Core strength is overrated
There seems to be a conventional wisdom that if you’re having low back pain you probably just need a stronger core. Well, it’s not true, the concept is misunderstood, and often irrelevant to back pain. That’s not to say core strengthening isn’t a good idea, it may be, but not as a primary approach for treating back pain (in most cases).
First off, how many people with low back pain report that sitting can make their pain worse, or even sleeping? A lot. Can you imagine performing either of these activities for prolonged periods of time “flexing” your core muscles the entire time? Long durations are common when it comes sleeping or sitting at work for example. Core strength doesn’t seem to be an effective strategy here.
How to make a complex concept simple? Imagine bending your finger backwards and holding it there for hours, or, dislocating your elbow. Do you think strengthening your finger muscles, or using your arm muscles to “brace” and “stabilize” the elbow injury would be the initial best line of treatment? Probably not. A more effective strategy would be to change the load you’re putting on your finger, or have your elbow joint put “back in place”. Don’t you think?
Let’s say someone gets pain with lifting. They let their back round out and put unneeded stress on the discs and ligaments. In most day to day situations we do not lift things so heavy that it equates to a 1 rep max (a weight so heavy we could literally only lift it once). It’s usually way below that load. In fact, often back pain patients will say they hurt their back doing the most mundane things like bending to tie a shoe, pet the cat, or sneezing. Clearly the average person has enough strength in these situations to maintain a flat back. Though they don’t, they let the back round out. This is really not a strength issue, its what we call a “motor control” issue. Having the strength to do something but lacking the awareness or attention to do it properly is not weakness, it’s poor motor control. It can be trained and improved and the fact is most people are not moving a manner they think they are. When I ask people to get their back flat, and take a picture of them to show them where they are, they are usually far away from what their internal sense tells them.
The point is doing things like planks, sit ups, V-ups, and whatever other cool core strengthening exercise are the bomb at the time, misses the concept that most back pain comes from subtle mechanical injuries or faulty loading strategies, not weakness. There are certainly benefits to exercising, and improving core strength, but understand there are other more important factors to address than that when it comes to reducing acute or chronic low back pain. In our clinic core strengthening is almost always the B-Game. There are so many other things that can be addressed that will provide rapid reductions in pain and restoration of limited motion and mobility. Don’t drink the Cool-Aid. Get the priorities in order and solve the problem, don't just treat symptoms.