Getting to the core of the problem
You have probably seen and heard plenty about ‘core exercise’ and the importance of ‘maintaining a strong core’. Certainly, many of you will have had advice from your Practitioner at Creative Chiro about incorporating these exercises into your daily routine, because it is often the key to preventing re-injury or recurrence of a postural issue.
But there is a common misconception when it comes to core exercise, that it just entails a ‘one size fits all’ approach of working on your ‘abs’ in pursuit of a six-pack. For the minority who can achieve that (and let’s face it, most of us can’t), it may look impressive on the beach or at the gym, but it isn’t necessarily going to help you address your individual postural issues. In fact, overworking one set of muscles may actually cause a postural imbalance that can destabilise you and lead to more problems.
Certain sports people, such as golfers, can encounter similar issues with overworked core muscles, due to the repetitive, one-sided movements they make.
And interestingly, it is not just targeted exercise that can cause this type of problem. Sometimes it is the nature of a person’s occupation. For instance, I see agricultural workers who spend whole days sitting in a farm vehicle, twisting back and forth continually to look back over one shoulder, as they work up and down a field. This can cause the core muscles on one side to be overworked, leading to muscles on the opposite side getting overstretched, resulting in instability and pain in the affected area.
The key to maintaining a strong, balanced core is understanding which muscles are involved, how to strengthen them effectively and, crucially, how to tailor the exercises to your individual needs.
So, basic anatomy first!
Your core is the central section of your body, and it is where all movement begins. It comprises of your lower back, pelvis, hips and your stomach muscles. The core muscles surround the pelvis, hips, lumbar spine, and abdominal organs. There are 29 pairs of muscles that make up the core… But, don’t worry, we won’t want you to exercise all of them!
The focus is mainly on those listed below. Each of these muscles has their own unique function in the body but, in essence, they work hard to support the pelvis and spine, providing stability and postural control, not only for your spine but also for the lower limbs from your feet to your pelvis. By understanding how these muscles work, we can surmise that if any of them are weak or firing incorrectly, it can create instability in the entire core system, leading to compensations or injury:
Erector spinae: These are a group of back extensor muscles that run from your neck right down to your lumbar spine (lower back). They are activated when you perform any lifting or bending movements.
Multifidus: Similar to the erector spinae muscles, these also run from the neck to the lumbar spine. However, these muscles are more concerned with stabilising the vertebrae of your spine, especially in the lumbar region.
Rectus abdominus: Commonly known as the “6 pack”. The main function is to stabilise your trunk when you bend or crunch forwards.
Transverse abdominus: This attaches to the lumbar spine, just beneath the ribcage and spans around to the back of the rectus abdominus. It maintains tension in the abdominal wall and helps to protect your abdominal organs.
Internal and external obliques: These are situated on either side of the rectus abdominus and provide strength and stability to the side and front of the trunk. Their main function is to provide support during trunk rotation, or during side bending.
Diaphragm: This muscle is situated just below the ribs, and is activated in the breathing process. This is why we always accompany breathing techniques when giving you core exercise. We are not just trying to confuse you with more things to focus on! If your posture is poor due to weak core muscles, this can affect your breathing. So, these techniques are important for each and every one of us, but especially athletes, where optimal breathing allows for optimal performance.
Pelvic floor muscles: These are the ones that you engage when controlling your bowel and bladder function.
Who needs to work on their core?
A strong, balanced core will help you with strength and stability in your daily life, regardless of age.
In the older demographic, it has been shown to improve balance, resulting in more purposeful movement and fewer falls. A 2021 review of studies by the Orthopaedic Research Online Journal (ORPOJ) found that results across a wide range of studies consistently showed that older adults undertaking core exercise programmes improved both their strength and mobility. This is particularly important, because as you age, you tend to lose muscle strength due to decreased physical activity in daily life.
For the more active among you, core strength can enhance your ability and accuracy in your particular sport, purely by improving the quality of movement and creating healthy movement patterns. It is an important factor in preventing injuries and also a key part of rehabilitating, post-injury.
As an example, a patient presented to me with long-term, recurrent low back pain. He was a young, professional cricketer who had, in the past year, suffered from a spondylolisthesis (where the vertebrae slips forward, out of place), due to an unstable fracture in his lumbar spine. He had undergone surgery to stabilise his fracture, but received no rehabilitation following surgery, before going back to competitive cricket as a fast-bowler.
After an extensive examination, I concluded that he first required a scan to ensure that there were no anomalies in his spine following his return to sport. The report showed that he had in fact snapped one of the screws securing his spine. He once again had an unstable spine that was not only preventing him from doing his job, it was also extremely painful, causing problematic compensations elsewhere in his body.
I recommended that prior to having corrective surgery, he undertook a course of gentle core stability exercises, along with chiropractic care for the rest of his body. Following the surgery, he had further core rehabilitation before being allowed back to sport, especially bowling.
10 months later, with his spine now protected by a strong core, he returned to playing professional cricket and has not had any further need for surgery. Not only had the core exercises assisted in stabilising his spine and protecting him from re-injury, they also corrected the poor biomechanics that had caused his injury in the first place.
Let’s get down to the nitty gritty!
Following a simple set of core exercises will help you to maintain a healthy core and make you more resilient to future spinal injuries. Our practitioners here at Creative Chiro have literally ‘got your back’ in this regard. We are able to assess you and advise the most appropriate exercises, specifically for you. But, to give you an idea of a good all-round training programme, I have listed my top 5 core exercises below. But, please remember that these exercises might not be the best ones for each and every patient, so always consult with your practitioner before trying any of them.
Cat/Camel: This exercise is a good one to start with to enhance movement.
Begin on your hands and knees (knees directly beneath your flexed hips, hands directly beneath your shoulders). Arch the spine up with the head flexed downwards (camel), and then slowly lift the head upwards whilst allowing the spine to drop slowly into a downward curve (cat). Repeat 5 times. Remember not to push your spine into a painful zone. Keep control and keep it pain free.
Bridge: This exercise is specifically for activating your gluteal (buttock) muscles.
Lie on your back with your knees bent, feet and arms on the floor. Contract your gluteal muscles, ensuring that the hamstring muscles (back of the legs) and the spine are not moving. Slowly raise the pelvis slightly off the floor. Hold for 5 seconds. Lower back down to the floor. Repeat 5 times. Initially, you will only raise the pelvis a little way off the floor, but as you get stronger or your back pain subsides, you can progress to lifting the pelvis until your knees, hips, and spine are in a straight line.
Bird Dog: This exercise targets your lower back and hip extensors, and helps to improve balance.
Kneel with your hips flexed and knees on the floor, directly under your hips. Keep your spine in a neutral position with your hands on the floor, directly beneath the shoulders. Brace your abdominal muscles to control the movement. Lift the right arm and left leg at the same time. With your arm and opposite leg parallel to the floor, hold for the count of 6-8 seconds and repeat 3-5 times. Repeat with the left arm and right leg. Be careful not to raise the arm higher than the shoulder, or the leg past the level of the hips.
Side Plank: This exercise targets your spinal and abdominal muscles.
Lie on your side, with your knees and hips slightly bent. Your upper hand should be braced against the side of your pelvis. Raise your hips, allowing your weight to be taken up by your elbow and knees. Hold for 8-10 seconds, lower to the floor and repeat 3-5 repetitions. Repeat on your other side. Remember to breathe normally.
Clamshell: This exercise is mainly for the hips.
Lie on your side with your knees bent. Keep your lower arm under your head for support, and your upper hand on your hip. Raise the top knee (opening your legs like a clam shell). You should feel your gluteal muscles contract, without allowing the spine to move. Lower the top knee down again. Repeat for 3-4 repetitions. Repeat on your other side.
Once you have established which core exercises are most suitable for you, including any positional modifications for your particular circumstances, you can incorporate core training into your daily routine. As you progress, the exercises can be modified to make them more challenging. The beauty is that you do not need expensive equipment or a gym membership. All you need is guidance and motivation, which the practitioners at Creative Chiro are always happy to provide.
Developing a strong, balanced core helps to improve posture and decrease lower back pain by providing a natural ‘corset’ around your spine, supporting it during movement. The stronger your core, the more control you have over your movements, allowing you to continue with all the things you enjoy doing.
If you would like to make an appointment at the Practice, please call our friendly, helpful team on 01328 854325 or email info@creativechiro.co.uk