The CORE is sexy…but are we missing something?

It doesn’t matter who you are; if you are an Olympic weight lifter, golfer, construction worker, or stay at home parent, you can benefit from exercises that improve mobility and endurance around your spine. The core gets a lot of love in the media. Why? Because it is freakin’ sexy that’s why! While six-pack abs are great, when we work with people in pain and delve into research we start to see a major piece of core training that is overlooked –Proprioception.

Proprio…what? Basically, proprioception an awareness of where your body is in space. This is one of the most common errors that I see in clinic, especially with chronic low back pain. Proprioception is a normal communication line between the brain and body. When there is miscommunication we will see increased pain and poor stability at the spine. This is somewhat of a chicken or the egg situation. Did the back pain come first? Or the proprioception problem.

Studies show that people with back pain tend to have proprioceptive deficits. This includes a reduced ability to sense motion at the back, and a reduced ability to localize where you are specifically being touched on your back. In Lorimer Moseley’s study, patients were unable to perceive the outline of their back on the painful side. When asked to draw their spine, subjects with chronic pain drew their vertebrae in a misaligned fashion compared to normal subjects.

Surprisingly, people unknowingly will position themselves in pain provoking postures. This is hypothesized to occur because of proprioceptive changes. Another hypothesis is that your muscles, spine, ligaments, etc. are being forced to endure excessive strain because of this miscommunication between the brain and your body. As a result of reduced proprioception (Tong et. al.).

If pain is a limiting factor, this must be addressed first. You have a wide variety of medical professionals available to you: physical therapists, chiropractors, acupuncturists, massage therapists, etc. I would personally recommend a skilled PT. This is only because I am one, end of story… Just kidding. I recommend a PT because we are trained to complete a thorough examination and are equipped to determine if your complaints should be treated conservatively or need a further work up.

Testing Proprioception

Before going hard on the core training we need to test the proprioception at your spine. Start with a quick stretch routine and/or some foam rolling to wake up the sensory fibers in the limbs and trunk. This will help enhance your proprioception. This is the progression I’d recommend:

 

1. Cat/Camel

Instructions: Position yourself on your hands and knees (better known as quadruped). Start by rounding your low back, try tucking your tailbone (coccyx) into your belly button…I know, weird visual. Next arch your back as much as you can within your comfort level. Last but not least, try to put yourself in a neutral spine position. Throughout this stretch, take a look in the mirror to see if it matches up. If you are not sure, consider going shirtless! Why you ask? WHY NOT?! This is where the song “I’m too Sexy” by Right Said Fred should turn on. Oh yea, you will also see the angles of your spine better. This helps give the brain a clearer message of what is actually going on at your back.

Goal: Find a neutral spine position 10 out of 10 times. If you accomplish this try to round or arch your lower back to a specific angle and then look to the mirror to see how you did.

If it’s not good, do not pass go, do not collect $200 or you are wasting your time on more intense core exercises.

 

2. Bird Dog

Instructions: Now that you can find neutral alignment, the goal is to maintain this alignment while reaching out with your opposite arm and leg, followed by bringing the opposite elbow and knee together. You should be using a mirror to ensure that you are maintaining good alignment. (Refer to picture). If you need some assistance, perpendicularly place a golf club or something similar on top of your low back. Sensation of the golf club moving as you move will give you a better sense of the position of your low back and hips. Overtime you can remove the club as your proprioception (aka awareness of body position) improves.

You should not need to squeeze your stomach like you have been constipated for a week. This should be relaxed. Namaste!

Goal: Perform 10 times on each side with good alignment

Increase difficulty: Place an unstable surface under hands and knees (ex. pillows, cushions, or airex pads)
Reduce difficulty: Start with moving just one limb at a time

 

Golfer Bonus:

Standing Pelvic Tilts and Standing Pelvic Rotation are a great way to improve coordination and proprioception at the lower back and hips, which can reduce pain! For my golfers, these moves will have a significant impact on your ability to perform a good, pain-free swing.

 

• Standing Pelvic Tilts: Similar to the Cat/Camel. Work on rounding and arching your back in a five iron posture, then find a neutral spine position. Being able to perform a posterior pelvic tilt (or rounding of your low back) is critical during the impact position of your golf swing. It keeps you from coming out of your posture during your swing. Which leads to the dreaded early extension position (aka the back killer)! Check any professional golfer’s impact position to reinforce this concept.

• Standing Pelvic Rotations: Also critical in the golf swing! Being able to dissociate your hips is SUPER important with rotational sports. It helps create an efficient kinematic sequence*, leading to straighter, longer, and more consistent shot patterns.

*Kinematic sequence: This is the sequence that your hips, trunk and arms move in during your swing or throw.

 

Conclusion

Improving proprioception in your back can be done in a variety of ways and these exercises are a great place to start. People that take part in sports and exercises that require this spinal awareness tend to have less back pain in my experience. For example, performing skilled Olympic lifts requires great mobility and an awareness of where your body is in space (proprioception). Performing higher-level moves such as these on a regular basis can be risky with the addition of speed and weight, but otherwise are a wonderful training method. The big takeaway here is that training the core requires a key pre-requisite– proprioception. Do not overlook its importance in your quest for pain relief or performance.

 

Other Big Takeaways:

1. Proprioception is the awareness of where our body is in space.
2. Pain must be addressed first to ensure optimal proprioception at the spine. Sometimes a quick stretching and foam rolling routine can do the trick.
3. Bypassing these exercises for higher level core exercises can lead diminished outcomes.

 

Dr. Michael Infantino, DPT

 

1. Moseley, G. L. (2008). I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain, 140(1), 239-243. doi:10.1016/j.pain.2008.08.001
2. Abdelraouf, O. R., & Abdel-aziem, A. A. (2016). THE RELATIONSHIP BETWEEN CORE ENDURANCE AND BACK DYSFUNCTION IN COLLEGIATE MALE ATHLETES WITH AND WITHOUT NONSPECIFIC LOW BACK PAIN. International Journal of Sports Physical Therapy, 11(3), 337–344.
3. Tong, M. H., Mousavi, S. J., Kiers, H., Ferreira, P., Refshauge, K., & van Dieën, J. (2017). Review article (meta-analysis): Is There a Relationship Between Lumbar
   Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis. Archives Of Physical Medicine And Rehabilitation, 98120-136.e2. doi:10.1016/j.apmr.2016.05.016