Core strength and it’s relationship to back pain is probably one of the most common things that I have to discuss with patients in the clinic each week.
There is a long-standing belief that having a weak core can be an underlying cause of back pain and that regular strengthening of the core will help to keep your pain at bay for the long term.
In this blog post, I’ll discuss where this idea came from, what the research says about it and what approach I use with my patients here at Diss Chiropractic Clinic.
Where does the idea of ‘core strengthening’ come from?
In 1996, a study by Hodges et al found that the delayed activation of the core muscles resulted in a reduction in the stability of the spine.
Since this study was published, this conclusion has been repeatedly misinterpreted.
If you read that first sentence again, you’ll notice that at no point did the researchers find a relationship between a weak core and pain. They simply found that the spine is less stable when the core muscles are slow to contract.
In my opinion, there is a distinct difference between stating that muscles which are slow to contract cause instability of the spine and that it causes spinal pain.
Unfortunately, the misinterpretation of this study seems to have given rise to one of the biggest myths in the world of back pain.
What does the research on managing back pain say?
As I will discuss in greater depth below, the research tells us that core strengthening exercises seem to be superior to general exercise for reducing back pain in the SHORT TERM, but that all exercise is great for managing back pain in the LONG TERM.
Marshall et al (2013) conducted a study, where they gave two groups of people with back pain some core exercises and stationary cycling exercises respectively. They found that at eight weeks, the people undertaking core exercises had a greater reduction in back pain.
However, after six months they found that both groups had experienced an equal reduction in pain.
There could be multiple reasons for the difference in outcome at eight weeks, such as;
- patients deem exercising the back to be more appropriate for their condition, so they experience greater pain reduction from it
- or exercising the painful part of the body is more effective at reducing pain in that area than exercising the body generally
Either way, we can’t deny that core exercises help in the short term.
But, if a weak core was a cause as to why people got back pain, then their results should be superior to the stationary cycling group in both the short term and the long term.
This is because, if the cycling group had not strengthened their weak core muscles, then they should still be in more pain than the core exercising group at the six-month follow-up.
The study that I have mentioned above isn’t actually the only study that found these same results…
Smith et al 2014
Macedo et al 2016
Saragiotto et al 2016
Wang et al 2012
These studies all found exactly the same results!
Does the type of core exercises that you do matter?
Coulombe et al 2017 conducted a study to check this…
They tried four different types of core strengthening exercises for people with low back pain.
They found that all four types helped to reduce back pain.
So, aside from making sure that the exercise choice is appropriate for a patient, it doesn’t seem that any specific form of core strengthening exercise is better than another.
In the second part of this article, we’ll delve into whether the type of core exercises you do matters, examine if strengthening your back is necessary for pain relief, and discuss other contributing factors to back pain. We’ll also outline practical steps to manage and reduce back pain effectively.
Stay tuned and take the first step towards a pain-free life with the insights we provide!
