Core Stability: Why it’s not always the answer for back pain

There’s a common misconception out there that a person experiencing lower back pain must have a core that is “unstable.”  It’s a thought process that intuitively makes a little bit of sense, but if you dig a bit deeper below the surface, you’ll find it’s rarely the case.

Study after study has shown that core exercises are no more effective than general exercise when it comes to addressing lower back pain.

Before we get into several reasons why lower back pain doesn’t always equal an unstable core, let’s look at the theory behind it. 

When most people refer to “core stability,” they are referring to the muscles that lie deep within the torso (think the muscles around the abdomen).  Muscles generally accepted in this group are:  the diaphragm, lumbar mutlifidus, transverse abdominis and the muscles of the pelvic floor, which link most closely to the spine.

Because these muscles act most immediately on the spine, the surface level thought is that they must not be working properly in people with lower back pain… or they must not be providing the proper stability to the spine.

This is a far too oversimplified way of thinking about the body, and would be similar to assuming the wheels on your car don’t turn because the axel isn’t strong enough.

Yes, it’s possible, but there are hundreds or even thousands of other variables that may be going on that contribute to the wheels on the car not turning.

The same can be said about lower back pain and core stability.

Pain is complex.  Movement is complex – we need to go deeper than the surface to find meaningful (and productive) solutions.

Unfortunately, this means that we can’t just point to the simplest possible answer (core instability) and say it’s why you’re having lower back issues.

Let’s look at the assumption a little more closely, and we’ll see how wrong it can be…

The core stabilizers are meant to do just that, provide stability.  In a general sense, they’re meant to absorb tiny forces around the spine to maintain balance.  Just think about the exercises and tools we use to isolate these muscles… bosu balls, physioballs, and balance boards. 

We’re not moving tremendous amounts of weight or moving with high velocities when we’re isolating these muscles, because that’s not what they’re designed to do.

Now, let’s think about the muscles that we DO train with heavy weight and high velocities.  These would be ‘mover’ muscles like the calves, hamstrings, quads, and glutes. 

They help to create and absorb tremendous amounts of force – not only in the gym, but in our day to day lives.  They are the main drivers for movements like bending over to pick something up, walking, jumping, and climbing the stairs. 

Looking at it this way, if either of these types of muscles (the smaller core muscles or larger ‘mover’ muscles) were unable to absorb force properly throughout the day, which do you think would contribute more to additional stresses on the spine (and possibly lower back pain).

I think the answer’s obvious – you would expect any dysfunction in the larger ‘mover’ muscles to play a much larger role in keeping stresses off the spine.. and it matches what we find with nearly all of our clients with lower back pain.  Rarely does our assessment process indicate any need to improve core strength.

This is just one great example of the many myths out there about lower back pain (and rehabilitation in general). 

If we look at problems within the body at the surface, you’ll get surface level solutions.  I encourage you to take a step back, whether you’re dealing with back pain or another issue, and dig at least 1 level deeper to find more meaningful (and hopefully productive) solutions.