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Effective core stability exercises train the core musculature without placing excessive compression and shear forcers through the lumbar spine.
There are many exercises that train the core effectively. Many of these exercises also place considerable loads through the lumbar tissues. If lower back pain is not a problem, people can do many of these exercises without any symptoms. When lower back pain is a problem some of the core stability exercises can make back pain worse, or at the very least keep the symptoms around.
Part of the picture with lower back pain is the inability of the tissues (discs and facet joints primarily) to attenuate load.
Pain and decreased activity levels result in the tissues of the lumbar spine being less resilient and less able to tolerate forces and loads. So it’s especially important for a core stability exercise program to improve the control, endurance, and strength of the core muscles without overloading the lumbar tissues. In addition to improving the muscle function of the core these exercises will place, healthy loads through the lumbar spine.
As tissue irritability and inflammation decrease the spine will gradually be able to tolerate increased loading. As the spine is able to attenuate increased activity and increased loading and as the core muscle function improves the exercises can be progressed.
This video covers the trunk curl-up, the side bridge, and the bird dog. Nothing new here, many of you will be familiar with these exercises. The key is doing each exercise precisely and doing each exercise consistently. Don’t let the simplicity fool you. These exercises together train the front, side, and back part of the core. They work all the trunk musculature without placing too much load through the lower back.
This video covers progressions of the trunk curl-up, side bridge, and bird dog exercises.
To progress the trunk curl-up put your hands behind your head, this increases the load on the anterior trunk muscles. You can also brace the abdominals, curl up against the brace, then take three to five deep breaths in the up position.
To progress the side bridge straighten out the legs and put the top leg over the bottom leg. Once this is mastered stack the top leg on the bottom leg.
To progress the bird dog hold the up position for three to five breaths. Another way to progress the exercise is to draw circles or squares with your hand and foot in the up position.
Each exercise can also be progressed by adding volume with additional sets and reps. Focus on mastering these three exercises and the progressions. As these exercises increase the control and stiffness of the trunk musculature lower back pain will decrease.
