When people get back pain, they may see a physiotherapist, chiropractor or osteopath. They may be assessed and be told that their core is weak. Then, they may be prescribed some core stability exercises to stop their spine from wiggling around. After doing their exercises, their pain goes away after some days or weeks.

Contrary to popular belief, back pain is not simply caused by a weak core.

There is a paucity of high-quality evidence to support a relationship between core stability and back pain. This is not due to a lack of effort, however, as there has been numerous research studies conducted over the last few decades.

What we know now is that back pain is complex and influenced by a multitude of factors, for instance: physical load, previous experiences, fear of movement, and worry because you were told that you have a weak core.

If back pain is not caused by a weak core, then why do core exercises work for some people?

Here are some more plausible reasons:

• Most people with back pain usually feel better with time so it might not have been the core exercises specifically that got you better.
• Back pain tends to fluctuate up and down, so anything you do on that ‘really bad’ day can look like it worked if you were naturally going to feel better the next day anyway.
• If you expect core exercises are going to help you, they are more likely going to help you.
• Core exercises are typically lower in load/intensity and performed in a supported position, such as lying on your back. These exercises can allow you to feel safe moving and to start rebuilding tolerance and confidence in your back.
• By starting to exercise, you are starting to boss the pain around rather than letting the pain boss you around.

Why core exercise works is likely a combination of reasons. Fixing your core is unlikely to be one of them though: your back and spine are strong and robust, and do not go out that easily.

So, should you do core exercises if you have back pain?

• If you prefer them over other exercises, go for it. You do not have to overcomplicate core exercises though, like worrying that you are contracting the ‘right’ core muscle.
• If you prefer other exercises, just do them instead.

Across the population, no one exercise appears to be dramatically better. However, you as an individual might respond better to specific forms of exercise, for example, if you enjoy it or see value in doing it.

TL;DR: Your spine don’t jiggle, jiggle, it holds. Exercise helps back pain but no one exercise is a magic bullet. Do something you enjoy and can stick to.

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References:

1. Lederman (2010) (PMID: 20006294)
2. Cholewicki et al. (2019) (PMID: 31092123)
3. Hayden et al. (2021) (PMID: 34538747)
4. Photo is by David Cross