You are a new mom and carrying of your little one is making your low back ache. You are an elite athlete who notices pain in your low back after a heavy lift. You work 10 hour days, mostly in front of a computer, and you back hurts after 30 minutes of sitting. You are an active retiree and can’t enjoy your favorite hobby of golf because your low back hurts when you drive the ball.
I haven’t examined you but I can guess, with a fair amount of certainty, that part of the problem is likely a weak core. Core weakness is a huge contributor to low back and pelvic pain. I’ve seen it present in both sedentary individuals and Olympic athletes. The challenge with our core is that once low back or pelvic dysfunction exist, it automatically shuts off. It is the equivalent to switching off a fuse in a fuse box. Even worse, when you fail to use your core, studies have shown that the muscles start to atrophy within 24 hours. The only way to reactivate your core is through retraining but how do you retrain muscles buried deep in your abdomen and low back?
In our last core post we discussed what constitutes the core (https://www.rpmphysiotherapy.ca/getting-to-the-core-of-core-stabilization/) but that information is only valuable if you know how to use it. In this core post we will discuss how to initiate your core and how to integrate that activation functionally into your daily activities.
There are two schools of thought on how to retrain the core. The first school believes in isolating the muscles of the core and to activate them individually before using them in conjunction with larger muscles. The challenge with this practice is the core muscles, especially those in the abdomen and pelvic floor are very deep and challenging for patients to find let alone isolate.
The second school of thought suggests that optimal power and stability come from muscle groups contracting together therefore suggesting that isolation is not important. The practical challenge here is that if clients don’t learn to activate the deep core, they often rely on the tension of larger muscles to stabilize the spine leading to muscle imbalance and strain.
The reality is we don’t all learn the same way so different approaches may favor different clients. Here is how I approach core retraining:
I teach transverse abdominus and multifidus contractions in a position where patients can palpate the muscle and have gravity assist the contraction.
Example: Lying on your back with your knees bent, palpate your abdominals just inside of your hip bones. Try to mimic the sensation of holding your bladder. You should feel a slight tension underneath your fingers. Make sure you are breathing properly and there is little to no movement in the rest of your body.
Add peripheral movement to increase the challenge of maintaining you core contraction.
Example: Take the original position and slowly let one knee fall out to the side. The movement should be small and shouldn’t cause rotation through the pelvis. The objective here is to maintain your core contraction throughout the movement.
Example: On your hands and knees try to isolate the same muscles by letting your abdomen relax then tightening the core as you draw the belly button towards the spine.
Make your exercise functional.
Example: Try contracting your core every time your cross and intersection. This will challenge you to integrate the contraction with muscle systems that support and move you while you attend to environmental distractions.
Make your exercise sport or work specific.
Example: For hockey players I will often have them initiate their core while in a single leg squat while extending the opposite leg – think trying to mimic a skating motion standing on dry land. If you don’t retrain your core in situations specific to what you do, it may never meet your athletic and work needs.
Happy training everyone. If you suspect your core needs to be strengthen, talk to one of our therapists or personal trainers.