If you are among the estimated 50% of all athletes who experience recurrent low back pain, don’t stress, there are exercises that can help…and a couple you should probably avoid.
Our ‘core’ is the link between our upper and lower bodies, and mastery of control here is the secret to improved strength, running efficiency, faster speed, and overall health and athleticism. In regards to back pain, our core needs to be solid to not only support a stable spine but provide for proper biomechanics when running, throwing, squatting, swimming, and even just walking.
From an anatomical perspective, our core is made up of the rectus abdominis, transversus abdominis, internal and external obliques, quadratus lumborum, glutes, and internally, the diaphragm and pelvic floor muscle. The goal of these muscles is not only to be strong but to provide a stable platform for our spine through any and all movements. Stability here has a dramatic impact on injury risk and should be a focal point in any sport and health training plan.
Lets use the example of a runner as the majority of our patient population are runners and almost every sport requires it. A strong core, one with ample endurance, allows for proper movement through our hips, legs, and upper body without excess expenditure of energy. If we are weak here, the late stages of a long run or race become challenging injury risk increase. As the core fatigues, the hips begin to dip, causing extension through the low back, excessive strain on the hamstrings, inward rotation of the femur causing excessive rotation of the tibia that can lead to excessive strain of the ligaments of the knee. This can travel down the chain and lead to poor pronation control causing shin splints, Achilles strains and plantar foot pain…you see where we are going here. Simply put, the core needs to function properly, or the whole system fails.
Most people understand parts of this and that core strength is important, but we still find people who lie on the floor, knock out 100 crunches, call it a day and then wonder why their low back hurts the next day. For this reason, I do not recommend sit-ups or crunches. These two exercises cause undue strain on the low back through repetitive flexion that stresses the discs, joints, and muscles of the lumbar spine.
While many finds these exercises easy to perform, and a staple in their routine, I want to introduce you to a more effective core routine. One that focuses on proper back support and overall functionality as an athlete, regardless of sport. These 3 exercises, termed ‘The Big 3’ were developed by Prof. Stuart McGill, rigorously studied, and proven to protect your back and improve core endurance.
The big 3 are made up of the Modified Curl-Up, Bird Dog, and Side Bridge.
1. Modified Curl-Up
Lying on your back, place one leg flat on the floor with the other bent. This position allows for a neutral pelvis during the movement and puts your core muscles in control of the movement without undue strain on the low back. Place your hands under the small of your low back to ensure a normal arch is maintained during the movement. Begin by bearing down to brace your abdomen, continue a normal breathing pattern throughout. If you have difficulty maintaining the brace while breathing, this is where you start. Now, pretend your neck, upper back, and low back are locked together and cannot move independent of one another (straight line from head to pelvis), slowly, lift your shoulders blades off the floor and return to the floor in a smooth pattern, only coming off the ground a couple inches. Take note of your posture, did your chin stick out, did your shoulders round forward from memories of doing endless crunches? Work through 2–3 sets of 10–15, slow and controlled.
2. Bird Dog
Begin in a quadruped position with hands under shoulders and knees under hips, both about shoulder-width apart. Brace your abdominals while maintaining a neutral (straight) spine. While maintaining this posture, breath in and out, squeeze your glutes and begin moving your right arm up to a point position while also bringing your left leg to a straight position. Our goal here is to avoid rotation through the spine, maintain our posture and keeping the hips in line. Slowly return to the starting position and then perform with the opposite arm and leg. That is one repetition, perform 3 sets 10–15.
3. Side Bridge
Lying on your side, prop yourself up on your elbow, hinge at the hips, and stack your knees on top of each other with a 90 degree bend. Maintaining a solid shoulder directly over the elbow on the ground, lift your hips up and push them forward, bringing your spine to a neutral position. Hold for a 5 count and then slowly return to the starting position. Be aware of head posture and hip extension, maintain a straight line from the head to the pelvis. Perform 3 sets of 10–15 on each side, holding each for a 5 count at the top.
Obviously, there are numerous other exercises that provide stability for the spine while strengthening the core, this is just a starting point. Focus and repetition will bring proficiency, and proficiency will bring improved performance! If you have any questions, please ask, I’m happy to answer what I can.
Until next time, train hard, train smart, and recover well.
Source: McGill, S. (2002). Low Back Disorders: Evidence Based Prevention and Rehabilitation. (2nd Ed).
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.