Does Core Training Help Low Back Pain?

Oh social media, thank you for always being able to give me something to write about when I am feeling a bit stuck for topics to discuss. You see, the other day Jessica sent me a post from a young physical therapist on social media claiming that there isn’t a strong relationship between core stability and low back pain. To be honest, that is a BIG can of worms.

First, if we look at research overall there does tend to be a rather strong correlation to core stability and low back pain…

“Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown greater efficacy.  Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention.” (Efficacy of Core Stability in Non-Specific Chronic Low Back Pain)

“In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with low back pain.” (Core Stability Exercise Versus General Exercise for Chronic Low Back Pain)

” It was concluded that exercise on the stability of the pelvic nucleus and muscles is recommended as the simplest and most favorable prevention of lower back pain and lumbar lordosis. The stability of the nucleus helps to overcome the main causes and deprive the body of functional disorders and pain.” (Effects of Core Stability Exercises, Lumbar Lordosis and Low-Back Pain: A Systematic Review)

 

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Coach Caroline Juster gives some better ways to progress our core training.

So, there definitely is a relationship, however, with a BIG but!!!! Research also does point to the fact that we have to actually differentiate people with low back pain being screened for spinal instability or not. In other words, just because someone comes in with low back pain does it mean we automatically give core exercises to them? Not really, we should screen to see if spinal instability might be an issue. Many clinicians have a series of assessments they can do for this, but fitness pros or those just interested can use a leg raise screen like shown below…

I said looking at the idea of low back pain is a can of worms is because low back pain is complicated and combination of many factors including psychological and psychosocial. If someone does not have a diagnosed low back condition that is obviously causing the pain then these other factors can play a role in neuroplastic pain. Now, the person that wrote the post I am referring to didn’t do a great job of explaining what that means and suggested “relaxing” the core muscles. Well, that is not exactly true and not exactly wrong.

What does happen when someone has any sort of chronic pain (like low back pain) the brain can start to react to “false alarms” and create pain signals that are absolutely real, but not related to any structural issues. “Just relaxing” isn’t really the advice as when anyone has told you to just relax, does that work? There are A LOT of strategies and specific therapies that can help these issues.

As far as the scope of this blog, we are going to focus on meditative movement training because these are types of training that have been shown to have a positive effect on chronic non-specific low back pain (1,2). That is where our Myofascial Integrated Movement (MIM) program comes into play as it reflects much more of the aspects of what is known in the literature as meditative movement training (MMT).

What makes MMT different? As the research explains, “is a term identifying forms of exercise that use movement in conjunction with meditative attention to body sensations, including proprioception, interoception, and kinesthesis.” (3) What does that mean? More simply? “first, a meditative state of mind, usually involving a focus of awareness on the body; second, some form of prescribed (or sometimes spontaneous) movement; third, explicit attention to the breathing; and fourth, a state of deep relaxation.” (3)

Point being, MMT is quite different than going off to the gym and doing your typical strength training workout. That is why I said the person that wrote this post kinda missed the boat as they focused more on strength as a way of helping chronic low back pain. While strength training can play a role, if the issue is identified as this neuroplastic issue of the brain, then MMT practices like MIM are probably going to be MORE helpful.

My real goal here is to say that addressing chronic non-specific low back pain needs to be a comprehensive plan. If core stability is found to be lacking, then it should be placed into the program. If someone is not working out, then a training program that helps them not just exercise, but learn to move better, should created. If someone is willing to share that they have excessive stress, they should be educated on how this false alarm system works (education is important, but be careful how you communicate to people) and MIM should be included as well.

There rarely is ONE thing that will solve a complex issue like chronic low back pain. I don’t believe talking about a potentially helpful method in a negative way is helpful because many people with any sort of chronic condition are looking for that ONE thing that will take them out of pain. The reality is there is no such thing and why I recommend resources like Dr. Howard Schubiner’s book “Unlearn Your Pain” as well to help people learn why they may be having pain and have strategies to implement in their life that may help too.

If anyone ever tells you ONE thing will help one’s chronic pain become VERY skeptical and realize they may believe in what they are saying and may be offering a useful tool, but rarely is it JUST one thing! Check out some of our great Myofasical Integrated Movement drills with Cory Cripe below and you can find out more HERE

Find out more in our online corrective exercise programs that are 35% off this week with code “corrective” HERE

 

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References:

1. Park, Juyoung PhD, MSW; Krause-Parello, Cheryl A. PhD, RN, FAAN; Barnes, Chrisanne M. BSN, MSN. A Narrative Review of Movement-Based Mind-Body Interventions: Effects of Yoga, Tai Chi, and Qigong for Back Pain Patients. Holistic Nursing Practice 34(1):p 3-23, January/February 2020. | DOI: 10.1097/HNP.0000000000000360
2. Ting-Han Lin, Ka-Wai Tam, Yu-Ling Yang, Tsan-Hon Liou, Tzu-Herng Hsu, Chi-Lun Rau, Meditation-Based Therapy for Chronic Low Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Pain Medicine, Volume 23, Issue 10, October 2022, Pages 1800–1811, https://doi.org/10.1093/pm/pnac037
3. Payne P, Crane-Godreau MA. Meditative movement for depression and anxiety. Front Psychiatry. 2013 Jul 24;4:71. doi: 10.3389/fpsyt.2013.00071. PMID: 23898306; PMCID: PMC3721087.