The reason for me to care is this: I see the confusion in the clients I support on what it means to have a ‘strong core’ to help resolve their back pain. The clients I work with regularly bring in interesting questions and reading content that they have found that may be of help/interest to myself and my partners here. All to say they are also working to find solutions, they want to do something that can help to make their core work to support their back.
When I turn to the best place to find information these days – Google!...and let’s say I Google ‘core exercises for back pain,’ I start to see an opportunity to help clear up the conversation.
The terms core training and core strengthening have been used interchangeably in the fitness industry for years and often the same exercises are given indiscriminately to everyone, regardless of how their core is functioning. Is core training the same as core strengthening? Are core stabilization exercises the same as core strengthening exercises? Do you know the difference? Is there a difference? Finally, it seems simple, but what is the core?
I think there’s been a sizable evolution in how we talk to and work with the systems that inform the core in the past 20 years. I think our understanding of what core awareness is, how to program the body to learn/relearn awareness, and then how to carry that awareness into increased support for our back and hips, and to get strong with all of it, is as good as it has ever been--I hope I’m not a victim of the Dunning-Kruger Effect (psychological tendency to assess their abilities as much greater than they really are.)
Where is your core...all of it?
The deep core is made up of the transversus abdominus, the multifidus, the pelvic floor and the diaphragm. Years ago, Anna Pattitucci, pelvic floor PT, explained that the diaphragm and the pelvic floor had a timing between them, and when that was out of sync, or compromised, the ability of the deep core to anticipate and prepare the core to support the body for movement was also compromised. The goals she talked about for core training were focused around training compliance of the 4 parts of the deep core. The exercises for this space are not crunches or pelvic lifts but rather they are focused around restoring communication, often cueing with breath work plays a large role here.
The outer core... ‘midsections’ are again the transversus abdominus, the internal and external obliques and the rectus abdominis. They are more the doer’s. They help you sit up out of bed, and brace well to throw a ball far...and any other thousand movements. They support the back with their power and support but they do not anticipate. They are obviously more under your control, like when you get out of bed, you essentially do a ‘crunch’ to pull yourself upright. Another feature of the midsections in this category is that they can and do support the hips and spine, and they can do so without much input from the deep core...but I’m not sure you really want that.
To train the deep core you would find yourself having exercises for the core that focus on timing and co-activation with other muscles. I recall Anna used to train a breathing pattern for women postpartum, so they could get off the floor, from say playing with their newborn child, without leaking urine. The diaphragm would deflate to tighten the pelvic floor and now there was support to the body in its rise against gravity that gave control over peeing one’s pants. Although there are professionals (and I am not one of them) that only teach breath to movement, and yoga certainly has a relationship to this ‘mode’; in my current form as a trainer, I do try to incorporate more opportunity to teach clients to move with their breath--one basic example: exert with exhalation and rest or hold on the inhale.
Here’s the challenge: the body can do everything without a responsive relationship between the diaphragm and the pelvic floor. Nothing will look different, your running gait will look the same, your deadlift will look similar, your driveway shoveling will look identical. However, over time, a deficit in the deep core often means adding load through the trunk, legs or arms that will break down joints and tighten muscles.
When you gain awareness of this deep core, the pay-off is you can reduce/change stress to joints and muscles that are impacted by the whole human core. Once you can activate the deep muscle system synergistically, it is time for core strengthening exercises. NOW, by adding loads through the trunk, leg or arms you will functionally strengthen a pattern of movement that keeps you going, rather than loading patterns of movement that are wearing to your back and hips. Whatever you come to call the muscles discussed in this article, they don’t train the same way, and both merit attention.
Ultimately everything does connect at your core. If you have any questions please email me at firstname.lastname@example.org.
In robust health!