Low back pain
Low back pain is a very common injury and form of disability amongst adults. It is the fifth most common reason for physician visits, and will affect approximately 60-80% of adults throughout their lifetime. Pain that occurs for greater than 3 months is considered to be chronic low back pain (Knan and Hargunani, 2014).
There are many different factors that can cause back pain. In people who have low back pain:
27% is caused by mechanical factors including; a herniated disc, scoliosis, spondylosis, fracture, spinal stenosis etc.
2% is referred pain from other illnesses that might include: renal disease, chronic pelvic inflammatory disease, pancreatitis etc.
1% is caused by non mechanical including; infection, neoplastia (cancer), inflammatory arthritis
70% is caused by non specific factors (lumbar strain or sprain)
The majority of cases of low back pain are caused by “non specific factors” which means that there is no direct diagnosable cause to the low back pain, this makes low back pain complex and difficult to treat (Allen and Hulber, 2009). However exercise has been proven to be an effective treatment for low back pain.
Exercise for the treatment of low back pain
With non specific low back pain, there are many different treatment options. Exercise therapy has been researched extensively and found to have beneficial effects for the management of chronic low back pain. Researchers have found that trunk coordination, strengthening and endurance exercises reduced low back pain and disability in patients with subacute (less than three months) and chronic (greater than three months) low back pain (Delitto et al, 2012).
Often treatment involves strengthening the muscles around the low back including the deep core muscles, and glutes including the (gluteus medius and minimus) to help support the spine.
Core Exercises for Low Back Pain
Your core makes up all the muscles in your trunk from your ribcage to your pelvis. You core helps you balance, prepare for movement, bend your trunk (torso) in all directions and stay stable during movement. For more information on what the core does click the button below.
Core exercises play an important role in the management of chronic low back pain. There are four general types of core exercises that can be done;
Balance exercises - in standing, sitting, or on unstable surfaces
Stabilization - holding your body in place (including: planks, side planks, bird dogs etc.)
Motor control exercises - learning how to activate and control core muscles
Segmental stabilization - activation of the deep core muscles
In the Journal of Physical Therapy Science one study found that all four kinds of core exercises were helpful in the treatment of low back pain, but particular focus should be on training the deep core muscles (Chang, Lin, Lae, 2015). Below we will talk about the role of these deep core muscles and how to activate them.
Strengthening the Deep Core Muscles
The deep core muscles help support and stabilize the spine. They contract in anticipation of movement in order to protect the spine. For more information about “what exactly is your core” click the button to the right. The two muscles of the deep core that are important in the management of low back pain are the transverse abdominis and lumbar multifidus. Both of these muscles are active even during static positions and support the lumbar spine (low back) during postural adjustments and whole body movements. These two muscles are the first to turn on when you move an arm or a leg - even before the muscles in that limb are activated! If these muscles are not strong, or able to be easily activated, they may work incorrectly which contributes to low back pain.
However we can’t forget the other muscles that make up the core. Stability of the spine is achieved by the coordinated activity of all the muscles in your trunk. This is why overall core strengthening can help improve the movement and stability of the spine helping reduce low back pain.
This muscle wraps around the torso acting as a corset to support and protect the internal organs by compressing against the abdominal wall. The transverse abdominis is also a stabilizer to the pelvis and the lumbar spine (low back) by providing support and preventing improper movement. If this muscle is weak or you are unable to control the activation of this muscle well, it is unable to do its job of stabilizing the pelvis and spine which can be a cause of low back pain.
A physiotherapist or kinesiologist can help you learn how to activate your transverse abdominis. Check out the video below for some beginner core activation exercises.
This muscle runs right along the spinal column. This muscle is small, yet powerful and helps extend your back and rotate your spine. Dysfunction of this muscle is strongly associated with low back pain. A physiotherapist or kinesiologist can help you learn how to activate and strengthen your multifidus muscle.
Without proper activation, the lumbar multifidis can atrophy, meaning that the muscle decreases in size, and as a result the muscle loses its function. Research has found a reduced size of the lumbar mulitifidus in people with chronic low back pain. The size of the lumbar multifidus can only be identified using an MRI.
It is difficult to learn how to activate your multifidus muscle without the help of a physiotherapist.
The video below highlights some beginner core exercises to help learn how to activate your deep core muscles. If you experience chronic or subacute low back pain, come book an appointment with our physiotherapists to help improve your core strength to relieve low back pain.
I. Khan, R. Hargunani et al. “The lumbar high-intensity zone: 20 years on.” Clinical Radiology, 6 June 2014, 551-558
Last, Allen R., and Karen Hulbert. "Chronic low back pain: evaluation and management." American family physician 79.12 (2009): 1067-74.
Mark H. Halliday et al., “A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference.” J. Orthopedic Sports Physical Therapy, 2016;46(7):514-522.
Anthony Delitto. et al., “Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association” J Orthop Sports Phys Ther. 2012;42(4):A1-A57. doi:10.2519/jospt.2012.0301 (resource - guideline based on level 1a and level 1b evidence)
Chang, W., Lin, H., & Lai, P. (2015). Core strength training for patients with chronic low back pain. Journal of Physical Therapy Science,27(3), 619-622. doi:10.1589/jpts.27.619