There is a widely held belief that strengthening the core muscles is key to resolving lower back pain. The number of patients who have told me they were treated based on this premise prior to coming me is staggering. The general idea is that the back muscles need assistance to support the back and if not assisted they will strain-- creating pain.

The sad reality is that the idea of the "Core" was created by people in the fitness industry in order to keep people interested in exercising. There were aerobics, then step aerobics, spinning and who can forget the use of the theraball with weights. The "Core" seems to have stuck the longest. Let's examine what it really takes to resolve lower back pain caused by strained lower back muscles.

Let's start with the abdominals as a key component for assisting the lower back muscles in support of the torso. The abdominal sheath is extremely thin. The rectus abdominus muscles, which are certainly the largest of the abdominal group, span from the rib cage to the pelvis. 

The major purpose of the abdominal sheath is to keep the organs in the abdominal cavity supported. If it has any benefit to supporting the lower back, it does by limiting the abdominal region from moving forward in front of the body. This limits an excessive load that would have to be picked up by the lower back muscles causing undue work which could cause these muscles to strain.

The obliques and the transverse abdominus are in an even weaker position to create force because of their size and attachment positions. This should hopefully eliminate the idea of any of these muscles playing a major role in support of the lower back.

Now let's look at strengthening the lower back muscles. This idea typically results from the premise that since the lower back muscles are straining, then the answer is to strengthen the muscles to prevent them from straining. This is the biggest fallacy of all. As I noted previously, the abdominal muscles are generally weak. They are unquestionably weaker than the lower back muscles. The lower back muscles are substantially thicker than the abdominal muscle group and have a more direct attachment to the rib cage and pelvis then does the abdominal group. They are not responsible for holding the organs in the abdominal cavity which makes them more adept than the abdominal group for supporting the lower back. This understanding that the lower back muscles are stronger than their opposing muscles (one muscle creates a movement and the opposing muscle performs the opposite movement), the abdominal group is key to understanding how muscles create force and knowing when to strengthen a muscle or not.

The most important question to be answered is how to keep the lower back muscles at their proper length so that they can create optimal force maximizing their function. The answer is maintaining proper balance of the front thigh, quad muscles and the back thigh, hamstring muscles. Both of these muscle groups attach to the pelvis. They have the ability to tilt the pelvis forward or backward. The quads are typically stronger than the hamstrings. Since the quads attach to the front of the pelvis, the shortened quads and pull the front of the pelvis towards the floor. This causes the back of the pelvis to rise. This shortens the distance between the back of the rib cage and the back of the pelvis. This shortens the length of the lower back muscles making them lose their ability to create force.

The key to sustaining strong lower back muscles is to keep balance of the hamstrings and quads. To keep the hamstrings strong, utilize straight leg deadlifts and hamstring curls. A short term method for decreasing back pain while strengthening the hamstrings, is to perform a quad stretch.

The idea of the "core" being the answer to preventing lower back pain must be ended. It is long overdue. Once this idea is put under the logical microscope, the lack of validity becomes evident. The idea of maintaining the proper length of the lower back muscles by sustaining balance of the quads and hamstrings as the key to good back health can be seen both theoretically and in clinical experience as the true mechanism.