Back pain is so common that it’s often described as a normal part of being human. More than eighty percent of people will experience back pain at some time during their life. Of course, when you have back pain it feels far from normal; but with the right approach to activity and acute care treatment it is usually short lived. What’s not normal is for back pain to continue and become a chronic issue.
There has been a huge amount of research into back pain. And what we now know is challenging a lot of the common beliefs about how we get back pain and how we recover well.
One of the most popular ideas in physical medicine has been the ‘core stability model’, which says back pain is caused by weakness of the abdominal muscles, and that recovery depends completely on making them strong again. The prevailing wisdom is that core strengthening can both prevent the onset of lower back pain as well as reduce existing pain. The scientific research into the relationship between core muscles and back pain provides eye-opening information that may surprise you.
What Is the Core?
The core muscles are those that support your spinal column. The abdominal group is central to core stability, controlling spinal and pelvic positioning. All of these muscles work together with other muscles in very specific ways in response to signals from your nervous system.
However, none of these muscle operate independently of the others. The isolation of a particular core muscles that is often taught as part of core strengthening programs never occurs during normal movement.
The Research: What is the Connection Between Core Strength and Back Pain?
Walking, sitting, bending and turning require surprisingly little effort from your core muscles. For example, studies measuring muscle activity during normal walking activity indicate that rectus abdominis muscle (your six pack) expends only 2 percent of its maximal voluntary contraction. The external obliques use only about 5 percent. This suggests that even quite weak core muscles can handle everyday movements with strength to spare.
The idea that specific strengthening of core muscles is necessary for a healthy back has also been challenged. In 2013, Karen Lomond and her team showed that a general exercise program was equally effective in improving both core muscle activation patterns and pain symptoms when compared with specific core strengthening exercises.
A 2014 research review of all clinical trials looking at the effectiveness of core stabilisation for low back pain found consistent and compelling evidence that core stabilisation exercises provide no greater relief of lower back pain than any other types of exercises. In fact, core strengthening is not proven to prevent the onset of lower back pain or reduce further flare-ups, either. In another study of 4325 soldiers, researchers found that education to help reduce the sense of fear and threat that can come with the idea the spine is weak or damaged was more effective at preventing back pain episodes than core exercise.
The current research evidence tells us that the causes of back pain are far more complex than simply your muscle strength. General health, psychological, social, work and behavioral issues as well as genetics significantly influence back pain, too. Clearly, core stabilisation does not address these factors.
Proven Ways to Relieve Back Pain
The preferred method for treating back pain used to be bed rest. If you have ever tried it, you know that it can actually worsen the problem. This is because you are not addressing the origins of the pain. Some people would rather stay stationary than risk feeling more pain in the moment, but limiting movement is now well known to increase the likelihood that back pain will become chronic.
So, we know movement is good, but exercises that focus on core strengthening have no special power to alleviate or prevent back pain. And for some kinds of back pain, certain core exercises can do more harm than good in the short term.
Taking a whole body approach during daily movement, mobility and light exercise is typically more effective for most people with back pain than trying to strengthen a specific muscle group. And very short sessions of movement or exercises regularly can be a good way to avoid additional strain and maintain good blood flow around healing tissues.
Relaxed back muscle are often important than strong ones. Gentle stretches and flexibility exercises keep your back and core muscles limber and your back relaxed. For example, slow gradual stretching, encouraging stressed muscles to incrementally relax and soften, helps free up your movement so your back can function more naturally.
Of course, if you are experiencing a new episode of back pain, be sure to consult with your osteopath before starting an exercise regimen that could potentially aggravate it.