Lets talk about Core Stability

"Why should I do core exercise?" is the most common question I field for people suffering lower back pain.

First, the anatomy - segmental instability occurs because a motion segment (vertebra - disc - vertebra) allows a component motion of sheer which is not anatomic. In other words the vertebra above should never sheer against the vertebra below. This abnormal motion would occur when a disc has lost its volume and therefore its height. we see this as a narrowing of the disc space on x-ray. Once sheer is allowed, it is safe to assume that the static stability of the spine is lost.

In this image you can see the loss of disc height.






Muscularly, there is an opportunity to stabilize the spine dynamically using the muscles that surround the core. In front and on the sides are the Rectus Abdominus, the Internal and External Oblique muscles and the Transverse Abdominus as well. In addition there is the strong lateral stabilizer - the Quadratus Llumborum and the posterior structures including the deep paraspinal muscles Multifidus and Rotatores and others. Further, there is the large back muscle Latisimus Dorsi that inserts into the thoraco-lumbar dorsal fascia and the Gluteal muscles that also do so and provide additional tension to the structures. Finally, there is the diaphragm above and the pelvic floor below that both play a significant role in providing true core stability.




Key core exercises tackle all these muscles. Front, back, sides, top and bottom. The secret is that it is not possible to compress water, and so by having a dynamic compression of the contents of the core, stability is created whereby the segmental instability described above is restricted from movement by the compression of the abdominal contents. Make sense?

There are other considerations such as muscle tightness and joint restriction above and blow the spine that contributes to the load at the unstable segment, perhaps perpetuating the instability and the consequence of that instability


on the pain one experiences. For example, the Hamstrings insert on the Ischeal Tuberosity and it is easy to imagine how the tight hamstrings would limit the ability of the pelvis to tilt forward during forward bending, which means that as one bends forward, the unstable segment in the spine would carry the load INSTEAD of the hamstrings. And because it is moving under load more than it should, and because the motion takes it past normal ranges due to sheering, an unstable segment is more likely to become even more unstable causing yet more pain and dysfunction as time passes.

What this means is that core stability needs to be a priority, but normalizing hip and thoracic spine mobility also need to be addressed for the core exercises to matter and for their effect to last.

Acute Back Pain

Here's the thing, even this episode is probably going to get better soon. Most acute episodes of Lower Back Pain (LBP) get better within 24 hours. If not, 8 out of 10 times, LBP resolves after a month, and 9 out of 10 times within two months. OK, but you hurt now, so what should you do?

During the last 26 years I have observed the following:

- Ice really works. Not blue ice packs, not frozen peas, not one of those cloth ice packs you get at a pharmacy, I am talking about refrigerator ice AND water in a plastic bag placed right onto the back in full contact with your skin. And it takes a half hour to an hour to penetrate to the deep tissues that need to be inhibited. 10 minutes per 1 cm, so think that the deep tissues are about 3 cm deep (if you are fat, add time accordingly!) What ice does is a. combat inflammation and edema, b. inhibit muscle guarding, and c. reduce pain.

- Get out and move. It is really important not to lie around when your back is hurting. You need to stay active. Ice will help, but go for a walk at a pace fast enough to work up a sweat. The reason for this is that inactivity promotes muscle guarding, and like the ice, activity helps keep the muscles from guarding. In the spine, the deep rotators "spy" on the adjacent vertebra up to five levels up and five levels down. Activity keeps your uninvolved muscles uninvolved, "quiet", if that makes sense.

- Rotation is key. In a half seated position (feet on the floor butt on the table, wrap your arms tightly around your chest, and rotate back and forth quite quickly (pain free though) for about 5 minutes every hour. Again, this both inhibits muscle guarding and encourages hydration and nourishment of the deep dense connective tissues. And it usually feels much better.

- 90/90 position for rest. Lie on the floor with your legs bent 90 degrees and the hip and 90 degrees at the knee, and your feet supported against the wall. This position is know to be the position with the least amount of intradiscal pressure compared to others.

- What if I am shifted? Well this is a complication for sure...but your first line of defense is described above.

- When should I see the doctor? If you have pain into your leg below the knee, numbness tingling or weakness, or intractable pain, any or all of these symptoms, go see your doctor.

- Is there an emergency situation? YES - if you lose control of your bladder, go to the ER - that is an emergency situation that is time dependent. Wait too long, and your bladder control will not likely return.

Finally, take a deep breath, use ice, go for walks, rotate, this too shall pass.