Mistakes physios make in core muscle stability treatment for low back problems?

I agree very much with postural causes for low back pain and problems since it comes with prolonged sustained activity. People who have longstanding back pain can have multifidus and transverse abdominus weakness, which can contribute to loss of spinal stability and excessive stress building on spine and giving pain. Core stability involves exercises are used to strengthen mainly the transversus abdominis and the multifidus.

First physios teach the patient to contract both these muscles in supine lying with knees bent or side lying or prone kneeling, whichever works for the patient. Then they progress by adding arm and leg movements while maintaining the contraction. Further they progress to seated position, standing and then start exercises with Swiss balls.

While concentrating on core stability, the big mistake most physios do is simply asking the patient to contract/tense up the abdominal muscles, without instructing them how much percentage of the contraction they have to exhibit in their abdomen. Obviously, tensing up the whole tummy would not be helping in strengthening the stability muscles. Any muscle needs to be isolated to get strengthened properly.

I feel if physios will ask the patients to contract or tense up their abdominal muscles only 25%- 50 % of their maximum capacity, the effect would be more on the TA or transversus abdominis and the pelvic floor muscles rather than the rectus abdominis. The other common mistake while doing the basic core stability with patients is the tilting of the pelvis, which again is not going to help in maintaining the proper 'S' shape of the spine throughout the exercise. Physiotherapists need to give proper instructions to prevent it as well.

It is also very important to develop an endurance pattern in these muscles, as these are the ones, which fire first to prevent any spinal injury, and on top of that, the most important thing is to develop an activation pattern in these muscles to contract transversus abdominis muscle.