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Your spine gives support to your entire body and assists in all kinds of movements while protecting your spinal cord. Your spine needs to be firm and strong to support your body weight and flexible enough to allow the upper and lower limbs to move freely.

Understanding your spine:

Your spinal column has 34 bones which are called vertebrae. These vertebrae are divided into four groups – 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused bones that make up the sacrum and the remaining fused bones to form the coccyx.

The cervical vertebrae support your skull and allow the neck to move in different directions. It is the most mobile segment of the spine.

The thoracic vertebrae make your midback, and they join the ribs on each side, thus protecting your heart, liver and lungs. During inhalation, the thoracic extends slightly, and during exhalation, it flexes. Rotation also occurs in the thoracic spine.

The lumbar vertebrae bear most of the body weight and act as a flexible joint between the upper and lower body.

The sacrum, which is a fusion of five vertebrae, is different in men and women. Men have longer and narrower sacrums, while women have wider sacrum to support childbirth. The sacrum connects to the coccygeal vertebrae through a joint called sacrococcygeal symphysis. Coccygeal vertebrae together form the tail bone.

Few facts about back pain:

1.     Worldwide back pain is one of the leading causative factors of disability that keeps people away from their everyday activities (Hoy D et al., 2014).

2.   According to experts, 80% of the population experience back pain at some time in their entire life span (Rubin DI, 2007).

3.     After skin disorders and joint disorders, back pain is the third most common reason for hospital visits (Sauver, JL et al.,2018).

4.     Most of the back pain is caused by mechanical reasons, which means they are not caused by infections, arthritis, fractures or cancer (Hartvigsen J et al.,2018).

Back pain and core muscles – The relationship

You must have heard that if you have back pain, you should strengthen your core. Most people think of the six-pack area or the abdominals when they hear the word ‘Core’. However, there is more to it. Your core consists of:

a.    Muscles of the front of the abdomen – Rectus abdominis.

b.     Muscles present at the side of the body – Internal and external obliques.

c.      Deep abdominal muscle of the front – transverse abdominis.

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d.     Small muscles present in your back between the vertebrae which run throughout your spine – erector spinae and multifidi.

e.      Diaphragm

f.      Muscles of the pelvic floor

g.     Hip flexors and gluteal muscles

So, when your core muscles are weak, your body relies on the passive structures like ligaments, spinal bones and discs for their stability which causes pain. One study found that core strengthening exercises reduce pain for short and intermediate-term more than general exercises (Elbayomy, Mahmoud., 2019).

A weak core may be one of the reasons for back pain, but it is not the only one. Here are some of the other reasons why you may have low back pain:

a.      Poor posture

b.     Falls or accidents

c.      Reduced endurance of trunk extensors

d.     Tight hamstrings

There are many core strengthening exercises, but they can’t be generalized as One size Fit All. Keeping the condition of the patient in mind, your physiotherapist prescribes the exercises for you.

For the beginners, following core strengthening exercises are suitable:

1.     Bridge – The exercise strengthens your core, butt and thighs. Lie down on your back and bend your knees, keeping your feet flat on the floor at hip-width apart.

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Keep your hands at your sides. While tightening your glutes and core, raise your hips until your knees are in line with your shoulders. Hold the position for 20-30 seconds. 

2.     Partial crunches – Lie supine with your knees bent, keeping your feet flat on the floor. Now put your hands behind your neck. For proper movement, you should tighten your abdominals and lift your shoulder from the floor.

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Don’t lead with your arms or elbows, as it will make your exercise ineffective. Hold the contraction for a while, and then lower your back. Repeat it 10-12 times. 

3.     Plank – Start on all fours, keeping your hands below the shoulders and knees below your hips. Now straighten the legs behind you while keeping them hip-width apart. Keep your core tight and hold for 20-30 seconds.

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4.     Cat and camel –Start on all fours where wrists are under shoulders and knees are beneath hips. While contracting your core and glutes, round your back towards the ceiling and tucking your chin to the chest.

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From there, reverse the arch of the back, starting from your tailbone to neck. In the end, your back should be completely curved towards the floor, and you should be looking up to the ceiling. Now again, come to starting position. This completes one repetition, which usually takes 15 seconds. Do five such repetitions.

Following are the advanced core strengthening exercises:

1.     Low side plank hold – Get yourself inside plank using your forearm and knees in such a way that your shoulder is over your elbow, and both the knees are stacked on each other in line with the shoulders.

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Try not to sag your hips. Repeat with the other side. Perform this exercise five times, with 15 -20 seconds of holds per second. 

2.     Lying wind-shield wipers – Lie on your back, keeping your arms on your sides. Raise the feet off the floor so that hips and knees are at 90 degrees, and press your lower back into the floor. Contract your core to maintain this position.

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Now from here, keep your legs together and slowly lower your legs to one side without any involvement of the shoulders or low back. Pause and then reverse the movement. Repeat for the opposite side muscles. Perform eight repetitions.

3.     Bird Dog – Start with hands and knees on the floor. Your wrists should be beneath your shoulder, and your knees should be under your hips. Maintain a tabletop position by contracting your core.

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From there, extend your one arm and the opposite leg up so that they are parallel to the floor. Maintain this position for three seconds and then repeat with the opposite side. Perform two sets of these exercises with 10-12 repetitions in each set. 

4.     Jack knife – Lie on your back while keeping your hands on the floor with palms facing downwards. Raise your legs at about 60 degrees keeping your legs straight. Now pulling your toes, legs are further lifted while bending your hips at a 90-degree angle.

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Now lift your lower back and pelvis from the floor while bending your spine without making any change to the 90-degree angle of the hip. Slowly lower the body to the floor. Repeat the exercise 4-5 times, depending on your stamina. 

Disclaimer: –These exercises must be performed under the supervision of a appropriate professional only. If performed unsupervised, the chances of getting hurt and causing self-damage are more.

If you suffer from chronic backache, visiting a good physiotherapy centre may be a good idea. Progressive Care is one such centre where you can get the best treatment from an expert for your backache.  

References:

1. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428

2.     Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007; May; 25(2):353-71.

3.     Sauver, JL et al. Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Mayo Clinic Proceedings, Volume 88, Issue 1, 56–67.

4.     Hartvigsen J et al. Low Back Pain Series: What Low Back Pain Is and Why We Need to Pay Attention. Lancet, June 2018; Volume 391, Issue 10137; p2356-2367.

5.     Elbayomy, Mahmoud. (2019). Core strengthening for chronic nonspecific low back pain: systematic review. Bioscience Research. 15. 4506-4519.