Back pain: Pay attention to your posture and core strength
Core strength and stability is concerned with all the muscles that are found in, or attached to, the torso. Of course this includes the abdominals, but also involves muscles of the lower back, hips, pelvic floor and diaphragm.
The relationship of these muscles and how they work together is key to maintaining body stability. Weakness in these muscles causes poor posture and can lead to pain in the back, shoulders, hips or even lower limbs.
Executing 100 sit-ups a day won’t give you a solid core, but keeping all these muscles in good shape will help protect from injury during everyday movements, lifting or playing sports. Training your core muscles will also help you to have a smaller waist and a flatter stomach and may also mean the difference between requiring or avoiding surgery.
Weekend asked three health and medical experts for their opinion on the importance of core strength. All agreed that in terms of preventing injury and pain, a sedentary lifestyle and poor posture have a lot to answer for.
Matt Poulter, co-director at The Chiropractic Centre, Clifton
“Core stability has, in recent times, become a buzz word and, as such, it’s easy to think that strengthening it is a cure-all for everything. In my experience, however, lifestyle and the type of job you do are huge factors influencing health, wellbeing and posture. A less active lifestyle can lead to a weak or imbalanced core, but it also reduces joint flexibility and muscle strength.
“These problems can build up undetected over a period of years and then, suddenly, an innocuous incident such as emptying the dishwasher or brushing teeth can bring everything to a head and cause enough pain that you’ll seek advice.
“I’ve also looked after professional athletes and I couldn’t doubt their core strength, but sometimes they still develop problems if the musculature and skeletal systems aren’t balanced.
“Anybody who participates in sports or a fitness regime will benefit from a strong core. Even a sprinter with the strongest legs in the world will wobble all over the place without a strong core. Different sports require a different type of strength and core training, so it’s important to seek professional advice if you have specific aims.
“I always encourage my patients to supplement their core exercises with functional exercise, such as walking, swimming, running or mini-circuit training.
“Typically, patients with weak core strength will have visible postural changes: weak stomach muscles lead to poor balance and you’ll be more likely to experience lower back or hip pain. In an athlete, I’d expect to see a worsening of performance; speed and strength will tend to decrease.
“The muscles in your abdomen and lower back work together to maintain good posture. If there is a weakness or imbalance in either of these muscle groups, then the overall stability and natural positioning can change. This can result in your upper back and shoulders coming forward into a slouching posture.
“When the strength between your abdominals and lower back is not at an optimum level, the pelvis can be pulled forwards or backwards, resulting in a change in the natural curvature of the lower back. These changes to the vertebrae, discs and surrounding joints may lead to pain.”
Bristol-based consultant neurosurgeon Nitin Patel, specialises in back surgery
“Health of the spine is all about prevention and the idea of core stability is proven in many research papers. It allows good, strong movement and sporting activities without causing injures and it will reduce the risk of injury.
“Core exercises are absolutely vital for spinal health. The spine allows you to flex and move and supports body weight and it is designed to keep you balanced, but it is also prone to injury because of the load.
“There are two groups of muscles concerned with the spine. The superficial muscles move the spine in various directions, while the deep muscles, so-called core muscles, actually resist movement in a way because they prevent excessive movement in any direction. If the core is not strong enough, it’s that excessive movement that causes injury.
“Back pain is the commonest condition of the spine, not necessarily seen by surgeons, though we see a fair proportion, but most cases are seen by physios and other primary care therapists like osteopaths and chiropractors. These cases shouldn’t get to us because 90 per cent can be managed by those therapists.
“If a person has a sedate job sitting in the car all day, or in an office with poor posture – perhaps they are putting on weight and smoking – all of these things will eventually start causing degeneration of the spine.
“Posture is very important. People with poor posture will have uneven wear of their discs and joints. The curves of the spine are designed to influence good balance and if someone is sitting at a desk and their posture is too far forward because they have never adjusted their chair correctly and their head is slightly forward, eventually the discs in the neck will wear unevenly because of that pressure – and that’s due to muscles not being used properly.
“Core stability and general good posture is very important as part of rehab after an operation. It allows people to recover much more quickly from surgery and re-enforces their view about how important these things are.
“After surgery I tend to send my patients to physiotherapists or chiropractors – whoever knows that patient – usually about four weeks after surgery to regain their muscles strength.
“They will have lost a lot of strength preceeding surgery because of the pain. We can cure them of the pain with the operation, but they’ve lost core stability and postural stance and, when they are out of pain, those muscles have to be retrained. There is a lot of lost ground to cover.
“Each surgeon will have their own views as to when it is appropriate after an operation for patients to return to exercise and regain the muscles they have lost. I usually start people off after a couple of weeks going for walks, then, after a couple more weeks, I’ll get them exercising in a swimming pool, then they’ll go for physiotherapy.
“Everyone’s different and an athlete who’s running marathons and has had a disc prolapse would recover very quickly, but someone who smokes and sits at a desk all day long has probably never had core stability and it is a wake-up call for those people; they shouldn’t go back to their old habits.”
Former international swimmer, physiotherapist and multi-disciplinary sports scientist Penny Porter has a practice in Henbury
“Core strength is important for all activities: the body needs to work as a whole. Among the physical problems which can occur in the long term if the problem is not spotted and corrected are chronic back pain, knee problems, and also shoulder problems in swimmers and throwers.
“Many non-sporty people suffer from back pain due to poor core stability (office workers, for example). In sports people, we often identify more specific areas of weakness relating to reduced core stability, such as muscle imbalance.
“Runners, for example, often present with knee pain, and when I examine them, I often discover that they have been favouring one side in training and have reduced core strength that we need to address with specific rehabilitation exercises.
“I often see people who suffer from back pain because they only do sit-ups and exercises to train their abdominal muscles (in a bid to get a six-pack), which actually weakens their back and promotes poor posture, such as rounded shoulders. It is important that you also train the muscles in the back and bottom as well as the abdominal muscles.
“Many women suffer from poor core stability for several years after they have given birth, and people who are office-based and do very little physical activity also often have reduced core strength.
“Pilates is a great way to train the core and, if you have an injury, being assessed by an experienced physiotherapist can identify areas of weakness, and specific exercises can be prescribed to treat the problem.”
Case study – Rebekah Randell
Runner, solicitor and soon-to-be-qualified personal trainer Rebekah, 37, lives in Clifton and is a member of the Bristol & West Athletics Club. She took up running in her 30s and has represented England in cross-country races, pictured.
She was building up to a marathon when, in March 2013, she picked up an injury in her right knee. Following keyhole surgery, she spent a year trying to return to fitness, with help from physiotherapist Penny Porter, but a second (successful) operation was carried out two months ago.
Rebekah says: “I took up running shortly after I had my son, who’s now eight. I focussed on mileage; that was what I was taught as a distance runner. I haven’t done a marathon yet, I was building up to that when I was injured, when I was running twice a day, six days a week, with a minimum of 70 miles a week.
“I believe my lack of core work contributed to my injury. When you’re churning out that kind of mileage you don’t realise the subtle imbalances in your body. We all have them, whether you pronate (feet roll in) or supinate (feet roll out) or whether you favour one side over the other, and, over a period of time, injuries do occur.
“What I learned about myself is that I am very quad (thigh muscle) dominant, instead of relying on my glutes (buttocks), which are hard to activate. That put a lot of pressure on my back and, ultimately, my knee, so I’ve had to learn the hard way.
“I am now in the midst of recovery and I’m doing a lot of basic rehab and core work again, including aqua jogging – I swear by aqua jogging because it keeps you incredibly fit and you’re not weight-bearing.
“I’m also swimming and cycling. I work my whole body, which is important for muscle balance.
“A lot of people think that core work is doing 100 crunches very day, but it’s not about that. I used to do that, and I thought it was really important, but you aren’t targeting the inner muscles.
“Now, I do a lot of plank-based work, press-ups and lower back work over a Swiss ball. I also work my glutes and hip flexors because it all contributes to a good core. All these muscles need to be working together.”
If all goes to plan, Rebekah hopes to start running again from the beginning of May.
By Kate Edser – 27/03/15