A Better Way to Core, Part 2

At some point, many of my patients with back pain will have a conversation with me about core muscle training – that is, learning to coordinate the deep trunk muscles that enhance the lower spine's robustness against outside forces. And I'm all for it – but I feel too much core training is done only in lying positions. 

Here's the problem: you don't need your core much when you're lying down. You need it when you're upright. For example, whether you're shoveling snow, keeping your balance on a moving train or executing your best cut on the basketball court, you're in some upright posture; and that "core" must coordinate smoothly with your body above and below.

Well, you might think, I can learn my core skills lying down and then just use them the same way when I'm on my feet. There are two problems with this. First, your body must deal with gravity and other mechanical forces very differently when upright, compared to lying down. Second, successful motor learning (such as developing your core) is often very context-dependent. That is, there's no guarantee that you can learn those "upright core skills" while you're lying down – supposing you even knew exactly what to learn!

For this reason, I usually shift my patients' "core" training to upright positions early on in our spine rehabilitation sessions. Simply put, it's more useful and functional for most of my patients' needs. 

Very often the first step is to train coordination of the entire lower body, so that the core muscles, once engaged, will contract around a well-balanced trunk. Here, for example, is one of the basic standing exercises I introduce for this purpose.