The Best Core Exercises for Back Pain

“What are the best core exercises for Back Pain?”

This is a common question Physiotherapists get asked, but before we go on and explain some of the best exercises to help fix your back pain, let’s get a bit of background behind back pain.

Firstly, it’s important to see a Physiotherapist to help determine the source and cause of your back pain. Your Physiotherapist will then use appropriate manual treatment techniques to assist in resolving your symptoms. You are then very likely to be prescribed exercises to help strengthen your back, and your core muscles to return to complete and optimal function. 

It is important you go through this process to make sure you are performing the correct exercises for your back pain. Each person will have a very different injury, even if a friend or family member describes similar aches and pains to yours. Therefore, exercises that one person completes, may not necessarily be appropriate for you! It is also important to know that the advice and exercises your physiotherapist prescribes for you have years of science and training behind why they have been recommended to you. Google can be a great source of information, but not always specific to your needs. One person’s back injury is different to another and therefore not all the same exercises are prescribed to both people. Your expertly trained physiotherapist will also be able to determine the severity of your back injury prior to making any recommendations. 

Secondly, at Instinct Health, we want to ensure you know exactly what is going on with your back, and your core muscles, and therefore we will teach you all the relevant information for you. The “core” itself is made up of small stabilising muscles that can contract together to provide support and stability for our backs and pelvis.

The main muscles that contribute to our core are:

– Transverse abdominis

– Pelvic floor muscles

– Thoracic diaphragm

– Multifidis

Two terms that are commonly used are “core stability” and “core strength”. There is a difference between the two and it is important to know the role of each.  

Core stability refers to the structure of the muscles listed above, and activating these muscles in a slow and controlled manner. The goal of core stability is to build endurance of these muscles in order to prevent injury to our backs, or other parts of the body. In order to build a stable core, we must become aware of our body’s position so that we can activate these muscles in the correct position. For example, for someone who gets low back pain after standing for long periods of time may arch their back. For this person, we would want to train them to first feel what that arching feels like, and secondly, active their core muscles in this position. This ensures that their exercise is both specific and functional for them. Once we can consciously activate these muscles, we can then start to build core strength.

Core strength is what begins to occur after we have built the foundation of good body awareness and core stability. Core strength is typically what we perceive as the “harder” or “faster” exercises. Generally speaking, our repetitions and sets will change to a classic strength dose of 3-4 sets of 8-12 repetitions. At this stage we can also begin to add resistance in the form of weights, or bands. For example, an athlete who has experienced back pain needs to develop power and strength on top of a stable core. If we compared this to a sedentary desk worker, their individual exercises would be vastly different. An athlete might need to complete sit ups, crunches and planks, whereas the desk-worker may need to complete slower exercises with higher repetitions.

So what are the best core exercises for back pain?

Exercises that help train both correct body positioning whilst activating our smaller, stabilising muscles are the best. These are usually Pilates-style exercises that focus on slow muscle activation in order to build stability & endurance before anything too heavy. 

Here are some of our favourite exercises for core stability and back pain from our Instinct Health team.

1. Crook lie leg lifts

Lie on your back with your knees bent and feet flat on the floor. Ensure your knees and feet remain hips width apart. Take a deep breath in, allowing your belly to rise. As you exhale, gently tighten your abdominal and pelvic floor muscles. Maintaining this contraction in your muscles, bring one knee in to tabletop position (hip at 90?, knee at 90?), then lower it down onto the floor. Repeat this movement with your other leg alternating back and forth, ensuring you do not lose the contraction in your abdominal and pelvic floor muscles.

1a. Leg lift and lower (progression from exercise 1)

A progression for this exercise is to take the leg from a tabletop position, extend the leg out so that both thighs are parallel. Bring the leg back into tabletop, then return your foot to the floor. Repeat with the opposite leg. Make sure as you complete this exercise not to lose the contraction of your abdominal muscles, and ensure you keep breathing throughout. 

2. 4 point kneel leg lift

Start on your hands and knees, with your hands under your shoulders, and knees under your hips. Make sure your back has only its natural curves, rather than completely flat. Gently squeeze your abdominal muscles and your pelvic floor. Without moving your back, squeeze your glute muscle and extend one leg directly behind you, as if you are sliding your big toe along the floor. Pause with the leg extended for 1 second, then slide the foot back to its starting position. Repeat with the opposite limb.  

2a. Bird dog (progression from exercise 2)

Once you have achieved leg lifts in isolation, you can begin to add in upper limb movement to destabilise your body and therefore add challenge to your balance. Starting in the same position as above, without moving your back, slowly lift one arm out in front, and the opposite leg out behind you. Pause with arm and leg extended, then return to the floor. Repeat with the opposite arm and leg. Make sure you continue to breathe throughout and maintain that gentle squeeze of both pelvic floor and abdominal muscles.

Functional exercises: 

Once the exercises above can be performed both safely and with correct technique, we can begin on more challenging and more functional exercises. 

1. Dead bug

Start in the same position as your leg lift and lower – both legs in tabletop and both arms pointed up towards the roof. As you exhale, gentle tighten your abdominals and pelvic floor muscles. While holding this contraction, extend your right arm overhead towards the floor. At the same time, extend your left knee and lower the heel towards the floor. Make sure your lower back does not arch away from the floor. Pause, then inhale and return both to their starting position. Repeat on the other side. 

2. Arabesque

This exercise is a great exercise to challenge your stability in a standing position. Stand on one foot with a slightly bent knee. Using your core muscles to hold you, extend both arms out to the sides (like an aeroplane) and slowly bend forwards from the hips. Exhale, and stretch the non-standing leg backwards in a straight line. Make sure you don’t arch your back as you extend the leg. Inhale, and return to a standing upright position. Complete 8-10 repetitions each leg and then swap legs. 

During each and every Pilates consultation, or Clinical Pilates class, our physiotherapists will make sure that you have a good understanding of the basics of any core exercise. From there, we will challenge you to make the exercises both entertaining and functional. These exercises can then be transferred on to a gym or equipment at home!

If you are experiencing any pain, or you have an existing injury, please consult one of our physiotherapists at Instinct Health to make sure you are doing the right things for your own body.

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