Many people who complain of low back pain are told that they lack core stability. They then embark on a series of exercises with varying degrees of success. However, core exercises alone do not always lead to improvement in low back pain. So what else could be implicated?

If you look at the structure of the back, the lumbar spine is relatively unsupported. The thoracic spine has a ribcage to protect the organs and help provide stability. The pelvis provides a framework to support the reproductive system and abdomen from the effects of gravity. However, the lumbar spine only has the protection of the soft tissues of the abdomen around it. So how does this area maintain stability given the forces that are put through the lumbar spine?

The key to providing support to the lumbar spine is intra-abdominal pressure. This is achieved through the efficient use of the diaphragm working with the core muscles of the body: namely the internal abdominal obliques, transverse abdominus and multifidi muscles as well as the pelvic floor. Together these provide a flexible corset of support for the lumbar spine, which allows the body to flex, extend, bend to one side or rotate by adjusting the support to where it is needed.

As we inhale, the diaphragm lowers into the abdominal cavity and the pressure in the abdomen increases. If we can also maintain strong engagement of the muscles around the abdomen we have maximum intra-abdominal pressure. When we exhale, the diaphragm rises into the ribcage creating more space in the abdomen and therefore it decreases intra-abdominal pressure.

If, when you are exercising and trying to activate your core, you do not think about how you are breathing then you are setting up dysfunction in your system. Just holding your breath will mean you don’t engage your other muscles properly: you do increase intra-abdominal pressure only because your diaphragm is contracted. Breathing out at the wrong time, for example when lifting a heavy weight, will lead to a reduction in intra-abdominal pressure, which means increased risk of instability in the back at a vulnerable time and possible low back pain as the muscles are strained or even worse: it causes a herniated disc or a hernia.

If we think of a can of drink, the top of the tin represents the ribs and diaphragm on the inhale – supported and strong – and the bottom of the tin is the pelvis, which is hopefully, in most people, holding the bladder, uterus and rectum from falling out. If the pressure is decreased in the tin (can is opened and drink drunk!), when pressure is applied the sides collapse as there isn’t enough support to maintain the structure.

It is much easier to squash a can when it’s internal support is gone. However, trying to squash an unopened can is much more difficult (and some might say even foolish!) because of the internal support.

That is why using your breath, together with engaging your core can be far more effective in reducing your back pain. Once you have your diaphragm working in conjuction with your obliques, transverse abdominus, multifidi and pelvic floor you are in a much better position to support your back and therefore reduce the risk of back strain, disc herniation or indeed an abdominal-type hernia.

So, do you need to focus on your core exercises to help your back pain? Ok, take a breath in and…. !

Susan Harrison is a Clinical massage therapist based in Woking, Surrey. If you would like more information or to book an appointment please email susan@powertouchtherapy.co.uk