Strengthening the Core Without Causing a Flare: Part One

Editor's note: Be sure to speak with your doctor before trying a new exercise program.

Building a strong core can be difficult for those of us with inflammatory back pain. Many exercises that target the abdominals can be stressful on the spine. Repetitive, forceful movements such as sit-ups may leave us feeling worse than when we started. Fortunately, you don’t have to do countless sit-ups and crunches to have a strong core.

What is the core?

You can think of your core as a canister!

Top of canister: Diaphragm muscle
Bottom of canister: Pelvic floor and deep hip rotator muscles
Back of canister: Deep spinal muscles
Front of canister: Rectus abdominis and obliques

Many people train the front of the “canister” (like with tons of crunches) but neglect the other groups. The larger muscles like the rectus abdominis and obliques are known as the "global muscles", but the smaller local muscles are just as important. Our daily activities require these muscles. These muscles allow us to sit upright, reach our arms, walk, squat, and lift a load, for example.

I will go over some exercises that I use in my practice as a physical therapist. In most individuals, these should not cause pain. If they do, avoid them and seek the advisement of a medical professional to determine an individualized treatment program.

Diaphragmatic breathing

When learning to activate the deep core muscles we often start with the breath and give attention to the diaphragm.

1. Lay on your back with your knees bent. Place one hand on your belly.
2. Breathe in allowing your belly to expand and rise into your hand. As the lungs fill with air and the diaphragm contracts downward, your abdomen should naturally rise.
3. Now, exhale or breathe out allowing your belly to fall, your belly should come away from your hand. Take several of these breaths.

Activating the transversus abdominis

1. Continuing with your diaphragmatic breaths, focus your attention on the falling of the belly.
2. With your next exhale, as you feel your belly come away from your hand, draw the belly button down just a bit farther. Try to hold this contraction for 5 seconds.

Another way to think of it is to visualize a string going through the center of your belly button down through your back to the floor/surface you are laying on. Imagine as you exhale that someone is pulling the string slightly. The movement is very small, and you should not be straining or holding your breath.

Isometric abdominal exercises

Now that you have the basics, we can add some excitement! Isometrics are great exercises for those with pain, as they simply require holding a position with good posture. No repetitive or spine shearing movements here!

Dead bug

Lay on your back. Activate the transversus abdominis. Lift both legs so your hips and knees are bent to 90 degrees. Reach both arms straight up towards the ceiling. Do not allow your back to arch. Hold the position for at least 10 seconds, build up for 4 sets of 20 seconds.

Modified plank

Place your hands on a chair, elbows straight, and walk your feet out so you are in a push up position. Make sure your head is neutral (not looking up or down), and tuck your hips under so you are not arching your back. Hold 10 seconds to 1 minute.

Keep your eyes out for Part 2!