What is the CORE of your pain?

As you read this week’s blog, it is likely that you may be experiencing pain somewhere in your spine or extremities.

Statistics indicate that the majority of the population does or will have some sort of musculoskeletal pain, and that this pain has a good chance of becoming chronic due to lifestyle, occupation, hobbies and even incorrect exercise techniques.

What is the CORE of your pain?

The core is your spine. It is where the body’s center of gravity is located and all movement begins.

An efficient core is essential for maintaining proper balance throughout the entire Kinetic Chain (the spine and extremities).

The core can be divided into two distinct but interrelated systems:

1.       Stabilization system (e.g. transversus abdominus, internal oblique, multifidus, pelvic floor, diaphragm and transversospinais)

·        Responsible for stability of the lumbo-pelvic-hip complex


2.       Movement system (e.g. latissimus dorsi, erector spinae, psoas, hamstrings, hip adductors, hip abductors, rectus abdominus and external oblique)

·        Responsible for movement at the core

The core operates as an integral functional unit, whereby the stabilization must work in concert with the movement system.

If the stabilization system is weak and movement system strong, the Kinetic Chain senses imbalance and compensates by increasing muscle activity of the movement system in order to create stability (albeit a false sense of stability).

This is known as synergistic dominance and results in compensatory movement patterns, pain and injuries.

In addition, weakness of the larger core movement muscles, such as the gluteus medius and maximus, can place extra strain on the smaller muscles around joints, which are easily fatigued.

 How Core Muscles Can Affect the Lower Extremity

If the core muscles are weak, particularly the gluteal muscles, then the pelvis will become unstable.

The gluteus medius abducts the thigh. Weakness in this muscle will have implications all the way down the kinetic chain.

If the gluteals are weak, then the femur will adduct and internally rotate excessively (knocked knees).

This leads to the knee falling into a more valgus position.

The tibia will then excessively rotate internally relative to the foot, which leads to an increase in pronation.

The smaller muscles in the leg and foot are not strong enough to resist the rotational and pronation forces of the body’s weight during gait if the gluteals are not functioning properly.

Consequently, there are a number of injuries that may not improve with traditional treatment if the hip abductors are weak and not addressed.

Some of these include: Plantar fasciitis, Achilles tendonitis, iliotibial band syndrome (ITBS) and medial tibial shin splints.

Treatments including ice, stretching, massage and heel lifts that focus on the local areas overlook the significance of the core and will undoubtedly yield temporary results.

In a study of recreational runners, researchers compared 30 runners with injuries to 30 randomly chosen healthy runners.

The runners had various injuries throughout the whole leg and there was a statistically significant difference in hip abductor strength in the injured runners’ affected limb versus the healthy side.

The uninjured runners did not have any difference in hip abductor strength.

Other studies have shown  correlations between patellofemoral (knee) pain and recurrent ankle sprains  and hip abductor weakness.

Should you stretch your hamstrings?

Many athletes routinely stretch their hamstrings because of perceived stiffness.

A study in the Scandinavian Journal of Medicine and Science in Sports showed that stability training of the core influenced hamstring stiffness.

The hamstrings act as global stabilizers and often become synergistically dominant (tight) in order to provide stability to a weak core.

Further stretching these muscles could adversely affect core stability, resulting in additional compensations, pain and impaired performance in athletes.

 The core and upper extremity pain/injuries

The core musculature serves two functions: lumbopelvic stability and the creation and transfer of forces.

Trunk musculature becomes active in a feedforward fashion during upper or lower extremity movements.

This feedforward mechanism occurs as the body prepares for potential perturbation, I.E outside influences that challenge spinal stability, when extremities begin movement.

Dysfunction within the kinetic chain will affect how forces are generated, summated, or transferred from proximal segments (legs, hip, torso) to the upper extremity.

Weakness within the core may contribute to the development of overuse upper extremity injuries such as: Shoulder impingement, rotator cuff tendonitis, tennis elbow and carpal tunnel syndrome.

 Key Diagnostic Tests for Core weakness:


1.       The overhead squat assessment- this identifies over and under active muscles, joint dysfunction, flexibility and stability

2.       Range  motion evaluation

3.       Muscle testing

4.       Trendelenberg sign for hip weakness- The body is not able to maintain the center of gravity on the side of the stance leg, so shifts towards the unsupported leg

 Do you have a weak core? Here are some signs:

Poor Posture

The core stabilizes your pelvis and spine, keeping your upper back and shoulders in a neutral position. If these muscles lack strength you are more apt to have poor posture

Lower Back Pain

When your core is weak or unbalanced, the curvature of your lumbar spine can change, resulting in pressure and tension on the vertebrae, discs or  facets that make up your spine, as well as the muscles, tendons and ligaments that surround it.


Overall weakness is also a sign that your core muscles are weak. This weakness, however, doesn’t need to manifest from the core itself. Instead, weakness in your arms and legs can indicate a poorly conditioned core. The muscles of your core stabilize your spine and pelvis, which helps transfer the strength needed to rapidly contract the muscles for more powerful movements, e.g. throwing a ball or taking a forceful stride.


Another potential sign of weak core muscles is the inability to hollow your stomach. Take a natural breath, and as you exhale, pull your belly button in toward your spine. Hold for a count of 10, then release. If you were unable to sustain the hold for the entire count, this is a good indication of a weak core.

A few of my favorite core exercises include: 

1.       Quadruped opposite arm/leg (AKA the Bird- Dog)

2.       Gluteal Bridge

3.       Clam shells

4.       Scaption

Got pain? You probably just need to   COREct it

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin