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by Staff Writer / Los Angeles Kings
By Dr. Hooman Melamed

Board Certified Orthopedic Surgeon
D.I.S.C. Sports and Spine Center

In fitness today, strengthening the core” is a hot topic. What most people don’t realize is that the core is more than just abdominal muscles. It is a combination of static and dynamic stabilizers of the lower back, pelvis and hip joints that work together to restrict or produce movements of these segments. Understanding how the core is structured will give you better insight into preventing back injuries and alleviating lower back pain.

The core consists of abdominal, lower back and buttock muscles, along with hip abductors and hamstrings. Acting in an harmonious fashion they ensure that the back, hips, knees and ankles do not get injured. This is analogous to a classical music concert when one member of the orchestra is out of rhythm, then the whole concert is meaningless.

Many back injuries occur because of a weak core. This does not imply that all of the muscle groups are weak. All that is necessary is to have one or two of the muscle groups weaker than the other ones and the person loses his/her ability to stiffen or stabilize the lower back for that specific activity. The harmonious firing of these muscle groups helps tremendously to off load the disc and joints in the lower back.

The major buttock muscle (gluteus maximus) is extremely important in transferring the work load between the hip abductors/hamstrings and abdominal/lower back muscles. The hip abductors (gluteus medius and minimus) are critical in leveling the pelvis and stabilizing the knee. Abdominal and lower back muscles (rectus abdominis, transverse abdominis, erector spinae, mutifidus, quadratus lumborum) are significant for increasing intra-abdominal pressure and thus stiffening and protecting the lower back. The hamstrings with the help of the gluteus maximus are responsible to support and work synergistically with lower back and abdominal muscles.

One of the mainstays of conservative management in patients who experience low back pain is to restore that person’s core. A routine gentle strengthening and flexibility program is most important. Exercises such as Pilates, gentle Yoga or Swiss Ball strengthening can be incorporated into a 15-minute, three-time-per-week program with amazing results.

Endurance training is as equally important as strength training. Most of the time injury happens when the muscles are fatigued and loose their ability to protect the lower back.

Under the guidance of a good physical therapist, chiropractor, personal trainer, or athletic trainer, one can achieve a strong and balanced core. It is extremely important that the trainer or the therapist be familiar with the specifics and the proper form of the exercises, otherwise, you can actually make your condition worse. Especially for those with persistent back injuries or pain, it would be wise to consultant with a board certified physician before starting any exercise program.

In the beginning, these muscle groups are isolated, but over time as you advance, all are combined in the final phase of the training. Once your body learns the neuromuscular pathways, your core becomes engaged in your activities without you being aware of it.

This is how you can avoid injuring your back as well as recover from lower back injury or surgery. And most important of all, use common sense; if you are in pain after a training session, then your are most likely doing the wrong exercise and/or using the wrong form.

Dr. Hooman M. Melamed is a highly-regarded Board Certified Orthopedic Surgeon specializing in complex cervical spine disorders and minimally-invasive spinal surgery. A Summa Cum Laude and Phi Beta Kappa graduate with a B.S. in Neuroscience from UCLA, Dr. Melamed attended the University of Pittsburgh’s School of Medicine. He completed his residency at the University of Illinois at Chicago, Department of Orthopedic Surgery where he had extensive training in deformity spine surgery at Shriner’s Hospital. Dr. Melamed was then Fellowship-trained in Complex Spine Surgery at Cedars Sinai Medical Center’s Institute for Spinal Disorders. Upon completion of his fellowship, he received the Depuy Spinal Fellowship Award. Dr. Melamed has been a lead author on multiple published peer- reviewed papers and has presented his research at numerous meetings. Dr. Melamed is a member of the American Academy of Orthopedic Surgery, North American Spine Society and candidate member of Scoliosis Research Society.

About D.I.S.C. Sports and Spine Center. Founded by preeminent neurological spinal surgeon Dr. Robert S. Bray, Jr., D.I.S.C. is redefining how health care is delivered. We are a true Power Player in Southern California when it comes to proving a full team approach to treatment of injuries and medical conditions for weekend warriors, aging baby boomers or elite amateur and professional athletes. We are the only facility to offer more than 20 board-certified physicians, conveniently housed under one roof offering fully integrated services. D.I.S.C. provides an unmatched continuity of care that encompasses next generation diagnostics, conservative care, pain management, chiropractic care, rehabilitation, wellness and preventative orthopedic health programs. Our a state-of-art surgical center is proudly “infection free” and specializes in minimally invasive spine procedures and advanced arthroscopic techniques. Our GOAL is simply to alleviate pain, restore function and help you return to an active and healthy lifestyle. For more information please call us at 310.574.0400 or visit us online at

Below are a few sample core exercises. Before starting any exercise program it is advisable to consult with a physician or other allied health professional.
Pike Crunch
The pike crunch is a core exercise that requires a lot of stability and balance to maintain proper form. This is a great upper ab exercise if done properly.

Level: Intermediate:
Works: Primary-Upper Abs; Secondary:-Obliques

Step 1: Start in a push-up position with your back straight, your core tucked and your legs up on the stability ball.

Step 2: While maintaining a tabletop with your back, tuck your knees into your body and contract your abdominal muscles.

Step 3: Keeping your back straight, extend your legs back to the starting position and repeat action.

Stability Ball Plank Exercise Level: Intermediate
Works: Primary-Lower Abs; Secondary-Obliques

The stability ball plank is an excellent exercise for building core strength as well as balance and coordination.

Step 1: Start with your forearms across the center of the stability ball. Keep your back straight and your abs very tight.

Step 2: Maintain this rigid position, breathing very shallow, keeping your belly button tucked up and your core muscles tight. Hold position until proper form can no longer be maintained.

Step 3: Hold for desired length of time. Rest. Repeat if needed.
Hamstring Curls
This hamstring curl exercise uses the stability ball. Hamstring curls improve balance and stability.

Level: Beginner
Works: Primary-Hamstrings; Secondary-Calves

Step 1: Lying on your back with both feet placed on top of the stability ball, bridge your hips up and hold position.

Step 2: While maintaining a solid bridge, curl your heels in towards your buttocks

Step 3: Straighten legs back out to the starting position and repeat.

Bosu Squat
This is a lower body exercise that uses the Bosu to increase the difficulty level. This Bosu squat also helps train balance and coordination while building lean muscle mass.

Level: Intermediate
Works: Primary-Quadriceps; Secondary: Glutes

Step 1: Start with feet nearly shoulder width apart, with a slight bend in your knee, maintaining neutral spine. For a more advanced workout add a 3 pound weight ball.

Step 2:
Lower your body down until your knees reach a 90 degree angle making sure to distribute your body weight evenly along the bottom of your feet and maintaining the same distance between your knees.

Step 3: Stand back up into the starting position, maintaining the distance between and slight bend in your knees, and repeat action.
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