Recently a patient of mine, Adam, was diagnosed with an inguinal hernia. A hernia is the protrusion of an organ or tissue through its surrounding walls, in this case the lower abdominal wall towards the groin. Patients typically present with pain or discomfort when coughing, exercising or during bowel movements.
Mechanical causes of this condition include improper heavy weight lifting, hard bouts of coughing, sharp blows to the abdomen, and incorrect posture. Furthermore, conditions that increase the pressure of the abdominal cavity may also lead to hernias such as obesity, over-straining during bowel movements or urination, and chronic lung disease. Hernias are also more likely to occur in people with weakened muscles as a result of poor nutrition, smoking and overexertion. Sometimes hernias can be left alone, but in this particular case, Adam required surgical repair to avoid untreated complications.
Adam returned for chiropractic care two and a half months post surgery. I was surprised to hear from him that he had received no recommendation to undergo any exercise or core strengthening program. With my understanding that hernias almost always co-exist in individuals with compromised abdominal and core strength, it seemed vital that some sort of rehabilitation should be undertaken.
I was concerned for Adam as he clearly did not have the knowledge of the seriousness of his condition, and how engaging in some sort of corrective strengthening program should be mandatory in order to prevent future complications. Adam’s experience, emphasises that the treatment aspect of a condition, be it surgical or conservative therapy, is really only a small part of the process of healing a patient. Educating patients about their conditions plays a central part in healing. The more patients understand their conditions, the more the mode of treatment of their condition makes sense to them, and most importantly, the more likely they are to comply with any post-treatment advice (exercise prescription, nutrition, rest, etc).
In Adam’s case, it was clear to me that he should be engaging in core strengthening exercises to tighten up his abdominal wall and thus prevent any future hernias or complications thereof. My first challenge was to help him understand what exactly the core is, and why a strong core would be the best remedy.
For me, the best definition of the core musculature, is that of Dr Stuart McGill’s, professor of spine biomechanics, University of Waterloo, Canada. He describes the core musculature as all the muscles that exist between the shoulder and hip joints. The core thus comprises many muscles and is not simply just your abdominal muscles. Its function is to create stiffness along the length of the spine. Sometimes I refer to the core as the “seatbelt of the spine”. It’s a useful analogy when explaining to patients the core’s function, which is to brace the spine for any impact it is about to experience. This might be resisting movement throughout the spine when bending over to pick up an object, landing after jumping, or even fending off an annoying sibling trying to poke you in the stomach.
Do you remember the famous Olympic sprinter, Michael Johnson? One of my favourite video clips demonstrating one application of core strength is some footage of Michael sprinting. You can watch it below, take extra special note of his running form from 1:00 to 1:12.
People often recall Michael’s running style to be unorthodox, or at least, very distinct. Today our understanding of the core’s function however, helps us realise that it was this distinct style that enabled Michael to run so fast, so efficiently. I know from my own limited experience in sprint training, that the faster you want to move your legs, the faster you need to pump your arms. It is impossible to run [with any efficiency] in such a way that your arms and legs move non-synchronously.
Remaining completely stiff through the torso whilst sprinting as fast as you can, sees the least amount of energy leak between the arms and legs, thereby improving efficiency. In other words, if you want to run really fast, you need to develop the skill of maintaining a very stiff core whilst moving your arms and legs as fast as you can. There is of course, a lot more detail to coaching sprinting and running technique, the point here is simply to illustrate where the core’s function fits in.
A stiff core essentially provides a stable foundation from which to operate other parts of your body safely and efficiently. In sport, a strong core is always beneficial as it enhances your ability to move, jump, throw, swing, lift, etcetera. If youre not a sportsman however, a strong core is still essential. Daily activities like lifting, dressing, cleaning, sitting and climbing and descending stairs, often see us moving our bodies into awkward and compromising postures and positions. If we do not have the ability to adequately brace and protect our spine, we can cause injury to this region, if not our other appendages.
Adam is a desk worker, and doesn’t exercise a great deal. He acknowledges this aspect of his life needs some attention, so I decided to set some achievable goals for him. It can be daunting for someone who isn’t in the habit of exercising, to suddenly embark upon a full exercise program. I gave him two core exercises to practice every other day, for two weeks: the plank and the side plank. These two exercises require absolute stiffness throughout the core in order to be performed properly, they also work the vast majority of muscles between the shoulder and hip joints, and so are very applicable to the objective.
Adam reported back to me two weeks later. His feedback was that whilst he could manage the exercises, performing them for the recommended duration was more challenging than he thought. More importantly though, doing the exercises combined with a deeper understanding of hernias, and their relationship to the abdominal wall and core strength, he is now motivated to integrate exercise and core strengthening into his weekly routine.
Obviously, there are a multitude of exercises available to facilitate a stronger core. The plank and the side plank are two simple-to-teach exercises which I feel most people should be able to perform well. In practice, if I find people are unable to hold a front plank for at least 30 seconds, and a side plank for at least 15 seconds, it is my opinion that they may be in danger of injuring their spine.
The topic of core strength is very detailed and there is much debate as to its definition, function and methods for training. The purpose of this article is simply to provide the lay person with a basic understanding of why core strength is important, and a starting point for training. Please refer to some other useful information on Core Strength and Sit ups are bad for you.
If you suspect you have a weak core and/or have been suffering any pain throughout your spine, book online with one of our therapists NOW.