Lower back pain myth No.7: my back pain's caused by a weak core.

A weak core does not cause lower back pain. Back pain is a bit more complex and multi-factorial than that, and is influenced by things like poor sleep, stress, anxiety, low mood, inactivity or unaccustomed activity.

Plenty of people who come to see me with back pain have perfectly good core strength, and most are holding some kind of excess tension or muscle spasm in core muscles, often as a kind of “bracing” against potentially painful movement. This excess muscle tension can be very painful in itself, and generally needs to be relaxed for things to improve.

There has undoubtedly been a bit too much of a focus on “one size fits all” prescription of core strengthening exercises for low back pain, a lot of the time when it’s not really needed.

This doesn’t mean core strength isn’t worth working on. Sometimes when I examine people standing, just a little gentle prodding around their low back will be enough to unbalance them a bit. This is kind of the definition of not enough core strength (the ability to stabilise your trunk while doing things like moving your arms and legs, carrying a load or reacting when you take a knock or something unexpected happens to throw you off balance). Rather than being tense and rigid, we need the ability to relax in order to respond and stabilise ourselves.

We tend to think of core strength as a specific set or type of exercises, often quite static, like planks, but we first develop core strength as babies, through simple actions like looking up, reaching, turning over, sitting up, crawling, eventually walking. The ability to stabilise ourselves while moving is clearly useful to us, so it’s worth thinking of dynamic exercises such as dead bugs or 4-point activation. It’s also worth recognising that we’re working our core in a variety of movements and more general exercise. Swimming, for example, is great exercise for our core. I used to get thrown around a lot doing martial arts, which was super-intense dynamic core exercise  just trying not to collapse in a heap.

Failing to do 5-minute planks is not a cause of back pain, but a variety of movement, exercise and activity that you enjoy is great for a healthy back.

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