Getting to “the Core” of Back Pain
By Dr. John Bowman, M.D. (Sport Medicine)

There has been a lot of talk in the fitness and exercise therapy fields about the importance of core muscle strength and the role it plays in the prevention and treatment of low back pain.

The core muscles extend from the spine at the back around to the front of the abdominal cavity. They are made up of two components, the inner and outer core. This article will focus on the inner core, since it plays the most important role in supporting the back.

The “inner core” is made up of four sets of muscles. The first set is made up of the transversus abdominis muscles, which are the deepest of the abdominal muscles. They act like a support belt, wrapping around the waist from the spine at the back toward the belly button at the front. The multifidus muscles make up the second set and are located at the back of the body and run along the spine from one vertebra to the next. The multifidus muscles act like guy wires to support the spine. The final two muscle groups are the pelvic floor muscles at the bottom of the abdominal cavity and the diaphragm at the top.

The inner core muscles are crucial for low back function (and dysfunction). They provide stability and support, thereby helping prevent back injury and pain. Conversely, many patients with chronic low back pain often have core muscle weakness.

Why do so many of us end up with weak core muscles? The answer rests with the fact that these muscles are controlled automatically without conscious input from the brain. For some reason our nervous system tends to lose the ability to activate these muscles and they weaken. The usual exercises we do such as sit-ups and abdominal crunches focus primarily on the outer core and don’t stimulate the inner.

So what can we do? Fortunately techniques have been developed to help us retrain our nervous systems to strengthen the core muscles. These techniques involve very subtle muscle responses and learning them requires time and a lot of patience. Once mastered however they can become part of our daily activities and be readily called upon when needed.

If you have recurring back pain I strongly recommend that you seek out a qualified person to teach you how to learn core muscle strengthening. Generally physiotherapists, certified exercise therapists and Pilates teachers will be able to help you.

John Bowman was a family doctor who now specializes in sport medicine. He is the Medical Director of the Collingwood Sport Medicine and Rehabilitation Centre.

Our Exercise Therapist, Judy McLenaghan has a Low Back Pain Therapeutic Exercise Management Program that will help reduce pain and improve function by retraining the spinal and core muscles. Depending on the need or preference, there are two programs available. 1) Two one-hour sessions for $75.00 or 2) Eight sessions for $179.00.