Low Back Prehab/Rehab: Core Strengthening


Welcome to our second episode of the low back prehab/rehab series!

In the first episode found here, we talked about hip strengthening. Today, we are discussing core strengthening.

Low back pain is often due to lumbar instability which can arise from weak muscles in the abdomen and lower extremities. In the last video I talked about hip strengthening and in this episode we will discuss proper core engagement and strengthening as a means to increase the stability of your lower back, thus decreasing pain and related symptoms.

Here is a quick explanation of the relevant anatomy...

A stable spine can be achieved by strengthening the deep back (multifidus) and abdominal muscles (transverse abdominis). In today’s video we mostly talk about the transverse abdominis or TVA, which is a diamond shaped muscle that frames the abdomen and plays a major role in stabilizing the lumbar spine. 

Let’s take a look at TVA activation and some progressions:

Step 1:

Learn how to activate the TVA in crook lying position. One way I like to think of this, is tightening the corset that the muscles of the abdominal wall make up. In the video you can see the keys to this are finding a neutral spine by tucking chin, neutral pelvis, and pulling the ribs down. Pull your naval in and up without moving the rib cage, pelvis or spine. Between your hips you should feel the lower abdomen tighten. Gradually build up the duration of the contraction. Once you can activate TVA with little effort for 10 repetitions, you are ready for the next progression.

Step 2:

Build endurance for bracing core over time and in functional positions. Of course, we don’t live our lives laying down, so we need to learn how to hold this contraction first in non-weight bearing, then weight bearing (standing), and finally dynamic weight bearing (squatting/lifting.)

  1. Non weight bearing: heel lifts, slides, and dead bug. Keep core active, still continually pulling belly button in. You should not feel your hip flexors doing most of the work here! Think about pressing your low back into the mat to keep it from lifting.

  2. Activation in sitting and standing.

  3. Activation during lifts: start with bodyweight squats, deep breath in to brace, maintain neutral spine, breath out on the way up.

The progressive retraining of the TVA should eventually result in constant and unconscious activation of this muscle. The idea is that your back should be stabilized at all times given that you are maintaining proper posture.

The beauty of core engagement is that it can (and should!) be practiced anytime and anywhere. Three things that strengthening your core can do is reduce pain, increase functional ability and increase muscle endurance. Give these tips a try and feel your core get stronger and experience less lower back pain.

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Written by Saveah Reinhardt. Saveah is a strength coach at Vagus Fitness, specializing in corrective exercise for healthy bones and joints. Saveah is a kinesiologist, and plans on attending school to become a physiotherapist. She loves working with clients who are new to strength training, or are looking to use strength training as a tool to live a stronger, more mobile and energetic life! Contact Saveah at saveah@vagusfitness.com.