One of the most misunderstood parts of the body is the function of the core, especially when it relates to back pain. There are many people who believe that the key to good function of the core and spinal health has everything to do with spinal flexibility and the ability to flex and extend the spine through full range of motion. The more supple the spine the stronger your muscles and the healthier you will be is the philosophy behind these type of methods. While it is good to have an adequate amount of spinal mobility, big problems often occur when it is repeatedly flexed and if it is not controlled. It is not more spinal mobility that people need when they have back pain, it is the exact opposite being stability or “good stiffness” that is required to prevent buckling and compression of the spine. In order for this to happen the muscles of the core must be trained to resist or prevent motion of the spine instead of creating it. This often leads to the second mistake, where people try to train the muscles of the torso to become stronger believing a stronger torso will protect them for this is exactly what I just referred to. Unfortunately, the strength of these muscles are dependent on the function of muscles above and below them and are very easily sacrificed or negated if there is a dysfunction. For example, if you do have not adequate hip mobility or a good understanding of functional movement patterns like bending it will not matter how strong your core is in isolation. In this article, I will explain in more detail why stiffness of the spine is more important than mobility, and how strength of the core and erector spinae must be obtained through functional movement as opposed to machines.

Recently, I met with a professional athlete looking for help in recovering from severe back pain and nerve pain from a bulging disc injury to L5/S1 segment. As he was a high profile athlete his club wanted the Physios to attend the assessment with him to see if what I was going to do was okay with their direction and current treatment. During my assessment I found out two key things that they were using that were unlikely to help him safely return to the level he needed.

Unfortunately, I did a very poor job of explaining this to them and I think they left the session feeling like I attacked their methods and that I was reckless in my approach and I doubt they would be returning to see me any time soon. Anyway, I thought this would be a good opportunity to explain what I should have said to them by writing this article. In all fairness to them the things they were doing were exactly the same as I what I was doing 15 years ago before I knew better. Their intentions were right just their reasoning was a bit off.

The first thing I found out was that were trying to encourage spinal mobility and this athlete was being taught imprint and using several Pilates exercises to strengthen the core. Sounds good at first doesn’t it? Every movement he did moved his spine into flexion which is more or less moving right into the pain and further exacerbating his problem and weaknesses in his body.

When I asked him to perform the action of bending over otherwise known as the Romanian Deadlift, which by the way was the main trigger of his pain, he was unable to do this effectively at all. I coached him through it and spent considerable time showing him how to remain in good form but the minute he attempted to bend over he would always try to use his spine. He had no understanding of how to use his hips to save his spine.

The physios questioned why I was doing this as they deemed it risky and I explained he needs to be taught how to keep his spine still, not mobile. Until he learned how to control this action he would always be at risk of injuring his back again. The sooner he learns this the better for he needed to learn how to do this movement for it is not a gym exercise but the action of bending over.

It is easy to get caught up in prescribing exercises and thinking of all the corrective strategies and forget to really drill home to the client that they must change how they move in life.

Many times we go through intense assessments, provide home exercises, stretches, stability drills for the client to do and after a few weeks the person has not changed much with their pain. Why?
In 99% of these cases the trigger that is causing their pain is still at play and has not been identified and corrected. All the rehabilitation exercises will be negated if the person continues to move with poor postures, motions and methods they had before.

Dr McGill refers to this as "picking the scab". Imagine cutting your hand with a knife and instead of letting the scab heal the cut you keep pulling the scab off everyday. Over time that small cut that would have healed in a few days will become infected and turn into a chronic problem. This is the exact same thing that happens when you continually move poorly forcing compression into the discs of the lower back. A great analogy to use to explain why so many people never respond well to their treatment, even when the treatment or exercise program is exactly the right thing. For the minute they get home or go to work they move exactly the same way that created the injury in the first place. You can read more about this in the article – Big lessons about back pain I learned from Dr McGill

In addition to this problem I found out he was using several isolated machine based strength exercises to strengthen his back.

These therapists belonged to the physiotherapy programs called Keiser that try to target specific muscles in isolation using specialized machines for spinal extension, flexion, and rotation. While these exercises may in fact create strength into specific muscles of the abdominals and the lower back this will all be pointless if the person does not know how to move correctly or does not have adequate mobility and strength with the hips.

All of the strength generated with the spinal erectors or the abdominal muscles will be instantly sacrificed the minute the person bends with poor form as seen below.

The big question is why does this person bend like this?

• Is it because they lack hip mobility?
• Is it because they lack gluteal strength?
• Maybe it is none of those things and they simply not know how to bend correctly? 

It could be any of the things above or all of them. What is not a factor is the strength of the abdominals or the mobility of the spine. If the load being lifted was extremely heavy then yes the abdominal strength will be a factor but most people hurt their backs bending over to tie their shoelaces or picking up a pencil off the floor. 

What you will find is that dysfunction at the hips with either stiffness or weakness is a huge part of the problem and along with poor coordination you will never find a lasting solution to your back problem until it is addressed.

The Core Muscles Are Designed Differently So They Must Be Trained Differently

One of the biggest misconceptions people have when it comes to strengthening their core is that they attempt to train this part of the body in the same way they would strengthen their bicep muscles to make their arm stronger. The muscles of the core are not designed the same way as a bicep muscle, so they should not be trained the same way.

I feel like I have spoken about this topic so many times in previous articles (click here to see index page) and I expect that everyone would know this by now, yet I come across different methods and philosophies all the time that tend to ignore this basic principle.

What people fail to understand is that your abs are unable to move you, other than making you wiggle or flop around like a fish out of water. You need your arms and legs to move you for your abdominal muscles are not capable of doing much. Basically the abdominal muscles have very little influence over how you move, for this is not their true purpose. This is very important to understand and will explain why I believe many core exercises are incorrectly implemented.

The CORE is really a combination of both small stabilizing muscles known as the Inner Unit, combined with large prime mover muscles that operate like a series of complex chains and systems to provide stiffness on a greater scale. This known as the Outer Unit.

True core strength requires the use of both.

The inner unit is incorporated in almost every movement of the human body. These muscles can act as an isometric or dynamic stabilizer for movement, transfer force from one extremity to another, or initiate movement itself. The role of the inner unit is to stabilize the spine. That’s it.

For example, consider the need for abdominal tension during a throwing action or a golf swing, but when you start breaking down what is involved you’ll see just how complex the “core” really is. As you throw the ball, everything that prevents you from twisting or turning can be considered a core muscle.

The lower leg needs to be braced and strong to prevent the foot rolling in, which will cause the knee to cave in upstream. Likewise the hips need to be strong to prevent the exact same thing. The muscles that surround the spine – from the small stabilizers right up to the powerful back muscles such as the lats - all act to stiffen and stabilize the spine during such actions. There is definitely abdominal involvement but it is not powerful enough to move, as it requires the legs to the bulk of the workload. In summary the core can then be thought of as all the muscles below your head.

The stabilizers are mainly concerned with providing joint stiffness and segmental stability.

Their work is what you would classify as low level activity needed for long periods of time. They are also known as "feed-forward" muscles in that they react quicker than any other muscle group, to prepare the body for movement.

The only way they can work effectively and influence the integrity of movement is to fire first.

The ability of the inner unit muscles to contract prior to force production of the larger prime mover muscles (geared toward movement) is more important than their strength. Research shows that in people with no history of low back pain, the TVA fires 30 milliseconds before arm movements and 110 milliseconds before leg movements.

This is much different to the bicep muscle in your arm and why the muscles of the core are more concerned with endurance than power and strength. The bicep muscles are not required to react as feed forward muscles either.

The key here is the core cannot provide movement and is not designed to. They need the outer unit muscles to do this. To maximise their efficiency the muscles of the core need to work with the outer unit during movements that develop their ability to resist movement and last a long time.

You can read more about the core and the interaction between the inner and outer unit in the articles below

• Are core workouts over-rated?
• To strengthen the obliques you must understand their purpose

Now that you understand a bit more about the core let me talk a bit more about the 2 big mistakes I see made with core training.

The Lumbar Spine Needs Stiffness Not Flexibility

Every single limb movement we make requires the core to be held stiff so that your body is stable enough to produce or resist force. If the spine buckles or relaxes it not only compromises the efficiency of the movement, it also exposes the spine to compression and shearing forces.

Imagine trying to walk if your spine was flexing or extending with every step you took. You would not be able to walk very effectively at all. A good example of this is seen with a Trendelenburg gait that creates a lateral rocking motion of the body to walk due to weakness and stiffness at the hips preventing adequate hip extension. This type of motion is very painful to the back and an example of where the core and spine is sacrificed to create movement.

The more force that is needed to be created the more stiffness the core will require. If you fail to do this injury and pain is not far away. The movement that often creates the most pain is bending over and this action is best performed using the hips to save the spine from flexion. The ball and socket design of the hip joint allows for multi-directional movement and full range of motion and is supported by the most powerful muscles in the body to provide the strength and control it needs.

However, if you learn to use your spine to create the motion instead of your hips you lose all of this strength and control and force compression into the discs. Eventually the disc fibres crack and the inner gel like nucleus seeps out through the outer wall resulting in the disc bulge.

This is easily seen with Pilates that emphasize exercises like pelvic curls, roll-downs, and roll-backs.  One of the key principles taught in all Pilates classes is to “imprint”, flatten your back out by rolling your pelvis into posterior tilt. This very method is not good for anyone with back pain especially a bulging disc for this type of posture is the very reason that discs are herniated in the first place. This is exactly what the physios were doing with the sporting athlete.

Their philosophy on using imprint is based on the research around the TVA which is a very important abdominal muscle for creating stabilisation of the lumbar spine and pelvis. They find it is activated more effectively by drawing the belly button in towards the spine in combination with a posterior tilt of the pelvis.

However there is no need to move the spine into a flat back position to recruit the TVA. This can and should be always be done in a neutral position and is more effectively used as bracing instead of hollowing as found in research by Dr McGill.

Watch the videos below to see how to do this.

Now all of this is not to say there is not a place for Pilates and that it is complete rubbish for there are certain people this method will work with quite well with and there are thousands of people who will claim that they feel much better by doing this. There are also many Pilates instructors who have a great understanding of these problems and have spent time like myself learning from people like Dr McGill to fully understand different methods. I have many friends who are Pilates instructors who do exactly this.

I have found that females are much more likely to be okay with Pilates as they have much more flexibility than males to begin with and they typically have a greater degree of anterior pelvic tilt. Those who are hypermobile or simply have a high degree of hip mobility will find Pilates style training is perfect for them and not suffer with problems using imprint or the roll-downs.

My theory on this is that their body will naturally default to a position of a slightly excessive anterior tilt that counters the effect of roll downs and imprint. It is no secret that many people who originally completed Pilates in the early days were dancers and ballet dancers who had excessive curvature of the spine and also their sport or activity required a supple back.

Many dancers will have an excessive anterior pelvic tilt that can lead to SIJ back pain and the flattening of the spine feels quite relieving to them. This is where they feel it is protecting their back from damage and to some extent it may be as it counters the excessive extension often used in their dancing.

Unfortunately, this type of training rarely works for males who do not possess the type of mobility that females have and also the type of training, sports, or occupations require their body to be stiff, not supple like a dancer. I also find there are a much larger proportion of males who have a posterior tilt already and this is where you could be using a method that is only going to create more problems at the spine using exercises like this. This is where you could be using a method that is only going to create more problems at the spine, for they forget the golden rule of spinal health which is to keep the spine in the safest place of all.

That position is neutral.

You can read more about this in the article – How to brace your core

The Safest Position for the Spine is in Neutral

Neutral is the healthiest position for the spine to function and where it is in its least stressed position from compressive forces and allows for fluid, efficient movement.

In Dr Stuart McGill’s book “Low Back Disorders” they tested several positions of the spine to determine if this was true and his conclusion was neutral was the safest position. The worst position was extreme flexion.

This neutral position is what you should be aiming to achieve with most daily movements to build a strong and healthy spine. This is even more important when we exercise or complete an activity that forces load onto our spine as the compressive forces on the discs and joints is amplified. Your posture and movement strategies determine the load and stress on your joints. The closer you are to a neutral posture, the less stress on your joints and the healthier your body will be.

In addition to compression is shearing forces, which is more accurately described as instability. This is when joints move excessively and begin to create friction and rub against cartilage and other soft tissue causing pain and inflammation. This leads to joint stiffness in an attempt to protect the joint from further damage.

Once again finding a way to hold the joints in neutral is the solution for this.

This was confirmed by researchers Cholewicki and Panjabi found that limitations in spinal stability led to muscular compensations, fatigue, and pain. They also found that spinal instabilities resulted in degenerative changes due to muscle-activation strategies that are easily disrupted due to the compensation.

Reference: Cholewicki J, Panjabi MM. A stabilizing function of trunk flexor-extensor muscles around a neutral spine posture.

This is contrary to many popular beliefs that the spine needs to be more flexible and will benefit from Yoga, Pilates, and stretching. The thoracic spine will benefit greatly from mobilizing and stretching for mobility is its main purpose, however, the lumbar spine will suffer greatly if you apply this type of thinking for its main purpose is the exact opposite.

To provide stability. It is also important to understand that it is stability and “good stiffness” that you are looking for with the lumbar spine and not strength.

A classic example of a popular exercise used in Pilates for spinal health is the “roll-up”. Here is Dr Stuart McGill’s thoughts on this exercise.

“This movement is essentially a sit-up that involves segmentally rolling through each joint of the spine. Our science has justified avoiding sit-ups as part of routine for a healthy spine and the roll-up takes a bad exercise and makes it worse. The exaggerated fashion puts and emphasis on moving through the spine, putting unnecessary load and strain on the discs. The real goal should be to minimize spinal movement and instead use our hips as primary centres for motion. This philosophy will allow the back pain to settle.”

Now that we have covered mobility it is important to discuss the other mistake which is strengthening.

The Spine Needs Functional Strength, Not Isolated Strength

Whenever we perform an isolated exercise we are employing a muscle action that is against the function of the nervous system and a pattern that we would never use. When it comes to the core, where all the muscles are meant to work together to provide stability of the pelvis and spine when we move, isolated exercises disrupt the timing of this natural mechanism.

Why do people try to do this?

Our attention is drawn to “fix” the area in pain or find an exercise to strengthen the muscles that are weak and for most people this is very easy to comprehend and apply exercise strategies to improve this. What is more difficult to understand is the role of several other muscles working further from the moving limb/s and how opposing muscles can work in contraction at the same time.

For example, the muscle interaction during the act of walking every muscle from the trunk down has one function the minute your foot hits the ground. All the muscles of the lower limb (glutes, quads, hamstrings etc) act together to stop the ankle, knee, and hip from bending to prevent you falling to the ground. All the muscles have the same function which is to apply the brakes and slow you down.

Machine training is even worse than body-weight or free weight exercises. For while it is very effective at building strength into the primary muscles by isolating the muscle and then overloading it to grow and get stronger. This all comes at the price of the ignored, but also under-utilized antagonist and stabilizer muscles that are not stimulated enough to do the same.

The end result is muscle imbalance, restricted range of motion, poor stabilizer strength and endurance, connective tissue that is not prepared to support the new muscle size and strength, and ultimately, a ticking time bomb for injury.

A classic example is with the leg press machine, where someone can start lifting incredible loads on the first day, yet be barely able to complete an effective squat with their own body-weight. The squat is superior to the leg press for it demands stability and coordination in order for you to move.

The leg press will not address the instability of the joints that does not allow you to squat with good form or strength. As a result your body will continue to move during the day with the same compensatory movement that is causing your problem. The strength gained from the leg press is negated and completely useless to you.

To change the faulty mechanics you have to identify the movement pattern and change that motor program. It is possible for the body to have perfectly good function with muscles in one pattern and not in another.

For example, the core and the muscles of the hip may perform perfectly in the squat but very poorly in a bending action or the single leg stance. This is an example of where the strength of the muscles is of little importance, for the problem is to do with the specific movement pattern of bending and single leg stance.

Weakness in a muscle could be the result of many things such as;

• Muscle inhibition
• Poor coordination and stability
• Protective mechanism

Trying to apply an isolation strengthening method will neglect the underlying problem and leave it to fester and become an even greater problem.

Great articles to read with more detail on this are shown below

• Why you can never blame a single muscle for a movement problem
• Why the body chooses stiffness over stability

Coming back to our original problem with back pain there are three important factors that must happen in if you want to achieve optimal stability of the spine.

These are:

1. The muscle/s ability to fire fast enough to provide stability, prior to the body moving.
2. Co-contraction of the abdominals and extensors.
3. The muscle/s ability to maintain strength for long periods.

What this tells you is that you do not need to expose the abdominal muscles with massive loads, or use isolated exercises that force these muscles alone to work for long periods. This indicates that it is more useful to engage the abdominals in many functional positions that will force ALL of the muscles to work together as a collective team to provide stability of the pelvis and spine. The easiest way to do this is to spend time with functional movements.

Below are some pictures of the machine exercises the physios were using with the sporting athlete and all of these ignore the 3 principles I listed above.

These isolated exercises DO NOT require the core to fire first to provide stability to the spine, for the machine does that for you. They also DO NOT require co-contraction of the abdominal muscles and extensors for the machine moves in only one direction.

Any strength obtained by this type of training is pointless, if you are unable to move effectively with functional movement patterns like bending for the body will have no choice but to sacrifice its strength in order to complete the full range of motion with the movement. It may not even have the strength in other muscles that should complete the movement such as the glutes and use compensate by using the spine to assist. This is the classic example of how a disc bulge will occur.

Does this mean all types of isolated strength training is useless? Absolutely not.

There is definitely a place for this in the beginning of learning to control joints and gain a better understanding of the skills you will need for more functional patterns. I use isolated exercises like lower abdominal leg lifts for the core and hip extensions for the glutes all the time. However, I recognize that there must be a progression to a more integrated version of stability training for any of this to make a difference.  Strength is important but how much strength do you really need?

Not as much as you might think.

In McGill’s research they found that only a modest amount of strength was required to maintain sufficient stability of the lumbar spine. Their research established that to maintain a safe amount of stability in most daily tasks it was more important to have great muscle endurance, more than peak individual strength. Having strong abdominal muscles did not seem to provide the stability effect they were looking for, yet muscular endurance did.

Reference: (Biering-Sorensen, O’sullivan, Twomey, and Allison 1997)

McGill found the amount of strength required was on average about 10% of maximal voluntary contraction depending on the task.

What needs to be implemented is a program that focuses on improving functional movement skills that demand complete activation of ALL the core muscles.

You can read more about this in the article – How much strength does your core really need?

Now that you know the core needs stiffness and that machines are not the best way to achieve this where do you start? Well it is impossible for me to give you an exact recipe to follow as each person is different so you need to complete a detailed assessment that identifies weaknesses and mobility restrictions.

To avoid this article taking up another 10,000 words I will break this down briefly into the main parts that I look for.

1. Improve hip mobility and thoracic mobility
2. Improve gluteal strength
3. Learn how to bend correctly
4. Learn how to brace correctly
5. Improve functional strength
6. Improve overall posture

You will find the article below takes you through this process perfectly and provides videos and exercise examples for each stage.

Bulging disc exercises and effective long term treatment strategies

I appreciate that many of the concepts I discuss in this article fly in the face of most people’s thinking and only from years of mistakes and constant dedication to learning did I find out these answers that baffled me and many others for a long time. I was never taught the things about health and fitness that I know today for the courses back then were very skewed towards body-building and losing weight and ignorant to functional movement. It is fair to say the courses that are provided today for new trainers and health practitioners have come a long way such as the ACE certification practice questions by Trainer Academy.

Do You Need More Help?

Before jumping straight into a corrective program make sure you have seen a qualified Health professional for an accurate diagnosis and assessment of your condition. I cannot stress this enough as self-diagnosing can potentially lead to more problems. We often refer out to Doctors, Chiropractors, and Physiotherapists before implementing our program to know exactly what we are dealing with. Being certain on where to start is crucial to the success of the program.

If you have seen a health professional and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program called Back Pain Secrets that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process!

Click here or on the image below to get a copy.

Summary

Once again I apologize for the length of this article as I wanted to ensure I explained all of the basic concepts in detail so you can understand what took me years to fully appreciate. While trying to rehabilitate your back problem in this fashion is much slower and time consuming, over the long term I have found it to be much more effective at maintaining good movement than the isolated muscle approach.

The main thing to remember is that the lumbar spine needs stability or good stiffness and not excessive mobility. The mobility should mainly come from the hips and thoracic spine. Secondly, the strength of the core is not of great importance but its ability to resist movement and react with fast timing to maintain a good posture and alignment. Strength of the core cannot be effectively achieved by sitting on machines and even when it is the body will sacrifice this strength if poor movement is continually used.

Using exercises that develop these skills are essential to the person with back pain getting on top of their injury for good.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 19 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• The Gift Of Injury - By Dr Stuart McGill and Brian Carroll
• 8 Steps To Pain Free Back - By Esther Gokhale
• The Vital Glutes - By John Gibbons
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek