Core Training and Low Back Pain

Low back pain is extremely common and is the number one cause of job-related disability. Around 80% of people report episodes of back pain at some point in their life. An important component of low back pain treatment is core training. If you think of your core as a barrel, it is composed of your diaphragm, lumbar multifidus, transverse abdominals, and pelvic floor. It is important to train each muscle to improve lumbar stability and support.



Studies have shown that people with low back pain show abnormal diaphragm position which can happen because the diaphragm is tight and/or weak. In these cases, people experience significantly more diaphragm fatigue than healthy individuals.

A tight and/or weak diaphragm can also increase your pain experience because of the impact on the nervous system and your pain receptors and because it can impact your alignment. For more information see the video below.

The diaphragm can be re-trained through specific breathing exercises.


Lumbar Multifidus

Studies have shown that in those with acute back pain, multifidus activation does not occur spontaneously. In fact, the multifidus muscle commonly wastes away by up to 1/3 after the first significant episode of acute lower back pain or injury. This can happen at any level in the spine depending on the level of the injury – even up in the neck!

The multifidus is a muscle deep in your lower back that aids in pelvic and lumbar stabilisation.


Transverse Abdominis (TrA)

Your transverse abdominis is a deeper layer of core muscles in your stomach, below your obliques and rectus abdominis (the 6 pack muscles). Studies have shown that there is reduced muscle activity of the TrA in people with low back pain. Clinically it is common to see significant differences in the way the right and left sides of TrA activate. Asymmetries in the TrA contraction, or a poor/absent contraction, can lead to shearing in the spine which leads to disc break down and bulging – particularly in the lower back.

This muscle can be trained with a range of different exercises but the key is to make sure you get the best quality, most symmetrical contraction possible. There are lots of different cues that may help you engage your core but the best way to make sure you’re getting a good and symmetrical contraction is with the guidance of a physio who is using an ultrasound to watch what your muscles are doing.

Some cues that may help activate your TrA are:

  • Imagine your pelvic bones coming together gently at the front

  • Imagine you are wearing a low slung belt that is slowly getting tighter around your pelvis

  • Slowly bring your belly button towards your spine without tensing your whole stomach

Pelvic Floor

The pelvic floor is a group of muscles and connective tissue that run from your tailbone to your pubic bone that literally create a floor for your pelvis on top of which sit your pelvic organs like the bladder, bowel and uterus. The pelvic floor also acts as the base of your core muscles just as the diaphragm acts as the top. Studies have shown that back pain can be related to altered activation of the pelvic floor – this can mean weakness, poor muscle tone, poor symmetry with contraction, or excessive tone/tightness in some of the muscles that make up the pelvic floor.

If your pelvic floor is weak, these are some cues you can use to activate it:

  • Squeeze the muscles as if trying to stop the flow of urine

If your pelvic floor is tight or overactive, some of the signs of this include:

  • Difficulty initiating urination or passing a bowel motion
  • Pain during intercourse or internal examination
  • Back pain or hip pain

If you are experiencing lower back pain, come in and see one of our amazing physiotherapists to get a full assessment and learn to properly cue and activate each of your core muscles to improve overall core stability and reduce back pain.


Written by Ashley Steinlauf

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