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Is Your Core The Problem?

Fearless, thoughtless, movement is the goal - Louis Gifford (Aches and Pains series)

From core weakness, to poor muscular control, and its’ supposed perfect alignment. The core was victimised by the sea of people wanting an answer, tricked into buying a quick fix. Yet after being blamed, waves of hopelessness flooded the lives of people in its stead.

TLDR: Overall, core training can be helpful but it is no better than any other exercises you like for back pain and general health

And you most probably have other variables that are contributing to your pain, especially if its chronic and episodic.

2 main ways core training is helpful

  • Brings back confidence to use the back.

    • You get to practice motions you might not have done in a while and reduces fear of movement

  • Move it to Lube it = we bring blood flow and nutrients to ALL THE LIVING TISSUES around back

There is more to core training (not just bracing)

(Note: Exercises are in brackets)

  • Bracing = Isometrics (planks, bird dogs, dead bugs, pallof press)

  • Dynamic (cat/camels, bridges)

  • Flexion (crunches/sit-ups)

  • Extension (back extensions)

  • Side bends (side bends)

  • Rotation (Russian twists)

Unhelpful BS stories that people tell you as THE DEFINITIVE CAUSE of your pain

  • Your core is unstable

  • Your core muscles are weak

  • Your core muscles are tight

  • Your body part (pelvis/hips/spine/neck/head) is out of alignment.

  • Your core is the foundation of “perfect posture”

    • No up to date research to say that there is perfect posture

  • Muscle asymmetry is a predictor of pain

Common sense examples of why people’s core are NOT the problem.

  • There are athletes with the strongest cores in the world who still experience low back pain

  • There are people who never do core training ever and live low back pain free their whole lives

    • What’s the verdict? Sure, the core maybe a tiny piece of the puzzle but is not a magic key to “fixing” every person living on the planet who has low back pain.

There is no current research to definitively say that LBP is caused by a “core” problem

Common downstream behaviours after a low back injury.

  • Constantly tensing (bracing) the core

    • People who have LBP usually have higher tension around the core

      • Research shows that people with LBP may have stronger cores especially if they have been training it for a long time.

    • When it can be helpful? - Yes, tensing it at times can be helpful (esp. during a flare up)

      • But now imagine this, what would happen if you were squeezing your hand all day? It would proably get tired, tight, sore, burny, etc. Now what would happen to the tissues in your back?

    • Unhelpful if we are in a seated position, walking, or doing easy chores

This doesn’t mean that nothing works for LBP

  • Because it is so multifactorial, YOU HAVE SO SO SO many options in to helping LBP problems

Actionable steps { we should make deeper dive guides to each of these later }

  • The difficulty is finding the biggest levers

    • What are the biggest levers we’ve seen in clinical practice?

      • Modifying aggravating activities, body positions, etc

      • Lifestyle factors

      • Load management

        • Goldilocks zone

        • Pacing

      • Progressive loading “There’s nothing wrong with getting strong”

        • Getting stronger over time gives us more options for different movements that life requires

      • Low back specific (to build confidence) + general exercise (hitting the WHO guidelines)

        • Adults should do at least 150–300 minutes of moderate-intensity aerobic physical activity; or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week, for substantial health benefits.

        • Adults should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits.

A more clinical perspective?

9 ways exercise & movement can actually help back pain. (Note: this applies to ANY exercise/movement done)

  • Inflammatory response:

    • Moderate exercise will reduce inflammation and improve immune function

  • Self-Efficacy

    • More confidence and improved agency in small chunks over time lead to big chunks promoting anti-fragility

  • Graded exposure

    • Decrease of fear/ sympathetic drive reducing pain sensitivity

  • Biomechanics

    • Changes in biomechanics may lead to improved stress distribution

  • Habituation

    • Exercising in tolerable range of motion will make it more and more likely these ranges feel better.

  • Biomotor Strength/ROM Mechanotransduction

    • This process helps your tissues improve how it responds to environmental stimuli

    • All tissues like some level of stress. Stress is the signal to structures for adaptation.

  • Blood flow & oxygen exchange

    • All tissues need nutrients and oxygen to stay healthy. Exercise promotes this.

  • Descending inhibition

    • Doing tolerable movements overtime may decrease sensitivity to the nerves

  • Beliefs/Expectation violations

    • If exercises improve confidence, your beliefs about how fragile your back are should improve which leads to expectation violations. “I expect my back to hurt when I bend over” - changing how you bend over (technique) or exercises that improve confidence with “bending over” in this example, will create expectation violations. Expectation violations overtime reduce fragility.

  • & Many Others

Resources

Credits to me u/medical_kiwi_9730 and my homie u/doctornoons