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I treated a professional tennis player, let’s call him Alex. He was dogged by persistent back pain. Despite undergoing the best strengthening regimen the USTA could offer, we tested his back strength and he was significantly weaker than the general population. 

Why do athletes like Alex, who are in great physical condition and have access to the best trainers and therapists, develop back and neck pain? Why are core muscle weakness and back pain so prevalent in these conditioned athletes? And for that matter, why are they so prevalent in the general population? With easily accessible exercises like sit-ups or floor exercises – or even manual assistance to strengthen the core—why can’t these patients suffering from back pain manage to build up the appropriate amount of strength to support their spines?   

There are four main reasons most people have not developed an optimal amount of back strength: 1) the main stabilizing muscles of the spine become weakened when we are in pain—patients with chronic pain voluntarily or involuntarily shut down their back muscles, 2) with standard core exercises it is difficult to control the resistance through the entire range of motion and to sequentially apply a measurable, heavier resistance, 3) many people lead sedentary lifestyles and/or have spine-weakening bad posture, both of which can lead to permanent problems, and 4) it takes hard work to build muscle.

It is critical to overcome these obstacles to developing good core strength. Muscle strengthening is best performed by isolating the muscle, exercising all of its fibers, gradually increasing the resistance over time, and measuring progress. Rest and good nutrition between training sessions is vital for maximal muscle growth. An effective program to treat back pain acknowledges and addresses the important roles played by stability, center of gravity, muscle anatomy, the nervous system, and flexibility. To strengthen the core, a training program must address not just the abdominal muscles, but more importantly, the stabilizing back and flank muscles. This can be difficult to accomplish at home without appropriate equipment to isolate these muscles, and as such, sometimes supervised medical exercise is necessary. 

Exercise performed correctly is empowering since we can experience the capabilities of our bodies first-hand. This is the best remedy against our fear when we have pain.