Columbia Advanced Chiropractic Newsletter, The Spinal Column

Welcome to The Spinal Column, where we post articles about chiropractic care and other health issues. Check out Dr. Manison's past articles. We welcome your comments, questions or opinions, so please feel free to contact us.

The Low Back and Core Stabilization

By Allen M. Manison, D.C., DACBSP® , CCEP, CSCS®, CKTP®

Low back pain affects 80% of our population at one time or another.  There are many reasons why people suffer from low back pain and luckily, there are conservative means to help people with such pain.  When someone suffers from low back pain and dysfunction, my job as a sports chiropractor is two-fold.

First, I have to get the person out of pain.  Joint, ligament, disc, and muscle pain is generally caused by aberrant spinal mechanics.  This means that the joints are not working right due to a physical cause (such as an accident or bad posture), chemical cause, mental cause, or any combination of the aforementioned.  Although many people think that disc injuries are the primary cause of pain in the low back, it has been shown in the literature that this is not always the case.  Many times, low back pain can be due to joint dysfunction (facet and disc) and the subsequent ligamentous and muscular compensation.  Regardless of the cause of the pain, the job of the sports chiropractor is to restore normal mechanics to help reduce the pain in the area in question.

The chiropractic manipulation is unique in that it triggers the neurological system by activating what are called mechanoreceptors.  These mechanoreceptors help the brain understand the body’s position and function.  They usually do not work properly when we have an injury because the pain nerve endings, or nociceptors, are actively firing.  Proper manipulation helps to activate the mechanical nerves, which send information to the brain faster than the pain nerves, and by doing so, help to reduce shut off the pain nerves.  In more simplistic terms, normal joint motion allows the muscles and ligaments that bind the joint(s) to work better and establish an environment for healing.  In addition to manipulation, a sports chiropractor will tend to have a lot of additional involving the assessment and treatment of soft tissue pathology.  Due to the fact that joint dysfunction inhibits adjacent muscular activity, taking care of the joints and soft tissue is often warranted.  When the body is working better and the patient is experiencing less pain, then the second stage of care, the rehabilitative/stabilization phase, can begin.

Core stabilization is a hot topic when we discuss low back rehabilitation.  So, what is core stabilization?  Core stabilization is the balance of muscles around the body from the chest to the pelvis that help to keep the body stable.  Unfortunately, most of us lack proper function of the muscles in this area.  The boundaries of the ‘core’ include the abdominal wall in front, the spinal muscles in the back, the diaphragm above, and the pelvic floor below.  There are many muscles and all of them play a role.  Although there is a lot of information available from various exercises classes, magazines, and the like regarding the topic of core stabilization, much of it is not correct.  Just as working out improperly in the gym leads to injury, so too can performing exercises for the ‘core’.  With that being said, proper core stabilization exercises are a MUST for those recovering from low back pain and dysfunction and only those with high-level training should teach core stabilization.  This is where working with a rehabilitation specialist is important! 

In regards to going to the gym and performing crunches, leg lifts, leg raises, etc… with the hopes of building ‘core’ stability, such stomach and psoas exercises to build strength do not tend to affect the muscles that help maintain core stabilization.  It is important to note that strong stomach musculature does not confer low back stability.  Strength and stability are very different!    In order to build stability, you have to train certain muscles by both isolating them and by including them with real-life activities.  We should end up training the body along with the brain!  For example, although floor exercises are a good way to learn how to feel certain muscles work, we don’t want to do too much ‘core’ work on the floor as most of our time is not spent on the floor.  Core stability training should involve exercises that prepare you for your activities of daily living (ADLs).

If a patient responds favorably to care within a short yet reasonable period of time, and if he/she is able to improve their ‘core’ stabilization, then there is a very good chance that a total or near total recovery from back pain can be achieved.