Understanding Core Strength Versus Core Stability for Back Pain Relief

Have you ever tried a series of core strength exercises, such as planks and sit-ups, in response to advice that your back pain is due to a weak core? And did you find that this approach did not entirely resolve your issues? If you’re here reading this, it’s likely the case.

Let’s delve into why this approach may not be the most effective for mitigating your back pain and explore an alternative solution.

Before we delve deeper, let’s clearly define ‘strength’. In essence, it refers to the ability to generate force to overcome resistance. So, if you’re experiencing lower back pain, your brain is essentially signaling that something’s not right in that area. When you perform core strength exercises, you’re effectively boosting your muscles’ capacity to apply force onto those areas in your lower back that are already in distress and signalling for attention.

Does this reasoning make sense?

I want to clarify that I’m not undermining the importance of strength in alleviating pain and maintaining an active lifestyle. However, I firmly believe that strength represents the apex of the pyramid, not its base. To make strength effective, you need to have good mobility, which is the capacity of your joints and muscles to move through an appropriate range of motion, and stability, which is coordinating adequate muscle contractions to prevent unnecessary motion. When we relate this to the core, it’s about the ability to prevent unwanted spinal motion as we move our bodies, thereby reducing the abnormal force exerted on your lower back while moving. Skipping these foundational stages could lead to overuse of strength when it’s not required, resulting in a lack of movement, persistent stiffness, and even pain from unnecessary abdominal bracing. Here’s a little experiment for you: stand up, place your hands on the back of your head, relax your muscles and rotate your torso as far as possible to the left and right. Remember how it felt. Now, return to your initial position, tighten your abdominals as hard as you can, and try to rotate again. Which technique felt easier? The first one, correct? So, why would we condition our core to maintain this rigid stance?

Considering these demonstrations, which approach seems more rational for reducing the strain on the structures in your lower back?

Dr Stuart Mcgill, a highly respected figure in the field of back pain rehabilitation, asserted that back pain is a result of activities that induce stress in the body, such as unnecessary lower back motion. He also stated, “you don’t train to get strong, you train to adapt”, suggesting that our emphasis should not be on strength training, but rather on eliminating the factors that stress the lower back. Paul Hodges, another esteemed researcher, supports this theory with extensive research indicating that “motor control exercises should aim at increasing admittance, inhibiting superficial muscles and stimulating deep muscles, training of proprioception, or instilling confidence in the ability to control lumbar motion.” Simply put, extensive contractions from our superficial muscles (or strength) are not effective in reducing force in our lower back. Rather, motor control or stability exercises should be promoted more to regain control of unwanted motion at the lower back and alleviate strain on the painful region.

In conclusion, we need to debunk the common misconception that core power is the ultimate solution to alleviate and prevent lower back pain. We should instead focus on promoting core stability training to both prevent and cure lower back pain.