Many individuals in this country, including athletes, has or will experience low back pain in their lifetime. Whether it is an office worker who sits for many hours or a high level athlete performing complicated, skillful movements, a debilitating low back injury can cause missed work or limited sports activity.

There are many causes of low back pain, some easier to diagnose than others. These include degenerative changes (i.e., spinal stenosis, osteoarthritis, degenerative disc disease), mechanical faults (i.e., joint pathology, hypermobility) and muscle strains. Symptoms can range anywhere from localized low back pain, to numbness and tingling into the lower extremities.

Fortunately, the majority of low back problems stem from mechanical faults. Individuals may feel occasional pain across the low back that varies with body position or activity. A specific exercise program aimed at correcting these faults may help reverse the underlying problem, restore proper functioning, and ultimately reduce symptoms.

There are several muscles that contribute to lumbar stabilization and core strength, but let us focus on the abdominals. There is a superficial and deep layer of the abdominals, both of which play an important role during activity. The superficial layer consists of the rectus abdominus and the external obliques, the muscles everybody strengthens because they want that elusive six pack. The rectus abdominus functions to flex the trunk and the external obliques function to rotate the trunk. These two muscles are responsible for force production and help the body handle large external forces, like hitting a forehand or swinging a baseball bat. The deep layer is the layer of most importance. This layer is made up of the internal obliques and the transverse abdominus which provide lateral and rotational support to the trunk. They form a cylindrical force, like a corset, that helps stabilize the lumbar spine when contracted.

People suffering from low back pain demonstrate a loss of control of the deep abdominal muscles. These muscles may be weak, atrophied, and/or improperly used to stabilize the spine during movement. To compensate, the rectus abdominus is used instead of the internal stabilizers in attempts to stabilize the spine. Despite the forces the rectus abdominus and external obliques can produce, they are not adequate stabilizers of the spine. If they are repetitively used in this role, they may make the existing condition worse. So, performing exercises that emphasize the voluntary control of the deep abdominal muscles is the first step to a healthy back.

What I like to call "setting the core" is the foundation for all exercises and strengthens the deep abdominal layer. If you can master this exercise you will be on your way to reducing your risk for low back pain. This exercise, and the ones that follow, require discipline and concentration, which may be hard for those of you who have the "get in and get out" mentality when heading to the gym. These exercises need to be performed in a slow, deliberate manner, preferably in a quite area so attention can be made to activating the appropriate muscles.

Setting the Core:

1. Lie on your back with your knees bent and your feet resting on the floor (a.k.a. resting position).
2. Place your fingers on the inside of your hip bones.
3. Cough and you should feel a muscle "jump up" into your finger tips.
4. Activate these muscles by drawing your belly button towards your spine and hollow out your abdomen, like you are trying on a tight pair of jeans. This is an isometric contraction.
5. Hold this for 5 seconds, while breathing, and repeat as many times necessary to perfect the contraction.

You are doing it incorrectly if:

1. Your spine is flat on the floor.
2. The abdominals are pushed up toward the ceiling, instead of pulled towards the floor.
3. Your superficial abdominal, low back, buttock and any other muscles are contracting. The only muscle you should feel is the muscle under your fingertips.
4. Holding your breath is the only way to perform the movement. You should be able to hold a conversation while keeping your belly pulled toward your spine.

Once you have mastered this exercise you are ready to start performing more dynamic exercises. Below are a group of exercises that will help train these deep abdominal muscles to stabilize when hitting a spike in volleyball or shooting a jump shot. Perform 3 sets of 10 repetitions of these exercises once a day. Do not forget to set your core throughout the day. For example, practice contracting those muscles when sitting at work, walking on a treadmill or cooking dinner. This will help retrain those muscles to fire as stabilizers when playing tennis.

Bent Knee Raise

1. Lie on the floor in the resting position.
2. Set your core.
3. Slowly bring one knee to your chest followed by the other.
4. Pause and lower one leg on the time.

Bridges

1. Lie on the floor in the resting position.
2. Set your core.
3. Squeeze your gluts, press your heels into the floor, and raise your pelvis so your knees, hips and shoulder make a straight line.
4. Hold at the top for 5 seconds and then lower.

Bird Dogs

1. Position yourself on your hands and knees, with your hands underneath your shoulders and knees under you hips, about 6-8 in apart.
2. Set your core. Your back should be flat, like a table top.
3. Slowly raise your left arm in front of you to shoulder height and your right leg straight back to hip height.
4. Once you have gained your balance, hold the position for 5 seconds, and then slowly lower you arm and leg back down to the floor.
Repeat with the other arm and leg.

Planks

1. Lie on your stomach with your elbows under your shoulders.
2. Set your core.
3. Slowly raise your pelvis up in the air so your hips are at shoulder height.
4. Hold this position for 5 seconds and lower.

This article was written by Bret Waltz, DPT, CSCS. Bret is a physical therapist at SERC of Lee's Summit.

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