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The Core of The Problem

Misconceptions about core, stretching and strength training for back pain

In my previous article, How to Eliminate Back Pain and Look Younger, I described the remarkable prevalence, causes and solutions to back pain. Here I will address the ways in which people do things in an effort to prevent or alleviate back pain that will eventually create or worsen back problems.

These back-bashing routines are on display every time you enter a gym. Unfortunately, many back problems result from uninformed trainers’ instruction. The ignorance of many doctors also makes things worse. Too often they rely on MRI or CT for diagnosis (these tests are quite limited in identifying the cause of back pain), use pain medication as a primary intervention and write one-size-fits-all physical therapy plans.

To make sense of what you should and shouldn’t do requires a quick review of back anatomy and function.

The spine consists of a column of bones (vertebra) that house the neurological cable that allows bidirectional communication (sensory and motor) between brain and body. Structurally, it provides a stable column that the limbs use as an anchor to produce movement such as walking, lifting, pushing or pulling. Without a stiffened back these actions are impossible. The core muscles provide this essential stability.

To visualize this idea, imagine pushing a door open. If the back were not held stable, the arms would simply push you away from the door.

The back functions optimally and is most resilient when in a neutral position, an elongated line with three well-defined curves.

Taking the back out of neutral position, back bending, stresses the disks, small rings of collagen between each vertebra. They are not designed for much motion and start to break down.

Repeated bending squeezes the disc and tears its fibers. As the disc wall weakens it bulges out and presses on nerve. This is how the vast majority of back pain is created in young people. Back pain in older populations results from years of dysfunctional posture and movement patterns that create arthritic changes damaging the vertebral joints and discs.

Posture affects load and stress.

When bending to lift something from the ground, flexion at the hip rather than the back allows a neutral spine. This maintenance of optimal spinal form prevents disc compression and the eventual bulging that causes pain.

Training The Core

The core muscles include the rectus abdominis or six pack, the obliques, the transverse abdominis and spinal muscles. All work together to provide a spring loaded girdle that translates powerful forces from the hip into actions of the limbs.  

Core muscles and limb muscles have opposite functions. The primary job of limb muscles is movement while the primary function of core muscles is to prevent movement. These roles define radically different training methods.

When core muscles stiffen, they act as a girdle to stabilize the spine. This occurs throughout the day when sitting, standing, walking, pushing, pulling and lifting. In other words, all the time. Therefore the two most important aspects of core training are endurance and maintenance of a neutral spine.

Don’t Do This

These exercises rehearse dysfunctional movement patterns.

· Crunch

· Sit up

· Sit up with twist

· Spinal stretches such as

o Pulling knees to chest

o Lying on back and dropping knees from side to side

· Any exercise that causes pain

Do This

The recommended exercises below target a network of muscles that work together. This principal applies to both core and limb muscles. Train movement patterns or stability, not one particular muscle.

· Bird-Dog

· Planks

· Walk

The Bird Dog

This exercise provides both spine stabilization and hip and shoulder motion simulating most real life activity. Opposite arm and leg are raised no higher than shoulder and hip height respectively. Do not point the toes. Think about getting as long as possible, not how high the limbs are raised.


Plank

All planks engage the spine stabilizing muscles but side planks are particularly beneficial. This posture also recruits quadratus lumborum, abdominals and latissimus dorsi. Beginners can first do side planks with knee and elbow touching the ground and progress to just feet and elbow.

Work up to holding the side plank for 10 seconds and then roll into front plank without twisting the spine. The torso is held stiff and movement hinges at the shoulder and hip. Hold for 10 seconds and then roll to other side plank for 10 seconds. Work toward three sets.


Chair Squats

The essential movement of the squat is hip hinging. As I explained in How to Eliminate Back Pain, this way of bending and lifting keeps the back healthy and pain-free.

Stand in front of a chair with feet shoulder width apart and arms at your side. Begin by taking the hips back as if sticking out your tail. Avoid the knees moving forward beyond a mid point between toe and heel. As you lower yourself bring the arms up in front of you until parallel to the ground. The back remains straight throughout. Come back up by pushing the hips forward and lowering the arms.

As you master proper form try to just touch the seat and return to standing, rather than sitting down each time. When this movement feels natural you can begin to load the squat by holding dumbbells, arms hanging by your side. Remember to always keep the back straight.

 

Walking

This provides a gentle challenge to the spine, core and limbs to work in a coordinated fashion. Ironically, slow walking often worsens back pain. The ideal walking style has a brisk pace, vigorous arm swings, firm abdomen and erect posture with head up looking forward, not down. Start with short sessions and stop when pain occurs. Progression can include incorporating inclines into your route. 

The key is to slowly advance these activities in a pain-free state.

For those hungry for more information, read Stuart McGill, the preeminent authority on back biomechanics and pain. He provides comprehensive coverage of these ideas and much more in Ultimate Back Fitness and Performance.

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