January 11, 2023 danny


Usually not. Let’s explain by using a patient of mine… 

Candace (not her actual name) is a fitness instructor by day and nurse by night.  She is 36 years old, strong, and flexible, built like an ex Olympic gymnast. Looking at Candace it seems impossible to believe she could have any pain at all. She really is the picture of health. Does not drink, eats well, you name it. But….she still has back pain! Nagging left side, low back pain with radiation to her left buttock. Like a lot of patients, it came out of nowhere and she doesn’t know how it began. That is where our story begins! 

Before diving into her case specifically, we need to back up and talk about core strength vs. core stability. Specifically, what they mean, why they are important but more specifically what is the difference between the two. 

Core Strength – Core strength is the actual raw strength and power of the muscles that make up our “core.”  These muscles include our rectus abdominis (6 pack), transverse abdominis, obliques, paraspinals, pelvic floor, and the diaphragm. Some “experts” also include the glutes, hamstrings, and hip flexors, as core muscles. I tend to agree with this. However, for this discussion, we will just say core muscles.  

Core Stability – Core stability refers to the coordination and timing and strength of the core muscles while performing specific movements and activities. Functional stability. 

What did we do with Candace? 

To begin we performed range of motion testing, as well as an orthopedic and neurologic evaluation. Not surprisingly these were all normal except…. The only limitation was pain with lumbar extension. Or arching the back while standing. I saw where this was going. Everything pointed towards a disc-related issue with some not so typical signs. I had seen this pattern before though. Next, we had Candace lay on her belly and do a little “press-up” or “cobra” style move. Interestingly this actually decreased the pain temporarily. So, this is where we began. We had her do this repeatedly, along with a form of traction we do at the office called flexion/distraction. We will save that topic for another day! 

Finally, we moved into some core stability exercises to connect the brain to the core while performing her daily activities of bending over patients and teaching her fitness classes. This is where the magic started happening.  By the second visit the pain in the glute had diminished dramatically. The core stability exercises we began with are called “McGill’s Big 3”. 

Candace already had a solid foundation for mobility and stability. So grasping these exercises was quite easy for her. Within a month she was back to teaching fitness classes and lifting patients again! 

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