The science behind “core strengthening.”
Many times, patients are referred to physical therapy for “spinal stabilization” or “core strengthening.” The research into spinal stabilization is quite impressive and by understanding what it is and how it works it will help you more effectively perform the exercises.
When pain are/or swelling is in a joint, muscles in/around the joint will actually “shut down: and not be able to contract as well as before. A good example is the knee joint. If pain and/or swelling is experience in the knee due to injury or disease, the thigh muscles (quadriceps) shut down. Studies have shown that this starts within a day or two. With the muscles not working appropriately, the joint has to do more work, thus increasing pain, which starts a vicious cycle of more muscle inhibition.
The same process occurs in the spine. When pain is felt in the spine, irregardless the exact pathology, muscles around the spine will not work as well as they need to, to support, unload and protect the joints of the spine.
Studies have shown that when simple tasks such as raising your arm or leg occur, back muscles immediately adjacent to your spine (called multifidus) and the deepest layer of the abdominals, the transverses abdominus (not the 6-pack) contract before your arm/leg muscles, to ensure that the stress of lifting the arm or leg (or any other activity) doesn’t put unwanted stress on the spine and it’s joints, such as disc. The same studies on people with low back pain have shown that when pain is present, these “stabilizing muscles” don’t contract quick enough and the movements of the arms, legs and trunk will put more/unwanted stress on the joints, which lead to additional injury, pain and subsequent muscle inhibition. So, the cycle continues.
The good news: With proper treatment and as pain subsides, these “stabilizing muscles” can be retrained to do the proper task. Physical therapists start a process of teaching patients “stabilization exercises” which focuses on having patients learn (re-learn) the correct firing mechanism and sequence for the muscles. It is important to note that spinal stabilization is NOT about strength, but rather “having the right muscles doing the right work at the right time and letting go at the right time.” Once a patient is able to fire the correct muscles at the correct time, he/she will be progressed by their physical therapist to functional tasks such as squatting, lifting or bending, knowing the stabilization muscles are protecting the spine and help sharing the load on the spine.
Quick notes:
- Learning spinal stabilization exercises in the beginning is tricky. You need to make sure the RIGHT muscles work. This is why a trained, professional physical therapist can assist you. In normal, pain-free, situations, these muscles fire “without thinking about it” and to actually have you think about it, is challenging. It’s the same as asking you to think about breathing in and breathing out….
- What about pain? Remember, when pain sets in, the stabilizing muscles shut down. “No pain- no gain” does not work! If pain sets in, work on easing the pain- medication, rest, stretches, etc. Once pain is controlled, initiate and start again with the basic exercises and then progress accordingly to more advanced exercises.
- Since these muscles work involuntary, get into a habit of engaging these muscles many times throughout the day, during common tasks. Research shows that these muscles learn faster by repetition. Examples would be:
-Blue dot exercise- put a little blue dot on your watch or cell phone as a reminder
-Task- every time you bend, engage the muscles
-Red light exercise- every time you stop at a red light, engage the muscles
*For more information- ask your physical therapist. This is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.