By Baxter Bell
In part 4, the last on my posts about back pain, I want to address what we often refer to as "the core," and its role in protecting your back.
There's a belief that having good “core strength” lessens the chances of injuring your low back and could aid in healing injury there. I hear this all the time from my friends who are Pilates instructors and often read it in articles about what people can do to protect their backs. But as far as modern research goes, there is no compelling evidence to support this assertion. Core-strengthening exercises are no better or worse than other forms of exercise that have been shown to be helpful for low-back pain. Before we go throwing the baby out with the bath water, I should define what I consider “the core.”
In my view, the core musculature comprises the four abdominal muscles (the rectus abdominis, the internal and external obliques, and the deepest layer, the transversus abdominis). Also, the psoas and iliacus muscles, the quadratus lumborum, the deep back muscle layer which includes a group known as the multifidii, and the intermediate back muscles known at the erector spinae. To top it off, the diaphragm and the pelvic floor muscles can be included in a complete vision of the human core. Three-dimensionally, this includes the front, sides, back, top and bottom of this area of the body.
If you have a balanced yoga asana practice, in all likelihood you will have a fairly balanced and strong core, and it's probably unneccessary to do additional core strengtheners, many of which have almost identical yoga equivalents: drop knee lunges like we use as preps for Warrior 1 and deeper backbends; dynamic reclining versions of Supta Padangusthasana; dynamic Cat-Cow to Child's Pose; Forearm Plank; Forearm Side Plank (Vasishtansana); Dynamic Cobra and Locust variations; Dynamic Bridge, and so on.
And even the extra core focus in or out of yoga class may be unnecessary, again, if your yoga practice is balanced. For example, I don’t ask my students to walk around with Mula Bandha engaged all the time, or to activate the transversus abdominis while driving. My feeling is that you strengthen these things via your practice, and then you move into your life without having to suck in your gut or tuck your tail while doing your daily activities. You allow these strengths and openings to be in operation in the background of your awareness.
But do I think these poses and other core strengthening exercises are reasonable? Sure. What they don't offer, however, and what yoga does (at least in my classes) is use bandhas and pranayama to positively influence the diaphragm and the pelvic floor muscles in addition to the dynamic and strengthening aspects of yoga asana.
In addition, in my back-care classes I teach a different variation to the “yoga sit-up” you may have encountered in some of your classes. Often, instructors will have you flatten your lower back on the floor as you do variations that look like a Western style sit-up. I prefer a small natural arch in the lower back that you maintain without letting it change as you roll your head and upper back off the floor a bit on your exhale (lower tips of the shoulder blades remaining on the floor), and lower back down on the inhale. I am assuming that the natural lumbar arch present when standing is architecturally the most stable for the most sensitive structures, such as the discs, nerves, and joint surfaces. So, I make sure it is here in the reclining position. This would seem to activate the deepest abdominal layer, the transversus, very effectively, as well as the deep back muscles. The vast majority of my students find this method accessible and comfortable for their backs.
My recommendations for low back pain and core strengthening are these: familiarize yourself with contemporary CS exercises and the yoga equivalents, and integrate some into your home practice. Also, do a good balanced yoga practice that has something from each of the different categories of poses (standing, sitting, inversions, etc.), and include some basic pranayama, and engage the lower two bandhas. And if a particular pose hurts your back, eliminate it, at least until you can have your teacher review your technique for any obvious glitches. Add in walking or any other form of physical exercise that you enjoy (both physically and mental/emotionally), that does not aggravate your back. And enjoy the process!
For those interested in learning more about the lack of good evidence for CS and back pain, search Google for an article called "The Myth of Core Stability," by Eyal Lederman.