Core strengthening exercises for chronic lower back pain an effective rehabilitation technique says a new study. Chronic lower back pain is a huge problem for many of us, yet few of us get the help we need to help it stay away. One of the big truths behind chronic lower back pain is that it is mechanically based. Another big truth according to Cheating Mother Nature, what you need to know to beat chronic pain (1) is that a distorted core or mid section is one of the most common findings in patients who suffer from this. The problem for most people is what to do. Many patients have been given exercises for the lower back by different types of providers however it isn't enough just to do exercises. The lower back and surrounding musculature must first be made more flexible and the gluteus Maximus must also be strengthened says a new pilot study (2) which was performed on 30 patients who were split into two groups on the basis of how long they experienced pain. Both groups saw improvement in the amount of pain they experienced. We believe that exercises are essential to success with any rehabilitation program however, even with flexibility and strengthening of the gluts, we need to question why they went weak in the first place. It is not enough to suggest that if we strengthen and lengthen, then patients will improve however many definitely will see symptomatic improvements. The question is, will those improvements be maintained and why did those muscles get weak in the first place. If you were told that you will need to do those exercises forever, why? Many people do no lower back exercises and are not having your problem, so don't buy into that suggestion; it shows that there is a lack of understanding of the mechanism behind your problem. Our advice to patients is that after performing myofascial release, Graston, manipulations to the extremities and joints; comprehensive chiropractic care is not enough; you need to do the exercises to get the maximum benefit. Think of the care we deliver as the cement and the exercises as the hardening agent. Beware of the distorted pelvis or torqued core. One more important concept to understand is the dynamics of a torqued core. A distorted core is not trainable, meaning, that a torqued core is unstable, is chronically placing the sacroiliac joints under strain, and because the core is distorted, it will not distribute the forces of walking, sports and general movement properly, leading to problems in the feet, legs and knees. It will also lead to secondary problems in the upper back that are compensatory which can cause chronic neck, mid back pain, shoulder problems and headaches being the most common. If severe enough, problems with vertigo and balance are quite common, especially in older populations. It is quite common for people with a torqued core to have many leg problems including plantar fasciitis, ankle pain, knee pain and to be generally inflexible which are important self diagnosis clues. To properly address a torqued core, the most effective therapeutic approach includes; 1. Wear shoes with arches or foot orthotics - these will level the pelvis and improve the way the core functions, relieving many knee, hip and foot problems. Off the shelf foot orthotics can work for many people but must be switched out every 3-6 months depending on use. Custom insoles are mandatory for some and tend to be more cost effective if you need to replace off the shelf inserts more frequently. Be aware that many podiatric orthotics are casted improperly, so the devices are only as good as the accuracy of the caste. Off the shelf inserts are predictable but are not designed to last as long. 2. Myofascial Release or Graston treatment to the tight tissues of the core. These techniques will quickly improve function to the core and render it trainable. Exercises are much more effective and comfortable to do when the core is not torque, Also, when the core is unstable, you will recruit into other muscles that will make you tighter, rather than looser. 3. Core stability protocols for lower and upper body. The reason for upper and lower body is that if you stabilize the lower body and the upper body is compromised by tight myofascia, the core will distort from the tight upper body. If you do Pilates, you should see continued improvement and graduation to different levels of difficulty and training. If you need constant training to maintain or you are told to do it a different way because you cannot do it as instructed due to pain or discomfort, you are either working at too high a difficulty too quickly or somebody is missing something and doing a modified maneuver is more likely to make your problem more chronic. 4. Spinal and extremity manipulation is essential for most lower back pain, because a torqued core has compromised joint movement. Manipulation will restore the movement, and is proven safe and effective, with chiropractors being the most experienced. It is proven safe and effective, with chiropractors having one of the lowest costs of malpractice in the healthcare industry. For those who have painful disc herniation's, many use flexion distraction which has proven to resolve many cases of disc pain as well as improving spinal stenosis symptoms, without the use of force. A sports chiropractor is a natural for this type of comprehensive approach and both Consumer Reports as well as Bottom Line Personal agree; any type of lower back pain should be treated by a chiropractor first. If the doctor cannot help or something more serious is present, a chiropractor is trained to do the necessary tests and will refer you to the most appropriate healthcare provider. 1. Read Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com. Author, William D. Charschan D.C.,C.C.S.P, edited by Mark Daniels 2. Journal of Back and Musculoskeletal Rehabilitation. 2014 Dec 2. Efficacy of core muscle strengthening exercise in chronic low back pain patients. Kumar T1, Kumar S2, Nezamuddin M1, Sharma VP3.