Published on April 20, 2018

therapy for lower back pain

How to activate your core muscles

 By Kim Squire, Lawrence Memorial Hospital

Jill just celebrated her 40th birthday. She works sitting at a computer and has stopped going to her Zumba class because she has constant lower back pain.

Friends and family are concerned and urge her to “get into shape.” A quick search on the internet indicates that “core weakness” may be contributing to her problem.

“Core” is a common word to anyone who has had treatment for back pain, exercises regularly or participates in any sport activities. But this word can be confusing: What exactly is my core? Should I be doing more sit-ups? How can I get help with strengthening?

The core has many interpretations. Some people describe the core as a “corset” of muscles that provide stability for movement and protection of the spine.

“The core has everything to do with everything we do,” said Gary Gray, a physical therapist at the Gary Gray Institute in Adrian, Michigan.  

Others from his institute describe it as “everything from your nose down to your toes.” Other sources define the core as the torso, which is a long list of muscles that make up the areas of the belly, mid and lower back, shoulders, hips and neck. It also includes the pelvic floor and diaphragm.

The core has more than a few roles in our body. It provides stability to our body so we effectively can move our arms and legs. It allows us to sit up straight and efficiently align our skeleton to transfer forces.

You may have heard the phrase “neutral spine,” which refers to the position of your spine when all three curves are in proper alignment and there is the least amount of stress placed on the spine joints. Your core allows you to find and maintain that position. Weakness or inefficiency in core muscles can lead to inefficient movement patterns, injury and pain — which is the case for Jill.

Listening to the advice of others, Jill decided to hire a personal trainer. But she made some common mistakes during her exercises: she stood with a slumped posture, held her breath during exercises, held her stomach muscles tight during exercise and performed high-intensity exercises before understanding how to correctly activate the muscles of her core.

Although the exercises with her trainer made Jill feel more in shape, her back pain persisted -- especially while sitting at work. Jill decided to visit her doctor, who told her to see a physical therapist for evaluation and treatment.

Physical therapists can determine what is contributing to a patient’s pain by evaluating core strength and posture, locating muscle imbalances and assessing harmful movement patterns. They work with patients to make goals and a specific plan to reach those goals. A therapist focuses exercises to get the most benefit for an individual’s needs. For example, an active tennis player should focus on exercises that strengthen their core and give them power when serving the ball.

It’s common for physical therapists to find that a person has a strong core, but is unable to activate the muscles effectively. For instance, Jill may have strong muscles as a result of her exercise, but she struggles to find and maintain her spine in a good posture.

Knowing how to correct your posture and “turn on” the core muscles can make a huge difference with back pain. It takes training and awareness to correct your own posture and real core conditioning to hold your good posture throughout the day.

Activation of your core muscles can be done multiple ways. One method is to gently draw lower abdominals toward your spine in a slow controlled manner.

Another way:

  • Lie on your back and relax with your legs bent, breathing in and out.
  • Place your fingers on each side of your belly button to find your core abdominal muscles.
  • Practice tightening and relaxing the muscles without movement.
  • As soon as you feel your muscles without movement, try to hold the contractions for 10 seconds. Remember to keep breathing.
  • One you can hold the contractions for 10 seconds, start mixing it up by doing this exercise sitting and then standing.
  • Remember to keep your spine in a good position with your chest up, ears in line with the tips of your shoulders and lower back.

Jill’s physical therapist taught her how to find her core muscles and how to activate them. Once she was able to locate them and hold a contraction, the therapist had her work on using her core muscles while sitting, standing, reaching and lifting.

She also made some changes at work. Initially, Jill started with a lumbar support in her chair to help her sitting posture. She then progressed to sitting on a ball at her desk. She also made sure to get up and stand or walk around the office every 30 minutes.

Within two weeks, Jill was able to use her core muscles without thinking about it or reminding herself. Her back pain improved and she felt less tired at the end of the day. Jill had consciously found her core muscles and engaged them throughout her day, and her back pain no longer stopped her from being active. She was able to be more energetic afterword and rejoined her Zumba class.

Kim Squire is a physical therapist at LMH Therapy Services. She can be reached at

How to activate your core muscles

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