Most runners are familiar with the increased attention the “core” has received in the popular media lately. Exercises to address the core are designed to improve performance and prevent back pain and other injuries. Why then, do many people continue to have back pain after performing thousands of crunches and sit-ups? 

Recent studies suggest that some back pain is closely related to a lack of muscle activity in key core muscles of the lumbar spine. These muscles include deep lumbar stabilizing muscles that form a protective corset around the spine. Activating these muscles may help prevent low back pain and improve running performance. Unfortunately, crunches and sit-ups do not automatically stimulate this are of the trunk. We need to return to the basics to activate this important area.

One of the most basic core exercises is the Transversus Abdominus (TA) contraction. To perform this exercise you must first understand how to find the neutral spine position. This is the back position that creates balance in the trunk and allows for an effective co-contraction - or cooperation - among the stabilizing musculature.

To find the position, lie on your back with your knees bent. Slowly press your low back into the floor then slowly arch your back to form a hollow space between your back and the floor. Repeat this several times maximally until you have a good feel for the overall range of motion. On the final repetition, maximally arch again until you feel slight tension in your low back. Now, back off about 10 percent until the tension eases. This is neutral spine.

Next, begin the TA contraction. While maintaining the neutral spine position, slowly breathe in and out, pulling your navel inward toward your spine or imagine drawing your abdominal contents inward. Hold your navel inward while continuing to breathe in a relaxed manner. Maintain the contraction for 5-10 seconds, then relax. You can monitor the effectiveness of your exercise by pressing your fingers deeply into the abdominal area just insifont>de the bony protuberances of your pelvis. You should feel a tensing of the TA in this area. Perform the exercise in sets of 10 repetitions until you are confident in your ability.

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Once you are comfortable with the basic contraction, it is time to take the exercise to the next level. Continuing on your back with the basic contraction we will begin to incorporate leg movements into the exercise. The object of the progression is to maintain both the neutral spine position and the TA contraction (stability with movement) as the legs move. 

A great way to monitor your ability is to use a blood pressure cuff to detect any movement in your trunk. Place the blood pressure cuff under your low back with it inflated to about “40mmhg”. The needle will remain stable when the exercise is done correctly. Any fluctuation in the needle happens because of movement of the spine and indicates poor performance or fatigue.

Progression 1 - The first level in the progression is a bent leg raise. Find and maintain the neutral spine position while contracting the TA then slowly lift and lower your bent leg so your foot is about 2 inches off the floor. Alternate from one side to the other until you reach fatigue or your form begins to suffer. Monitor your progress either by feel or the use of the blood pressure cuff. 

You are ready to move to the next level when you have good control with about 20-30 reps.

Progression 2 - The second level is a leg slide. Begin the exercise as before but this time slide your leg along the surface of the floor, extending your leg as far as possible. Return to the starting position and repeat with the other leg. 

Progression 3 - The third level involves sliding your leg along the floor as in Progression 2. This time keep your foot about 2 inches off the floor as you extend the leg.

Progression 4 – Now you are ready for a straight leg raise. Lie with one leg bent and the other leg straight. Slowly lift and lower the straight leg about 12 inches off the floor.

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Each of the above exercises can be made more difficult by adding either ankle weights or elastic band to the legs to create increased resistance. Better yet, think about adding the basic exercise to your regular workout routine. The following are just a few examples of how to progress the exercises – the options are endless. The key to each exercise is to maintain the principles of the basic contraction, the neutral spine position, and continuous breathing as the focus. Weight should be moderate to light. These muscles work in an endurance fashion so we should train them in that manner. Do 2-3 sets with a weight that is challenging enough to cause fatigue after about 20-30 repetitions. When you can do 30 easily with good form, it is time to move to more weight.

1. Squats – Perform basic squats to approximately 90 degrees of knee bend with and without weight while performing the basic TA contraction.

2. Split squats – Stand with one leg forward and one leg back in a lunging position with or without weight. Slowly lower the back knee to the floor and back again. The bend at both knees should be approximately 90 degrees. Again, the basic TA isometric and neutral spine position make up the foundation of this exercise.

3. Plank / leg raises – Perform a basic yoga plank pose focusing on the TA contraction and neutral spine. Ask a friend to observe or watch in a mirror as you do the exercise to make sure your spine is in the correct position. When you master the plank, begin straight leg raises, lifting one leg about 2 inches off the floor and holding the position for a 5 count. Alternate between right and left legs.

4. How to Increase Mileage Running – One of the best ways to simulate functional running patterns is by using a standard cable column found in most gyms. Set the cable column so the cable is in the uppermost position with a weight that is fairly easy. Balance on your left leg and grasp the cable with your right hand. Simultaneously pull down on the column while driving your right knee forward as if running. Of course, the main focus is on TA contraction and maintaining the neutral spine position. This exercise can be modified by attaching weight to the nonstance leg as you are pulling upward.

5. Running Progression - Once you are comfortable with the basic exercise and have tried some of the progressions, begin adding the TA isometric to your running workouts. Perform 30-second contractions while running, repeating this 5-10 times during a one-hour run. 

These simple exercises can be effective in improving running performance and preventing low back pain and SI-related injuries. 

Thomas Minton, PT, Cert. MDT, C.E.E.S. is a physical therapist and the Fitness and Wellness Coordinator for the Mission Rehab and Sports Clinic in Asheville, North Carolina. He specializes in sports-related injuries specific to endurance athletes. He is also a USA Cycling Level II Coach. For questions, email Thomas at [email protected] . 

References

Hides J.A., Jull G.A., Richardson C., (2001). Long term affects of specific stabilizing exercises for first episode low back pain. Spine, 26, E234-238.

Hodges P.W., Richardson C.A., (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominus. Spine 21:2640-2650.

Hodges P.W., Richardson C.A., (1998) Delayed postural contraction of the transversus abdominus in low back pain associated with movement of the lower limbs. Journal of Spine Disorders 11:46-56.

Richardson C, Jull G, Hodges P, Hides J, (1999) Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain, Churchill Livingstone, Edinburgh.