower back up towards the ceiling. Tip your head slightly down towards the floor as well. Hold for 5 seconds or so and release back to neutral. Repeat 5 times.
  • Squats – slowly squat down at a 45 degree angle as if you are aiming to sit on a chair. Keep your spine static and in a neutral position at all times. Repeat 5 – 10 times 
  • Correct sit-ups! Technique is critical here. Lie on your back and maintain the arch in the low back. Think of keeping this arch in your back at all times and bend the knees up to prevent injury. Support your head with your hands and try and keep your head and neck as a rigid block with the movement going the thoracic spine or mid-back and no movement occurring in the lower spine. The emphasis should be on working the tummy muscles without involving much spinal movement as you gently curl up. Slowly increase the distance you lift your head from the floor – starting with simply engaging the tummy muscles without lifting. Repeat 10 – 15 times slowly with no bouncing.
  • Side plank or side bridge. Lie on your side and lift your upper body off the floor with the weight on your elbow, then lift your lower body up so that the weight is on your knees. Keep your spine and lower body in line and hold for 30 seconds to 2 minutes. As you improve, take the weight of the lower body onto your feet / straightened legs
  • Plank. Same as the side plank but you are facing the floor with your upper body weight on your elbows and lower body weight initially on your knees and then on your feet. Keep your legs and back in line.
  • Superman position – again, in the table top or four point position with your back flat (hands under shoulders and knees under hips on the floor), simply lift a hand or knee one at a time about an inch off the floor and hold for 15 seconds. Progress to straightening and lifting one arm or leg at a time off the floor until they are in line with your spine and hold for 15 seconds. Finally, you can then raise an opposite arm and leg simultaneously holding them parallel to the floor for at least 10 seconds. Keep the spine neutral and straight with no motion throughout the exercise. Repeat each stage as you progress 5 times.

Try and repeat this routine at least five times a week and, although I have specified the number of repetitions, you can continue as long as you do not lose form – stop as soon as you are doing so. Improving muscle endurance is the key rather than muscle strength. Stop these exercises if they are causing pain and feel free to contact me if you have any questions about these exercises.

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