You may have heard that strengthening your ‘core’ by doing core exercises can help with low back pain. This is true, but what exactly is your core? Most people think of their core as their abdominal muscles, but this is only looking at one piece of the puzzle.
One helpful way to understand and visualize your core is to think of your inner abdominal cavity as your ‘core canister.’ This canister consists of your respiratory diaphragm on the top — your pelvic floor on the bottom — your multifidus in the back — and your transverse abdominis in the front. All of these muscles work together with movement and exercise to create stability around your spine.
Here’s how it works: when you inhale, your diaphragm lowers to allow your lungs to fill with air. This creates intra-abdominal pressure that causes your abdominal and pelvic floor muscles to lengthen. When you exhale, your diaphragm goes back up, and your abdominal muscles and pelvic floor recoil. The interaction of these muscles enhances their function — they work better together.
Most of the time, these muscles do their job without us having to think about them. In fact, research has shown that our core will involuntarily activate before we perform a movement task . Our bodies are incredibly smart!
The problem arises when pain or injury alters this system. People with lower back pain have altered core muscle activation patterns, including delayed firing of the transverse abdominis with movement  and decreased movement of the diaphragm with inhalation .
When this happens, our bodies will recruit other muscles to compensate, which can feed into a cycle of pain and dysfunction. Working on your breathing is a simple way to start retraining your core so that it can support you in an optimal way.
So how can you work on your breathing to optimize your core function?
1. Find your balanced breath
Lie on your back with one hand on your chest and one hand on your belly. Take a deep breath in. What do you notice? Did one hand rise before the other? Did one hand not move at all? Next, move your hands to the sides of the bottom of your rib cage. Do you feel movement out to the sides? Is the movement symmetrical?
With a balanced breath, we should feel our belly rising and our ribs going out to the sides equally as we inhale. The chest may also rise, but that should not be the dominant movement. As you exhale, your belly should flatten, and your ribs should come back in. Imagine blowing up a balloon with your inhale and letting the air out with your exhale.
2. Don’t hold your breath
Have you ever caught yourself holding your breath while trying to do a challenging exercise — or maybe even a not-so-challenging one? This is a common compensation that people use to create core stability, but it doesn’t allow you to use the muscles in your core canister in an optimal way.
Remember how these muscles work as a system? If one stops moving, the others can’t move as well. In other words, an ineffective diaphragm leads to an ineffective core.
3. Inhale to prepare, then exhale on exertion
In order to use our core muscles in their full capacity, we must be able to lengthen them as well as contract them. To prepare for a challenging movement or exercise, take a deep breath in while allowing your ribs and belly to expand.
Letting the belly expand might feel counterintuitive to those who have been cued to always keep their abdominal muscles tight while exercising. But without this lengthening, you are missing out on the opportunity to use these muscles in their full range of motion.
After a good inhalation, start your exhale to facilitate an engagement of your core stabilizers. Continue your exhale throughout the exertion.
Breathing is the foundation of all core exercises. Working on breathing optimally is a powerful strategy to use your core muscles in a more efficient way and to help low back pain.
LEARN MORE BY SIGNING UP FOR A FREE WEBINAR. On Thursday, November 5th at 11:00 EST, Dr. Tyler Tredway and Dr. Krystal Sterling will present a webinar on Relieving Back Pain: The Healing Power of Your Breath. [REGISTER HERE]
1. Hodges P Cresswell A Thorstensson A. Preparatory trunk motion accompanies rapid upper limb movement. Exp Brain Res. 1999;124(1):69-7
2. Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord. 1998 Feb;11(1):46-56. PMID: 9493770.
3. Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. doi: 10.2519/jospt.2012.3830. Epub 2011 Dec 21. PMID: 22236541.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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