Specializing in Spine, Sports & Physical Medicine

Getting to the Core- Exercises for Low Back Pain

It’s everywhere you look. Work on your core, get a strong core, it’s all about the core. It’s on the TV, in magazines and in the newspaper. All the celebrities are doing it. If you have back pain then all you have to do is strengthen your core! What’s all the fuss? After over two decades taking care of people with acute and chronic back pain I honestly do not know.

Below is a picture of the muscles that make up the trunk or core muscles. It looks very impressive and conventional wisdom should be correct that strengthening and learning to coordinate all of these muscles should help back pain sufferers. The thing about conventional wisdom is that more often than not it is wrong.

Core Muscles

Throughout my years as a practitioner I have seen many treatments for the spine come and go and then come back again. For decades the recommendation for acute back pain was bed rest. They used to admit people to the hospital for what was called “traction.” I remember seeing patients in the hospital with weights attached by a pulley system to their legs and hanging off the end of the bed. When I was an intern I asked one of the attending doctors if the weights really do anything. His reply was that traction does nothing more than keep the person in bed and let them rest. They no longer admit back pain sufferers to the hospital for traction.

Well, what about exercise for back pain. At first there was a series of exercises known as the William’s exercises. These were nothing more than a flexion based routine that really did nothing. Around the mid 90’s a national committee of back pain experts was convened to tell doctors and the public what was the best way to treat the problem. Bed rest for more for longer than a few days was a no-no and we were all told to exercise our backs. It was around this time that an exercise routine known as lumbar stabilization was becoming popular in the physical therapy world. Doctors and therapists were traveling the country lecturing on this form of treatment. It was all the rage. Did it work? Did it prevent or reduce back pain suffering? The answer is simply no. The focus of the treatment was about correcting postural alignment, the so called neutral spine. Patients were instructed to slightly tuck in their butts so that the curve in the lower back was reduced just enough to take pressure off of the discs. People were taught to contract this paper thin muscle known as the transverse abdominus and to hold this posture all day long. It was impossible for the overwhelming majority of people to hold this posture for even a few minutes let alone an entire day. As the neutral spine started to retreat into the background the CORE was born. Now we were told to strengthen all of the muscles of the CORE. That meant the front, the sides and the back muscles. Just like the original William’s exercises and the neutral spine, the core stabilization and strengthening program swept the nation. Now it is a multibillion dollar industry. Does it work? No. Has it ever been studied by medical researchers? Yes. What did they find? The following two articles sum up the medical science on the current state of knowledge on the CORE exercise routine for low back pain.

Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature. 

Kent J Stuber, Paul Bruno, Sandy Sajko, Jill A Hayden.  Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine 2014 March 20.

Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Core Stabilization as a Treatment for Low Back Pain. 

Christopher J. Standaert, MD, Stanley A. Herring, MD. Department of Rehabilitation Medicine, Department of Orthopedic and Sports Medicine, and Department of Neurological Surgery, University of Washington, Seattle, WA.  Archives of Physical Medicine and Rehabilitation Volume 88, Issue 12 , Pages 1734-1736, December 2007

Below are the conclusions from the two articles, one written in 2007 and the other was just published in March of this year.

  1. The quantity and quality of literature on the use of core stability exercises for treating LBP in athletes is low. The existing evidence has been conducted on small and heterogeneous study       populations using interventions that vary drastically with only mixed results and short-term follow-up. This precludes the formulation of strong conclusions, and additional high quality       research is clearly needed.
  2. There are few prospective studies on patients with LBP, and there is even more limited discussion of the concepts of patient selection, dose-response, and long-term outcome associated with these approaches. There also is a significant lack of uniformity regarding the meaning of “core stabilization” and what therapeutic exercises may be most effective.

To sum up the authors conclusions there is currently no scientific evidence to support a program of ‘core stabilization” for low back pain. So what’s a person supposed to do? Just exercise. Do whatever you like and do it often. That is the current recommendation from the experts around the world. In other words, what the science tells us is that what you do is not as important as  just doing something and preferably some form of exercise that you find enjoyable.

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