Spinal Rehab and Core Stability

If you have made it to this page it is because:

you are interested in your core stability

or

we've asked you to take a look at it


What are we trying to achieve with Spinal Rehabilitation

You can leave the care of your back entirely in our hands but it will take you longer to get right and you may feel as though you have abdicated most of the control of your problem.  Far better, we believe, is that we get it all working well with your help and you then keep it that way. This is why Spinal Rehabilitation is so important.

Rehab should be an essential part of your recovery process. It will help prevent reoccurrence of your problem by strengthening, and more importantly, developing stability in your back.

Rehab involves specifically designed exercises for your condition. These will be tailored to your own pretty unique problem and will be shown to you by one of our practitioners (this is an area that Rebecca Strange, Ben Tolson or Simone Croker, who are our sports injury therapists, are all really strong on). One of the most important parts of Spinal Rehabilitation is developing your Core Stability and this is covered next.

Core stability

Now, a vast amount of rubbish is spouted about core stability, especially by those poorly trained blokes you meet in gyms. For many of them the terms ‘core function’, ‘core strength’, and ‘core stability’ have become chants delivered with no real understanding of what the words mean. However, you will, every now and then, bump into one of them who has a profound understanding of these concepts and, if this is the case, ‘bind them to you with hoops of steel’.

The guru on all of this is Prof Stuart McGill, whose lectures and books we have devoured, and we would argue that he is the leading researcher in the world on low-back stability.  To give you a feel for what you are up against he talks about the following:

The unstable spine 

To give you an idea of how injuries occur to the back whilst doing what seem to be easy tasks such as bending over to shave or picking up a pencil Prof McGill uses the concept of an unstable spine. Keep in mind that bending over puts a relatively massive load through your low-back and is a bit like lifting a plank up by the thin end.

His spectacular, and spectacularly, painful research shows that these daily tasks can cause your spine to ‘buckle’ if your spine isn’t working well or is unstable. This buckling causes joint injury, tissue irritation and loads of pain.  What causes this to happen is a momentary dip in neural activation of some of the deep intervetebral muscles, leading to a slight uncontrolled rotation in one of the loaded spinal segments. His solution to this is to train the deep muscles to “stiffen the spine against buckling” and improve its stability leading to a stable spine.

The stable spine

All your bones (vertebral bodies) in your spine have to be able to move and they are brilliantly made to rotate as well move along the three axes.  They all have an inherent ‘joint stiffness’ because of the way they are designed, their joint capsules and the surrounding ligaments. Additionally, the muscles are able to control stability of these joints by coordinated muscle coactiviation.

So, for us at C1, what we have to do is take your spine from the unstable to the stable.  Pleasingly, the task of creating a stable spine is testing but we are rarely working with nothing. The goal is to deliver ‘sufficient stability’ which directly relates to optimal stability and mobility with no compromise to the spine.  This can be done with exercises that develop this coactivation of the deep intrinsic spinal muscles and the abdominal wall muscles.

The main lumbar spine stabilizers 

Prof McGill used deep intramuscular electrodes (long thin needles stuck into the deep muscles - told you it was painful, but he did do it on himself) to identify the functional roles of these significant spinal stabilizer muscles. He also produced some mathematical models of spinal muscular activity and some amazing computer models to find out how these key muscles worked.

He suggests that the important intrinsic muscles of the spine include the Multifidus, Quadradus lumborum, Longissimus, Iliocostalis and the Transverse abdominins (I'd suggest Google for this lot). Some surprises for the gym staff in this list as there is no mention of your rectus abdominis, so, as we suspected all along, the six-pack may only be for decoration.

The low back training program

From Prof McGill’s research on low-back stability, the data suggest that the healthiest training for the spinal flexors involves muscular endurance not strength training. He adds:

“The safest and mechanically most justifiable approach to enhancing lumbar stability through exercise entails a philosophical approach consistent with endurance, not strength; that ensures a neutral spine posture when under load (or more specifically avoids end range positions) and that encourages abdominal muscle co-contraction and bracing in a functional way.”

Bracing can be understood as if the muscles are guy ropes for your spine as a tent pole. It is a neurophysiological phenomenon involving co-contraction of the abdominal wall and deep intrinsic muscles of the spine in an effort to better stabilize the low back.

Finally, the core exercise bit:

The Cat and Camel Exercise - Flexion-Extension Warm-up

Always start with about six flexion-extension cycles of the “cat-camel” exercise. These are important and you must do these as a mobility exercise to reduce any present stresses on the spine, not as a stretch, and to get the right neuromuscular pathways firing. These are shown really well here on YouTube:

Cat and camel exercises

or also in pictures on:

Canadian Government cat and camel web site (or psychosocial back exercises, no less) (and you can see the Prof’s fingerprints all over this one.)

Then start the Plank - the core stability exercise itself

Here it is shown well at this YouTube link:

The plank or bridge depending on where you are in the world

So, do the cat and camel and then start the plank.  You should do the plank to the point that you start shuddering (which is a neurological control issue rather than a fatigue problem) or until you reach the 20 second point and rest for a bit and then do it again, and again (so three times in all). 

The next time try to increase the time you are in the plank position.  Repeat this exercise till you can crack 30 seconds. You can do these exercises as often as you like but try to get in twice a day. 

Now, the technical stuff for those who want to know is what you are training:

Quadratus lumborum training

For Quadratus lumborum training he recommends the horizontal isometric side bridge (stick that in Google images and you’ll see what we mean or follow the link above) which can be done from a knee supporting position on the floor or a more testing version which utilizes a feet supported version. Another advanced version that involves the maximal involvement of the Quadratus lumborum and obliques, with co-contraction of the critical spine muscles and Transverse abdominis, is the rolling side bridge.

Rectus abdominis, Obliques, and Transverse abdominis training

Prof McGill states that there is no single abdominal exercise that effectively challenges all of the abdominal musculature.  He recommends several versions of crunches for the rectus abdominis and obliques.  Pleasingly, he suggests avoiding sit-ups (with bent or straight legs) due to the high psoas muscles activation and the compressive loads this causes in the low-back.  Similarly, leg raises also cause a great deal of psoas muscles activation and lumbar spine compression.

Back extensor training

Front lying (prone) upper torso (or leg) lifts off the floor may not be wise for people with low-back pain as these may place to much load on the spine.  In this exercise the lumbar spine pays a very high compression penalty to a hyperextended spine (approximately 4000 to 6000 N) which transfers load to the facet joints and crushes the interspinous ligament. This exercise is certainly contraindicated for anyone at risk of low-back injury or re-injury due to the high spine loads and the extended posture. In my opinion it should not be prescribed at all.