Core stabilization is the concept of learning how to contract key spinal stabilization muscles, prior to various functional activities, as a means to control spinal movement. In the low back, key muscles located deep in the abdominal and lumbar regions have the function of contracting ‘prior’ to movement, helping stabilize the spine. They act in anticipation of movement, with the understanding that your brain knows you are going to perform an activity even if you are not consciously thinking about the task, and these muscles ‘fire’ in anticipation for this movement. The deep abdominal muscle is called the ‘transverse abdominis’, while the low back muscle is named the ‘multifidus’.
Research has identified an inhibition of these core muscles with low back pain, and they continue to be dysfunctional even long after the back pain episode goes away. Approximately 80% of low back pain resolves without intervention, but it is well-known that back pain ‘comes and goes’, with the next episode sometimes more painful than the one prior. The inhibition of these muscles is one thought as to why back pain has that tendency to recur over time. After the initial back pain episode, the lumbar spine is lacking the normal stabilization which should occur with activities, and an increased chance for injury is present.
Along with the inhibition of the deep core stabilizers, the large muscles of the low back region tend to be over-active and ‘guard’ the low back as a way to protect the low back during painful episodes. These larger muscles are not meant to be active all the time, but rather only being active when the body is challenged in positions which require their activity. Their over-activity puts adverse stress on the spine and can also become a source of low back pain chronically.
Physical therapy can help assist patients with acute and chronic low back pain, with a treatment plan that includes spinal stabilization. Treatment is geared towards relearning how to relax the large muscles of the low back region, while isolating the deep core musculature, which is how the body normally functions. As the patient progresses with decreased pain and improved function, progression exercises continue to challenge the lumbar spine in challenging positions while maintaining spinal stabilization. The exercises are individually prescribed, depending on the activity level and goals of each patient. This stabilization program is designed to help patient’s get back to their normal activity level, while also helping prevent future recurrence of back pain episodes.
Low back pain is common in our population, and recurrence of pain is one of the main reasons patients are functionally limited long-term. The physical therapist is trained to evaluate and diagnosis patients with acute and chronic low back pain, and are able to design a treatment plan for managing their pain, which may include core stabilization. Specific retraining of core musculature has been shown to be effective in improving back pain and patient’s function, and physical therapists understand how to isolate this deep musculature as a way to retrain normal movement patterns and help decrease and manage patients with low back pain.