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Low Back Pain – Why you’re activating your core the wrong way!

Low back pain is one of the common musculoskeletal injuries that health professionals in Australia have to treat. At the Injury Rehab Centre our team of Physiotherapists and Osteopaths see many patients from Cheltenham, Moorabbin, Mentone, Highett, Hampton, Black Rock, Beaumaris and Heatherton who present with both acute and chronic low back pain. There are multiple techniques and strategies that a health professional may utilize in order to address a patient’s low back pain, but a common conservative strategy is therapeutic exercise. Often the first thing many patients think of is that they need to work on their “Core Strength” or their “Core Stability.” But what does this truly mean?

For individuals with low back pain we know that “CORE STABILISATION” exercises:

  • Decrease pain
  • Reduce disability
  • Restore/Increase muscle function
  • Promote stability
  • Reduce risk of subsequent injury

As a patient, you may be unaware of this but there are currently two schools of thought on what this really means. To understand why these two schools exist a quick anatomy lesson about what muscles make up your core has to be discussed.

LOCAL & GLOBAL CORE MUSCLES

Together core muscles can help to increase stiffness and enhance stability of the spine when activated.

Local muscles are thought to help promote specific, segmental stability and are better suited to control shear movements in the spine while avoiding excessive compression to the spine.

Local Muscles consist of:

  • Transverse Abdominis [T.A.]
  • Multifidus

Global muscles are the bigger generators of actual movement that create the movements that we generally get from the spine (Rotation, Flexion, Extension, and Side-bending). ALL muscles demonstrate a delay in activation after low back injury and not specifically just the local muscles as pain will cause changes in movement, not just changes in movement cause pain.

Global Muscles consist of:

  • Erector Spinae
  • Rectus Abdominis
  • Quadratus Lumborum
  • External/Internal Obliques

MOTOR CONTROL APPROACH

This strategy uses an approach to emphasize rehab and assessment around the local small muscles around the spine.

One of the hallmark exercises utilized for this strategy is the “Drawing-Maneuver.”

Where an individual is instructed to attempt to isolate the local muscles (T.A.) without overpowering the muscle with the global core muscles. This exercise is taught in multiple and instructed to perform in various positions (Sitting, Hands and Knees, Standing).

GENERAL EXERCISE APPROACH

This strategy is utilized in order to address all muscles with its theory founded on the basis that often the best way to overcome the stresses and strains placed on the lower spine is to increase the strength and capacity of the body as a whole to improve overall tolerance. Often this involves using the hips in combination with the spine as this represents the bodies true “core”.

Hallmark exercises in addressing the core from this approach include the “Bird-Dog.”  “Side Plank,” and “McGill Crunch” exercises as well as other big compound movements such as Squats, Deadlifts and Overhead Presses.

IS ONE BETTER THAN THE OTHER?

A review of the evidence revealed that both approaches helped to REDUCE PAIN AND DISABILITY with chronic and subacute pain. Most of the cases that directly compared these two approaches, there was no significant difference; but 2 studies did find that the general approach were associated with better outcomes.

At the Injury Rehab Centre we don’t believe there is such thing as a bad exercise or movement, but sometimes they can be inadequately prescribed. Often we encounter many patients whose extent of developing “Core Stability” ends with very simple isolation exercises that don’t take the patient far enough to develop greater capacity for what they want to do! It is easy to imagine a simple activation exercise not being enough if what you want to do is handle heavy weights in the gym, return to running or simply want to dig a whole in the garden pain free!

TAKE HOME MESSAGES:

  • The core has global and local movers that both contribute to spinal stability
  • Therapeutic exercise and core stabilization are a cornerstone of helping to alleviate low back pain
  • Evidence suggests there is no difference in helping to reduce pain or disability in either of the approaches discussed, the key is that some type of exercise is better than none.
  • It may be unnecessary to focus on specifically focus on trying to activate purely the local muscles as there is no difference in outcome and delays in activation tend to occur in all muscles with pain!

What do the Physiotherapists and Osteopaths at the Injury Rehab Centre in Cheltenham do?

At the Injury Rehab Centre We specialise in assessment and collecting actionable data using the latest technology previously only found in elite sporting institutions when dealing with lower back pain patients. This includes:

  • M.A.T Assessment created by the therapists of the Injury Rehab Centre to laser focus on areas of flexibility, balance and movement that identify the risk factors of low back pain.
  • Slow Motion Video Analysis of fundamental lifting techniques such as squats, deadlifts and presses TO FIND BAD HABITS that can cause injury to areas such as the lower back.
  • Strength Testing to identify any strength discrepancies that have a huge role in injury risk.
  • Force Plate Technology to put a number on differences in the power you can generate through each leg that can lead to compensations and can cause repetitive stress injuries such as those activities that contribute to back pain.
  • Traditional Physiotherapy and Osteopathy examinations to identify dysfunction.

Next our treatment process achieves pain relief in the shortest amount of time by using hands on Physiotherapy and Osteopathy techniques such as soft tissue massage, joint manipulation, articulation and stretching techniques. This may include the use of the True Stretch system as well as Dry Needling and Taping techniques.

Finally your management plan will involve an individualised training plan to build your strength and capacity (muscle and tendon strength, stamina, specific flexibility) often to improve discrepancies from side to side that could be the true cause of your low back pain and build confidence in your body.

If you suffer from low back pain and want to get off the treatment merry-go-round and back to feeling better, moving better and performing better contact the Injury Rehab Centre today on 95537024 or book online using the link at the top of the page.

 
REFERENCES:
Brumitt, J., Matheson, J. W., & Meira, E. P. Core stabilization exercise prescription, part I: current concepts in assessment and intervention. Sports Health. 2013 Nov; 5(6): 504–509.
Brumitt, J., Matheson, J. W., & Meira, E. P. Core stabilization exercise prescription, part 2: a systematic review of motor control and general (global) exercise rehabilitation approaches for patients with low back pain. Sports Health. 2013 Nov; 5(6): 510–513.

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