Why a Strong Core is Your Best Guard Against Back Pain

A group of adults are taking a fitness class together at the gym. They are working out on exercise mats and are holding a high plank.
A group of adults are taking a fitness class together at the gym. They are working out on exercise mats and are holding a high plank.

A physical therapist answers your questions

If you suffer from back pain, you’ve probably heard that strengthening your core can bring you some relief. But is this always true? And if so, how do you do it? We spoke with Cleveland Clinic physical therapist Patti Mariano, DPT, to find out.

Q: What is your core?

When most people think about the core of the body they think of the abdominal or six-pack area just below the ribs. While the abdominal muscles are an important part of the core, we consider other areas important, too.

Your core includes:

  • Front abdominal muscles — the rectus abdominis
  • Muscles along the side of your body — the internal and external obliques
  • A deep muscle that wraps around the front — the transverse abdominis
  • Muscles in your back that are located between your spine bones and run along your spine — the erector spinae and multifidi

Your core also includes the diaphragm and muscles of the pelvic floor. I also consider the gluteal muscles as core muscles.

Q: What is the relationship between core strength and back pain?

Theoretically, if your muscles around the low back are weak, your body will rely more on passive structures, including ligaments — the tissue that connects bone to bone — as well as the spinal bones or discs, which lie between the spinal bones, for stability, which can cause pain.

But some studies have shown that specific core exercises are not any more beneficial than general exercise for low back pain. What we know is that exercise in general can help, and focusing on core muscles may provide some additional benefit.

Q: What are some exercises for the core that can help with back pain?

Here are my top five:

  • Side plank — Sit on the floor with your right hand below your right shoulder and feet stacked. Lift your body, keeping your legs long, abdominals engaged and feet stacked. Hold. Repeat on the other side. You can modify this pose by dropping your bottom knee to the floor for extra support.
  • Plank — Kneel on all fours. Pull in your abdomen and step your feet behind you until your legs are straight. Keep your hands directly under your shoulders and your neck straight. Hold your abdomen and legs tight and avoid letting your lower back sag. Hold and breathe for 30 seconds. You can modify this pose by lowering your knees.
  • Bird dog — Kneel  on all fours. Reach one arm out in front of you, draw in your abdomen, and extend the opposite leg long behind you. Repeat on the other side.
  • Scissors — Lie on your back with your arms at your sides and legs pointed straight into the air above your hips. Press your lower back into the mat and tighten your abdomen. Lower your right leg until it’s a few inches from the floor. Raise your right leg up and begin lowering your left leg the same way. Continue switching right and left.
  • Upward dog — Lie face down with head slightly lifted and hands palm-down under your shoulders. Point your toes. Exhale, then press through your hands and the tops of your feet and raise your body and legs up until your arms are straight and your body and legs are off the ground. Keep your neck relaxed and long and thigh muscles tight as you hold and breathe.

For the plank exercises, start by holding them for 15 seconds to 30 seconds. For bird dog and scissors, try three sets of eight or 10 repetitions. For upward dog, do one set of 10 repetitions.

Q: Can you injure your back by trying to strengthen your core?

Any exercise performed incorrectly, whether it is core-strengthening or otherwise, has the potential to cause discomfort.

Twisting exercises or even incorrectly completing the exercises cited above can cause pain in the low back. But it’s highly unlikely that one repetition of an exercise will seriously harm your body, unless it’s an exercise using a very heavy weight.

The best way to keep your body safe is to listen to body cues such as pain during and immediately after an exercise, and the next day after exercising.

Q: When should you talk to a doctor about your back pain?

If any of the following is going on you should consult with your doctor:

  • Your pain has been going on for longer than a month, despite resting from activities that make it worse.
  • Your pain is getting worse.
  • Your pain wakes you from sleep.
  • Your pain is in your low back but also is going down one or both of your legs.
  • You notice that one leg is becoming weaker than the other.

Q: Where should you turn if you want help in creating a plan to address back pain?

Physical therapists train as musculoskeletal experts — they are the experts on muscles, bones and human movement. These professionals are the most qualified, aside from an orthopedic doctor, to assess back problems.

Since there are many factors that impact low back pain and many types of low back pain, it is a good idea to visit at least one time with a physical therapist for an evaluation and subsequent plan of care. This will give you an individually tailored plan with exercises that progress safely.

The idea of core strengthening, while beneficial, is just one piece of the low back pain puzzle.




Alcohol and COPD Flare Ups

Chronic obstructive pulmonary disorder (COPD) is a lung disease caused by long-term lung damage, usually due to smoking. Although smoking has been identified as the primary culprit for causing COPD and triggering COPD exacerbations or “flare-ups”, what effect would the use of another drug have on COPD, say, for example alcohol?

When alcohol is administered to a person without COPD, it nevertheless produces alarming side effects. The acute effects of ingesting small doses of ethyl alcohol are: euphoria, mild stimulation, relaxation and lowered inhibitions. Whereas, the acute effects of consuming large quantities of the substance lead to drowsiness, slurred speech, nausea, emotional volatility, loss of coordination, visual distortions, impaired memory, sexual dysfunction, and loss of consciousness. The effects of long-term abuse and overuse of alcohol are even more distressing and include high blood pressure, stroke, cirrhosis, nerve damage, and ulcers among others.

Long term alcohol abuse is a health risk for anyone; however, alcohol and COPD research has yielded some rather conflicting results.

In people without COPD, moderate wine intake is associated with overall better lung functionality.  Also, heavy alcohol consumption is not linked to increased risk of a COPD flare-up, when it is independent of smoking.  Although, chronic long-term alcohol consumption combined with oxidative stress (such as, tobacco smoke, air pollution, dangerous chemicals and other airway irritants) does not lead to acute lung injury and aggravation of COPD symptoms. While, abstaining from alcohol improves the diffusing capacity of the lungs, it does not improve airway obstruction in COPD.

Unfortunately, it does get worse from here; alcohol abuse causes a grave deficiency of glutathione (an antioxidant) in the lungs which makes your more susceptible for serious lung diseases not to mention aggravating any existing COPD symptoms. Chronic alcohol consumption is also associated with a higher risk of decreased total lung capacity, residual volume, forced vital capacity, and the diffusing capacity of the lungs, which poses a definitive health risk for COPD sufferers. This risk is only augmented when considering the fact that long-term overuse of alcohol weakens mucus-clearing ability and decreases mortality in COPD. It is also important to remember that alcohol may interfere with several COPD medications such as, glucocorticoids and antibiotics. Alcohol can also potentiate the effects of anxiety and pain medication which could slow down your breathing rate to such an extent as to be fatal.

The decision to drink alcohol is a personal one which should not be undertaken lightly, as with all other aspects of your lifestyle which relate to COPD.  The most reasonable approach to drinking alcohol, if you have COPD is to consult your doctor for specific guidelines. A qualified physician will be able to assess your medical history in combination with your current health to provide you with the best advice on how much alcohol you can consume without it endangering your health or well-being. By being well-informed and maintaining healthy communication with your doctor, COPD doesn’t have to prevent you from living the life you want to lead –with or without alcohol.