Low Back Pain and Core Weakness: What’s the connection and which comes first?

It’s the classic argument of what comes first - the chicken or the egg, or in this case, the low back pain or the weak core? It has often been said among healthcare professionals that a weak core will lead to low back pain; however, this blog post is going to dive into the truth behind that statement and determine how core weakness and low back pain interact as well as what we as rehab professionals can do to help find the root cause in order to build a treatment plan off of that!

What does cause low back pain?

There are many factors that can contribute to low back pain, and oftentimes, it’s not as black and white as we may hope. There are instances where there is a very specific and apparent “cause” for low back pain - like a fracture, malignancy or infection, for example. However, for the majority of people who experience low back pain, the cause is often due to multi-factorial reasons and because of that, can be difficult to localize it down to one specific contributing factor. Some examples of multiple factors contributing to low back pain may be things like:

• Profession

• Activity level

• Socio-economic background

• Other lifestyle factors (such as smoking and obesity)

This can be frustrating for those who are currently experiencing low back pain to not have a solid answer as to what exactly is causing it. It’s human nature to want to know the issue and then move forward with solving the problem, but in this case, it’s not always that simple.

Does a weak core cause low back pain?

While it has often been thought that core weakness causes low back pain, research suggests that it’s actually the other way around. Simply having a weak core is not necessarily cause for low back pain, but low back pain can definitely contribute to core weakness!

Why does this matter?

As a physical therapist, our job is to determine the driver of low back pain and treat that. If we believe that a weak core is causing your low back pain, then the natural treatment plan would be to strengthen the core. But if core weakness isn’t what caused the low back pain, then strengthening the core may not help your symptoms!

The Importance of a Holistic Approach

The fact that it is MORE common for low back pain to be caused by more than one thing is exactly why a holistic approach (to any condition, really) is extremely important.

If we were to only focus on the low back during treatment for low back pain, then we may be missing some other contributing factors, such as posture, gait pattern, repetitive motions performed throughout their day, an old injury that may have caused some compensatory changes, just to name a few.

The point is, it is the physical therapist’s job to determine as many contributing factors as possible behind the low back pain issue and develop a treatment plan to address those factors. And this means that a holistic approach is absolutely necessary to finding those contributing factors.

Where does core strengthening fit into this?

We would be remiss if we were to ignore core strengthening just because we don’t believe that it is the “reason” for the low back pain, because we also know that low back pain often LEADS to core weakness.

Our core is at the very center of our being, and it’s foundational strength is crucial for being able enjoy movement. When low back pain begins to rear it’s ugly head, that often can lead to more sedentary choices, which in turn leads to generalized weakness, but particularly core muscle weakness.

In order to combat this, physical therapy will focus on core stabilization exercises and learning movement patterns that are tolerable and will benefit you long-term. While a complete PT/rehab program should have many different facets to it, core stabilization exercises should absolutely be included!

Foundational Core Stabilizing Exercises

To start off building a solid foundation with core stability, I recommend diaphragmatic breathing as your first activity. While simply breathing may sound like less of an activity and more of a sub-conscious response, this type of breathing is ultimately one of the best ways to reconnect your mind to your body, which is essential for regaining core strength.

To start with, try laying down with your knees bent. As you take a deep inhale, you want to focus on your rib cage expanding and your belly rising. A typical response to an inhalation is also for the pelvic floor to lengthen and relax, so you want to make sure you focus in on that happening as well! Remember, the pelvic floor is the base of your core and hugely important for core stability.

As you exhale, you want to allow the breath to naturally come out versus forcing it out. Once you’ve gotten the sequence down of inhaling while focusing on your pelvic floor and deep core relaxing as well as noting your rib cage expanding and belly rising, followed by a passive exhale, the next piece of this is adding in “bracing”.

Bracing is a term for gently contracting your deep core, and in this case, we want to coordinate it with your breathing pattern. Here’s how this would look:

• Breathe in, feel your pelvic floor lengthen and relax while your belly rises and your rib cages expands in all directions.

• As you breathe out and allow the air to naturally expel, you want to gently contract your pelvic floor and deep core pulling your pelvic floor up/shortening and gently drawing your belly button in towards your spine (without a forceful “sucking in”). Another way to think about contracting your deep core is to imagine you’re pulling your two hip bones closer together and wrapping up your lower abdomen.

• When you go to take another breath in, you want to make sure to return to relaxing your pelvic floor, deep core and start back over with your belly rising and rib cage expanding.

This will take some practice and focus! Remember, this is all about mind to body connection. You want to be really in-tune with what you’re feeling and what your muscles and breath are doing. Every piece of this should be done slowly and with control. There shouldn’t be any forceful sucking in or drawing in, no breath holding, and no forceful contractions or squeezing as hard as you can - gentle, gradual and controlled are what you are going for with diaphragmatic breathing with bracing!

When you’ve gotten this coordinated breathing and bracing activity down in a laying down position, you can then progress to sitting and then eventually standing!

After you’ve progressed through the different positions of diaphragmatic breathing and bracing, another great foundational core stabilizing exercise to try is referred to as a “Pallof Press”.

You will want to start off in a full kneel position, while holding a resistance band against your chest while it’s attached to the side. You will slowly push your arms forward into full extension and then back in to your chest. The goal is to remain in a neutral position with the rest of your body, not allowing the force of the band to rotate you or pull you to the side that the band is attached.

Make sure to focus on performing this motion slowly and with great control, ensuring that you keep breathing and engage your deep core and pelvic floor throughout the activity in order to maintain your neutral position. To make it a little harder, you can hold your arms in the extended position for a 5 count before pulling back in to your chest.

You can progress this activity to a half kneel position and then into standing, as pictured, to make the activity more difficult.

Standing - Pallof Press

Advanced Pelvic and Spine Physical Therapy

If low back pain is something you are looking for support and guidance with, we are here to help! If you are local to the Reno, Nevada area, and you’re looking for a holistic and individualized approach to your spinal concerns, make sure to book an appointment today or reach out with any questions.