We’ve all had it happen at some point in our lives. You move a weird way, you sneeze, you sleep in the wrong position, you bend over to pick something up or put on your sock and WHACK – you hurt your back!
No injury seems as debilitating as an injury to the back. It affects nearly everything you do: walking, sitting, sleeping, all of it. When you hurt your back, you’re simply miserable. While lower back pain (LBP) has a number of different causes, there are evidence-based exercise methods that could make it a thing of the past. To understand those methods, you must expand what it means to train your “core,” because the deep core muscles that keep your spine healthy go far beyond your abs.
How Common Is Lower Back Pain?
If your back hurts, you have plenty of company. According to the World Health Organization, an estimated 619 million people live with LBP, and it is the leading cause of disability worldwide. Data from the CDC show that 39% of American adults dealt with back pain within a three-month window, making it the most common site of pain in the body. Whatever metric you look at, LBP is shaping the daily lives of an enormous number of people.
Causes & Types of Lower Back Pain
While it’s clear that LBP affects many people, what’s less clear is the cause. Determining the underlying cause of an injury or pain is inherently complex. The biopsychosocial model of pain suggests that how we perceive pain involves more than biology and anatomy. Psychological, emotional, and social factors all influence how much something hurts.
You don’t need every nuance of pain science for this article. The short version: pinpointing the precise cause of your LBP is challenging, so don’t expect a clear-cut answer here. Even the American Association of Neurological Surgeons notes that causes of LBP are multifactorial. Broadly, though, the common causes sort into two groups.
Two Families of Lower Back Pain
Select one to see the causes and the right first step for each.
These are what I consider acute injuries. They arrive suddenly, and they call for advanced, sometimes aggressive medical care. If this describes your pain, consult your physician before anything in this article. Exercise comes later, once your medical team clears it.
These causes manifest over a longer time horizon. Symptoms may flare up and feel acute, but the underlying issue has been bubbling for some time, so the pain tends to come and go. A qualified medical professional should still be involved, but in non-extreme cases care isn’t as aggressive, and systematic training has a real role to play.
It is the chronic causes, along with generalized lower-level LBP, that could respond well to training the real core muscles in a systematic way. Before you start, check with a qualified medical provider to determine what’s appropriate for you.
Redefining “Core” Relative to Lower Back Pain
Somewhere along the way, the exercise community confused a lot of people about what the core muscles actually are. You might be one of those people, and I’m sorry if we confused you. So-called “exercise professionals” have reduced core training to the rectus abdominis, the six- or eight-pack muscles, largely because of the aesthetic desire for a ripped midsection. Our industry has a long habit of conflating exercise that helps us function with exercise that helps us look “better” (in quotes, because I have no idea whose standard of better we’re trying to live up to).
For this discussion, let’s set aside training the core to look better. Unless, of course, you consider being hunched over in back pain all day to be a good look. If not, then the core we’re about to talk about might be exactly the thing that keeps you upright and out of pain, and that seems pretty good looking to me.
As an exercise physiologist, I hold a much more expanded view of the core. The core musculature stabilizes the pelvis, spine, and shoulder blades in the right positions. That stability lets us maintain proper posture while sitting, standing, lifting, and walking. It puts the deep core muscles in their best positions to produce force, and it puts our bones and connective tissue in the least injurious positions to accommodate force. The net effect can be greater functional capacity, more strength, and a lower risk of the kind of dysfunction that feeds LBP.
Once you hear “pelvis, spine, and shoulder blades,” it becomes clear we’re talking about many, many muscles, and almost none of them are the six-pack. Below are the most critical muscles involved, split by what each group needs. Click any muscle to learn more about it.
Strengthen These (They Weaken With Sitting)
Stretch These (They Tighten With Sitting)
The rotator cuff splits its loyalties: the external rotators (infraspinatus, teres minor) need strengthening, while the internal rotators (supraspinatus, subscapularis) need stretching to support shoulder blade stability and posture.
You’ll notice muscles like the rectus abdominis and the external obliques are missing from the list. Developing those muscles might make your midsection look better, but it won’t necessarily make your spine more stable or less prone to injury and LBP.
Since I’ve mentioned posture quite a bit already, we need to define what proper posture is, review what it does for your lower back, and look at how modern daily life wreaks havoc on it.
The Role of Posture in Lower Back Pain
Proper posture does three important things with regard to LBP:
- It puts muscles, bones, and connective tissue in positions to tolerate the mechanical forces of daily life.
- It creates optimal positioning for lifting and moving objects.
- It minimizes stress on the weak links in the chain, the areas of the body that can’t tolerate load quite as well.
All the muscles listed above work together to achieve and maintain proper posture, and one of its hallmarks is that the body is in extension. Legs extended, back extended, head and neck extended. Holding that position asks many of those muscles to contract at a low level all day long.
You don’t have to be a biomechanist to notice we don’t spend much time in extension. We spend most of the day in flexion: at our desks, in our cars, on our couches. When flexion dominates, the strengthen-these muscles from the list above get progressively weak, and the stretch-these muscles get progressively tight.
Reciprocal Inhibition: Why Tight Muscles Create Weak Muscles
Weakness feeds tightness and tightness feeds weakness through a physiological principle called reciprocal inhibition. It sounds complicated, but a cup of coffee explains it.
To drink your coffee, you contract your biceps and the front of your shoulder to bring the cup to your mouth. For that movement to be smooth, the muscles that oppose the action, your triceps and the back of your shoulder, have to relax. That’s exactly what happens: the nerve signal telling muscles on one side of a joint to contract simultaneously tells the muscles on the other side to relax. Great for fluid movement. Bad for posture.
As we sit, our hamstrings, hip flexors, pecs, and internal rotator cuff muscles shorten and tighten, which signals all the extensor muscles that oppose them to relax and, over months and years, weaken. Tightness drives more weakness, weakness allows more tightness, and the cycle pulls us out of healthy extension and deeper into flexion. How much of your day feeds that cycle? Count for yourself.
The Flexion Audit: Check Every Statement That Describes Your Typical Day
Your score shows how hard modern life is working against your posture.
No judgment: this is the modern default, and it’s exactly why your extensor muscles need direct training. The five exercises below were built for you.
You have some built-in movement, but flexion still wins more hours than extension. The exercises below will help you balance the ledger.
You’re ahead of most modern schedules. The exercises below will reinforce what your daily movement has started.
Five Ways to Train Your Core to Reduce Lower Back Pain
Enough of the anatomy lesson. Here are five exercises, really four exercises and one all-day habit, that train the real core and push back against the flexion cycle.
Putting It All Together: The Core Workout
Here’s a simple workout incorporating the exercises above, minus proper posture, which is an all-the-time thing. Run through it one to three times per week, and treat the numbers below as starting points to progress from, not ceilings.
Exercise 1 never stops. Proper seated and standing posture is the daily practice that makes the other four exercises stick. The workout builds capacity; your posture spends it well.
Take Home Message
You don’t have to accept LBP as a permanent roommate. Expand your definition of core beyond the six-pack, spend more of your day in extension, and train the muscles that stabilize your pelvis, spine, and shoulder blades with the five exercises above. The pattern that pulled your posture into flexion took years to build, and unwinding it is a practice rather than a quick fix, but every session moves you toward a back that lets you live your life.
At Applied Fitness Solutions, we’re here to help you on that journey. Our degreed, nationally certified exercise physiologists can assess your posture, tailor these movements to your body and history, and progress you safely. Reach out today to chat with one of our coaches; we’re here for you.
Ready to Train the Core That Counts?
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Sources
- World Health Organization. Low back pain fact sheet.
- Lucas JW, Connor EM, Bose J. Back, lower limb, and upper limb pain among U.S. adults, 2019. NCHS Data Brief No. 415. National Center for Health Statistics.
- European Pain Federation. What is the biopsychosocial model of pain?
- American Association of Neurological Surgeons. Low back pain: conditions and treatments.
- ScienceDirect Topics. Reciprocal inhibition.
- Physiopedia. Individual muscle references linked throughout the article.