With Pilates programs increasing in popularity over the past ten years, Pilates and core stability have become common terms in exercise.  Many people pursue the dream of the “6-pack abs”, or a flat stomach, by doing sit-ups, crunches, and working out on a variety of abdominal machines. Although having a toned abdomen looks good, and a “gut” can put a strain on your low back, traditional abdominal exercises do not provide core stability. These exercises, along with hip strengthening, increase superficial muscle strength or what’s called core strength.  However, these muscles do not necessarily provide the stability that the spine needs to function.  

What is core stability?  It is the deep muscles in the front and back of your spine (transverse abdominus and multifidus muscles), your diaphragm, and your pelvic muscles forming a brace when contracted to hold your spinal column in alignment.  Building endurance and eliciting co-contraction (when all the muscles tighten together to form a brace) of these muscles, will provide the stability to control movement and limit potential injury to the spine and trunk.  This stable base of support absorbs the forces transferred from the legs or arms when you swing a golf club, run, lift a bag of groceries, or reach up to a high shelf.  Having good core stability helps prevent injury when performing home, work, and athletic activities.

When you develop back pain, the muscles that provide core stability are often inhibited or ‘turned off’ and don’t always switch back on once the pain goes away.  This inhibition causes the muscles to lose their memory and not provide the stability to your spine, predisposing you to injury or re-injury.  The focus on rehabilitating the core stabilizers is not strength as much as endurance.  These muscles are contracting and are under stress all day long and require endurance so they do not become fatigued and are able to provide stability when your spine needs it. 

Pilates, a specific type of core stabilization exercise, involves low grades of contraction held for long periods to improve endurance and strength.  It would be optimal to start exercises that increase core stability in a structured environment to insure that you have the correct alignment and technique.  Starting with and maintaining good alignment of your pelvis and spine is critical for re-training these muscles and that can sometimes be difficult simply watching a video or reading a book.  Along with diaphragmatic breathing (tummy breathing – watching your tummy come out and in means that your diaphragm is working, rather than your rib cage), the pelvis must be level or neutral to encourage correct muscle action.

Not everyone has the opportunity to take Pilates classes but a few basic instructions will help get you off to a good start.  To begin, lie on your back with your knees bent and feet flat on the floor.  Form a triangle with your index fingers and thumbs.  With your thumbs as the base, place the tips of your thumbs at your belly button and your fingers pointing down toward your feet.  This triangle should be level with the floor.  If it is not, tighten your stomach and ‘rock’ your pelvis until your lower back presses gently into the floor and your ‘triangle’ is level with the floor.  Now your pelvis is in your neutral position.

While keeping your pelvis in neutral, breathe in through your nose, expanding your stomach.  As you exhale through your mouth, pull your belly button down toward your spine squeezing your lower abdomen in (as if you are trying to zip up tight jeans).  This is called diaphragmatic breathing and you can continue this while maintaining your neutral pelvic position.  When you feel comfortable, you can add simple movements. With both knees bent, inhale and raise your right knee up. Return to neutral as you exhale. Perform 5 times on each side. Another exercise to try is starting with both knees bent and let one knee slowly drop to the side as you inhale.  Exhale and return to neutral.  Perform 5 times, alternating on each side.  With each exercise, don’t let your pelvis rock.  These are basic exercises and can be the foundation before you start a class or start an exercise video.  Remember that the technique is important and if you can’t maintain the neutral pelvis and breathe properly, then you will need to slow down the pace of your repetitions. 

A core stability exercise program will improve the deep trunk muscles that provide spinal stabilization and lead to the improvement of everyday life, injury prevention, chronic back pain reduction, and enhanced sports performance.  To view some of our videos on spine stabilization, click on Rehabilitation and then choose the ‘Back’ category.