The term "core stability" is a common phrase for anyone who has ever had a low back injury or who is involved in gym programs. In the past few years it has become increasingly well known that strengthening the core muscles will help with stabilizing the lumbar spine, therefore playing an important rehabilitative role. Athletes are also realizing the importance of this as having a strong core allows for better function and overall improvement in performance.

As common as this phrase is, the interpretation of this is often ambiguous. The understanding is that this refers to your abdominal muscles. When asked many people report that they are religiously working on "core exercises." There is frustration when these same people continue to experience low back or pelvis pain. It is true that the term core does refer to those muscles that support and stabilize the spine. In fact, when performed correctly the result is increased stabilization, less excessive movement, and therefore less pain of the lumbar spine and pelvis.

What most people do not understand is that there are multiple abdominal muscles; some that function as true "core" muscles and play a major role in stabilizing the spine, while others are instead the "mover" muscles of abdomen. The abdominal muscles that are commonly trained and thought to be the stabilizing muscles are in fact the "mover" muscles of the body, these being the rectus abdominus (six- pack muscle), and the obliques. The rectus abdominal muscles are used in crunch style exercises, while the obliques work to rotate the trunk of the body.

There are two important stabilizing muscles of the lumbar spine and pelvis. They are transverse abdominals (TA) and multifidus. These muscles sit deep in the body, close to the spine. This makes sense as there proximity to the spine decreases there lever arm, in other words they are not able to move the body, as in a crunch exercise, but instead when contracted work to prevent movement between the vertebrae. The transverse muscle is located in the lower abdominal area and runs horizontally, with attachments to multiple areas of the abdomen and lower back so that recruitment of this muscle works as a corset to stabilize the spine. The multifidus muscle group is a large muscle that lies parallel along the spine in the back, deep to the skin. They run between vertebrae and when contracted control movement of these segments. The ability to recruit these muscles properly must be assessed before the addition of other abdominal exercises. If an individual cannot recruit the transverse abdominus and multifidus then they may be doing more harm than good in continuing with exercises aimed at strengthening the rectus abdominal and oblique muscles.

Cueing of these muscles is important. It may not be enough to say "pull your belly button towards your spine" and assume that the individual will be doing this correctly. This must be assessed and often cued as this is difficult to do as it is often an underused muscle. Many people who think that they are recruiting the transverse muscle are in fact engaging the other abdominal muscles, meaning that they are not effectively stabilizing the lumbar spine. Multifidus training is something that many people are not familiar with, and proper instruction of this muscle recruitment is necessary as if done incorrectly can also result in aggravation of symptoms, but when done well plays a large role in stabilizing the spine therefore decreasing pain.

If you are someone who has been diligently working on your "core exercises" and are frustrated due to the lack of improvement, or if you realize that you have not been training your true stabilizing muscles then you are someone who will benefit from a physiotherapy assessment. During a physiotherapy session your ability to recruit these muscles will be assessed and you will be taught how to correctly perform these important muscles that play such a large role in stabilization, and therefore rehabilitation, of the lumbar spine and pelvis.

The term "core stability" is a common phrase for anyone who has ever had a low back injury or who is involved in gym programs. In the past few years it has become increasingly more well known that strengthening the core muscles will help with stabilizing the lumbar spine, therefore playing an important rehabilition role. Athletes are realizing the importance of this as having a strong core allows for better function and overall improvement in performance.

As common as this phrase is, the interpretation of this is often ambiguous. The understanding is that this refers to your abdominal muscles. When asked many people report that they are religiously working on core exercises. There is frustration when these people continue to experience low back or pelvis pain. It is true that the term core does refer to those muscles that support and stabilize the spine. In fact, when performed correctly the result is increased stabilization, less excessive movement, and therefore less pain of the lumbar spine and pelvis.

What most people do not understand is that there are multiple abdominal muscles, some that function as true "core" muscles and play a large role in stabilizing the spine, while others are the "mover" muscles of abdomen. The abdominal muscles that are commonly trained and thought to be the stabilizing muscles are in fact the "mover" muscles of the body, these being the rectus abdominus (six- pack muscle), and the obliques. The rectus abdominal muscles are used in crunch style exercises, while the obliques work to rotate the trunk of the body.

There are two important stabilizing muscles of the lumbar spine and pelvis. They are transverse abdominals (TA) and multifidus. These muscles sit deep in the body, close to the spine. This makes sense as there proximity to the spine decreases there lever arm, in other words they are not able to move the body, as in a crunch exercise, but instead when contracted work to prevent movement between the vertebrae. The transverse muscle is place located in the lower abdominal area and runs horizontally, with attachments to multiple areas of the abdomen so that recruitment of this muscle works as a corset to stabilize the spine. The multifidus muscle group are large muscles that are place in the back, very close to the spine. They run between vertebrae and when contracted control movement of these segments. The ability to recruit these muscles properly must be assessed before the addition of other abdominal exercises. If an individual cannot turn the transverse abdominus and multifidus muscles on, then they are doing more harm than good in continuing with other exercises aimed at strengthening the rectus abdominal and oblique muscles.

Cueing of these muscles is important. It is not enough to say "pull your belly button towards your spine" and assume that the individual is doing this correctly. This must be assessed and cued as this is often difficult to do as it is all too often an underused muscle. Many people who think that they are recruiting the transverse muscle are in fact engaging the other abdominal muscles, meaning that they are not effectively stabilizing the lumbar spine. Multifidus training is something that many people are not familiar with, and proper instruction of this muscle recruitment is necessary as if done incorrectly can also result in aggravation of symptoms, but when done well plays a large role in stabilizing the spine therefore decreasing pain.

If you are someone who has been diligently working on your "core exercises" and are frustrated due to the lack of improvement, or if you realize that you have not been training your true stabilizing muscles then you are someone who will benefit from physiotherapy. During a physiotherapy session your ability to recruit these muscles will be assessed and you will be taught how to correctly perform these important muscles that play such a large role in stabilization, and therefore rehabilitation, of the lumbar spine and pelvis.

Sharina Zantingh

BScPT RCAMT