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Low Back Pain

This is an excerpt from Developing the Core-2nd Edition by NSCA -National Strength & Conditioning Association.

Low back pain (LBP) is a common disorder affecting people throughout the world (74). Up to 84% of people will experience LBP, and approximately 23% will have chronic LBP (6, 53). Because of the high rates of LBP, determining proper treatment is important. Exercise has been repeatedly shown to benefit those experiencing LBP (16, 17, 30). Core exercises produced better outcomes and improvements in pain and disability ratings than general exercise for those with LBP (14, 65, 77). While using core stability exercises early in the injury process is beneficial, long-term improvements in pain and functional levels are similar between those who perform core stability exercises and those who participate in general exercise programs (76, 77). However, patients are more likely to cite core exercises as being more effective than the use of other pain-reduction methods (14, 50).

A commonly held belief is that those with LBP have an impaired ability to activate abdominal muscles to perform tasks. Specifically, it has been postulated that the deep abdominal muscles have impaired function in those with low back pain. There are large individual variations in the activation pattern of the deep abdominal muscles, which makes it difficult to confirm this conclusion. It is possible that addressing the feedforward onset of these deep abdominal muscles is beneficial (28), but more challenging is to know why (2, 7, 45, 71, 73).

Conditions That Benefit From Core Training

Core exercises are typically advantageous in managing injuries to the lumbosacral spine. Similarly, the risk of experiencing most low back injuries can be decreased by proactively performing core exercises (67). A partial list of injuries that benefit from improving core stability includes the following:

• Muscle injury. The large number of muscles comprising the core means many muscles can be injured. An injury to a muscle is a strain; muscle fibers can tear either partially or completely (56). Lumbar strains are among the most common injuries to the low back (79).
• Disc injury. With few exceptions, the bones of the spine—vertebrae—are separated by intervertebral discs. This disc can move outward (a bulge, typically posterolaterally) and may cause a disc herniation (movement of a disc beyond its usual location).
• Bony injury. Each vertebra is susceptible to injury. The most common lumbar bone injuries are compression fractures and stress fractures. Compression fractures are small breaks of the vertebral body. Stress fractures are common in young athletes active in sports that involve higher loads and lumbar extension, like football and gymnastics. A stress fracture is termed spondylolysis; if the fracture allows the vertebra to slip out of alignment, this is called spondylolisthesis.

While each of these categories of low back injury can involve neural structures, this list does not specifically include nerve-related injuries. Using core training to address neural injury is more thoroughly reviewed in other resources.

Common Core Exercises for Low Back Pain

Core exercise for the low back should involve each of the following:

Multiple planes

• Sagittal, like an abdominal curl
• Frontal, like a side plank
• Transverse, like a PNF (proprioceptive neuromuscular facilitation) chop

Multiple muscle action types

• Concentric, like a medicine ball slam
• Isometric, like a Pallof press
• Eccentric, like the downward movement of a PNF lift

Multiple movement goals

• Generate force, like a reverse hyperextension
• Resist movement, like an anti-rotation cable walkout

Movement related to sport and activity function

• Squat
• Deadlift

More Excerpts From Developing the Core 2nd Edition

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