Although core stability is often sought for better sports performance its roots lie in lower back rehabilitation. This is due to 60-70% of the stabilising force to your spine being provided by the deep muscles in your back, which form part of the core muscles.
The lower back stabilising muscles form a muscular corset which supports and controls your spine, but they often stop working when you are injured and can then fail to recover in the coming weeks. Research has shown that specific exercises that retrain your lower back stabilisation muscles are one of the most effective ways to manage your back pain.
Retraining your lower back stability
Learning how to correctly activate the core, and perform exercises to rebuild core stability, may appear simple, but requires detailed attention to ensure success. Retraining these stabilising muscles is very specific and as such, your physiotherapist will be able to guide you through the different stages.
Being able to ‘switch on’ these lower back stabilising muscles can help prevent straining or re-injuring of the back. When back pain does flare up, the muscles will tend to stop working and will then need specific attention to restart proper function. Either way it is likely that some form of the back exercises prescribed will need to be continued indefinitely to protect and manage your back.
The exercises are by no means a quick fix and will take time and effort to ensure that they work. Also factoring in flare ups of back pain is realistic, as it is the nature of back pain to recur for often unclear reasons. It may just be a consequence of overdoing daily activity or exercise, but does not mean that you have to stop activity altogether. Instead your daily routine can be discussed in your physiotherapy consultation as to how best this can be managed.
If you are noticing pain, pins and needles or numbness in your back or leg either during or after these exercises, stop immediately and consult your physiotherapist. Please do not exercise through pain.
Learning to contract your lower core stabilising muscles
If you have watched any of the Backfocus spinal rehabilitation program videos you will have heard the instruction at the start of each video to “..make sure your lower core stabilising muscles are switched on”.
Stage one of the spinal rehabilitation program teaches how to contract the lower back stabilising muscles that include your lower stomach, pelvic floor and deep back muscles. This muscle contraction must be correct before progressing to any of the other stages of the rehab program. Everyone takes a different amount of time to successfully complete this stage but a reasonable contraction should be achieved within 2 weeks of practice.
Also it may become apparent that some positions make it harder to successfully contract the muscles than others. By starting with whichever position is easiest, it is possible to build confidence when working with the harder positions.
The pelvic floor, lower stomach and deep back muscles should all work as one unit for core stability, but initially it is good to practice focusing on each one separately.
Pelvic floor muscles
- squeeze the back passage of your pelvic floor as if trying to stop yourself from passing wind
- squeeze the front passage as if you are hanging on to go to the toilet
- squeeze both and lift. Hold for 10 seconds
- keep your breathing relaxed
Lower stomach muscles
- relax upper stomach
- slow pelvic floor contraction
- keep breathings
- gently pull in lower stomach, down near your pubic bone
- hold for 10 seconds
Deep back muscles
- lying on your stomach, feel on either side of your spine (right at the bottom) with your fingers
- contract the back passage of the pelvic floor and tighten the back muscle under your fingers
- keep your spine and pelvis completely still
- hold for 10 seconds
- as you get better at it hold the contraction for up to 2 minutes
Some basic contraction of lower back core stabilising muscles
Once you are able to identify the three areas that provide core stability in the lower back, then it is time to combine the contraction of all three muscle groups. This will ensure that the deep muscles in your back work together with the lower stomach and pelvic floor, for full stability.
Be sure to avoid straining by using only 30-50% effort. The contraction should be soft and gentle, with a minute rest between positions to give the muscles a chance to recover. Please continually check that the upper stomach is not moving, otherwise core stability will be weakened.
The following are some simple positions in which you can perform the contraction of the lower back stabilising muscles.
Four Point Kneeling
- make sure hips are over knees and shoulders are over hands
- square off shoulders and relax upper stomach
- tighten stabilising muscles and hold for 10 seconds
- good to use in the morning before you get up
- contract stabilising muscles
- use your fingers to feel the lower stomach move in
Lying on your back
- make sure your back is relaxed
- Curl your tailbone up, stretch the back out and relax the back onto the bed if needed
- contract stabilising muscles
Where now for lower back and core stability?
As we all have a unique physiology, so too are the stresses and strains we are encounter with our mix of daily activities. Therefore it stands to reason that our treatment and exercises prescribed will require some level of customisation to fit individual physical needs.
Our spinal rehabilitation program has eleven levels of back stability retraining and generally takes eight to twelve weeks to complete. This will vary according to the degree of muscle weakness, how often the exercises are performed, and the specific back problem. Starting with the aforementioned basic contraction, the program progresses to using core stabilisation when performing everyday activities, and eventually, to high level exercises.
In the program, up to an hour of lower back stabilisation exercises can be provided. Better results can be seen if there is a commitment to at least four sessions per week to do the exercises, and even better results if they are performed daily.
There should be a clear change in muscle performance and strength occurring weekly, and usually it take at least four weeks for noticeable changes to occur in levels of function and pain. Generally the ability to bend or stand will improve, before an improvement in pain levels is noticed. Although time frames may vary, after three months a clear change should be noticed, otherwise refinement options can be discussed during the next physiotherapy session.
Other than a reduced level of back pain, improvement will provide the chance for soft tissue injury to heal, and ultimately a lower recurrence of injury. So too, the capacity to exercise, along with the carrying out of day to day physical, tasks will improve as a consequence. This should also culminate in a reduction of medication or passive therapies.
The skills learned in lower back rehabilitation will help empower self management of back pain and to gain control over the movements of, and forces acting upon, the spine when in motion and at rest.
In plain terms this means you can get back to what you love most.