30 Seconds Of Therapy: Stabilization Strategies for Athletes With Low Back Pain

Jun 24

3 min read

Man holding lower back in pain with highlighted spine, illustrating lumbar discomfort or injury related to low back pain.

START

Inner Core Motor Control
1. The first rule? “Inner core activation must precede global strengthening.” Begin with:
  1. 90/90 Diaphragmatic Breathing – for intra-abdominal pressure training.
  2. Abdominal Draw-In Maneuver – to isolate the transverse abdominis (with minimal IO activity)
  3. Contralateral Arm Lifts in Split Stance – activates the lumbar multifidus, enhanced with 2 lb resistance.
Neurodevelopmental Progression
1. Train stability in the order the nervous system develops it.
  1. Supine: Core-assisted single-leg raise, resisted bridges
  2. Quadruped: Resisted leg lifts, bird dogs
  3. Kneeling: Half-kneeling lifts and chops
  4. Standing: Loaded single-leg hip hinge
Restore Quality Then Load
1. Once movement quality is restored, stabilize it under load:
  1. Kettlebell Swings – ballistic control.
  2. Deadlifting with Load – reinforces hip hinge and lumbar control.
  3. Turkish Get-Up – multi-planar control.
  4. Download PDF Exercise

STOP

Skipping the Clinical Prediction Rule
1. Use the Stabilization CPR to determine eligibility:
  1. Age < 40
  2. SLR > 90°
  3. Positive Prone Instability Test (PIT)
  4. Aberrant trunk flexion movements.
Prescribing Stretching as Your First Strategy
1. Stretching hamstrings won’t fix motor timing issues.
Progressing Without Mastery
1. Don’t load dysfunctional movement. Follow this sequence:
  1. Inner core activation.
  2. Motor pattern retraining.
  3. Functional integration under load.
  4. Functional Movement Screen and Y-Balance Test before discharge. The dancer scored a composite 13 on FMS — clear and objective discharge readiness.

WHY

Focus on core timing, not just strength?
1. Because strong muscles don’t help if they fire too late. Athletes with low back pain often have delayed activation of deep stabilizers like the transverse abdominis and multifidus. Teaching these muscles to fire on time prevents poor movement patterns that lead to pain.
Why does this method work so well? Stabilize Movement Control
1. Stabilization of the lumbar spine improves movement control by addressing the source of the issue and preventing further irritation and inflammation allowing the body to heal. Stabilizing muscles allow larger muscles to activate without further damage, but the process takes time and repetition for the patient to recognize the sequencing.

References: MedBridge Athletic Low Back Pain: Secrets for Effective Management and Treatment Kyle Matsel, PT, DPT, PhD, SCS, CSCS Delitto, A., George, S.Z., Van Dillen, L., Whitman, J.M., Sowa, G., Shekelle, P., Denninger, T.R., & Godges, J.J. (2012). Low back pain. Journal of Orthopedic Sports Physical Therapy, 42(4), A1–57. George, S.Z., Fritz, J.M., Silfies, S.P., Schneider, M.J., Beneciuk, J.M., Lentz, T.A., Gilliam, J.R., Hendren, S., & Norman, K.S. (2021). Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopedic Sports Physical Therapy, 51(11), 1–60. Mann, S.J., Lam, J.C., & Singh, P. (2022). McKenzie Back Exercises. In StatPearls, StatPearls Publishing LLC. Paige, N.M., Miake-Lye, I.M., Booth, M.S., Beroes, J.M., Mardian, A.S., Dougherty, P., Branson, R., Tang, B., Morton, S.C., & Shekelle, P.G. (2017). Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA, 317(14), 1451–1460. Park, K.N., Kwon, O.Y., Yi, C.H., Cynn, H.S., Weon, J.H., Kim, T.H., & Choi, H.S. (2016). Effects of motor control exercise vs muscle stretching exercise on reducing compensatory lumbopelvic motions and low back pain: A randomized trial. Journal of Manipulative Physiological Therapy, 39(8), 576–585. Satpute, K., Hall, T., Bisen, R., & Lokhande, P. (2019). The effect of spinal mobilization with leg movement in patients with lumbar radiculopathy-a double-blind randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 100(5), 828–836. Selhorst, M., Allen, M., McHugh, R., & MacDonald, J. (2020). Rehabilitation considerations for spondylolysis in the youth athlete. International Journal of Sports Physical Therapy, 15(2), 287–300. Stanek, J.M., Smith, J., & Petrie, J. (2019). Intra- and inter-rater reliability of the selective functional movement assessment (sfma) in healthy participants. International Journal of Sports Physical Therapy, 14(1), 107–116. Thornton, J.S., Caneiro, J.P., Hartvigsen, J., Ardern, C.L., Vinther, A., Wilkie, K., Trease, L., Ackerman, K.E., Dane, K., McDonnell, S.J., Mockler, D., Gissane, C., & Wilson, F. (2021). Treating low back pain in athletes: a systematic review with meta-analysis. British Journal of Sports Medicine, 55(12), 656–662.