Q&A: I have a slipped disc and need to strengthen my core
Q: Hello Jen! I wondered if you can help me, I had two operations recently, I had a slipped disc L5/S1. Do you know what core strengthening exercises I can do that would benefit me? I love watching all your videos, and I'm gutted I'm out of the gym at the moment but I need try something new now, and strengthening exercises I think would be good for me.
An excellent example of spinal hyper-extension
Hey Stacey. I get this question a lot actually. Either relating to slipped discs or back pain. Something that I hear a lot is “I need to strengthen my core because I have a slipped disc/suffer from back pain”. For most people “core” means “abs” and so they go to the gym and work really hard doing lots of crunches and planks and other traditional ab exercises.
So to address your question, we firstly need to understand a little bit about the anatomy of the core. There are lots of muscles that make up the core: externally there is the rectus abdominis (the six pack) that is responsible for spinal flexion (or a crunch movement), but there are other muscles that wrap around the sides of the waist (the obliques and transverse abdominis), as well as a big group of muscles located on your back that support the spine. These all make up a kind of cylinder that wrap all the way around your waist. To add to this, internally we also have a diaphragm (which sits at the bottom of your ribcage) and a pelvic floor (which sits at the bottom of your pelvis). All these muscles join together and form a closed system that has the shape of a coke can.
This system works in two major ways:
It can create movement around the spine like flexion (crunch), side flexion, extension and rotation.
It can create stability by working as a unit to create intra-abdominal pressure (IAP) and stabilize the spine
The way that most people go about strengthening their “core” is by focusing on the first of these two functions: doing lots of direct ab work (like crunches). While this might have some value in strengthening those superficial muscles of the anterior abdominal wall (like the rectus abdominis), it won’t do much to strengthen the system that includes all the muscles that I mentioned above that work together to create central stability.
To strengthen all these muscles together as a unit to create central stability, you might want to try exercises like a Paloff press which is an anti-rotation exercise – the resistance band wants to pull you sideways and you have to RESIST this movement. Side planks may also be an effective “core” exercise, as they work anti-side flexion. Regular planks may have some value too (they are an anti-extension exercise) and they probably won’t do you any harm if you’re doing them with proper form (check out Dr. John Rusin’s tutorials on RKC planks ).
The real take away here is that:
a) crunches only train spinal flexion and are pretty useless in training the “core” as a unit; and
b) exercises that RESIST movement, “anti” exercises (anti-flexion, anti-rotation) are much more useful in building real central stability.
On top of that, in the case of slipped discs, the muscles that REALLY need strengthening are all the many muscles that wrap around the spine and stop unwanted movement INTO spinal flexion. These are all the spinal erectors. (Watch this tutorial starting at 4:50). There is unfortunately a (misguided) focus on "core" (read: abdominal muscles) in the fitness industry. Often strengthening the anterior wall of the core is pretty useless and more focus on the posterior wall of the core (and entire back) would bring far more results.
So you should probably focus more on strengthening your back. To strengthen these, what you really want to do is exercises that work ANTI-spinal flexion, so where the spine wants to go into a crunch and you RESIST that movement using your spinal erectors (and a whole bunch of other muscles that make up the back). Deadlifts and squats are the best for this, and I have a couple of pretty comprehensive tutorials on YouTube explaining exactly how to do these. See my Squat Series and Deadlift Series.
So the idea, if we take the deadlift as an example, is that from a standing position, I bend forward from the hips, but keeping my spine (back) totally straight (it doesn’t bend or curve). In a deadlift I hold a weight in my hands that is essentially pulling me into spinal flexion (bending my spine) but I have to resist that pull. This is ANTI-flexion and is strengthens the many muscles that make up the entire back.
Most people with slipped discs or back pain are PETRIFIED of doing these movements, and with good reason: if you go straight into it with heavy weights and get the movement wrong, you can do more damage. That is why in my tutorials I explain how to master the technique with NO weight first, (for example, doing a good-morning on the way to mastering the deadlift), progressing onto deadlifts with very little weight (like a 4kg kettlebell) then gradually adding slightly more weight. Remember: correct movement IS corrective movement. You will be doing a lot to strengthen your back just by doing correct technique with a very low weight (something that some people call “greasing the groove”). As you get more confident with the technique you can increase the weight gradually (say 2kg a week) and work in a very high rep range to begin with (around 15 reps per set).
So the major take-away here is that your focus shouldn’t really be strengthening your “core”, rather strengthening your BACK. You will build muscle around your spine, and gain greater control over spinal movement. This in turn stabilizes the physical structures of your spine, including where you have a slipped disc. This prevents future re-injury to the area because there is more muscle mass (and neuromuscular control) supporting the injured area.
Remember that it's always important to consult with a physiotherapist and get proper treatment for these sorts of injuries, but the way you train in the gym can have a huge impact on your rehabilitation of these sorts of conditions. You can either help or hinder your progress and ultimately your quality of life. It's important and very possible to not just train AROUND injuries like this, but learn how to use your time in the gym to prevent further injury or re-injury.
For even more detail on the topic of building an incredibly strong core, I highly recommend this article by Dr. John Rusin