In this blog, we will dispel and explain the myths related to core training and low back pain. For years, many therapists and exercise gurus focused on strengthening the core muscles to reduce or eliminate low back pain. This often included a strong focus on isolating the core muscles to achieve the desired outcome. Let us start by listing the most common misconceptions:

  1. You can isolate “core” muscles to work more independently from others.
  2. You must tuck your tummy for proper form. (TrA Engagement)
  3. Working on core stabilization can prevent low back pain.

For years, many therapists and exercise gurus focused on strengthening the core muscles to reduce or eliminate low back pain. This often included a strong focus on isolating the core muscles to achieve the desired outcome.

Myths of Core Training and Low Back Pain

The fact is that evidence does not support these claims. In fact, general exercise has been shown to be just as effective as targeted core work when dealing with low back pain.  Additionally, there is no one muscle that is more important than another when comes to core control.

The Role of Anatomy Slings

Illustration of Oblique and Anterior Sling - a healthy sling system does more than support the core

Lower Back Pain – working the core with Sling Therapy

Your body has a built-in system known as ‘anatomy slings’ that stabilizes the spine when muscles are fired a certain way and direction.  These structures are also known as myofascial slings. This allows movements to be functional in nature when strengthening the core.  A simple example of this is found in the action of swinging a golf club.  Muscles connect from the shoulder to the opposite hip, forming what is called the oblique sling.  Think of the motion you use when swinging the club, how you reach across the body in the opposite direction of your lead leg.  When muscles are healthy and strong, they pull on this sling, and create stability.

Simple Exercises Can be Effective

But even if this and other high functioning movements are too much, simple exercises like stick raises with diaphragmatic breathing can activate the core in an easy and safe manner.  This is especially helpful for those that cannot lay supine or stand to work on core strengthening.  Raising the arms can pull on the structures to promote tension and create stability. If needed, sit in a chair, and raise a stick–work your core.  Many patients with low back pain are not able to do the more difficult core strengthening exercises.  Sling exercises facilitate improvement while minimizing strain.

To hammer home this point, think about simple things you did growing up: crawling, throwing a ball, riding a bike.  We must have proper neuromuscular control to function properly. These are things that help develop that control and stability when we grow up.

Conclusion

What can we take away from this?

  1. There is no need to focus on the core myths for most low back diagnoses.  The evidence does not support it.
  2. Using the body’s built-in slings can help stabilize the core by pulling on structures and creating tension.
  3. Core training does not have to be difficult or high level.  Simple breathing and arm raising exercises can help promote core stability.

While there is much more that can be said, this is helpful information for addressing not only low back pain, but the extremities as well.  Properly working the core muscles not only provides a stable spine, but they allow for proper movement of the upper and lower extremities with ADLs and sports.  There is currently no superior rehab method, so continued research and testing will be needed to determine what is the gold standard.  In the meantime, we can throw out what has been proven to not work and focus on training that will help with movements that we use day to day.

About the Author
Kyle Graf, PTA at Frederick Sport and Spine Clinics, has been practicing Physical Therapy for 10 years. Kyle is a 2010 graduate of the Physical Therapist Assistant Program from Mercer County Community College in New Jersey. He has been working exclusively in outpatient physical therapy. He enjoys seeing patients reach their desired level of function and achieving their goals. Through continuing education courses, he will continue to increase his knowledge and learn new skills to help patients succeed.