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Part 3a Core Stability, Back Pain & Chiropractic

This follows on from Part 1 that compared two of the more common methods of core training and Part 2 which compared functional training methods.  Part 3, is going to go through some basic exercises to improve & maintain core stability.  These exercises, along with chiropractic care, are key parts of how I treat chronic lower back pain.   The first exercise is the McGill side plank:

The McGill Side Plank.

What does it do?

Lower back pain and core stability

  • Its primary purpose is core stability, which, along with chiropractic care, is something I commonly use in the management of chronic lower back pain.
  • Core stability is essential for overall spinal health,  and functional movement
  • It specifically targets the lateral muscles of the core, including the quadratus lumborum and obliques, which are crucial for maintaining proper spinal alignment and stability (McGill, 2007).
  • It does this with minimal activation of the erector spinae muscles.
  • Because of this, it is particularly suitable for people with lower back pain, as it strengthens the core without placing excessive stress on the spine (McGill, 2007).

Pelvis Instability and Knee Pain

  • In addition to treating back pain, improving core stability (along with chiropractic care aimed at improving lumbo-pelvic alignment and mobility), is often useful for certain types of knee pain.
  • Pelvic instability often results from weak core muscles, leading to compensatory movements and imbalances that affect the entire kinetic chain.
  • The McGill side plank helps strengthen muscles that stabilize the pelvis.
  • Improved pelvic stability can lead to better movement mechanics, reducing the risk of injuries in the lower extremities.
  • Knee pain is often associated with poor alignment and instability in the hips and pelvis.
  • Strengthening the core muscles through the McGill side plank can indirectly alleviate knee pain by promoting proper alignment and reducing undue stress on the knee joints.
  • Studies have demonstrated that enhancing core stability can lead to significant improvements in knee joint function and pain reduction (Zazulak et al., 2007).

Important Warning

  • If you experience any pain while performing the McGill side plank, it is crucial to stop immediately and consult an appropriately qualified health professional.
  • As a trained professional, I can assess your condition and determine whether this exercise is suitable for you.

So, how do you do the McGill Side Plank

Click this link to go the Move Well Chiropractic You Tube channel for a video instruction.

  1. Starting Position: Lie on your side with legs extended and stacked on top of each other. Position your elbow directly beneath your shoulder, ensuring your forearm is flat on the ground and perpendicular to your body.
  2. Body Alignment: Maintain a straight line from your head to your feet. Your top hand can rest on your hip or be extended along your side.
  3. Engaging the Core: Tighten your abdominal muscles as if ‘bracing for a punch’ and contract the glutes. This engagement is crucial for maintaining trunk stability throughout the exercise.
  4. Lifting the Hips: Raise your hips off the ground, forming a straight line from head to feet. Avoid letting your hips sag or tilt. Your weight should be supported by your forearm and the side of your bottom foot.
  5. Holding the Position: Maintain this position for the desired duration. Start with 10-20 seconds and gradually increase as your strength improves. Keep your breathing steady and avoid holding your breath.
  6. Switching Sides: Lower your hips back to the ground in a controlled manner, switch sides, and repeat the exercise.

Ideal Benchmark Times

  • At first, aim for 10 to 20 seconds each side..
  • This is not meant to be a test of will, rather we are building strength and endurance in small steps.
  • In fact, if your breathing becomes laboured, or your body starts to get the ‘speed wobbles’ stop.
  • This is because you are likely starting to compensate with muscles other than the ones we are targeting.
  • When I spoke to McGill circa 2020 (back when I trained with him), his benchmarks were that the average person should be able to hold this for around 30 seconds (without ‘getting the shakes up’).
  • I find this is usually enough for a person not engaged in hard manual labour or playing intense sport.
  • His intermediate benchmark was about 30 – 45 seconds (generally, women closer to 30 and men closer to 45 seconds)
  • Similarly, for athletes or those that do intense physical jobs, his bench mark was 60-90 seconds.

Regressions & Progressions

  • If this exercise is too strenuous, come and see me – I have several regressions (including versions off knees, pulses, and even standing versions against a wall).
  • Similarly, if you want a challenge, and particularly something relevant to your activity, I have plenty of progressions (including dynamic and explosive variations, sports specific drills for kicking athletes, and progressions with abduction, such as Copenhagen variations).

Conclusion

  • The McGill side plank is an excellent starting point in improving core stability, which is often a factor in chronic lower back pain and an excellent adjunct to chiropractic care.
  • I frequently prescribe these, among other exercises, as foundational type exercise before progressing to more dynamic and/or functional type exercises.

References

McGill, S.M., 2007. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Human Kinetics.

Zazulak, B.T., Hewett, T.E., Reeves, N.P., Goldberg, B., & Cholewicki, J., 2007. The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. The American Journal of Sports Medicine, 35(3), pp.368-373.