Does a weak core cause back pain?

The core has been given a bad reputation over the last 2 decades as the cause of low back pain. I wouldn’t recommend doing this but if you google “how to fix back pain”, you’ll find hundreds of thousands of references to core strength and stabilization and probably walk away from that search thinking your core is weak. But is it truly a problem and can strengthening your core fix back pain?

Like most questions and situations in the physical therapy world, the answer is “it depends”. It is certainly not the end all, be all of back pain. To get a better understanding of the relationship of the core and low back pain, let’s explore some history and anatomy.

 

Since back pain has such a high prevalence in the US, many people have claimed that they have the fix for it.

Core exercises, or stabilization, became popular in the last quarter of the 20th century and have stuck around since then.

What makes up the core?

Generally the core is considered your center of gravity and the surrounding musculature:  your abdominals (there are 3 layers), the muscles in your back, the diaphragm, and the pelvic floor. Often, the gluteals (butt muscles) are grouped with them.

Get a visual of them here. 

The muscles that make up the core control the movement of your low back in all directions. So it seems rational that strengthening them would help with back pain.

But consider this: the spine, especially the lower back or lumbar portion, is an inherently stable structure. It is designed to support your body through every movement it makes. Despite some verbiage out there, discs don’t “slip” and the back doesn’t get out of alignment. 

More often than not, patients presenting to physical therapy are dealing with excess stiffness or stability in one or more areas of the spine.

When one portion isn’t moving as much as it should, other surrounding structures (muscles, ligaments, etc) might try to make up for it. Then, these other structures become painful because they are doing more work than they’re designed to.

These clients often need mobilization or mobility exercises to improve their pain. If we give them core strengthening and stabilization, we’re making a stiff area more stiff and not getting to the root of the problem.

 

Each client/patient has different needs.

A treatment plan including core strengthening and stabilization may work for one yet hinder another. A physical therapist can help determine the best course for the individual.

About the Author:

 

Dr. Chelsea Walter is a Doctor of Physical Therapy with an emphasis on treatment of spinal conditions. She graduated from Saint Louis University in 2014 with her Doctorate of Physical Therapy and completed undergraduate work at the same institution. From 2018 to 2019, she was a post-graduate resident with the McKenzie Institute. There she achieved certification in the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) and board certification in orthopaedics (OCS). Chelsea enjoys working with clients who are active in the gym or with recreational sports. She has led an active lifestyle from early on in life and enjoys hiking, travel, and spending time with family