Spinal Stabilization and Core Strengthening

Core strengthening has become a very fashionable catch phrase. Every exercise class claims to "work on the core" everyone at the gym is doing supposed core exercises and late night infomercials are constantly selling the latest gadget designed to isolate and strengthen the core. However, the bottom line is most of these gadgets and exercises are not truly isolating the "core" and many of these exercises and devices are worthless for people that have issues with their back or neck.

Another common misconception about core training is "strengthen your stomach to help your back." We've all heard a bit of advice like this at one time or another. Although people mean well it is an old wives tale. For most people if they want to strengthen their stomach they naturally think of sit ups or crunches. Unfortunately this is not an effective way to rehabilitate your back and can actually worsen your symptoms.

Many people have also heard the term "spinal stabilization" used by doctors or therapists. Spinal stabilization refers to rehabilitation exercises specifically designed to isolate, stabilize and strengthen weak muscles of the spine. If you want to know why these muscles get weak and what you can do about it read on…

Review of the anatomy

The human spine is a very complex piece of anatomy. It is composed of bones (vertebrae), discs, ligaments and muscles. The spine is divided into 4 unique sections the cervical spine (neck), thoracic spine (midback), lumbar spine (low back) and sacrum (tailbone). The spine has natural curves that help absorb the forces that our daily lives generate. Each part of the spine plays an important role in the overall health and stability of our backs.

The human spine is not very stable

The human spine is very unstable if all of the muscles are removed. It can only support around 20 pounds before it will completely collapse. Therefore muscular support of the spine is critical. The term spinal stability describes the ability of muscles to stabilize or hold the spine as well as coordinate movements of the spine. There are literally hundreds of muscles that attach to your spine. These muscles are susceptible to a variety of injuries and unfortunately many of these injuries have lasting consequences.

Spinal stability is like a 3 legged stool

Spinal stability is comprised of three individual components:

  • The passive system of the spinal column (bones, tendons, discs and joints)
  • The active system of spinal muscles (multifidus, transverse abdominus etc.)
  • And a neural control system (nerve communication)

A compromise in any of these areas can cause issues leading to back or neck pain. We often use the analogy of a 3 legged stool. If there is a problem with any of the legs it will directly affect the other 2.

How does instability cause back pain?

Back pain is said to occur when one of these three systems is not functioning normally. This can cause abnormally large motions of individual vertebrae which in turn can cause compression or stretch on pain-sensitive structures such as discs, ligaments and joints.

There are superficial muscles of the back that are used for movement and there are also deep muscles in the back called multifidi that are used to stabilize spinal segments. Scientific studies have shown that these multifidi muscles play a key role in chronic back and neck problems. They begin to weaken (atrophy) as soon as 24 hours after the onset of back or neck pain. Another frustrating part of that process is that the muscle weakness does not always resolve by itself after back pain has resolved; this can lead to an ongoing battle with recurrent low back pain. Research has shown that a specific exercise program directed toward the strengthening of these muscles can restore the strength that was lost and help to abolish the reoccurrence of low back pain. These various exercises are known as stabilization activities.

What do stabilization exercises do?

Stabilization activities include: mobility exercises for "stiff" (hypomobile) segments, strengthening exercises in a shortened range for "loose" (hypermobile) segments, postural training to ensure movement in a controlled range, activation and strengthening of specific stabilizing muscles including the transverse abdominus, multifidus, and quadratus lumborum. Stabilization activities should be chosen based on the direction in which the segment is susceptible to excessive movement. A properly trained RehabAuthority Physical Therapist can educate you on the injury process along with the proper steps of recovery. Our therapists will provide you with a detailed exercise prescription based on your individual needs.