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physical therapy for the spine

The Spine

The 360° Core

The core is a loose umbrella term that describes muscles that support the spine and pelvis directly. These muscles play a crucial role in running and overall movement, as they provide stability and support for the spine and pelvis, allowing the legs and arms to move efficiently. A strong core can improve running performance by enhancing balance, coordination, and power. During running, the core muscles stabilize the pelvis, which in turn helps to maintain good posture and alignment of the spine, hips, knees and ankles. Additionally, a strong core helps to transfer power from the legs to the upper body, which can increase the efficiency of running. This means that with each stride, the body is able to generate more power and speed with less effort.

The core is traditionally thought of as the rectus abdominus or ‘the 6-pack’ that sits along the front of the torso. However, this is only one of many muscles of the core and does not provide a full description of the core. The rectus abdominus is a good power generator and for this reason is commonly overused by athletes. Other muscles surrounding the rectus abdominus may not provide as much power, but are pivotal in providing stability and endurance. These muscles include the external obliques and internal obliques in the front; paraspinals and multifidus in the back, and the transverse abdominis that connects the two from back to front. 


A better conceptualization of the core is that of a 360° core. This does not only include the front of the core but also the sides and the back. Working together, muscles of the 360° core provide stability for the lower limbs to generate power while running. The core also connects the lower body to the upper body and an efficient core allows more power transfer of the arms to the legs while running.  Below are some exercises to develop strength and power not only in the front of the core but also the sides and the back of the core while running. 

physical therapy for the spine





physical therapy for the spine
physical therapy



The Front

Front Plank


Laying on your belly, come up on your forearms and toes. Draw your belly button towards your spine to neutralize your back. Can perform with small hip kicks, keep your back neutral.


3x30, 15, 15 sec

Laying on your back, bring your knees up into a table top position keeping your back flat and drawing your belly button towards your spine. Perform both legs bent for 30 seconds, then 15 seconds each of one leg straight. 

The Side

Side Plank


Laying on your side, come up on your forearms and foot. Draw your belly button towards your spine to neutralize your back. Can perform on your knees or as a full plank.

Side plank March


Laying on your side with knees bent, come up on your knees. At the same time, march your knee towards your chest. Can perform on your knees or as a full plank.

Side plank Hip Abduction


Laying on your side with bottom knee bent, top leg straight. Come up on your bottom knee. Kick your top leg up and slightly back.

Side plank Clam


Laying on your side with knees bent, come up on your knees. With a band around your knees, pivot your top knee up keeping your feet together.

The Back

Reverse Plank


Lying on your back on your forearms and your feet propped on a step lift your but up and hold an inverted plank. Can be performed one your upper back with your arms over your chest as a modified version. 



Laying on your belly lift your chest and feet up and hold this position. Arms can be positioned at your side or in front to make the exercises harder. 

Banded Bridge


Lying on your back with a band around your knees. Press out into the band as you lift your hips up so that they are level with your hips and shoulders. 

Bird Dog


On your hands and knees, lift opposite hand and opposite leg towards the ceiling. Try not to arch your back. 

Imaging and the lower back 

Athletes who have back pain often think that there’s something mechanically wrong with their back- a disk bulge, a slipped vertebrae, or a fracture. However, more often than not a nerve or muscle in the back is irritated, but the spine itself is not damaged. Nerve root irritation caused by inflammatory cytokines is very common, and can contribute to stiffness and pain along the muscles surrounding the lower back as well as neural pain. However painful inflammation may be, it is usually something that can be treated conservatively in physical therapy. 


Athletes are quick to jump to imaging to find the cause of their low back pain. However, imaging can be misleading because it often does not show nerve root irritation, or inflammation. In fact, findings on imaging are often benign and not related to pain at all. The majority of the population over the age of 50 has some kind of degenerative changes in their lumbar spine; however, not all of those people who have degenerative changes have pain. The same can be said for bulging discs- a large volume of the general public has some kind of bulge or herniation of a disc in their lower back, however, very few of those people actually have symptoms associated with the bulging disc. Therefore, we cannot jump to conclusions and assume that imaging is directly related to pain.


This is why it is very important to consult with a physical therapist to determine if you are appropriate for imaging and if it is related to your pain.

Mobility at the Back

Maintaining a healthy amount of flexibility at the back is important for optimal muscle function and tissue recovery. Foam rolling muscles that surround the back as well as controlled rotational movements are excellent ways to mobilize the core and spine.   Below are some exercises to work on mobility of the muscles surrounding the back and core. 

spine physical therapy

Cat Cow 


On your hands and knees arch and bend your back. Repeat for 10-15 repititions. 

Foam Roll Paraspinals


Lay on a foam roller over your lower back. Work up and down the paraspinal muscles starting low and then working up your upper back. 

Open Books


Lay on your side with your knees bent toward your chest and arms in front of your body. Raise the top hand towards the ceiling and let your shoulders and upper back follow until you are reaching towards the floor. 

THomas Stretch


Lay on your back at the edge of the bed. Bring the knee farthest from the edge to your chest. Let the other knee fall off the bed to stretch your hip.

LAX Paraspinal Mob


Using a lacrosse ball or double lacrosse ball, place the ball on either side of your spine and lay onto a wall or the floor. Work up and down through your muscles along  the length of your spine.

Thread the Needle 


On your hands and knees reach one arm towards the ceiling, then lead with that arm under your body as you move through the upper and then lower back. 

Stability at the Core

Muscles of the back and pelvis are dynamic stabilizers. They work to coordinate movement between the arms and the legs as well as provide a stable base to generate power while running. Muscles of the back play an important role in mitigating forces down the kinetic chain. A weak core can cause misalignment in the lower body, which can lead to imbalances and poor running form.  Stability of the lower legs also requires good stability of the muscles of the core. Below are some exercises that work on achieving stability of the core:

Single Leg Pallof Press


Standing on one leg. Press a band anchored laterally back and forth from your chest.

Step Up March


With one leg on a high step, march by driving your other knee to waistline and balance for several seconds. 



Stand on one leg 6-12in from a wall. Rotate your body and peck the wall while maintaining your balance. 

Single Leg Balance 


Standing on an uneven surface, stand on one leg. 

KB March


Holding a KB or dumbbell at your shoulder drive one knee up to waistline and balance. Repeat this while walking forward. 

SHort Plank Shoulder Taps


Come up on your toes from a hands and knees position. Without losing stability, tap your shoulders, alternate arms. 

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