Core stability

The lumbar bones are placed on top of each other with discs in between.

This structure is not very stable on its own if weight is put on it or in movement.

The ligaments hold the bones together and give a some stability but much of the stability of the back is provided by muscular contraction.

This muscular system is often disrupted in people with low back pain and it is useful to attempt to correct this.

The stability system

Recent research has shown that there is a stability system in the abdomen and low back which involves mainly two muscle groups:

• The transversus abdominis muscle. This is a muscle deep in the tummy which runs between the prominent hip bones which can be felt at the sides of the abdomen
• The multifidus muscle, at the back, which runs from one back bone to another along the spine

When a person has a back injury the multifidus muscle reduces in size at the level of the injury in the spine, in as short a time as 14 days. When the injury has settled and the pain gone the multifidus does not recover its size and strength automatically. This means there is a area at the injured level which is more vulnerable to reinjury. This may be a reason why people have repeated episodes of back pain after the initial one.

Research has also shown that if the muscles are exercised correctly they come back to their original size and coordination which may lessen the risk of recurrences.

Symptoms of instability

• Sudden jolts of pain in the back for no particular reason, eg. when performing a trivial action
• Difficulty getting back up to the vertical after bending forwards, often having to push up on the fronts of the thighs to stand upright
• A sudden catch of pain when almost returned to vertical from bent over
• A sudden severe pain with a giving way feeling of one leg

Instability means the muscular corset which supports the lower back is not performing well and regular small episodes of pain are occurring. This does not let the pain problems settle down and may lead to worsening over time. See Core stability exercise for the start of an exercise programme to address this problem.

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