Why is core strength important for back pain?
Updated: Feb 10, 2019
Rugby is very close to my heart, as it has made up a big part of my adult life both personally and professionally.
So when I was asked to write a blog pertaining to rugby, a lot of options came to mind. Shoulders, necks, knees – all commonly injured joints when playing rugby. But something that people don’t talk about enough in rugby players is the importance of core strength.
When I worked as Head Physiotherapist to Anglican Church Grammar School’s rugby program, we would often reminisce on alumni, David Pocock, who would do 450 sit ups before bed each night from when he was just 14 years of age. Pocock has since gone on to play 65 tests for the Wallabies since leaving the rugby program, but the legacy of his training lives on to this day.
Luckily for readers of this blog, we will not be prescribing Pocock’s training plan. Thankfully, our understanding of the body and how best to look after it has advanced beyond 450 pre-bed situps.
Whether you’re a professional rugby player, social footballer, backyard cricketer or one of the 38% of our population who experience back pain – this blog is for you. We all know that core strength is important, but people don’t necessarily know why, much less how to train it effectively.
For starters, I want to make a clarification. “Core strength” is an interchangeable term. Other ways to describe it are: Core stability, lumbopelvic stability, trunk stability and motor control. Personally, I believe “Core Stability” is the best term, as stability encompasses strength and endurance in a functional manner. It’s all-encompassing and ‘ticks all the boxes’ so to speak.
Why is core stability so important?
Brukner and Khan say it best: “a comprehensive strengthening or facilitation of core muscles has been advocated as a preventative, rehabilitative and performance-enhancing program for various lumbar spine and musculoskeletal injuries”. So core stability is for more than just our elite rugby players, it’s for people recovering from, or trying to avoid, injury.
What is the core made up of?
Think of your core as a box. The pelvic floor and hip girdle musculature make up the base, the diaphragm acts as the lid, the abdominal wall represents the front of the box, the paraspinals and gluteals represent the back of the box and hip abductors and rotators make up the sides of the box.
Therefore the lumbar spine depends on this musculature to give it stability. While it's assisted passively by bony and ligamentous structures, without the muscles of the "box" engaging, the lumbar spine cannot bear much compressive load.
Which muscles need training?
A number of muscles function to stabilise the spine. The muscles can be classified into 2 groups:
Global (dynamic) muscles:
These are the large, ultra powerful muscles that generate a lot of torque. These muscles include: the rectus abdominis, iliocostalis and external obliques.
Local (postural) muscles:
These are the muscles that attach directly onto the vertebrae of your spine. They function to stabilise the lower back during movement. These muscles include: multifidus, psoas major, quadratus lumborum, transversus abdominis, the diaphragm and the posterior fibres of the internal oblique as well as the lumbar fibres of iliocostalis and longissimus.
Figure:- Cross-sectional anatomy of lumbar spine
While I admire 14 year old David Pocock doing 450 situps before bed each night, it’s not an efficient way to build core stability. The old school of thought was to train global muscles. Thus situps were the go-to exercise for people trying to prevent, or even rehabilitate, injury. In recent years, we have come to learn that the “local” muscles are equally, if not more so, important. Numerous studies have shown that the poor endurance and delayed activation of the transversus abdmoninis and gluteals (medius and maximus) have been noted in individuals with lower back pain.
Therefore, both muscle groups need to work effectively to stabilize the spine and an exercise program needs to reflect this. 450 situps alone cannot do this.
What’s best for you?:
This is where we come in. Our team of experienced and highly skilled physiotherapists can thoroughly examine you to determine where your weaknesses are. Assessments such as the prone plank and single leg squat can tell us a lot about where your deficits lie.
From here, one of our Strength and Conditioning coaches who specialise in rehabilitative exercise can tailor a plan to maximize your training. Newest Ultra Sports Clinic team member, Rodrigo Alemeida, is a rehabilitation specialist and is a certified Mat Pilates instructor. Tim Murray and Simon Dainton have worked with A-List celebrities, athletes and everyone in the middle to reduce pain and improve performance.
Personally, I have instructed hundreds of Reformer Pilates classes over the years. After sustaining a serious lumbar disc injury in 2015, I decided it was time to practice what I preach and made a concerted effort to improve core stability.
How to strengthen your core: An example of exercises that are effective in improving core stability are listed below. If you are recovering from, or have a history of injury, please see a physiotherapist before attempting any of these exercises.
Clam: 2x Sets; 12-20x Reps each side
Clam with resistance band: 2x Sets; 12-20x Reps each side
Bridges: 3x Sets; 12-20x Reps
Single leg squat: 2x Sets; 8-12x Reps each side
Wobble board: 3x Sets; 30-60 second hold
Dynamic Plank: 2x Sets; 20x reps of a slow and controlled movement
Level 1: Knees
Level 2: Toes
Dynamic Side Plank: 2x Sets; 20x reps of a slow and controlled movement each side
Level 1: Knees
Level 2: Toes
Bird/Dog: 2x Sets; 20x Reps of alternating sides (Left arm + right leg à right arm + left leg)
Bridges with leg extension: 2x Sets of 12-20x Reps each side
Single leg squat on balance board: 2x Sets; 8-12x Reps each side
Leg lift on physioball: 2x Sets; 12-20x Reps each side
Advanced: Swiss Ball roll outs: 3x Sets; 10x Reps of slow and controlled movement
Abdominal crunch on ball: 3x Sets of 12-20x Reps
Bridging on ball: 3x Sets of 12-20x Reps
Push ups on ball: 3x Sets of 12-20x Reps
Whether you’re pilfering a ball from a ruck, lifting your baby from the pram or sitting at a desk for 8+ hours a day - core stability will help you.
Don’t do 450 situps before bed each night - instead book an appointment at Ultra Sports Clinic today for a proper assessment and management plan or take advantage of one of the numerous strength and conditioning packages we offer.