The “core” is the area of our body between the legs and or trunk. The muscles of the core can act as static or dynamic stabilizers for movement, to transfer force from one extremity to another, or initiate movement itself. However, most often the core acts as a stabilizer and force transfer center rather than a prime mover. When our core muscles do not sufficiently stabilize during movement, our spine can be subject to abnormal stresses that can lead to pain.
There are many muscles in the core area, but the deep core muscles are the most directly involved with stabilizing the spine while the more superficial muscles create movement. Research has shown that when people have back pain, the deep core muscles get inhibited or “turned off” and that we have to re-train these muscles in order to return them to their full function. With core training – we are retraining the muscles on when and how to fire so that they perform when they should to protect and support the spine.
The deep core muscles are generally considered to consist of the Transversus Abdominis, Multifidus, Pelvic Floor and Diaphragm.
- Transversus Abdominis – This is the deepest abdominal muscle and acts as a corset to maintain abdominal pressure to support the organs and spine. Through its connective tissue attachments, it really wraps around the whole abdomen, top to bottom and front to back. When transversus abdominis contracts the waist narrows slightly and the lower abdomen flattens. The function of the transversus abdominis is to stabilize the low back and pelvis before movement of the arms and/or legs occurs.
- Multifidus– The multifidus is one of the most important stabilizers of our spine. It is deep to our back muscles and connects multiple vertebrae along the spine. This allows for it to provide stability to the spine while the spine is stabilizing forces from the extremities or performing movements such as bending or rotation.
- Pelvic Floor Muscles – These are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). The muscles of the pelvic floor work with the abdominal and back muscles to stabilize and support the spine. Additionally, the muscles support the pelvic organs, control bowel and bladder emptying, and are important to sexual function.
- Diaphragm– Our diaphragm is a large bell shaped muscle that helps you breath, but also works in conjunction with our pelvic floor to provide stability to the spine.
This discussion would not be complete without addressing the hip muscles. The hip muscles are responsible for stabilizing the pelvis on top of the legs. Without adequate stability and mobility of the hip muscles, the pelvis can be subject to being pulled excessively in one direction or another which transmits up to the spine potentially causing excessive tension and pain.
Common “Tight” Hip Muscles – The hip flexors and hamstrings commonly lack sufficient mobility, or the ability to relax, in our patients with back pain. The hip flexors are on the front of the hip. When they are tight, they tilt the pelvis forward, creating an excessive arch in the low back and encouraging us to stand in a “sway back” posture. The hamstrings span from the “butt bone” to the knee on the back of the thigh. When they are tight, they encourage the pelvis to tilt backward, creating an excessively flat lumbar spine.
Common Weak Hip Muscles – The gluteus muscles include the gluteus maximus, minimus and medius. They are responsible for stabilizing the pelvis and are quite commonly weak in our patients with back pain. Training these muscles can help to stabilize the pelvis and spine.
As you begin to strengthen and retrain the core and hips muscles, you will often notice a concurrent relaxation in those muscles that appear “tight”.
If you are experiencing back pain, it’s important to resolve it relatively quickly to prevent it from possibly becoming a chronic condition. If your symptoms are mild or if you would like to prevent back pain; your trainer can work with you on targeting the correct muscles. If you have any pain while doing the exercises, you should stop and consult your physical therapist.
We thank Angel at Mountain PT for contributing this article to our newsletter.