Core stabilization is the general term used to describe how the muscles of the torso secure the spine, providing a solid foundation for movement in the extremities. This, in turn, helps us to stay upright and balanced when we move. The core muscles lie deep within the trunk of the body, and, when they are strong and activated, work automatically to synchronize our every movement. They attach to the spine, pelvis, and scapula (shoulder blades), stabilizing these areas to create a firm base for coordinated movement of the legs and arms. When the core muscles are strong, they contract immediately whenever the arms and legs initiate motion, balancing the body and decreasing the likelihood of injury, even when an unexpected force or unevenness in the terrain catches us off-guard.

Especially when used in the context of back injury prevention and rehabilitation, core strength, has become a term that most people recognize, but how many of us incorporate it in a meaningful way to everyday life? Even though it is known to prevent injury, core exercises are most frequently introduced during rehabilitation for an injury that has already occurred. Why is that? Would daily core exercises be more interesting if there was a chance that a strong and activated core could improve athletic performance and stamina? How about if it could maximize power while minimizing injuries? Based on my experiences, I think these are all likely outcomes with a simple daily ritual of partial sit ups (crunches), leg lifts with knees bent, and sustained bridge and plank poses (30-60 seconds each). I would also add leg and arm stretches to ensure balance around all the moving joints. All together, this wouldn’t take more than 20 minutes of your day. If you are in good health and already exercising regularly without any problems, I challenge you to add some simple core exercise to your workouts, 3 or more times per week for 6 weeks, and see what you find out. You’ll be surprised at how easily you can increase your strength, coordination and balance; all of which improve athletic ability, regardless of your activity.

The venue I chose for this undertaking was the Inaugural Oakland Running Festival Marathon, as I felt the excitement of a first ever event might conjure up some extra inspiration for me. I started training in December 2009, following recovery from an injury-filled marathon that I had recently, and just barely, finished. Using the Less is More Marathon Plan from the August 2004 issue of Runner’s World, I committed to three days of running per week, and two days of cross-training. Some weeks I made better than good on this pledge and other weeks, not as much. Regardless, I continued forward, leaving those perceived failures in my dust. Earlier in the year, I had happened upon what proved to be a very useful lecture along these lines during a continuing education course. The talk was given by a chiropractor, Dr. Eric Plasker, about his book, The 100 Year Lifestyle. He made several points that resonated with me, but one particular idea proved invaluable to my training psychology. In explaining his proposed principles for living long and with quality, he said something like “aim for progress, not perfection.” He went on to explain that dwelling on past shortcomings is completely useless, and that we generally accomplish our goals, not in one large jump, but in a series of smaller steps. We also fall off course sometimes – this is normal human nature, not failure. When this happens, the only focus we need is that of getting back on track. As long as we have net forward motion at the checkpoints, we are successful. And, without the baggage of all that dwelling, forward motion is likely. Using Dr. Plasker’s advice, I progressed through this training schedule, trudged at times, and didn’t worry about the lack of perfection in my training. At the end of it all, I felt strong, prepared and, most importantly, incredibly excited for the event.

In addition to running and cross-training, which included cycling, walking, hiking, and yoga, I focused as much on daily core stabilization exercises and stretching. From basic biomechanics, I knew that good posture during motion is critical to injury prevention, and also that good posture is impossible without optimal mobility of the joints, muscles and connective tissues, as well as strong and activated core musculature. Danny Dreyer talks about this at length in his book, Chi Running, and I will write more later about how this made all the difference for me. I gave equal attention to nutrition, both in my overall diet for building strength and endurance over the training period, and in the specifics during the longer runs for preventing “bonking” at the higher mileage. I had experienced the pitfalls of electrolyte imbalance and nutrient deficit in past events, and was impressed by the difference a little planning could make for this one. I didn’t get the race day nutrition perfect, but was content with the extra insight this shortcoming provided.

At the onset of this project, I hoped for good subject matter to write about and an experience that would either support or refute my previously held ideas about endurance training. As I progressed through the plan, however, I found more; that the positive side effects of exercising in a deliberate and self-preserving manner, for reasons other than winning or firming up the thighs, completely steamroll any other motivations one might have. I wasn’t crushed by the heaviness of the commitments, but instead felt empowered, energized, and elated. I came to understand the runner’s high, but it didn’t come from where I thought it would.

Most expectant mothers will experience some degree of lower back pain during their pregnancy. In order to make room in the pelvis for the growing baby and prepare for delivery, a pregnant woman’s body secretes a hormone aptly named relaxin, which causes the ligaments to relax and loosen. Add to this the extra weight, weakened abdominal muscles, and shifted center of gravity that are unavoidable during pregnancy, and you have a recipe for back pain. While you may not be able to completely avoid back pain during pregnancy, there are some ways you can help make it more manageable.

First of all, prevention is key. Although heavy lifting will not hurt your baby, it is likely to hurt you. Even though I know better, I stupidly tried to move a 300 lb table during my first trimester and ended up spraining my pelvis. Please don’t follow my example! Let someone else do the heavy lifting. How often in life do you have such a great excuse for sitting back and letting others do the work? If you must lift something, make sure to bend your knees and lift with your leg muscles.

Proper foot wear is also essential to prevent back pain. Heels may look cute, but they are horrible for your back, especially during pregnancy. High heels push your center of gravity forward, causing you to arch your back in order to keep from falling over. During pregnancy, your back is already arched due to your big belly, so adding heels to the equation effectively causes you to squish the facet joints in your spine- ouch! My advice: ditch the heels at least during your pregnancy (but preferably forever!) Get some supportive flats, sandals, and walking sneakers. On a side-note, it is also a good idea to have your feet measured before making your purchase. Chances are, your feet have grown a size or two!

So what can you do if you find yourself with back pain despite these precautions? My four recommendations are: exercise, bracing, chiropractic, and massage. Gentle exercise such as walking, swimming, and yoga can do wonders for back pain. A few specific exercises that may be helpful are: lunge stretch, tailor stretch, cat-cow, and leg extensions. To do the lunge stretch, go down on one knee with the other leg bent in front of you at a 90 degree angle with the foot on the floor. Lunge forward slowly at the hips but keep the torso up straight. You should feel a stretch in your hip/groin area. Hold for 30 seconds and repeat on the other side. You can do the tailor stretch while seated. Cross one ankle over the opposite knee and lean forward, keeping the back as straight as possible. Cat-cow and leg extensions are done on your hands and knees. To do the cat-cow, arch your back up like an angry cat and tuck your buttocks under for a few seconds, then let your back relax and your belly sag for a few seconds. Repeat 10-20 times. For leg extensions, slowly move one leg straight behind you, hold for a few seconds, and then return to starting position. Repeat on the other side. Do 10-20 of these, making sure to keep your back as flat as possible.

If you find yourself getting sudden twinges of pain in your pelvis/buttocks whenever you stand up from sitting or if it feels like your hip sometimes “gives out” when you are walking, you may benefit from a sacroiliac brace. Essentially this is a belt that goes around your pelvis and helps hold the joints in place. The best ones that I have found are the “SI-LOC” and “Mother-to-Be” belts. Both can be found online at www.OPTP.com. The SI-LOC is better for earlier stages of pregnancy. The Mother-to-Be is better for the later stages of pregnancy when the belly is very big, or for women who are overweight to begin with. Both can be worn inconspicuously under your clothes.

Chiropractic treatment is another safe, effective option for back pain during pregnancy. A chiropractor can mobilize the joints in your spine and pelvis that have become stuck in the wrong position, thereby reducing inflammation and pain in the joints and helping the surrounding muscles relax. Theoretically, a well-aligned pelvis also maximizes the size of the pelvic opening, which many women have said leads to an easier delivery. Some chiropractors can also adjust your aching feet and address other problems you might be having, like headaches or carpal tunnel disorder. When shopping around for a chiropractor, ask if they regularly treat pregnant women and whether or not they have a special table or pillows to accommodate your expanding belly. Ask if you can meet with or talk to the doctor before making an appointment. It is important to find someone you like and trust. Chances are, you’ll need your chiropractor after having the baby as well; holding and breastfeeding an infant tends to cause some upper back tightness and pain.

Last but not least, I recommend that every mother-to-be gets at least one massage during her pregnancy. Growing a baby puts a lot of strain on the body. Muscles tend to get tight and sore, and you may be retaining water. You also may be feeling tense and anxious about your upcoming bundle of joy. A good massage can not only reduce muscle tension and reduce pain, but also provide mental relaxation and decrease swelling. And besides, every pregnant woman deserves a little pampering, right? Look for a licensed massage therapist who specializes in prenatal massage. He or she will know how to accommodate your changing body, either by doing the massage in a side-lying posture or using special pillows to support your breasts and belly.

In most cases, pregnancy related back pain will resolve several weeks after delivery, when you have lost some of the pregnancy weight and your ligaments have tightened back up again. That being said, there is no need to just wait and suffer throughout your pregnancy. By trying some of the tips that I have mentioned here, you will be more comfortable and able to enjoy the miracle that is happening within you.

Before starting into the mechanisms of these injuries and prevention, let’s look at some definitions and statistics. The general term for injuries that occur while serving some function to the world are termed “ergonomic” in nature. Ergonomics are literally the laws (normos) of work (ergos), and are defined as the science of adapting the job and/or equipment to the human for the purpose of maximal safety and productivity. Today, computer workstations are the major area of relevance for ergonomic applications, though the principles apply with equal importance to cars, cockpits and factories [1]. Humans were not designed to sit at a desk, hovering over a computer for hours at a time. For this reason, the workstation and behaviors must be adapted to fit the human if we are to prevent injury.

To get an idea of the impact these injuries have on the livelihood of our population, consider the following statistics taken from a report on Ergonomic Injuries in California by the US House of Representatives Committee for Government Reform in March, 2001 [2]. “Ergonomic injuries account for 1/3 of all occupational injuries and illnesses and constitute the single largest job-related injury and illness problem in the US.” “The National Academy of Sciences has estimated that the costs of ergonomic injuries to employees, employers and society as a whole can be conservatively estimated at $50 billion annually.” “Ergonomic injuries cost California’s economy over $4 billion each year.” Additionally, mechanical low back pain (that means back pain related to musculoskeletal injury, without any underlying disease) is the second most common symptom related reason for seeing a physician in the United States, and 85% of the population will experience at least one episode at some point during their lifetime [3]. This is not new information, and many employers are well aware of the benefits, from a business perspective, of providing furniture, computing tools, and employee programs that support good ergonomics. Even so, there are still many companies and individuals who have not yet been informed.

So, how do these injuries of the low back occur? In general, back injuries result from one or more excessive load(s) placed on the supporting structures of the spine. These include the vertebral joints – or facets, intervertebral discs -  or discs, ligaments, the layers upon layers of muscles, and nerve roots (two at each vertebral level). The purpose of the spine is to provide stability for protection of the spinal cord, while allowing enough mobility for the moving around that is necessary for our continued survival. This trade-off for mobility compromises stability, which, while necessary, means there are inherent weak spots. Fortunately for us, we have nice big brains that are capable of learning how to outwit nature and make up for these slight imperfections.

With long periods of sitting, it is the discs that are most commonly compromised and, eventually, injured. Why? As the major shock absorbing structures of the spine, the fibers of the outer ring of the disc are subject to continuous stresses, which sometimes cause small tears to develop. If one of these tears is large enough, and the stresses inside the disc are strong enough, some of the inner nuclear material (the gel-like, shock absorbing substance located within the center of the disc) can leak through the tear. The disc is most vulnerable to injury postero-laterally, at the weakest parts of the outer ring, which also happens to be where nerves pass from the spinal canal and exit toward the legs (not the best design, in my opinion). If disc material compresses one of these nerves, there can be pain both in the back and down the leg, as well as deficits in neurological function [4]. Under a flexion load, the majority of the stress goes right to these postero-lateral weak spots. Flexion loads occur when we bend forward, lift something from the ground or a low shelf, or sit for long periods, especially if we sit without lumbar support. Rotation, or twisting, of the spine adds additional stress to the disc, such that turning to access file cabinets and/or pick things up further increases your chances of injuring a disc.

Slumped posture alone, though, over a long period of time, day after day, places tremendous stress on the disc. Furthermore, the constant strain that this chronic posture places on surrounding muscles and ligaments causes temporary deformity in the tissues, which lasts for a couple hours. As a result, instability in the region occurs for a time, forcing the disc to pick up the slack (remember, it’s the major shock absorber), and placing additional stress on it. This repetitive and sustained loading of the disc causes an accumulation of minor damage that, over the years, adds up. Finally, a single unguarded and seemingly innocuous movement, such as bending over to move a sprinkler in your yard, can result in sudden intense pain and disability; the type that lands some in the emergency room. Did I mention that painful spasms of the large back muscles accompany this type of damage to the underlying tissues? Both protective and painful, these muscle spasms are the most memorable part of throwing one’s back out.

Now that we know where things go wrong for the supporting structures of the spine, how can we prevent playing this scenario all the way through? First and foremost, we start paying attention to our postures and motions. All movement of the body is performed against a background of subtle postural adjustments. For this reason, good control of posture is important for spinal stability. Neutral posture is what you have when your spine has that nice S-shaped curve seen in all of the books and magazines. This is the posture that requires the least amount of energy for your body to maintain, and is also the position of which the least amount of strain is put into the supporting structures of the spine. The body is balanced and efficient when neutral posture is utilized, and, whether still or in motion, the supporting structures are afforded additional protection.

Next, we reinforce our stability. Remember? It’s a major function of your spine. The core muscles lie deep within the trunk of the body. They attach to the spine, pelvis and muscles that support the scapula, and stabilize these areas to create a firm foundation for coordinated movement of the legs and arms. The human spine was not intended to be the primary mover. That function was intended of the arms and legs. Every time we move, we depend on core muscles to hold us steady, and muscles of the arms and legs to actually move us. Core stabilization is the general term for how the muscles of your trunk keep your spine and body stable, which helps you stay balanced when you move. If your core muscles are strong and they contract when the arms and legs start initiate motion, your body is balanced and less likely to be injured.

The next issues are muscle flexibility and joint mobility. Short tight muscles perform less than optimally, add additional compressive load to the joints they surround, and decrease range of movement in the joints. Flexible muscles, on the other hand, allow reduced muscle tension, increased range of movement in the joints, enhanced muscular coordination, and increased circulation of the blood to various parts of the body. To maintain mobility and flexibility, muscles must be stretched and joints must be taken through their full range of motion daily.

The last component is activity and exercise. Aerobic activity builds stamina, which is important for maintaining postural control. It also promotes strength and flexibility, and supports a healthy circulatory system. Lastly, it stimulates and reinforces motor patterns. The complex neurological paths between the brain and moving body part involve an assembly of muscles, with subtle adjustments at the core and opposite side of the body to maintain balance, relaxation of antagonistic muscles to allow movement across the joint, and finally movement of all muscles along the kinetic chain to achieve a single action. Imagine how quickly this all must occur, one firing after another, to produce meaningful motion. Every one of the pathways involved becomes stronger, more hard-wired, each time a motion is performed, which is why attention to posture during activities is critical. Our brains remember the position of every joint involved during the motion and will replay it that way, unless there is conscious override. If we consistently perform sloppy and unfocused movements, which put stress into one or more of our tissues and/or joints, this will become our natural way of moving and will likely contribute to an overuse injury down the road. Conversely, the simple act of repeatedly focusing on how we move creates a subconscious ready position for the brain, such that unexpected external forces, like accidentally stepping off the side of the curb, will be easily compensated through motor coordination. Without this involuntary level of control, we might, instead, take a dive off the curb. I imagine that most people will prefer to stay on their feet if they can help it.

This is a lot of information to process, but it is fundamental to good musculoskeletal health and well being. Please refer back as often as you need. Now that you have this knowledge and the power that comes with it, please get back to work and save your back!

References:
1. Answers.com, Definition of Ergonomics, 07.22.09, www.answers.com/topic/ergonomics
2. Ergonomic Injuries in California, oversight.house.gov/documents/20040624115434-95141.pdf
3. eMedicine, emedicine.medscape.com/article/310353-overview, Mechanical Low Back Pain, 2006
4. Steadman, R., Lumbar Disc Herniation Overview. 2005, www.steadman-hawkins.com/spine_lumbarDisc/overview.asp