As a perfect follow up to the previous post Getting Down to the Core of the Problem, this post will be talking about the starter exercises that I typically recommend to any patient experiencing low back pain.  This post will cover the basic groundwork that needs to be done before starting the core exercises (that will be covered in Part II).

My philosophies about conditioning the core are largely based on Dr. Stuart McGill’s research, and his rehabilitation experience. I was lucky enough to take Dr. McGill’s course at the University of Waterloo, which played a big part in stirring up my interest in low back rehabilitation and chiropractic. If you are interested in learning more about Dr. McGill’s internationally recognized work regarding the low back, pick up a copy of his book Low Back Disorders, or preview it here.  It is an interesting read, and I highly recommend it.  

Before I introduce the true core exercises, it is important to make sure that you know how to activate your core, and how to properly ‘brace’ your spine, especially if you have low back pain.  The abdominal brace is probably the most important piece to any core exercise you will do, so it is important to master it.  The abdominal brace is performed by activating the core.  In order to get the right sensation, imagine I was going to punch you hard in the stomach (don’t worry, I would never actually do that). In order to stop me from hurting your internal organs (yes my punch can do damage), you would need to stiffen your abdominal muscles.  In that situation, you would likely stiffen your abs close to 100% of your maximal force to protect yourself.  It isn’t a sucking in of the stomach or a pushing out, but a stiffening of the abdominal and back muscles.  It might be difficult initially to get that sensation, especially if your core hasn’t been doing its job for a while.  Another way to bring activation to your core is to imagine straining on the toilet.  If you have to strain hard, you will likely activate your core.

Now that you have an idea of what core activation feels like, I want you to scale down the activation to about 25% of the max. This gentle activation of the core is what I call the abdominal brace.  You should be able to maintain this level of activation while breathing, and while performing daily activities.

If you suffer from or have a history of low back pain, it would be helpful to think of using your ‘abdominal brace’ whenever you are performing any type of activity involving the back.  For example, whenever getting up from a chair, lifting, climbing stairs, getting out of the car, spitting into the sink after brushing your teeth, etc. Your brain should be telling your core to gently activate during those activities anyways, but when your core is deconditioned, the brace may be weak or lazy. By bringing your awareness to activating the core prior to performing those activities, you are re-teaching the brain and the body how to protect the spine.  Eventually the brain will take over, and will activate the core automatically before you start the activity.

I’m dedicating this entire post to the abdominal brace simply because it is so important.  I will be posting the core exercises soon, but this gives you time to practice your abdominal brace.

Hello, and welcome to my first ever blog!  I will be using this blog to answer questions that I often get asked in clinic, to go over some rehabilitation type exercises, and to discuss health related topics. 

One of the most common things that I treat is low back pain.  Researchers estimate that 80% of the population will experience low back pain at some point in their lives, so it is not at all surprising that this is a common problem.

When looking at back pain, there are a few different structures that could contribute to the pain including:
-       The joints of the spine,
-       The muscles of the low back,
-       The nerves that come from the spinal chord, and
-       The discs that sit in between each vertebra, to name a few.

Different treatments are prescribed based on what structure is hurt.  However, in most cases of low back pain, irrespective of the main source of pain, de-conditioning of the spine stabilizing muscles is an important contributing factor. 

Our society today spends a lot of time sitting, slumping, slouching, and adopting all sorts of strange postures.  Most jobs are completed at a desk, or in front of a computer, and very commonly the sitting continues once home from work – watching television, searching the internet, answering emails, or playing video games. Although sitting is a necessary part of our daily lives, the problems that result from too much sitting can be a pain in the back, literally.

The spine is a very important structure in the body, made up of 24 bones called vertebrae, with discs sandwiched in between.  The job of the spine or vertebral column is to protect the delicate nerves and spinal chord from injury.  The spine itself isn’t very stable.  Imagine a very tall, skinny tower.  Without proper supports, it can be easily swayed with the wind, or toppled over with a swift push.  The muscles of the “core”- work together to stabilize the spine, just like guy wires surrounding a tower. The tension in the wires must be even around the tower so that the tower stands tall and straight. If one wire is slack, the tower will lean towards the tight wire.  Similarly, the core muscles act like guy wires to the spine, they include: rectus abdominus, transverse abdominus, internal and external obliques, erector spinae, also the pelvic floor muscles, and the diaphragm.  A well-conditioned core provides even tension to the spine, creating an exponentially stronger spine than when the muscles are removed.

Sitting for long periods of time, especially in slouching postures, allows the core muscles to shut off. After years of sitting for hours and hours a day, the core muscles become lazy, and become used to shutting off.  This leaves the spine in a very vulnerable position.  Any small miscalculation from these lazy muscles can result in back pain.  Even a simple task like picking up a pencil, can cause significant back pain if your muscles do not fire properly.  Imagine if one core muscle ‘forgets’ to fire when bending forward.  The tension of the ‘guy wires’ surrounding the spine becomes uneven, which can cause injury to occur in the spine, resulting in back pain.

I often see patients that are baffled when they hurt their back doing a simple task.  They cannot understand how bending forward to pick up a dropped piece of paper, or retrieving a small bag of groceries from the trunk, can cause them to “throw out” their back.  The strength required to do the task has little to do with injury, instead, it is the de-conditioning of the core muscles in the days, weeks, and years leading up to the event that caused the injury.  Your core muscles don’t become de-conditioned overnight.  It is the result of hours of sitting, adopting bad postures, and failing to keep the core muscles’ endurance up.

So I challenge you to keep your core healthy.  When sitting down at a desk, make sure your low back is supported.  Make sure your workstation is fitted to you, so you don’t find yourself in an awkward posture.  Take walk/stretch breaks every 20 minutes of sitting. Practice hinging at your hips instead of bending your low back when lifting, shoveling, or exercising, and perhaps most importantly, make sure you condition your core muscles.  You should do exercises for your core muscles to increase their endurance and to keep them from getting lazy.  It is by conditioning your core muscles through exercise, that they can support your spine, and keep you from experiencing pain and injury.

**Stay tuned for my next entry on “The Big 3” exercises to condition your core muscles safely and effectively**