The musculoskeletal core is made up of the spine, pelvis, hips and abdominal structure. It is responsible for the maintenance of stability of the spine and pelvis, helps the transfer of energy and force from large to small body parts during activity and provides a solid base for our arms and legs to work from
If our core is weak then joints and tissues will be stressed in a way they are not familiar with, or not designed to cope with. This is one of the ways by which back pain can arise. Equally, if the core is weak and unable to control/ withstand the forces that you impose on it, then other muscles, joints, connective tissues will be forced to compensate, and inevitably be overworked, which can lead to a wide variety of injuries and dysfunctions as well.
The easiest way to describe the core is to explain its function in relation to its design. Some authors have described it as the ‘abdominal box’. Our abdominals act as the front (our 6 pack muscles) while our paraspinals (muscles that run either side of the spine) and gluteals (bum muscles) act as the back sides of the box. The diaphragm acts as the roof and the pelvic floor as the base. An integral part of the core is a muscle called the transverses abdominis (TVA); it wraps around the abdomen and lies underneath our internal obliques. It is a deep muscle laying 4 lays deep in our abdominal tissue acting as a natural corset and makes up the sides of our ‘abdominal box’.4
Picture from reference 6
Closely related to the TVA is the thoracolumbular fascia. This is an expanse of tissue incorporated into the maze of core muscular attachments. It acts as ‘natures back belt’ and plays a big role in core stabilisation. The TVA has large attachments to the middle and posterior portions of the thoracolumbular fascia creating a stability blanket across the entire midriff.5
This concept is easier to understand when relating it to securing a tent against the wind. The tent itself (thoracolumbular fascia) is held up by the centre pole (spine); without the support and tension provided by the guy ropes (abdominal musculature) the centre pole bares the full weight of the tent putting it under stress (back pain). In this state the tent is vulnerable to being blown over (becoming injured). When the guy ropes are pulled tight (core contracts and stabilises) the tent (thoracolumbular fascia) is pulled tight, giving the centre pole (the spine) even, bilateral stability and integrity against the elements (activity).
Rehabilitation, the Core and Back Pain
Over the past few decades, exercise has been promoted with increasing enthusiasm for a treatment for back pain.1 As a result of this, systemic reviews have concluded that exercise based rehabilitation can be beneficial for patients with chronic low back pain allowing them to return to normal activities and work.2 In most cases, exercise does not increase the risk of back pain or sciatica, nor does it encourage further damage or pain to an already existing problem.1
With this said, attention is directed at off-loading the area of pain and stabilising the spine with aims to tackle the dysfunction at its root to prevent it causing further malfunction and pain. If however a spinal restriction is causing the problem, then our aims are to release the restriction and use exercise rehabilitation to mobilise and strengthen the area to prevent re-occurrences.
The explanation above is merely touching the surface of a very large subject matter. New research is constantly being completed and old theories updated.
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- Finno M, Hartigan C, Jouve C, et al. Exercise as a Treatment for Chronic Low Back Pain. The Spine Journal. 2004: 4; 106-115.
- Esmail R, Koes B, Malmiyaara A and Van Tulder M. Exercise Therapy for Low Back Pain. A Systematic Review within the Framework of the Cochrane Collaboration Back Review Group. Spine. 2000: 25; 2784–2796.
- Kibler WB, Press J and Sciascia A. The Role of Core Stability in Athletic Function. Sports Med. 2006: 36; 189-198.
- Nadler DO, Scott F, Venu Akuthota MD. Core Strength. Arch Phys Med Rehabil. 2004: 85; S86-92.
- DeRosa C, Porterfield JA. Mechanical Low Back Pain: Perspectives in Functional Anatomy. 2nd ed. Philadelphia: WB Saunders; 1998.
- Image from (http://www.nzihf.co.nz/media-resources-1/articles/core-training-as-a-personal-trainer-where-do-i-start) 7/12/2010.