Is your chronic low back pain a weak core? Or is it something more?

We’ve all heard it.

If your back hurts, you need to strengthen your core.

It’s probably not a bad idea, and it will likely improve your symptoms somewhat, but it isn’t the whole story.

Think of the core as a box, the top is your diaphragm, the walls are your abdominal muscles and fascia and the floor is your pelvic muscles.

Intra Abdominal Pressure (IAP) is the tension that is created when all of the muscles of the core are engaged and balancing each other. Tension is required all around the core for the structure to hold.

If one piece is missing, the core becomes unstable and you get compression which leads to degeneration and injury.

What I see again and again, is that people with chronic back pain have an issue with coordinating their breath while maintaining intra-abdominal pressure (IAP).


They can’t maintain a solid core brace while breathing. So one of those has to compromise: either they hold their breath and struggle through a movement or they sacrifice IAP, lose spinal stability, and eventually hurt themselves.

They may even be fit, do a lot of core exercises, and still miss this subtlety. In fact, I often see it in people who love to train (runners, HIIT class people I’m looking at you).

Retraining this skill doesn’t have to be so hard. It begins with slowing your breathing. This is done by constricting the glottis, the space between your vocal cords. You can feel it when you whisper “ha” or pretend to fog a mirror but leave your lips closed.

When you constrict this space, slowing and regulating the flow of breath, it gives resistance to the air, which allows you to develop control of the diaphragm. To not just let the air out, but slowly push it out. This helps maintain IAP; purposefully engaging the diaphragm, expanding and collapsing the lower rib cage in 360 degrees, and maintaining alignment of the pelvis.

From a neurological perspective, the vocal cords and the diaphragm are both innervated by cranial nerve X, the vagus nerve. When you activate these structures through the breath and proper core brace, it helps drive parasympathetic tone (regulating our heart rate, blood pressure, digestion, immunity, cognition: everything good).

Retraining IAP with breath requires awareness. It is a conscious effort until it isn’t.

Once I help a patient find it, I jokingly say “Good, now just hold that for the rest of your life”.

It’s not really a joke.

Maintaining this core brace is going to serve you in all of your movement. This applies to running, walking, lifting something heavy, dancing, etc. Every exercise is a core exercise if done correctly.