Core Exercises For Back Pain

It’s likely you have been lead to believe that this topic is far more simple than it really is, most people find that some explanation of these exercises beneficial. 

The other thing to know is that these exercises require quite lengthy explanations as they guide you into a deeper awareness of your core. Legitimate core exercises involve isolation of deep muscle groups, like so many good things this takes time and sincere effort. The payoffs for great effort  however can be significant and long lasting. 

For most of us the first step towards effective core exercises is to dispel the whopping myths that exist in regards to the core. 

The most common whopping myth by far on the topic of back pain exercises is that you can reliably jump into core exercises at the gym and they’ll sort you right out. A handful of people have success with this, research shows that people with the worst bad backs almost never do. 

The second most common whopping myth about the core is that exercises like sit-ups and planks ‘target’ your core. How this one got traction is anyone’s guess. It’s about as accurate as believing the world to be flat… it is flat in places!! 

Having mythbusted, the good news is that effective back pain rehab doesn’t need to be fancy, in fact it’s better if it isn’t. 

Rather than complex, strength based movements it is better to focus on absolute absolute mastery & persistent execution of simple, deep internal exercises that help ‘re-organise’the activity of your core. For these reasons, this exercise sheet contains very simple exercises, but with fairly in depth explanations on the  how’s & why’s of their execution. 

The simple fact is that your true core is INTERNAL, the muscles are really deep inside unlike those you do a sit up with. This means that learning to focus deeply into the core muscles using considerable concentration is the cornerstone of all ‘true’ core exercises. 

Core Self Assessment

If you can’t isolate your core from the rest of your trunk muscles and your respiratory muscles it is absolutely essential that become aware of this fact. If you know where you are at you can appropriate exercise choices and build from what ever your authentic start point is. This guide is not a substitute for the advice of a trained professional, there are many possible causes of back pain

If you follow this short self assessment guide you will develop a realistic assessment of..

  • how strong your core is
  • how ‘well organised’ your core is.
  • how supple your core is

If you find that you don’t have great strength,  control and elasticity of your core you might as well temporarily put everything apart from the following exercises on hold. This is because the foundation of all core exercises and any benefits that come from them is the ability to control the core in isolation from other movements…  that’s what the following exercises teach us. But first a reality check…

Test 1

*Stand side on to a mirror and let your tummy relax completely. Your tummy should be lean and flat when there is tone in your abdominal wall, it should also be able to relax like any muscle

* If you cannot distend your tummy like in the pics you have a problem with ridgidity in your core, this is likely to be due to a faulty pattern of activation that you have developed over time. You may be looking at the cause of your back pain.

*If you can relax your tummy in a natural way congratulations you passed the first healthy core test.

core exercise for back pain treatment

abdominal wall that cannot fully relax – note there is still quite a lot of ‘flatness’ especially in the upper portion.

core relaxation - treatment for back pain

abdominal wall in a completely relaxed state – able to protrude.

Test 2

From you relaxed tummy position, or your ‘as relaxed as i can’ position continue to stand side on to a mirror. Now focus on the section of your abdominal wall from your belly button down (the lower half basically). Draw this lower portion in towards your spine (like in first pic). You should find that you can ‘pull in’ or retract the lower half without pulling the upper half inwards.

*If you can pull the lower half of your tummy right in and keep the upper part completely relaxed you get top marks. Your core is both strong and well coordinated enough to support your spine. If you find this but you have back pain the cause may be in your feet or in some other condition.

core activation for back pain multifidus

lower core pulled right in – upper abdominal wall relaxed and striking out slightly – excellent result

core exercises for back pain 2

upper abdominal wall sticking out slightly – lower pulled in completely – core is working

*If you are able keep the upper tummy relaxed  but you can’t draw the lower half inwards very far it reflects reasonable coordination but a lack or strength. You could well be looking at the cause of your back pain.

core activation for back strength

lower core can flatten somewhat without flattening the upper abdominal wall – reasonable coordination of the core but lacking strength

*If you find that you can only pull in the the lower part if you also pull in the upper part first you have poor strength and coordination in your core. This is likely to be a part of why you have back pain.

*If you cannot pull in the lower part of your tummy at all, but you find it very easy to pull in the upper part, perhaps even to the point where you have a skin crease .. sorry to give you the bad news but your core is in really deep trouble. Its highly likely that you are looking at the cause of your lower back pain.

core weakness exercise - back pain sign

strong retraction of upper abdominal wall – no retraction of lower core – sign of a very weak core

core weakness - sign of back pain

upper abdominal wall pulled right in – lower core can’t retract at all – very poor coordination and strength in core

Quadruped – Core Strength Exercise For Back Pain

  1. Kneel on all fours making sure you are very square. You don’t want your arms or your legs at an angle like the first 2 pics. The third pic shows a nice squared off posture with the thigh bones and arms vertical. The second thing to notice is in the 3rd picture below is that the spine is relatively flat & neutral. This is achieved just by keeping your spine relaxed, and very very gently sticking your bum in the air.
quadruped core exercise for back pain multifidus

square start position – upper arms and thighs verticle – spine neutral

  1. The next step is to engage your your core gently and to the best of your ability. This must be gven the greatest focus and attention of any step in this exercise.

To activate the core you want to gently contract your pelvic floor. To achieve this in an extremely reliable, and somewhat amusing way, imagine that a veterinary surgeon was going to put a thermometer up your bum.

Assuming you are like most of us and think that doesn’t sound fun you will automatically activate your pelvic floor to prevent this attack on your dignity. 

Holding this contraction gently there are 2 ‘add on’s’ that your need to get full control of your core. 

The first ‘add on’ is to gently imagine the pelvic floor extends up into your lower back (no need to overthink this, just kind of visualise it)

The second ‘add on’ is to breathe now and throughout the exercise.. When you activate your pelvic floor and lift your legs (the upcoming step) the temptation to hold your breath will be overhwhelming. 

So to recap, in preparation for the coming leg lift

a. activate your pelvic floor

b. gently and loosely visualise that contraction raising up to your lower spine.

c. ensure you are breathing and prepared to continue doing so thoughout.

internal aspects of core exercises for back pain

internal activation of the pelvic floor – the core – the breathing.

  1. Lift your right hand 3 inches of the ground and your left knee 3 inches off the ground. Gently reaffirm ‘sticking your bum out’  so that you aren’t tempted to round your back ( like that first pic ) and your spine stays flat. 

hand lift for back pain exercises 2

lifting the hand very gently and under control.

knee lift for back pain core exercises

gentle kine lift – opposite side – under control

hand and knee elevation exercise for back pain

hand and opposite knee both elevated – creating strain in the trunk.

Now that your hand and knee are raised your job is to focus on the original core activation steps. Pelvic floor – pelvic floor in lower spine – breathing. Maintain this focus and position for 10 breaths, notice it requires a fair amount of focus. After 10 breaths lower the knee and hand back to the floor and only then release the pelvic floor etc. 

  1. Now repeat the whole process with the left hand raised and right knee raised. Follow all this steps carefully.
  1. After a brief rest repeat both sides 2 more times. So at the conclusion of the exercise you will have done 3 on each side. 

Sitting Pelvic Floor Activation

  1. Use on an upright chair like a desk or dining chair. Sit toward the front of the chair without using the back of the chair to lean on. Feel your ‘sit’ bones underneath you contact the seat,  and sit up nice and straight without straining too hard to do so. 

    sitting core exercise for back pain

    standard unsupported upright sitting position on a chair

  2. Gently direct your focus to your pelvic floor where it contacts the chair underneath you remembering that contraction you did in the first exercise. Before you contract your pelvic floor take a moment to really try and feel the muscle in it’s relaxed state. 

    sitting pelvic floor core exercisers for back pain

    activation of the pelvic floor – easier to feel than to photograph – this is deep internal work.

  3. Once you have located the muscle and felt it to the best of your ability initiate a contraction of your pelvic floor. Try to active your whole pelvic floor by ‘visualising’ an attempt to prevent yourself going no.1’s and no. 2’s simultaneously.  Hold this contraction firmly and continue to be consciously aware of feeling the muscle contracting. Hold and consciously feel the pelvic floor for 5 breaths, then let it go slowly with a lot of control. 
  4. Repeat steps 2&3 five-ten times in total 

*keeping your eyes shut is essential, you will be able to feel more if your eyes are shut 

*make the contraction firm but fair, an effort level of around 6 should be enough.

*this exercise (like all our rehab) is based as much on FEELING the muscle as it is on contracting the muscle. Most back pain sufferers have a desperate need to connect consciously with their deep muscle groups. Learning to feel the muscles effectively it the key to developing proper control of them over time. These are feeling exercises as well as doing exercises.

Sitting Core Activation 

This exercise is a combined pelvic floor and and core activation. It uses the easier pelvic floor activation as a gentle ‘spring board’ which gives you access to activating the deep core.  It builds on the sitting pelvic floor exercise and the foundational steps are identical.

  1. Use on an upright chair like a desk or dining chair. Sit toward the front of the chair without using the back of the chair to lean on. Feel your ‘sit’ bones underneath you contact the seat,  and sit up nice and straight without straining too hard to do so. 

    sitting core exercise for back pain

    standard unsupported upright sitting position on a chair

  2. Gently direct your focus to your pelvic floor remembering that contraction you did in the previous exercises. Before you contract your pelvic floor take a moment to really try and feel the muscle in it’s relaxed state. When you have ‘tuned in’ the the sensations of the relaxed pelvic floor, gently activate it noticing the sensation of pressure. Maintain the hold.
  3. Now attempt to draw the sensation of the pelvic floor hold gently into the centre of the lower back. What you are looking for here is a smaller version of the same sensation deep in the lumbar spine. Now that you have this hold in place,  make sure that you are breathing and continue the hold as best you can for 5 breaths. After 5 breaths let the whole contraction release very slowly and with a great deal of awareness.

    deep core activation for back pain - multifidus

    X marks the spot – start from pelvic floor – gently contract 2-3 inches deep from this point in the lower back.

  4. Repeat the process – activate the pelvic floor – bring the sensation of the hold up into the lower back as deeply and gently as you can – establish 5 easy breaths – let go under control. 

*it is normal to feel quite uncertain about whether you are actually achieving a contraction in the the lower back when you start doing this exercise. 

*be really gentle and patient with the exercise and gradually over time you will realise that you are activating that deep core muscles.

*if you are uncertain about whether the core has engaged pay special attention to the moment you let it go – you can feel a release in the lower back as you let go if you were doing it right. 

*if it becomes hard to breath during the contraction 

It means you need to go MORE DEEPLY & MORE GENTLY with the contraction – even if it means that it starts to feel like you aren’t really doing anything .. trust in tiny contractions they have great power when applied over time …  in the same sense as a little warm drip of water will eventually melt a mountain of ice !!!