Core Stability Exercise and Causes of Low Back Pain

doctorjet March 12th, 2009

Today I was talking with local bike fit specialist Cameron Chambers of BikeSource, when the subject of core stability and its relationship to low back pain came up. He related that as an athlete himself he has been lucky enough to not have experienced problems with back pain during competition and training. Regardless of this fact, from time to time he is still influenced by the endless chatter about the importance of core stability and its ability to improve performance and prevent injury. Unfortunately, each time he gets into a routine of core work, he inevitably starts experiencing one of the very problems he was trying to prevent… Low Back Pain. He wasn’t the only one either. Several of the very people he was helping get properly fit to their bike have experienced the same problems.I think that most people confuse core work with trying to flatten their stomach. Where I see this the most is in practice whenever anyone approaches me with questions regarding pain in their low back. This is when I always question their core stability. At that point I can usually see the patients eyes glaze over as visions of “7 Minute Abs” start to run through their mind. However, there is a difference between the ongoing struggle for a chiseled six pack and achieving your goal of good core stability.

It is safe to say that most of the low back pain CAUSED by abdominal work can be tied back to the Psoas Muscles. These powerful hip flexors actually attach in part to your lumbar spine. So in understanding this muscle runs from your low back to your hip, you should be able to picture that as you attempt to flex your hip, the tension that is lifting your thigh is also pulling the opposite direction on your lumbar spine. This pulling, or shearing, force creates stress on the low back that can lead to pain. That shearing force is exactlly what you are creating when you perform old school sit-ups. So, instead of preventing injury to your spine, you’re causing it.

In short, the best way to prevent back pain caused by ab work is to take as much of the resisted hip flexion out of these exercises as possible. Old style sit-ups where we used to hook our feet under an object and pull our elbows up to our knees were very much a hip flexor exercise. Even leaving your feet on the floor while you perform partial sit-ups or crunches encourages engagement of the hip flexors. This is why it is recommended to bend your hips and knees to ninety degrees and lie flat on your back while performing crunches. By just focusing on engaging the abdominal muscles themselves and not the hip flexors, you are performing a safer more effective exercise.

Much of core stability is similar in this “crunches not sit-ups” concept. It’s not the super hard, deep burning, killer ab routines that are required (or even recommended) for basic core stability. It’s the more specific targeted moves for stabilizer muscles that do the trick.

I have much more to say on this basic but important concept. So look for future blogs on the subject and feel free to ask any questions.

Take care,
Dr. JET