by
Shawni DeSalvo, ATC
Most people today are likely to experience low back pain (LBP) at some time in their life. Traditionally health professionals focus on the individual structures rather than core strength and imbalances in the lumbo-pelvic region. Most often LBP starts as a result of weak core muscles, particularly the transverses abdominus (TVA). For years there have been studies done focusing on the importance of the TVA and functional activity, however, not until the last 1-2 years has the mass media picked up on this new phenomenon.

Core Stability is something that everyone can benefit from and it is not difficult to incorporate into a daily routine. Awareness of posture throughout the day is a crucial part of preventing LBP. The simple task of sitting up straight and drawing your belly button toward the spine while in a seated or standing position is the first step to working on core stability. We are a society spends a great deal of time sitting behind desks, in front of computers or driving, becoming completely engrossed in our work causing us to neglect our posture and our bodies pay for it. The transverse abdominus muscle is one of the most important muscles involved in core stability but is a muscle that is significantly under used by most. The TVA wraps horizontally around the abdomen and attaches to the thoraco-lumbar fascia. When this muscle is properly activated it helps to support and prevent compression of the spine. By supporting the spine the TVA takes some of the load off smaller spinal muscle that are not meant to be primary stabilizers.

Once the patient has learned how to activate the TVA and maintain control in single- planar activities the next step is to incorporate functional exercise. Functional exercise includes multi-planar movement requiring acceleration, deceleration, and dynamic stability. To reduce LBP it is crucial to do exercises that have carry over to daily living. This means learning how to control posture using core stability under a load or doing exercises that simulate daily activities. It is not difficult to learn core stability in a single- planar movement however, maintaining that under dynamic movement is much more difficult. Functional exercise is about progression from stable to unstable exercise. This progression should not be made until there is complete control of the postural and core stability in a single-planar movement. In order to develop the proper motor pathways and increased neuromuscular efficiency each exercise needs to be performed with good form. If exercises are learned incorrectly and faulty motor pathways are developed it takes about 5000 repetitions done correct to retrain that pathway. While forward progression is important it is also important to make sure exercise is performed at an appropriate level.

The final step to reducing LBP is to continue exercising, working on postural control, and core stability after the pain is gone. Exercise needs to be a way of life not just a quick fix for a problem. By continuing with an exercise routine that incorporates core stability an increase in balance, strength, speed, and dynamic posture control will result. This helps to resolve LBP and will decrease chances of further injury.