Is a Weak Core Really the Villain in Low Back Pain?


Low back pain (LBP) is a common complaint among otherwise healthy adults, and most often it is not caused by direct trauma, but rather by overuse or misuse of the muscles that contribute to spinal stability.

During physical activity, the muscles of your core fire in a synchronized way to control the motion and position of your trunk, to maintain it over your legs and pelvis as your arms and legs move in various ways. In effect, the core forms a natural girdle or brace that supports and protects your spine as you move.

Do weak core muscles cause LBP?

In the 1990s, research conducted by Hodges and Richardson (1996, 1998) indicated that dysfunction of the deep core muscles, particularly the transversus abdominis, may lead to inefficient stabilization of the spine. The physio and fitness communities ran with that information, and much ado was made about core stabilization training to both prevent and treat LBP.

Since the ‘90s, however, further research has emerged that fails to give credence to the notion that core strengthening exercises are the most effective treatment for LBP. In fact, a number of studies assert that core stabilization and strengthening exercises are no more effective than other types of physical activity for treating or preventing LBP.

That being said, the human body is made to move, and insufficient physical activity can lead to a number of imbalances and motor deficiencies that interfere with the efficient production, transfer and control of forces in your low back and pelvic region, and that in turn can lead to LBP.

Factors contributing to LBP

Having a weak core may certainly be among the factors contributing to LBP, but it would be remiss to place all the blame on core dysfunction. After all, spinal stability and alignment can be affected by a number of things, including:

  • Poor posture
  • Lack of flexibility
  • Tight hamstrings
  • Poor respiratory patterns
  • Low endurance of trunk extensors
  • Excessive sitting
  • Poor stabilization strategies
  • Obesity

Taking a one-size-fits-all approach to treating LBP by zeroing in on core strength alone makes little sense, when multiple other factors might be at play.

Getting to the bottom of things

Your nervous system coordinates posture, muscle activation, respiration, and other factors to produce efficient movement. Your muscles, joints, bones, connective tissue and nerves all work together to form a kinetic chain whose links are interdependent.

And we all know that a chain is only as strong as its weakest link.

A physical therapist can assess and analyze the way you move, and help pinpoint the factors that are most likely contributing to your LBP. They can then design a corrective exercise and treatment program to stretch, strengthen and stabilize your body to restore balance, relieve pain and promote optimal function.

LBP Treatment at NYDNR

At NYDNRehab, our Midtown Manhattan Physical Therapy clinic uses sophisticated technology coupled with specialized computer software to analyze movement and identify problems.

Our technological toolbox includes:

  • Diagnostic ultrasonography
  • EMG for muscle activation analysis
  • Force plate technology
  • 3D motion capture video
  • C.A.R.E.N, our computer assisted rehabilitation environment
  • Integrative computer software

Our experienced and caring staff uses that information, along with the results of your clinical exam, to identify postural, mechanical and lifestyle factors that may be contributing to your LBP. Treatment is completely individualized, with you, the patient, acting as a central participant in your own treatment plan.

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018) At: Paris, France

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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