The “Core” of Low Back Pain

Low back pain is routinely listed as the largest cause of chronic pain in the US, responsible for more occupational disability than any other cause.

This problem has deep roots in modern western lifestyles. However, we’re not going to address – and certainly not fix – the insults to our body wrought by chairs, desks, computer mice and keyboards, automobiles, couches, etc. There is another post for that!

Many people have been through an episode of LBP that was severe enough to be referred for therapy. The craze over “strengthen your core” is largely a response to the low back problems associated with 21st century lifestyles. There is broad agreement about this.

The more important questions now are:

  • What are truly “core” muscles?
  • How are they related to my pain?
  • How do I activate, strengthen and or stretch them?

For our purposes, “core” muscles are a loosely defined group of muscles that are very deep within your musculature, generally more concerned with stabilizing your body rather than moving it, and often operating with significant unconscious engagement. Note that we are lumping together the connective and nervous system tissue related to these muscles (neuromyofascia) and simply using the common, but incorrect term “muscle”. Examples of true “core” muscles would include:

  • Diaphragm (the primary muscle of respiration)
  • Transversus abdominis (or ‘TA’; the abdominal muscle used to brace/bear down)
  • Quadratus Lumborum (or ‘QL’; lateral flexion and stabilizing the connection between hips, spine and ribs)
  • Iliopsoas (the deep hip flexors)
  • Multifidi (deep muscles responsible for segmental control of the spine)
  • Longus Colli/Capitis (the deep cervical flexors)

Note that we did not include the most popular muscles listed as “core” by Wikipedia and others:

  • Rectus Abdominis – (the “six pack” muscle)
  • Spinal Erectors
  • Latissimus Dorsi
  • Trapezius

Let’s think about why these muscles did not make the cut. Looking at this illustration of the abdominal muscles we can see that the true “core” ab muscles is the TA. This is your “internal weight belt”. The muscles addressed by conventional ab work might give you a flat stomach but won’t support your lower back.

The illustration below has more detail than we would like, but it does illustrate well how deep and how interconnected the diaphragm, TA, iliopsoas and (QL) are. They are the essence of core musculature. It also shows us why core strength and stability begins with the breath and the deep abdominal muscles.

posterior abdominal wall 400x400

A healthy TA is really important for low back health. This muscle is intimately connected with the diaphragm, the QL and the iliacus (the ‘ilio’ in iliopsoas). It forms a crucial bridge between breathing and movement.

The iliopsoas is considered the primary flexor of the hip. However current anatomical research shows that along the QL, it also has a major role stabilizing the relationship of the trunk to the lower body as we move. It seems obvious just looking at the picture that these muscles are clearly helping to hold the trunk and lower body together.

Our spines suffer because the muscles and connective tissue at this critical junction are no longer working together effectively.

Another important group of core muscles that is rarely addressed by trainers and therapists are the multifidi and rotatores, pictured below:

multifidi croppedThe muscles on the left are the more superficial spinal erector muscles. On the right they have been cut away to reveal  the multifidi and rotatores – tiny muscles that run from one vertabra to another, allowing us precisely control the spine well – think of belly dancing…

Note that to even show the spinal erectors, we needed to remove the very superficial trapezius, latissimus dorsi, rhomboid and serratus muscles.

multifidi detail small

These tiny muscles, most less than an inch long, are the deepest spinal muscles. People that are otherwise very fit often have well developed spinal erectors but little or no development or activation of these smaller muscles.

Localized LBP is often directly related to tight bands and spasm of just a small number of multifidi.

They are also located very close the the nerve roots exiting the spine and can easily be irritated by leakage of small amounts of propulsus (the interior contents of a spinal disc) into the area.

So, we’ve clarified what core muscles are and some of the ways they relate to low back pain. What can we do about it?

  • Situps and other abdominal exercises will NOT help and may actually cause back pain.
  • Proper training of the deep abdominal muscles begins with diaphragmatic breathing and abdominal bracing.
  • The intention of training of these and other core muscles is to provide stability as we move.
  • Re-training these muscles includes movement therapy that recreates the developmental process we experienced as infants.
  • For more information on specific exercises for a healthy low back, check out our article on Reducing Low Back by Restoring Muscle Balance.

Improving Dynamic Movement Stabilization improves function and relieves pain. It is a simple method and it works. We continue to use and improve this approach for treating lower back pain with great success. Everyone is different and many of us have additional challenges and complications, We tailor our treatment plans to the individual, but there are common foundations to this work with everyone.

Email us at Help@WestSubPainRelief.com or call us at 630 858-0000 to learn more about how you can reduce pain, increase flexibility and gain strength from simple self-care activities.

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2019-01-13T10:50:55-06:00
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