If you have made it to this page it’s because we have asked you to, or, you are interested in spinal rehabilitation and core stability.
You can, of course, leave the care of your back entirely in our hands, however, it’ll take longer to get better and you may also feel that you’ve abandoned control of the problem. Far better, we believe, is that we all get it working well and then let you keep it that way. This is why Spinal Rehabilitation and improving your core stability is so important.
Rehab is an essential part of your recovery process. By strengthening, and more importantly, developing stability in your back, rehab helps prevent reoccurrence of your problem. Rehab involves specific exercises for your condition. These should be tailored to your own unique problem and may be shown to you by one of our practitioners (this is an area that our Sports Injury Therapists are all really strong on). However, the most important part of Spinal Rehabilitation is improving your core stability and this is covered here:
Now, we’ll admit that a vast amount of rubbish is spouted about core stability, especially by those poorly trained blokes you sometimes meet in gyms. For many of them the terms ‘core function’, ‘core strength’, and ‘core stability’ have simply become chants delivered with no real understanding of what the words really mean. However, you will, every now and then, bump into one of them who has a profound understanding of these concepts and, if this is the case, ‘bind them to you with hoops of steel’.
In our opinion the guru on core stability is man called Prof Stuart McGill. His lectures we’ve attended and books we’ve devoured, and we would argue that he is the leading researcher in the world on back stability. To give you a feel for what you are up against he talks about the following:
The unstable spine
To give you an idea of why injuries occur whilst doing what seem to be easy tasks, such as bending over to shave or picking up the kids, Prof McGill uses the concept of an unstable spine. Bending over puts a relatively massive load through your low-back, a bit like like lifting a plank up by the thin end. His spectacular, and spectacularly painful, research shows that these daily tasks can cause your spine to ‘buckle’ if your spine isn’t working well or is unstable. This buckling causes joint injury, tissue irritation and loads of pain. What causes this to happen is a momentary dip in neural activation of some of the deep intervetebral muscles, leading to a slight uncontrolled rotation in one of the loaded spinal segments. His solution to this is to train the deep muscles to “stiffen the spine against buckling” and improve its stability leading to a stable spine, like this:
The stable spine
All your bones in your spine have to be able to move and they are brilliantly made to keep you upright as well as move about. They all have an inherent ‘joint stiffness’ because of the way they are designed, their joint capsules and their surrounding ligaments. Additionally, local muscles are able to control stability of these joints by coordinated muscle co-activation. So, for us at C1, what we have to do is take your spine from the unstable to the stable point.
Pleasingly, the task of creating a stable spine is testing but we are rarely working with nothing. The goal is to deliver ‘sufficient stability’ and mobility with no compromise to the spine. This can be done with exercises that develop this co-activation of the deep intrinsic spinal muscles and the abdominal wall muscles.
What are the main lumbar spine stabilizers? Well, Prof McGill used deep intramuscular electrodes (long thin needles stuck into the deep muscles – told you it was painful, but he did do it on himself) to identify the functional roles of these significant spinal stabilizer muscles. He also produced some mathematical models of spinal muscular activity and some amazing computer models to find out how these key muscles worked.
He suggests that the important intrinsic muscles of the spine include the Multifidus, Quadradus lumborum, Longissimus, iliocostalis and the Transverse abdominus (I’d suggest Google for this lot if you really want to know where they are). But, you’ll see that there are some surprises for the gym staff in this list as there is no mention of your Rectus abdominis, so, as we suspected all along, the six-pack may only be for decoration.
The low back training program
From Prof McGill’s research on low-back stability, the data suggest that the healthiest training for the spinal flexors involves muscular endurance not strength training. He adds:
“The safest and mechanically most justifiable approach to enhancing lumbar stability through exercise entails a philosophical approach consistent with endurance, not strength; that ensures a neutral spine posture when under load (or more specifically avoids end range positions) and that encourages abdominal muscle co-contraction and bracing in a functional way.”
Bracing can be understood as if the muscles are guy ropes for your spine that’s acting as a tent pole. It is a ‘neurophysiological phenomenon’ involving co-contraction of the abdominal wall and deep intrinsic muscles of the spine in an effort to better stabilize the low back.
Finally, the core exercise bit itself:
Start with: The Cat and Camel Exercise – a flexion-extension warm-up
Always start with about five or six flexion-extension cycles of the “cat-camel” exercise. These are important and you must do these as a mobility exercise to reduce any present stresses on the spine, not as a stretch, and to get the right neuromuscular pathways firing. These are shown here on this YouTube link:
or also in pictures on:
Canadian Government cat and camel web site (or psychosocial back exercises, no less) (and you can see the Prof’s fingerprints all over this one.)
Then, start the Plank – the core stability exercise itself:
So, do the cat and camel and then the plank. You should do the plank to the point that you start shuddering (which is a neurological control issue rather than a fatigue problem) or until you reach the 20 second point and rest for a bit and then do it again, and again (so three times in all) and slide some Cat and Camels in between each set
The next time try to increase the time you are in the plank position. Repeat this exercise till you can crack 30 seconds. You can do these exercises as often as you like but try to get in twice a day.
- Quadratus lumborum training
- Back extensor training
- Rectus abdominis, Obliques, and Transverse abdominis training
For Quadratus lumborum training he recommends the horizontal isometric side bridge (stick that in Google images and you’ll see what we mean or follow the link above) which can be done from a knee supporting position on the floor or a more testing version which utilizes a feet supported version. Another advanced version, the rolling side bridge, involves the maximal involvement of the Quadratus lumborum and obliques with co-contraction of the critical spine muscles and Transverse abdominis.
Front lying (prone) upper torso (or leg) lifts off the floor may not be wise for people with low-back pain as these may place too much load on the spine. In this exercise the lumbar spine pays a very high compression penalty for a hyperextended spine (approximately 4000 to 6000 N) which transfers load to the facet joints and crushes the interspinous ligament. This exercise is certainly contraindicated for anyone at risk of low-back injury or re-injury due to the high spine loads and the extended posture. In my opinion it should not be prescribed at all.
Prof McGill states that there is no single abdominal exercise that effectively challenges all of the abdominal musculature. He recommends several versions of crunches for the rectus abdominis and obliques. Pleasingly, he suggests avoiding sit-ups (with bent or straight legs) due to the high psoas muscles activation and the compressive loads this causes in the low-back. Similarly, leg raises also cause a great deal of psoas muscles activation and lumbar spine compression.
There you go, and good luck!
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