Core Strengthening Programmes

The "core" refers to the deep muscles that surround and support the spine and pelvis — the abdominal muscles, the deep back muscles and the muscles of the trunk that work together to control posture and movement. Core strengthening, or motor-control and stabilisation exercise, aims to improve the strength, endurance and coordinated control of these muscles so the spine is better supported and moves more efficiently. A physiotherapist teaches and progresses these exercises, tailoring them to the individual. The purpose is less about brute strength and more about control — the muscles working at the right time in the right way.

I think it helps to be balanced. Core and motor-control exercises do reduce pain and disability in low back pain, which is why they are widely used. But the evidence, taken as a whole, shows that they are not magically superior to other forms of exercise — general exercise, walking and staying active work too, and the most important factor seems to be doing regular, progressive exercise of some kind rather than any one special technique. So core strengthening is a valuable tool, but it is one tool among several, and it is not a cure-all or a substitute for overall activity. Setting that expectation honestly is part of good advice.

For most people with back pain, a physiotherapist will include core and control work as part of a broader active programme rather than in isolation. As a surgeon, I value it because a well-supported, well-controlled spine copes better with the demands of daily life, and because building strength and confidence in movement counters the fear and inactivity that so often accompany back pain. It is also part of rehabilitation after surgery, where rebuilding trunk strength and control supports a good recovery. But the design and progression of these programmes belong to the physiotherapist, not to me.

Motor-control (core stability) exercise has been studied extensively. A Cochrane review found that motor-control exercise reduces pain and disability in chronic non-specific low back pain, and systematic reviews and meta-analyses confirm this. Crucially, those same reviews find that motor-control exercise is generally no more effective than other active exercise approaches — the benefit comes from exercising, not from the particular method. This is exactly the balanced picture I present: core strengthening helps, but as part of an active lifestyle rather than as a unique solution.

As with all exercise, benefits build over weeks with regular practice, and a physiotherapist will progress the programme over time. The most durable results come from making activity a lasting habit rather than a short course. If back pain persists despite a good, sustained programme, that is useful information that helps me and the team decide whether further assessment is needed.

• —Saragiotto BT, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev 2016. (PMID 26742533)
• —Macedo LG, et al. Motor control exercise for persistent, nonspecific low back pain: systematic review. Phys Ther 2009. (PMID 19056854)
• —Byström MG, et al. Motor control exercises reduce pain and disability in chronic and recurrent low back pain: meta-analysis. Spine 2013. (PMID 23492976)
• —Smith BE, et al. Stabilisation exercises for low back pain: systematic review with meta-analysis. BMC Musculoskelet Disord 2014. (PMID 25488399)
• —Hayden JA, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev 2021. (PMID 34580864)