In a post a few weeks ago we started a three part series about how seniors build a strong core. We focused on the importance of flexibility and I think the big take home messages were as follows:
- A strong core (that decreases back pain) requires flexibility, strength,and one more (secret) component
- Strength without flexibility is pointless
- Stiff joints don’t cause pain, joints with too much motion cause pain
- The lower back usually has too much flexibility in certain areas, so stretches should be focused above and below (the mid spine and hips specifically)
- Stretches are held for 30 seconds, once a day
So we’re going to tackle strengthening our core today! I hope you took your vitamins and drank your milk!
(Look at that hulking core brotha)
With regards to the language “strengthening the core”, I believe most PTs would all agree that the term “stabilizing the core” is more appropriate. What’s the difference? Strengthening implies that your core will be able to lift heavier loads (weight) than it is now. We like to strengthen our legs, arms, shoulders, etc… to pick up or carry heavy things, but anything related to the spine is more about stabilization, which implies controlling motion or even limiting motion vs. lifting things. The reason for this is because pain occurs in the spine due to minute amounts of “sheering” motion (abnormal grinding joint movement usually in a forward motion).Preventing this motion requires QUICK (to start), small, and prolonged tightening of muscles on either sides of the spine. Those muscular contractions are stabilizing, not strengthening the spine.
Was that too much? It was way too much
How about this- think about stopping a ball rolling down a ramp. If we use strength- we would be pushing the ball back up over and over. If we quickly put our hand out and prevent any further rolling, we have stabilized the ball on the ramp. Strengthening vs. stabilizing!
Good? Great, moving on 🙂
Oh wait, before jumping into it- it is important (and legally responsible of me) to recommend you do not attempt these exercises without first seeing a healthcare provider able to clear you for your safety. These exercises are pretty safe, but at no point should you throw caution in the wind.
Ok, back to our big question: How can we focus on stabilizing our core? We start by exercising with any motion eliminated first. The best exercise here would be a prone plank. That is when you lie face down on your forearms and toes only with the rest of your trunk completely straight and still. Too difficult? No problem start this on an elevated level, like a kitchen counter. The closer your feet are to the counter, the easier it is. You will want to find a placement that does not hurt and is a bit of a challenge rolling into 15-20 seconds. When stabilizing, we focus more on endurance than repetitions, so you want to be able to increase the length of time completing these movements vs. doing them for 3 sets of 10. After you can maintain a position for 45 seconds or so, I would recommend moving to the next pain-free position until you are horizontal with the floor.
As you can imagine, the benefit here is strengthening in a completely straight pain-free position, which is an excellent measure of endurance with regards to static stability, but shows nothing with regards to dynamic stability with functional movement (in english: you can stand with a strong core, but the second you move, you got NOTHING). So let’s discuss this functional stability, you know, a strong core while doing things.
There are many exercises that I could recommend because there is so much involved with functional stability- but I chose one I love to prescribe due to familiarity and relative ease…
The Lunge: A Physical Therapist’s Panacea
If you’re unfamiliar with lunges, it is when you step forward (or backward) and bend both knees lowering yourself to the ground. This can be done while holding onto something when learning the exercise. I suggest our familiar rendezvous, the kitchen counter. With one hand on the counter, face parallel to the counter and take a step forward with the foot further away from the counter and bend both knees. When you get comfortable, start removing the whole hand and use just the fingertips until eventually you are hovering your hand above the counter only. Best to complete one set of 10 to start and working your way up to 25-30 reps in one set per leg.
To make this a better core exercise, I recommend you become aware of the most important component the goal here… INTENTION! If you simply throw you leg forward, barely avoid collapsing to the ground, and then use your hands to return to a standing position… you should stick with the planks only.
This exercise works because you’re hopefully preventing your spine from collapsing into the same motion as your hips and also because your core is king with regards to balance, and this IS a balance exercise.
Just circling back to intention for a moment. If you want the graduate level instructions, realize the purpose of this is to strengthen the core, so step heel first with both feet facing 12 o’clock, gently draw you naval into you spine, breathe relaxedly, and use your hand as a safety feature, not an assist in returning to an upright position. Focus your mental energy in minimizing motion in your spine. Is that a lot? You betcha!!! We went from beginner’s exercises to mastering mental imagery in one paragraph. What’s the pearl of wisdom here? Just exercise with intention.
(If all else fails, lean up against a wire fence for a fool-proof 6 pack)
Stabilizing the core is an incredibly important way to limit your risk of back pain, along with maintaining healthy flexibility in the hips and mid spine. There is one more article to be written in this series, care to guess what the last one is? Comment below!
Dr. Daniel Davids PT