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What is your core?

You do what you can save your back. You exercise, eat well, sit with good posture. But inevitably you get that twinge, that tightness, that uncomfortable feeling in your back. It can be mild, or it can be severe. But eventually, almost everyone will deal with low back pain in their lives. It’s estimated that approximately 80% of people will deal with low back pain at some point. Worldwide, it is the leading cause of disability. It is also an extremely costly condition. It is the number one cause of missing work. In the United States alone, that accounts for two full days of missed work for every full-time worker due to back pain and cost Americans $50 billion dollars in healthcare cost. If you add in the lost wages, that number skyrockets to $100 billion a year. 


These numbers may be scary, but don’t panic. There are a lot of things that can be done on your own to decrease your chances of dealing with low back pain, decreasing the severity of low back pain you deal with and generally make you a stronger more resilient individual. 


It starts with the core. Our core is what gives us the great stability and mobility needed to accomplish what we do, day in or day out. Our core is not just the abs we see on fitness models in magazines and on Instagram. Our core is composed of our diaphragm, pelvic floor and all the muscles in between. When these muscles and structures work well, we are strong and stable. Our lumbar spine can do what it needs. It even works to stabilize every other part of our body to allow it to work better. Let’s try a little experiment. Place one hand on your stomach. Apply a little pressure. Now raise your other arm out in front of your body as much as you feel comfortable doing. A big theme I preach with all my patients is that it is never no pain no gain. Rehab and exercises can be uncomfortable. What you should feel, is your abs starting to engage, if you don’t, then we have some work to do because proximal stability, leads to distal mobility. Meaning if you have a functioning core, everything you try to do gets easier. 


To get our core working right, one of the first things we must address is our breathing. Breathing is one of the first things we learn to do correctly, but one of the first things we forget how to do. Our diaphragm should be the main muscle of respiration. If it is working the way it should, we shouldn’t see our chest move too much when breathing, really not much at all unless we are doing intense exercise. To train this pattern right is simple. It can be done laying in bed, ground, where ever you have space. To do this, lay flat on your back, bend your knees slightly and place one hand on your chest, and one on your stomach. As you breathe in, your hands should move. Focus on keeping the hand on your chest still. The hand on your stomach should be moving up and down. It’s that simple. This exercise engages the diaphragm and core, getting them to work together as they should. 

This is something that can be easily done when you wake up before you go to bed or at any time throughout the day. As you get better at it, try it sitting or standing. You can even do it with no hands.


To get the rest of your core to wake up, I love Dr. Stuart McGill’s big 3 exercises. All of these targets some aspect of your core to get it to properly engage without much effort. All of these can be modified to make easier as well.


The first is the curl up. We all know what a sit-up or a crunch is, but this version will engage your core without stressing your low back. Laying flat on your back, have one leg straight, and bent. You can either place your hands under the small of your back or on your stomach. While breathing, raise your head, upper back and shoulders off the ground a few inches. This is not a full sit up. Hover here for 3-5 seconds then slowly return to the ground. Repeat several times then switch legs. When doing this, make sure your neck remains straight to prevent strain there. 


The second exercise is the plank. Laying on your side, place your elbow (same side you’re laying on ), on the ground directly below you. Bend your legs to about 90 degrees. Place the up hand on your hip. Raise yourself off the ground, maintaining a straight posture and hold for as long as you feel comfortable then return to the ground. When doing this, make sure you breathe. Switch sides and repeat. 


The last exercise is the bird dog. Get on all fours on the ground. Maintain a flat back, and extend your right arm in front of you and left leg behind you keeping them in line with your torso. Slowly return to the ground and switch sides to repeat. To further increase the activation of your core, clench your fist when you extend your arm. This exercise is one of my favorites because it is infinitely modifiable. Is it too easy? Well, try extending the arm and leg on the same side together. Or place a baseball or softball in the small of your low back and keep it there. Too hard, try one arm by itself, then move to a leg by itself.



As I've said before and will do many times again, when doing this, you should be pain-free. Don’t push through the pain and stop if you feel any pain. While these four exercises are great for your low back, sometimes more is needed, and that’s ok. Please let us know if you would like additional help. 


Dr. Maurice Pearl





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