Is better core strength the answer to all back pain?


imagesIs better core strength the answer to all back pain?

As a devoted Pilates instructor I would love to answer this question with a simple “YES!”. Unfortunately though – the answer is a little more complicated than that.

Over the years as I’ve met more people with lumbar-pelvic pain, I’ve come to realise there appears to be some sort of consensus that having a strong core will be the ‘cure all’ for such pain. If only it were this easy!

Firstly lumbar-pelvic pain is quite a general term used to describe pain of varying origins within the lumbar spine and/or pelvic girdle. The underlying cause for pain in this region can vary considerably from person to person. So the idea that one solution (more core strength) will be the answer for each individual situation is unlikely.

An analogy I like to use to describe this point is likening your body to a car. In the same way that a car requires many different components working together to run well, the same can be said for our bodies. Like a car we require the correct fuel (nutrition). We need an electrical system to relay messages (similar to our nervous system). We need the correct shock absorption to limit loading through inappropriate areas (as we do via our feet and thorax). We need a centred wheel alignment to prevent wear and tear in the wrong places (just like we need appropriate posture and body symmetry). We need the engine to provide force (the same way our muscles assist in movement). And lastly we need nuts and bolts to hold the whole car together (just like our core).

Now if you took your car to the mechanic you would expect them to check all of these functioning systems to accurately diagnose which may be contributing to the problem. Similarly for each person who presents to their healthcare provider with lumbar-pelvic pain, a thorough assessment needs to be conducted to determine the cause of the problem. Unfortunately there is not simply one answer for each and every individual.

So is a weak core the culprit for your lumbar-pelvic pain? Possibly. However there may be other factors contributing to the problem, such as an alignment (postural) issues or poor shock absorption through the thorax. Each person is different.

So should everyone with lumbar-pelvic pain run out and dress themselves head to toe in lycra and become a dedicated Pilates fanatic? Or become a professional “planker”? Not necessarily. In much the same way that not everyone with knee pain should immediately begin quadricep strengthening exercises. Am I refuting that good core strength is required to function optimally? Not at all. I am simply trying to encourage people to consider all functioning parts when diagnosing the cause of lumbar-pelvic pain. If you are experiencing lower back or pelvic pain I would suggest you visit your local healthcare professional who will provide a thorough assessment and diagnose the components that may be contributing to your pain and point you in the right direction as to what exercises may help or hinder your progress.

Now it would be silly of me not to point out that Pilates is not simply all about ‘core strength’. Pilates is  a very well rounded form of exercise that can help to improve mobility, core strength, pelvic floor dysfunction, peripheral strength and overall movement patterns and posture. So certainly Pilates is a discipline to consider wether or not you have pain for great general health and prevention of injury. For locals I can highly recommend a fantastic boutique Pilates studio in Avalon that is run by the lovely Jessica Dalziel. Pure Form Pilates offers private 1:1 classes or semi-private classes of 1:3. All instructors are highly qualified and passionate about their discipline. Visit for more information.

Kat King
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Preparing for the ultimate surf trip!

1012986_10152551340626930_5051132506875291365_nWho wouldn’t love a whole holiday dedicated to nothing but surfing, eating and sleeping?! 10 days on a boat or a secluded spot with friends, waves and solitude. What could possibly go wrong? Fatigue and injury if you’re not physically prepared….. that’s what. Let’s be honest, despite our hopes and best intentions, the everyday surfer probably gets in the water an average of 2 to 3 times per week (if you’re lucky). So what makes us think that our bodies will automatically be conditioned to hit the waves 2 to 3 sessions daily, day after day after day during that long awaited surf trip?

All too often I hear that by day 3 or 4 people start to succumb to fatigue, often leading to some form of overload injury (that’s if the rib soreness hasn’t already stopped you in your tracks!). Now, while the only thing that is going to save you from rib pain is spending more time on the board in the lead up to your trip (or custom made rashes and wetsuits), fatigue and overload injury can be prevented by adding just a few specific exercises to your usual routine in the lead up to your holiday.

In my experience, the areas of the body I most commonly see affected by overload during surfing include the shoulders, neck and lower back. In some cases this is due to a lack of appropriate strength, endurance or mobility, though can sometimes be something as simple as your posture on the board.

Let’s start with the shoulders. Without a doubt, the most common pathology I see here is a sub-acromial impingement. This is a global term used to describe impingement (squashing) of one or more of the rotator cuff tendons, within the subacromial space. This condition frequently occurs in combination with sub-acromial bursitis (inflammation of the bursa). Characteristically it often presents as pain with either overhead movement or putting your hand behind your back. Commonly in surfers this impingement of the humeral head (ball part of the joint) onto the tendons/ bursa occurs due to a muscular imbalance between the front and back of the shoulder. Due to the nature of paddling, many surfers tend to be strong and tight in the muscles at the front of the shoulder (think pecs and anterior deltoid) and comparatively weak and lengthened in the muscles at the back (think teres minor/major and rhomboids). This causes the humeral head to tilt forward in the socket and impinge onto the cuff tendons. It also changes the dynamics of how your shoulder blade moves during paddling. To prevent this occurring, we therefore need to open the front of the chest and shoulders with exercises such as pec stretches, open heart yoga poses and thoracic extension mobility exercises. To improve the strength at the back of the shoulder complex we should look at exercises such as upright row, bent over row or bent over fly style movements.

The next most common area of pain I see with surfing is the neck. In my opinion this has a lot to do with our body positioning on the board during paddling and waiting. Unfortunately to be able to paddle and see what’s in front of us, we require the neck to be in a relative amount of hyperextension, which is not ideal for long periods. While paddling there is a little we can do to avoid this – though I would encourage if you are in for a long paddle, stop every couple of minutes (if you can) and stretch your neck by looking down for 10 seconds, just to ease some of the pressure on the upper neck. Then try to ensure that while you’re waiting in the lineup, if possible, sit on your board instead of lying down. This again gives your neck a chance to rest between paddling. And finally at the end of a session, ensure that you give your neck a good stretch in a forward position again to relieve pressure on the upper neck. If you are a die hard regular surfer, it may be worth checking (or have someone check for you) your everyday neck posture. As with most non-optimal postures, they firstly develop as habits. And if your habit is to sit on a surfboard for a couple of hours each day with your neck in hyperextension, it is quite logical that is where your head and neck will stay for the the rest of the day, and this is definitely not ideal. This could very well lead me into a whole other rant about how strongly our posture can affect our movement and function and so I will leave this for another day!

Lastly let’s discuss the lower back. Again, during paddling, to keep weight off the upper area of the board and improve paddling efficiency, we require extended periods of lower back hyperextension. Yep you guessed it….. this is not ideal for long periods, especially when the majority of us lack the muscular endurance and hip flexibility to maintain an ideal position. This often results in facet joint pain. To overcome this I suggest improving your lumbar spine muscular endurance, as well as ensuring good flexibility through the front of your hips to allow your body to ‘share’ the required positioning. Exercises to improve lumbar spine endurance may include movements such as the yoga ‘Locust’ pose, Pilates ‘swan’ exercise or fit ball ‘roll outs’. Exercises to improve your hip flexor mobility may include forward lunge stretches or the ‘up dog’ yoga pose. You may also like to release the hip flexors using a foam roller or massage ball.

1888615_10151910025246930_1740516496_nMoral to the story? Prepare! Don’t let that ultimate surf trip result in injury and the rest of your holiday spent watching your mates shred. If you feel you would benefit from a specifically tailored exercise program or are concerned about pain or discomfort during surfing, contact us @ The Physio Shack. If you are looking for more guidance on improving your performance then give our legend Nic Laidlaw from Balanced Studio a call ( Nic is a super talented surfer and extraordinary personal trainer here in Avalon. He will have you surfing fit and performance ready in no time.


Stay tuned for our next blog on tips to improve your surfing performance!


Kat King
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Preparing for a fun, injury free holiday

10386381_10152876562862246_2195520200075422747_nAh holidays. Time to throw away a schedule and do whatever it is you love. Sometimes this may involve a deck chair, a cocktail and a talented masseuse. However, often (and especially when holidaying with my husband) our time is spent doing something a little more adventurous, and let’s face it – exhausting.

I’m referring to the holidays that are centred around activities such as trekking, surfing, skiing, mountain biking etc. While theses activities are considered by some to be ‘leisure’ pursuits, when performed all day, everyday for weeks/ months on end, they certainly require some level of physical fitness and often start to resemble some sort of bootcamp situation.

Now I in no way want to discourage people from planning active holidays. I do however want to encourage people to ensure that they are physically prepared for such an event. Because nothing puts a dampener on a holiday like an injury.

The importance of this preparation has never been more evident to me than during our recent holiday adventure trekking in the Himalaya of Nepal. Never have I seen so many people sporting some sort of knee support whilst walking in my entire life. People residing in aged care facilities have less rates of required joint supports!

Now don’t get me wrong, I knew this trek was going to be tough. 7 days of uphill slogging to altitude of 55oo metres is no walk in the park. However I consider myself to be reasonably fit and thought I’d be up to the challenge. What I failed to account for was the steepness of both the incline and decline of the track. I quickly came to realise why so many fellow trekkers were sporting knee braces. While most people know that walking up HUGE size boulder stairs requires quite a bit of lower limb strength (quads, glutes, calves) and cardiovascular endurance, most fail to realise the strength and control required for the downhill part of the trek. Especially when that downhill lasts for days. When muscles start to fatigue, they often tighten, which can lead to mal-tracking of the patella (knee cap). Hence the high ratio of fellow trekkers suffering from knee pain after day 3. Another important point to make here is that if some of your muscles are fatigued, it usually means that other muscles in the complex need to work harder to take over the load of the fatigued muscles. This muscular imbalance can significantly affect the optimal biomechanics needed for the task at hand and again lead to pain. Now while the use of trekking poles can help to absorb some of the load (approximately 20-30%) – quite a high level of lower body strength is required to ensure optimal biomechanics on a walk of this nature.

In the end my husband and I actually managed reasonably well with some creative use of sports tape and ‘end of the day management’ of any niggles. However in hindsight, we both should have made an effort to improve the strength of our quadriceps, gluteals and calves just a little in the lead up to our trip. Exercises that resembled our desired activity such as step-ups, single leg squats and calf raises on an unstable surface would have done nicely.

Example exercises that you might like to add to your current program if you are planning a trekking holiday include; Squats (varying styles), lunges, step-ups, calf raises, calf stretches and crab walking. It may even be a good idea to do some of your more functional exercises such as step-ups in the shoes you intend to walk in to get your body use to their structure. Of course the specific exercises that each person requires to prepare adequately are individual to their current fitness and there is no ‘recipe’.

So if you’re planning your next holiday and it’s going to involve something a little more strenuous than a deck chair and cocktails – come and see us at The Physio Shack for a specifically designed lead-up exercise program to ensure you enjoy that precious holiday time injury free!

Kat King
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