Surviving Summit: Rethink your core to find relief from back pain
May 3, 2016
When you think of the back, do you also think of the "core"? It all starts with a solid foundation of core strength, but what is core strength?
The first thing that might pop into your head is probably a shredded six-pack, just like what you see in the magazines or on TV. Having a strong core requires more than just doing a lot of sit-ups and other ab exercises. While those things may be relatively good for fitness, shifting your focus from ab-only exercises to overall core strength will greatly improve your physical health and performance.
Back issues are pretty darn common. According to a survey conducted by the American Physical Therapy Association in 2012, back pain affected nearly two-thirds of Americans. Before we get to the nitty-gritty of what to do about your back, it is good to know how things work and what causes back pain or discomfort.
The human spine is an incredibly dynamic structure. It is designed to be both a stable and mobile platform with three basic curves: the cervical (neck), thoracic (middle back) and lumbar (lower spine) regions. These three curves all balance each other out.
Posture is the alignment of these stacked segments, along with the head, shoulders, pelvis and extremities. Maintaining normal posture requires muscular stability from muscles like the transverse abdominis (TA) and multifidi. When these stabilizing muscles become weak and don't engage properly, it sets the stage for the discs, joints, nerves and muscles in the back to be stressed and possibly injured. Some or all of these structures can be the source of back pain.
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OK, so what can I do besides a bunch of sit-ups and ab exercises?
Answer: Engage your core. You really need to think about it and feel it. It's something that should occur naturally with movement and positioning. That means your core should be active with walking, running, sitting, standing, weight lifting or strength training, skiing and cycling!
The list could go on, but you should get the idea by now. And, yes, the truth is, your core will be active with those endless crunches and ab exercises to get the six-pack abs we all wish for.
Core activation boils down to conscious effort and good body awareness. Eventually, it will become unconscious and anticipatory — meaning your core activates to provide stability before and during activity.
The very first place you should start is with posture in the standing and sitting positions. Envision this, or just look in the mirror: Sit on a chair and let your back hunch forward and shoulders follow. Now "squeeze" to sit up tall and engage your core oh-so-slightly, but not so much where you are trying to flex for a selfie. You'll need to bring your shoulders back and together as well.
The goal with this quick exercise is to feel the upright and balanced alignment of good posture. This is the kind of core engagement and posture you strive for during your day of sitting, standing, walking, etc. Of course, this is easier said than done, but, with a little bit of time and conscious effort, you will naturally do it throughout your day without thinking about it.
It's never too late
But what if I already have back pain, have seen multiple doctors, chiropractors and physical therapists, and nothing is helping?
Your answer might be in the focused training of yoga, Pilates or a different approach with therapy. Your body's muscles are all connected, and everything is designed to move. That means you need to thoroughly assess your alignment and movements — both of which are challenged with the poses and motions in yoga and Pilates.
It's easy for the muscles in your back or legs to become tight from your daily routines and weekend athletics. While some muscles become adaptively shortened and tight, like our hamstrings, others can get inhibited (disengaged) from pain, like the TA and multifidi. When done correctly, yoga and Pilates can help stretch our tight muscles and activate the core stabilizers. It might be worth your while to attend one of the many local classes offered or visit a local medical provider who's in tune those activities. It's understandable if going to yoga classes aren't for you but at least consider incorporating some simple poses to the end of your workout.
Now that we have discussed proper core alignment and engagement, you can make sure you are mindful with your daily routine and recreational activities. We are all guilty of going through the motions or doing an exercise fast, with sub-par form or poor engagement of the core muscles. Remember, you really need to focus on the quality of your posture and core-muscle activation, whether you're running or hiking or lifting weights.
After all the medical visits, quick fixes, workouts and training, you should know by now that combating back pain all starts with the basics of good posture. So, whether you exercise all the time or not at all, you can take the first step by building good posture and rest will follow.
Eric Dube is a licensed physical therapist and orthopedic clinical specialist with Howard Head Sports Medicine in Summit County.
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