A normal healthy person should be able to touch their toes in standing with straight legs. People who can’t often blame tight hamstrings. The question that too few people ask is why are my hamstrings tight?

Think about this: The human body has evolved over millions of years. One of the guiding principles of evolution is to preserve energy efficiency. Tight hamstrings mean that the hamstring muscles are over working. This is not energy efficient. The body must therefore have a good reason for those tight hamstrings. Stretching them off will not help because they are tight for a reason and stretching does not address that reason. Most likely the hamstrings are tight because they are trying to stabilise the low back! In fact aggressively stretching the hamstrings can destabilise the back even further and lead to a more serious injury and low back pain. Most cases of tight hamstrings can be resolved with an effective core stability programme... the real sad thing is that most people do not have a clue what ‘core stability means!!’

Some people confuse the term ‘core strength’ with ’core stability’ because they think the two terms mean essentially the same thing. Well they don’t!

Core strength.

Exercise for low back pain has been used for many years with the assumption that improved control and support of the spine and pelvis will result in reduced pain. This is based on a model that argues that low back pain results from stimulation of nociceptors (pain nerves) due to poor control of the spinal structures. Exercise interventions based on this model focused on changing the strength and endurance of the trunk muscles to improve ‘control’. This is an old and outdated approach.

Core stability.

More recently exercise focus has shifted to control and coordination of the trunk muscles. These philosophies incorporate factors such as re-education of hip and lumbar movement patterns, correction of muscle length and re-education of control of different muscle groups. These approaches that address control of the muscles are gaining support from randomised control trials.[1]

The complication

Recent scientific developments are improving and changing our understanding of pain. Specifically in this context no discussion of low back pain is complete without discussing the complex interaction between biomechanics, psychology and the social elements of pain. As this series of articles progresses I will discuss the requirements for control of the bony spine, the motor strategies used by muscles and nerves to meet these requirements, how this system changes when people have low back pain and finally I will discuss my clinical strategy for exercise management of low back pain.

Summary: What the patient with poor core stability needs to know.

Core stability means the functional ability of the muscles to control movement.

The term ‘Core strength’ is outdated. Thus exercises like sit ups or heavy lifting which challenge strength not stability are rarely indicated clinically.

If a ‘core’ muscle is weak there will be a reason why. Strength training to improve this without resolving the reason why is very unlikely to improve stability.

The reason why a muscle is weak does not have to be purely biomechanical. This means a good practitioner will take time and ask lots of questions before committing to treatment.

Adam’s pearl of wisdom: How to choose a practitioner.

Ask how long the appointment slots are. Does a practitioner run a conveyor belt practice with patients in and out in 20 or 30 minutes or do they take the time to thoroughly investigate these very complex issues?

At LMC we use 80minutes for initial consultations and 40minutes for follow ups!!

The Importance of Thoracic (Upper Back) Mobility.

The Benefits of good thoracic ROM[1].

Better posture – Many people have an exaggerated kyphosis (forward curve of the upper back). Improving thoracic mobility is the first step to dealing with this.

A more stable lower back – Your lumbar spine will be free to provide stability, rather than make up for your lack of mobility.

Healthier shoulders – A rounded upper back brings the shoulders forward and restricts scapular movement especially during overhead movements. Thus increases the likelihood of a shoulder injury such as rotator cuff impingement.

More lung volume – Improving thoracic mobility improves the rib mechanics which improves lung function.

Better functional fitness – By engaging your thoracic spine in times of spinal rotation, flexion, and extension (like throwing a ball or a punch), instead of your lumbar spine, you will get stronger, faster, and more explosive in those movements.

Why does the thoracic spine get stiff?

The thoracic spine (T-spine) is crisscrossed by lots of muscles and connective tissues as well as being where the rib cage attaches. Movement is therefore naturally restricted when compared to the cervical or lumbar spine. This means that when the area becomes dysfunctional is can get VERY tight. As well as having direct consequences on local muscles (such as causing them to ache) it can create problems in other areas of the spine such as the neck and lower back as the whole thing is one functional unit.

I often see patients who have poor core stability AND restricted T-spine ROM. In this circumstance the two dysfunctional states are quite likely to be maintaining each other. I.E. If the thoracic spine is not moving as it should the low back might be forced to function in a way it’s not designed to. Thus, upper back restriction = extra demand on muscles supporting the low back = extra load on lumbar spine = ouch!! Similar is often also true for neck pain which might also be predisposed by poor thoracic mobility.

It is important to remember that improving thoracic mobility may be an essential element in resolving lumbar or cervical issues.

Exercises to improve thoracic mobility

I have produced a video of my favourite thoracic mobility exercises. To view it visit www.lacemarketclinic.co.uk , click the link to the ‘Video Library’ and scan down until you find it.

NB This video contains some powerful exercises. It has been produced specifically as an aid to treatment not as a replacement for it. If you have poor thoracic mobility, or an undiagnosed condition, doing all of these exercises without advice might make things worse.

My next article on core stability will discuss more clearly how low back and core stability problems may be related with poor thoracic mobility.