Can a Weak Core Cause Lower Back Pain?
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Hinge Health member’s question:
“My back pain keeps flaring up. I’ve heard it’s because I need to work on my core strength. Is that true?”
Hinge Health physical therapist Paige Nelson’s answer:
I get this question all the time. People with back pain come to me and say, “I know I need to strengthen my core” right off the bat. But back pain is not necessarily related to lack of core strength. So my short answer is always: Back pain can be related to core strength, but it’s only one potential factor.
Revisado por nuestros expertos clínicos y médicos
Claudia Canales, PT, DPT
Paige Fortney, PT, DPT
What Is Your Core, Really?
Let’s first clarify what we mean by the “core.” Many people think of the core as just their abs, specifically the six-pack muscles (rectus abdominis). But your core is much more than that. It’s a cylinder of muscles that surrounds your entire torso. This includes the muscles in your abdomen, your sides (obliques), your back (erector spinae), and the muscles around your pelvis (glutes and pelvic floor). It also includes deeper muscles like the diaphragm and the transverse abdominis, which help with breathing and maintaining posture.
How Your Core Affects Back Pain
Now, can a weak core lead to lower back pain? It’s possible, but it’s important to understand that having a weak core isn’t necessarily the direct cause of back pain. It can be a factor in pain for some people, but even athletes with incredible core strength can have back pain. Back pain is complex and often stems from overusing some muscles and underusing others. It’s not always a matter of weakness, but more about how well you can activate and control these muscles. Motor control, or the ability to engage the right muscles at the right time, plays a big role in managing back pain. So, while core strengthening exercises can help, they aren’t the only answer.
In fact, I’ve seen many cases where back pain is more related to weak or underused glutes and hips, rather than the core itself. Glute and hip strength often play a bigger role than core strength in supporting your lower back.
Core Exercises for Back Pain
That’s not to say strengthening your core isn’t beneficial. Research shows that people with back pain who do core strengthening exercises do tend to see a reduction in back pain. But it’s important to approach core training holistically. Instead of focusing solely on crunches or front-side ab exercises, I emphasize working the entire core, including the back, hips, and glutes.
When I work with patients on this, we might start with simple exercises, like lying on your back or working on all fours, to retrain those muscles. A couple of my favorite moves are supermans and planks. Gradually, we can build up to standing exercises, and eventually, you’ll be activating your core during everyday movements.
My Main Takeaway
While lack of core strength can contribute to back pain for some people, it’s definitely not the whole story. Many people think strengthening their abs will fix their back, but addressing back pain requires a balanced approach that often includes working on flexibility and strengthening other areas like your hips and glutes. Consider giving some of these back exercises a try:
Got joint or muscle pain? Hinge Health provides each member with their own physical therapist, health coach, and personalized exercise program so you can reduce your pain with a plan that’s tailored for your needs, goals, and ability. Learn more about Hinge Health’s digital physical therapy program and see if you're eligible. (There’s $0 cost to you because it’s covered by employers or benefit plans.)
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
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References
Chang, W.-D., Lin, H.-Y., & Lai, P.-T. (2015). Core strength training for patients with chronic low back pain. Journal of Physical Therapy Science, 27(3), 619–622. doi:10.1589/jpts.27.619
Alqhtani, R. S., Ahmed, H., Ghulam, H. S. H., Alyami, A. M., Al Sharyah, Y. H. H., Ahmed, R., Khan, A., & Khan, A. R. (2024). Efficacy of Core-Strengthening and Intensive Dynamic Back Exercises on Pain, Core Muscle Endurance, and Functional Disability in Patients with Chronic Non-Specific Low Back Pain: A Randomized Comparative Study. Journal of Clinical Medicine, 13(2), 475. doi:10.3390/jcm13020475
Cho, H., Kim, E., & Kim, J. (2014). Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain. Journal of Physical Therapy Science, 26 (8), 1237-1240. doi:10.1589/jpts.26.1237