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Core Strengthening or Flexibility for Low Back Pain?


Approximately 80% of people will developed low back pain symptoms at some point in their life. Most of these cases are nonspecific low back pain, meaning their is not specific cause or diagnosis. Exercise is beneficial for reducing chronic low back pain and as effective as other nonsurgical treatments in acute low back pain. Unfortunately, the parameters for core exercises and exercise are unknown.

Low back pain is caused by many factors and low back pain is linked to physical, lifestyle, psychological, cognitive, social, and neuro-physiological factors. Some nonspecific low back pain cases are thought to occur from the inability to react to a sudden load on the spine. Abdominal bracing is a method of increasing spinal stability and is one method of core training. However, the effectiveness of abdominal bracing over time is not well researched. All that is known with abdominal bracing is that it creates more spine stability and increases co-contraction, potentially reducing the risk of low back pain.

Aleksiev (2014) randomized six hundred patients with at least 2 episodes of recurrent low back pain in the past twelve months, with the episodes lasting more than 24 hours. ┬áThese six hundred patients were split into four “treatment groups”:

1. Strengthening without abdominal bracing.
2. Flexibility without bracing.
3. Strengthening with instructions to use abdominal bracing during exercises and daily activities.
4. Flexibility with additional instructions to use abdominal bracing in daily activities and exercises.

At the beginning of the trial, every patient was trained individually for 2-weeks, once daily for 30 minutes. Unfortunately, the exact exercise procedures and guidelines in this study were not described well, making it hard to extrapolate more information.

Patients were monitored eleven times over a ten year period.All groups had significant improvement of the pain outcomes during the first 2 years. The bracing group showed a lower pain intensity compared to the nonbracing groups. There was a significant improvement in pain intensity from the start to the finish of the trial for the bracing, but not the nonbracing groups. The pain frequency was also significantly lower in the bracing groups. The pain duration was also significantly lower in the bracing group. Exercise frequency was also higher in the abdominal bracing group.

Overall, the main effect in this study was exercise frequency, which was higher in the abdominal bracing group. The author feels the abdominal bracing contributed to this frequency and also added spinal stability, yet this was not clinically tested.

The exercise frequency is more important than the type, duration, or intensity of the exercise regarding the long-term prevention of recurrent nonspecific low back pain. It is advisable to exercise more frequently, rather than more intensively or longer.

At COR, we utilize abdominal bracing in many of our personal training, boot camps, exercise classes, and physical therapy. Although this study appears positive for abdominal bracing, it doesn’t provide a clear and concrete answer for its use. Despite the promise of a 10-year randomized study, little can be drawn from this piece.

Nonetheless, if you are looking for techniques for abdominal bracing, here is how we prescribe abdominal bracing with our clients, enjoy!


1. Aleksiev AR. Ten-year follow-up of strengthening versus flexibility exercises with or without abdominalbracing in recurrent low back pain. Spine (Phila Pa 1976). 2014 Jun 1;39(13):997-1003.