Core Strengthening Exercises to Ease Back Pain

You have probably had back pain at some point in your life. From a minor niggle to a full-blown back attack, the intensity can vary. Sometimes you can tell exactly why it comes on, because you pulled a muscle, sustained an injury, or just didn't sit/stand/bend right. At other times, it develops over time; it comes and goes for a bit or just lingers and you just cant seem to put a finger to why its happening. However, a fairly new culprit is modern life. While it has had its fair share of blessings, it has also resulted in a plague of back problems in the past years, thanks to endless hours of sitting, barely any time for exercise, and way too much stress. Lets delve into some of the common causes that put an undue burden on our backs:

1. Improper posture While there is no right definition attributed to a normal posture, varying with capacity and age of an individual, there is a possibility you might have it wrong. Telling signs include frequent back/neck/shoulder pains which means it might be worthwhile to see a doctor who can rule out postural problems.
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2. Lack of muscle strength - Muscle strength and flexibility have a lot to do with keeping the spine in a neutral position and saving you from unrelenting amounts of pain. So, when your muscles weaken, either because of improper posture, lack of adequate nutrition, not getting enough exercise, or due to an injury, it can cause pain.
3. Injury to the spinal musculo-skeletal architecture - This could be due to trauma or other constitutional conditions such as neuropathy, myopathies etc.
4. Other systemic conditions like Tuberculosis, calcium deficiency, ankylosing spondylitis, and spinal infections, among others can also generate pain.
   
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Now while some of these triggers might need treatment, others can be prevented or cleared up with a little care and exercise. So lets take a closer look at point numbers two and three.

To gain insight into the spinal musculature, it is pertinent to observe that the muscles are classified into two main groups: -

1. Global muscles like rectus abdominis, erector spinae, intercoastal group of muscles are primarily concerned with mobility
2. Core muscles like transversus abdominis, multifidus and pelvic floor muscles perform the job of providing stability to spine.
3. Transversus abdominis: Often referred to as the corset muscle, this deep-seated muscle in the abdomen is an intrinsic core stabilizer. It contracts in anticipation to movement to safeguard the joints, muscle and disc. It is critical to prevent degeneration of your lower back/pelvis.
4. Multifidus: These are short, powerful muscles that provide support to the spine. They run from one vertebra to another producing fine-tuning movements which give us postural awareness. They are recruited while we perform actions such as bending sideways/backward or turning our body to the sides.
5. Pelvic floor muscles: For a brief overview of what pelvic muscles look like, imagine a mini-trampoline tied between the tail bone and pubic symphysis and joined side to side between the two ischial bones. The primary function of pelvic floor muscle is to provide stability to the pelvic organs and spine. This pelvic floor layer has two passages in men (Urethra and anus). In the case of women, there is a third passage for vagina. To feel this muscle, try retaining your urine while passing it through. The muscle that contracts is the pelvic floor muscle.

Even though there are quite a lot of ab exercises out there, many are directed at obliques or upper abs. While those are great, they dont do much to create a core that is stronger. Youve got to work all these muscles. Learning how to activate some of these muscles can be challenging, but once you get the hang of it, you can keep back pains at bay. It is interesting to note that the spinal architecture functions as a syncytium and it is impossible to recognize when youre actually activating muscles such as transverse abdominis via exercises. Given below are exercises if performed with proper attention to detail and technique for adequate amounts of time can go a long way in strengthening the core muscles.

• Prone planks: - This ones a must if you want to keep your spine healthy and for good reason. It thoroughly activates all the important muscle groups like spinal muscles, pectoral muscles, and pelvic muscles. It tends to be more of an entire body exercise and is useful in generating strong contractions of the transversus abdominis.

Position yourself on all fours. Straighten one leg out followed by another and maintain a straight line from the head to the heel. Look ahead. It is important to keep your breathing going. Keeping a count can help. Hold this position for at least 30 seconds. You can progress via the addition of 15 seconds each week. In case of those who are severely incapacitated, even holding for 10 seconds can make all the difference but it needs to be done right or it can do more harm than good.

• Standard plank: Observe the straight alignment of body there are no peaks and no valleys. You should be able to put a glass of water on your back without spilling any. It is necessary that you refrain from stopping your breath.

Below is a multitasking variation of this plank that you can use:

• Variation: Prone plank using a vestibular ball can promote contractile strength. The ball is an unstable base of support that can require constant adjustments to balance and thereby result in recruitment of additional myofibrils.

Red flags to watch for: Acute pain in back while maintaining the posture.

• Side planks. This is pretty much like a prone plank, but it works the muscles on the sides of your body with lesser base for support. It also requires concentration to stay rigid and is buoyed through a single shoulder and lateral aspect of the same ankle as touchpoint. Start off by lying on the ground sideways. Plant your forearm on the floor with the elbow right under the shoulder. Hold it for a minimum of 30 seconds with progressive increase of 15 seconds each week. Repeat on both sides. This results in better activation of hip abductors along with core muscles. It is recommended to face a mirror, to ensure correct maintenance of posture.

Red flags to watch for: Acute pain in back while maintaining the posture.

• Kegel`s exercise: - These exercises strengthen the pelvic floor muscles, which support the bladder, uterus, rectum, and small intestine. They are beneficial in cases of leaky bladders in both the sexes and to improve premature ejaculation in men. They are also said to improve sexual performance by improving vaginal blood flow and muscle tone. Some women find it difficult to relax the vaginal muscle during sexual intercourse resulting in painful intercourse. Performing Kegel`s exercise regularly can aid in relaxing the pelvic muscles and thereby resulting in better experiences.

Technique of performance

While urinating, try to halt the flow, hold for 30 seconds and then let it flow again. The muscles that you feel contract are the pelvic floor muscles which seem like they are pulling the pelvic region (imagine the scrotum or vagina) upwards and inwards. Once you get the knack of it, you become more conscious of the contractions. You can progressively increase the count by 30 seconds each week, till you hit 2 to 3 minutes.

Another method is by trying to draw the anal clefts closer and shut the anal sphincter, thereby activating the pelvic floor muscles. It can be repeated 20-30 times using the hold-relax technique. The number of counts can be built up progressively.

While it is common to think that remaining immobile can speed up recovery, it is more likely that inactivity will simply make it worse. Therefore, it is essential to practice good postural mechanics and build an appropriate exercise program that can aid in core muscle strengthening.

Article by Dr. Ganesh Reddiah Chunduri, MBBS, FRCS (Glasgow)

Consultant Orthopedician, CallHealth

Have a question? Consult Dr. Ganesh online.