Under-Utilized Core

This article was reviewed by David W, DPT with Outreach.

Experiencing low back pain? Shoulder pain? Shortness of breath?

These could be symptoms of a weak or under-utilized core. Core has been a ‘buzz-word’ for quite some time now, but many fitness fanatics and weekend warriors misunderstand what the core actually is, and how it is often at the root of many issues.

Think of your core as a box; the front and sides is your transverse abdominis, which winds around the sides and connects to the fascial networks in your low back, like a corset. The top of your box is your dome-shaped diaphragm, and the bottom is your pelvic floor musculature. Together, your diaphragm and pelvic floor contract and relax to stabilize and maintain intra-abdominal pressure. Lastly, you have your spinal erectors and multifidus in your low back which help contribute to your stability.

One’s ability to engage and effectively use these muscles is often retired to as ‘core stability.’

Having good stability of the core helps create a stable platform for the arms and legs to operate off of. In fact, having a weak core, or difficulty engaging the core to stabilize has been indicated in a number of studies to correlate with increased injury in the lower and upper extremities.

Engaging these ‘core’ often requires a co-contraction of the transverse abdominis muscle along with the core muscles, which makes it difficult to breathe for those who are not used to this (just try ‘sucking in’ your stomach and breathing; are you able to maintain a hollow stomach without holding your breath?). Some research has shown a decrease in diaphragmatic and transverse abdominis tone following a 60 second period of hypercapnia (increased carbon dioxide in the blood due to decreased respiration).  This simply means that if you can’t breathe while engaging your core, it is most likely further negatively impacting your ability to recruit those muscles. This underscores the importance of integrating breathwork into your exercise routines, and ensuring proper breathing while exercising.  Make sure to work with your therapist if you feel that this is an issue. Additionally, practices such as yoga, tai chi, and pilates all emphasis proper core strength through sound breathing.


1. Core Stability Exercise Principles
Akuthota, Venu1; Ferreiro, Andrea1; Moore, Tamara2; Fredericson, Michael3 Current Sports Medicine Reports: January-February 2008 – Volume 7 – Issue 1 – p 39-44

2. Breathing pattern disorders, motor control, and low back pain
Chaitow, Leon Journal of Osteopathic Medicine , Volume 7 , Issue 1 , 33 – 40

How Outreach Can Help

We provide in-home Physical Therapy, Occupational Therapy, and Speech Therapy to individuals that have a difficult time getting/going to an out-patient rehabilitation facility on a consistent basis, prefer not to go to a facility, or those that are more effectively treated within their home.

We also have an out-patient clinic at 1110 2nd Avenue in the Sutton Place/UES area where we provide therapy for those who are adamant about receiving care in a clinic setting. Our evaluations are 45 minutes and treatments are one-to-one with an ample amount of treatment time per client (no double bookings allowed.)