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Back pain: core strengthening exercises to protect the spine
Targeted core strengthening work can reduce the risk of back pain
Anatomy of the healthy spine
The human spine is comprised of 33 bones (vertebrae) separated by 23 intervertebral discs, which when fitted together make a ‘lazy S-shaped’ curve – ideally suited to minimising the stresses and strains on the spine when under load. Although each vertebral joint only allows a small degree of movement, together they allow large ranges of movements in the spine as a whole.
The spinal column is further stabilised by ligaments, which attach to the vertebra. These ligaments are similar to those in other joints; they can be strained and sprained – a risk that is increased by sustained stretches or awkward movements of the spine. Fortunately another level of spinal stabilisation exists. A number of deep (core) muscles in close proximity to the spine act as a kind of muscular girdle and help to stabilise the vertebrae in the spine during activities involving spinal movement such as throwing or kicking a ball, twisting, turning, bending etc. Physiologists now believe that these stabilising muscles play a crucial role in maintaining spinal integrity and keeping injury at bay.
There are a number of causes of spinal pain, but many involve a disc prolapse, where the nucleus of an intervertebral disc is subject to unusual or excessive force and herniates out, pressing onto an adjacent nerve, causing pain (often but incorrectly referred to as a ‘slipped disc). The risk of a disc prolapse increases during movements or prolonged postures involving bending or twisting, particularly when spinal control is poor due to weakened core muscles.
Spinal health and core strength
Core strength refers to the degree of muscular control exerted by the core muscles to stabilise the spine during movement. In recent years, studies among the general population have demonstrated that training and strengthening these muscles not only improves the function and mobility of back pain sufferers, but also reduces the risk of re-injury1-3.
Athletes are no different; although being fit and active is known to reduce the risk of back pain, this is negated by research showing that high-volume training performed by elite athletes may increase this risk4. However, while athletes undertaking heavy training loads seem to be at a higher risk of developing back pain, the good news is that they generally respond very well to back pain treatments5.
Sports specific spinal health and specific sports
Although there’s no doubting the benefits of core strength work for athletes, there’s a dearth of research on specific core strengthening routines for specific sports. However, some sports are renowned for the unusually large amounts of loading they can create in the spine; a few of these are briefly mentioned below:
A combination of over-strong and tight hamstrings, tight hip flexors and calves, over-developed rectus abdominis but weakened core muscles, and a tendency for footballers to favour one leg over the other can result in poor pelvic and trunk stability and reduced spinal flexibility. Ideally sport specific stretches including hamstrings, quadriceps, hip flexors, calf and abdominal wall stretches are recommended to improve stability and reduce injury6.
Forward players in particular are prone to developing muscular imbalances in the neck and shoulders, and to tight hip flexors. Much of this arises from the requirements of the scrum, where a lot of time is spent bending forwards. A combination of specific stretches (especially for the neck) and a general core-strengthening program can be of great benefit to rugby players.
A stress fracture of the vertebra is a surprisingly common injury among cricketers, especially bowlers. Studies have indicated that it’s not the volume of bowling that creates the problem; rather the technique7. Fast bowlers in particular use the spine as a whip for the arm while simultaneously subjecting the spine to rotation and sideways bending, placing stress on a region of the vertebra called Pars Interarticularis’, leading to crack formation in this area. Prevention of this injury often requires the adoption of a ‘squarer’ technique to reduce rotation in the spine, which may require analysis of foot and hip movement too. Stretches for the spine, shoulder girdle and scapulae area are also strongly recommended as well as core strengthening work.
The repetitive and prolonged forward bending action in rowers with loss of the ‘lazy-S’ position can place the ligaments and disks in spine under stress, leading to an increased risk of low back pain. This risk is increased with any left/right asymmetry as rotational strains can then develop. Thoracic pain can also be a problem. Rowers often develop tight rectus abdominis and chest muscles and have poor core strength. Stretches that target and open up the chest are recommended as well as a general core strengthening routine.
Although more studies on core strengthening work to reduce the injury risk in specific sports are needed, the available evidence suggests that the inclusion of a number of simple core strength and stretching exercises in a sport conditioning program can help reduce spinal injury risk and provide a solid foundation for the execution of sport specific skills and movements.
1. Med Sci Sports Exerc; 2004; 36 (6): 926 – 934
2. Curr Sports Med Rep; 2004; 3 (1): 41- 46
3. Curr Sports Med Rep; 2004; 3 (1): 35 – 40
4. Curr Sports Med Rep; 2004; 3 (1): 41- 46
5. Spine; 1996; 21 (22): 2640 –2650
6. Man Ther; 2001; 6 (4): 213 – 220
7. Sports Med; 2002; 32: 633 – 653
Original article by TJ Salih
Summary by Andrew Hamilton