When we talk about “core” with patients, most people still believe that they must perform some type of sit up to achieve abdominal strength. However, this protocol changed over 15 years ago when we realized that sit ups cause lower back pain due to loaded flexion of the spine. The two most common movements associated with back injury are forward flexion (bending forward, usually rounding the back) and twisting.
The flexion shifts significant load to the back of the spine instead of evenly distributed across the inter-vertebral disc. Twisting now takes that force and focuses it on one corner of that disc with a portion of your body weight. This can result in back injury (even when you are lifting very little weight, like a newspaper) especially if your core muscles are weak.
So what do you need to do to strengthen your core correctly? You must work all three areas of the core; the abdominals, the lower back, and the obliques. The abdominals are 40% of your core strength, your lower back is another 40%, and the obliques represent the final 20%. The exercises needed to work these areas are:
This exercise is gentle enough for anyone to begin performing since it is a physical therapy exercise that would be given to a back patient, but it can be advanced even for serious athletes. You start by lying on your back with your knees bent and feet flat on the ground (think sit up position) with your arms on the ground by your sides. Tighten your glutes (butt) and lift your hips off the ground until your body is straight from your shoulders to your knees. You do not need to hold this position, return hips to the floor and you have completed one repetition. Start slow and gradually work up to 3 sets of 15 repetitions. Advancing the exercise-add weight over the hips (dumbbell or flat plate weight resting on the lower abdominal) to continue strengthening the lower back.
While planks may seem like the easiest exercise, they are the most complete core exercise of the three. The military is looking to replace the sit up component of their fitness test with planks to measure abdominal strength and endurance. I recommend starting with 4 repetitions of holding the plank for 15 seconds each. Gradually working to hold the plank for greater duration until you can hold the position for 2 minutes (the fitness standard for up to 65 years of age). Think of push-up position but resting on your forearms/elbow instead of your hands. Keep your body straight from shoulders to ankles while sucking the navel into the spine and keeping the glutes tight and don’t forget to breathe. Advancing the exercise-hold the plank position while alternating extending one arm out straight, then return it back to the standard plank position.
This exercise is the most challenging of the three, but it also works one of the most overlooked areas of the core, the obliques. This area is what most people would call the “love handles”. The reason why they are important is they tie into and help support the lower back. A side plank is similar to the standard plank except you are only on one side and one arm. The other difference is that I recommend not holding this position, but dropping the hip towards the ground and then lifting it back into plank position. The reason for this change is that we are trying to increase strength, there performing repetitions (2 sets of 8-10 per side) instead of holding the position for muscle endurance.
The core muscles are utilized during almost every physical movement. Correctly working all three areas of the core is very important to reducing your risk of a back injury. If you have previously injured your back, then improving your core strength will reduce your risk of another injury. Take care of yourself.