Back pain is one of the most common complaints we come across at Balance in Motion Physiotherapy in Bondi.
This might not be a surprise to you but what might surprise you is how often we hear patients say “I’ve been doing core exercises but my back pain is the same”; sometimes we are told that core exercises make back pain worse!
Why do core exercises not always work? And why do they sometimes make pain worse?
Your abdominal, lower back, and trunk regions have many different muscles – some deep, some more superficial (closer to the surface). The core muscles are the deep muscles and include your pelvic floor (the bottom), the transverse abdominus (the front and sides), the deep multifidus (the back), and the diaphragm (the top). Together these muscles work as a unit to provide your body with the appropriate support it needs when you do Yoga, ride your bike, go for a run, and all your daily movements.
At Balance in Motion the most common cause of lower back pain we come across is a mismatch between how much the deep muscles (your core) and the superficial beach muscles of your body are working – lower back pain is often accompanied by over-activity of the superficial muscles (such as your ripped six pack) and underactivity of the deep muscles.
This is the reason why core exercises often don’t help with back pain and can sometimes make it worse. Peoples eyes roll into the back of their head when I say “Your shallow core is too tight” or “Your 6 pack is causing your back pain”. Without proper activation and coordination of the deep muscle system your body will revert to using the superficial muscle system creating poor movement patterns that result in pain.
When we ask patients who come to us with lower back pain how they turn on their core, we’re often told they’ve been told to “squeeze their abs”, “lift your pelvic floor”, or “flatten their stomach” before doing specific exercises. Almost each time we assess the deep core muscles we see the mismatch between the deep and superficial muscles – these cues are using the superficial muscles too much.
So what is the best way to get your core firing and decrease your back pain?
We have a Real Time Ultrasound machine so people can literally see what their muscles are doing when they tense their core. We find it is a far quicker way to teach people how to use their core properly. You can identify exactly how to isolate your core muscles before training them to be strong and coordinated during movement and exercises. This often starts with a simple cue that turns on the deep core muscles without using the superficial ones and some very easy movements you can control in order to make sure the deep muscles are the ones that are doing the work.
If you’re struggling with lower back pain and have been working hard on your core with no results (or even if you haven’t been working hard on your core and you’ve got a bad back), come and visit us and we’ll find the right solution for your back pain AND get your core working well! 02 93650004