by Ann Harman, D.O., L.M.T.
Core strengthening has become a common strategy for treating back pain in physical therapy and is emphasized in methods such as Pilates. Many people in the health care professions believe that lack of core strength is the causative factor for any low back pain which does not have an obvious cause (such as a herniated disc), and that strengthening core muscles is a universal solution.
However, there are a variety of problems with this concept. There is considerable research that does not support the basic concepts of core strengthening. Some research shows that core strengthening is no more effective than other exercise. And some recommendations that are often given to patients are in opposition to principles of efficient movement.
For example, in a sitting or standing position, look up at the ceiling with a relaxed belly. Now tighten your core and do the same movement. Which way is easier? To look up easily and efficiently, the abdominal muscles need to lengthen as the back extensors contract. Try the other ranges of motion: rotating the spine and side bending. Do these with a contracted core and then with a relaxed belly. Often, people suffering from low back pain are instructed to keep their core muscles contracted for stability; yet this interferes with most everyday movements.
Nonetheless, core strengthening often relieves low back pain, although perhaps for reasons other than the generally accepted ones. It is a popular approach because it often works. Yet, sometimes it aggravates the pain. I worked with a gentleman who came to my office complaining of low back pain who said, “I have back pain because my abdominals are weak and I’m doing eighty crunches a day and it still hurts.” His psoas muscles were extremely hypertonic, and the crunches were aggravating the hyper-contraction of the psoas. Treatment of the psoas relieved the pain.
People who work with core strength sometimes develop a habitual co-contraction of the abdominal flexors and back extensors. Co-contraction is when opposing muscle groups contract together, instead of the antagonist relaxing as a muscle contracts. (Example: normally the triceps relaxes while the biceps tightens. In co-contraction, they would both tighten at the same time). There are times when co-contraction is useful; for example while picking up a heavy object co-contraction of abdominal and extensor muscles simultaneously can protect the low back against injury. However, habitual co-contraction outside of conscious control can lead to low back pain and reduced efficiency in movement.
As massage therapists we deal with clients with low back pain, who are frequently misinformed and often confused about these matters, it is important to be able to talk intelligently about the anatomy and physiology of low back pain. It is also important to know hands-on strategies for dealing with hypertonic psoas and co-contraction of flexors and extensors when people present with these problems.
In “Explorations in Movement-Based Bodywork: Understanding Core Strength” we will explore these controversies in greater depth. We will do movement explorations based in the Feldenkrais Method© of movement education that develop a multidimensional core strength, as well as organizing the muscles to discourage habitual co-contraction. We will also explore organic core strengthening from the “Continuum” Method developed by the late Emilie Conrad. We will learn hands-on techniques to address hypertonicity of the psoas and co-contraction.
Those who wish to read further about these controversies can read The Myth of Core Stability by Eyal Lederman, D.O.
