You have had back pain for a long time. You have seen your primary care physician on numerous occasions and have even been referred to a spine specialist. You have tried medication, rest and stretching, but none of them have seemed to work. Finally, someone suggested that the key to your success is in strengthening your core muscles. But what exactly are your core muscles, and how can they help your back pain?
Core stabilization is a buzz phrase used in many gyms and clinics around the country. When most people think of having a good core, they get a picture in their mind of a lean, muscular person with washboard abdominals. They imagine doing lots of sit-ups and crunches to achieve a stomach they'd be proud to show off at the beach. This, however, is not what core stabilization is about.
Most cases of low back pain originate from injuries to the intervertebral disc, commonly referred to as disc bulges. The disc is a critically important structure in maintaining full mobility and health of your vertebrae. The disc serves to provide shock absorption for the spine, increase stability and prevent the development of arthritis.
When a disc bulges, the fluid inside of the disc leaks out and the disc collapses inwards. When this happens, the ligaments surrounding the vertebrae and disc slacken up and no longer hold the spine in a tight and protected posture. Without ligamentous support, the vertebrae can slide around on top of the disc, creating a sheer force that is the origin for many types of back pain. This pain often feels like a deep ache or a thick band of pain across the low back.
Core stability is not a new concept. Physical therapists have known for decades that the deep muscles of the stomach work directly to improve function and stability of the spine. It is well documented in patients with back pain that these muscles become weak and in many cases shut down completely. It is also important to note that theses muscles can become so impaired that you have no protection against simple tasks such as brushing your teeth, getting out of bed and picking something off the floor.
The deep muscles of the stomach are extraordinarily important to maintaining back health. There are also small muscles that line the spine directly that help to provide stability for rotational and bending movements. These muscles, like the muscles of the stomach, also shut down in the presence of pain. Because pain brings about such a vast neurological and muscular impairment, it is important to address core stability as soon as possible.
The muscles of core stabilization are deep and not visible to the naked eye. Only specifically directed exercises will strengthen these muscles, so don't be under the impression that the ab-crunch machine at the gym will do the trick. Furthermore, be wary of exercise advice from someone else who has had "back pain." Their situation will most likely be different than yours and require a different treatment.
Using exercise alone, most patients can expect a good outcome in a fairly short period of time - usually about six weeks. Some recover faster, depending on the nature and severity of the case, whereas others take a while longer - typically the patients who have had back pain for a long time. Personalized physical therapy programs often involve a series of back mobilizations coupled with exercises giving you a large effect quickly - the benefit of having supervision.
If you're having back pain or if you feel as if your back could "go out" at any moment, see a physical therapist for an evaluation.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to Joe by e-mail: joedivincenzo@comcast.net.
