Physio Fix for Core Dysfunction (Breathing and Posture Included)

Core breathing exercisesCore dysfunction isn’t caused by weak abdominal muscles. Poor abdominal control is usually only part of core dysfunction.

Unfortunately many people mistakenly believe that doing abdominal exercises will fix their core dysfunction.

There are actually 2 key elements underlying core dysfunction. It’s vital to address these 2 elements before commencing abdominal core exercises for anyone with core problems.

Common core problems include pelvic floor dysfunction, weak abdominal muscles, spinal pain and pelvic pain.

This Physiotherapy guide and video teach you:

A. What is Core Dysfunction?

B. How to Fix Your Core Video

C. Retraining Your Abdominal, Spinal and Pelvic Core Muscles

D. Incorrect Core Exercises

A. What is Core Dysfunction?

The core is another name for the middle and lower parts of the trunk (shown right).

Core dysfunction occurs when the core muscles don’t work well together in a well balanced and coordinated way.

Common problems related to core dysfunction include:

  • Chronic back and/or pelvic pain
  • Pelvic floor problems e.g. incontinence, pelvic floor spasm, prolapse
  • Breathing problems e.g. upper chest breathing, low energy
  • Poor posture

The core has 2 main roles in the body:

  1. Posture control and support
  2. Movement control of the spine and pelvis

Core dysfunction is often obvious in an individual’s posture (i.e. the way they hold their body when they sit, stand and move).

B. How to Fix Your Core

This short video is a great starting point for correctly activating your deep core abdominal muscles. Scroll down for more details on breathing exercises and posture correction to fix core dysfunction.

Strength & Core Workout for Women (Download or Hard Copy)

Strength and Core DVD download

Strength & Core video is a pelvic floor friendly core exercise workout with Physiotherapist Michelle Kenway

This whole body workout that strengthens your core abdominal and pelvic floor muscles in addition to whole body strength and posture training.

Strength & Core Benefits

Strength & Core Workout includes exercises designed to:

  • Exercise safely and avoid injury
  • Train core abdominal muscles
  • Strengthen pelvic floor muscles
  • Strengthen and tone hips, butt and thighs
  • Improve posture
  • Strengthen back muscles
  • Body weight management

The 2 Key Elements Underlying Core Dysfunction

The 2 key elements underlying core dysfunction are:

1. Breathing

2. Posture

These two elements are interdependent. If your posture is poor, your breathing will be affected and vice versa.

Core training must correct these 2 key elements before commencing specific rehabilitation exercises including pelvic floor, deep abdominal and spinal muscle exercises.

If you’re suffering from core dysfunction, the first place to start your training is your breathing i.e. training your diaphragm.

Breathing exercises have been shown to improve pain and quality of life with core dysfunction – related conditions such as chronic lower back pain.4 The deep abdominal, pelvic floor and spinal muscles work best when breathing patterns are corrected.9

1. Breathing Exercises

One of the most common issues underlying core dysfunction is poor breathing patterns. Many people with core problems breathe incorrectly using their upper chest.

Correct breathing involves using the diaphragm well and breathing into the base of the lungs.

This pattern of breathing is known as ‘diaphragmatic breathing‘.

How to do Diaphragmatic Breathing

  • Start lying down
  • Imagine a ring encircling your lower ribs and wrapping right around your body
  • Breathe in and expand this ring
  • Breathe slowly drawing the breath into your back and abdomen making your rib cage wide (feel your back and your abdominal wall both expand outwards)
  • Avoid lifting your ribs and upper chest forwards as you inhale
  • Breathe out slowly and make sure your rib cage moves back to your starting position (your rib cage shouldn’t be elevated or raised forwards)

Progress Breathing Exercises

Progress breathing exercises into sitting and standing positions when you’ve corrected your posture (outlined next). Watch the movement of your rib cage in a mirror as you breathe to monitor and encourage outward movement of your lower rib cage as you breathe in.

2. Posture Correction

The 2 Typical Postures With Core Dysfunction

Stand side on to the mirror and look at your posture. This will tell you a lot about how to correct your posture and your core problems.

1. Sway Posture

You will see a large inward curve in the lower back and the abdomen will bulge forwards (shown right). This means that the abdominal muscles and side trunk muscles are not working well, you probably breathe with your upper chest and have poor deep abdominal muscle control. 6

2. Slump Posture

You will see a flattened arch in your lower back and a slouching forwards of your chest and shoulders. This posture suggests you have overactive upper abdominal muscles (rectus abdominis or ‘6 pack’ muscles), poor deep abdominal muscle control and you’re likely to breathe with your upper chest. This posture is common in pelvic pain syndromes.6

3. Correct Upright Posture

You will see the spine lengthened, a small inwards curve or arch in the lower back, no abdominal bulging, the chest is not raised forwards and breathing expands the lower rib cage.

How to Correct Your Posture

Correct posture involves a ‘neutral spine’ position.

This position involves a slight inwards curve of the lower back with the chest and rib cage relaxed.5

Correct Your Sitting Posture

  • Sit with your feet flat on the ground, knees approximately hip width apart
  • Rest with your weight evenly distributed between your two sit bones
  • Lengthen your spine by lifting upwards through the crown of your head upwards
  • Keep your chest relaxed rather than raised forwards as you breathe
  • Gently engage your deep abdominal muscles
  • You should notice a slight inward curve in your lower back (adjust your pelvis accordingly so that your lower back curve remains ‘neutral’) shown right

Research shows that this sitting posture involves greatest core abdominal and spinal muscle activity compared with slumped forwards posture and hyper extended back (arched) posture.7 This sitting position also involves greater pelvic floor muscle activity compared with slumped forwards sitting.8

Correct Your Standing Posture

  • Stand with your feet slightly apart
  • Balance your weight evenly between your feet
  • Unlock your knees (keeping both knees soft rather than bent)
  • Lengthen your spine by lifting the crown of your head upwards
  • Keep your chest relaxed rather than raised forwards as you breathe
  • Gently engage your deep abdominal muscles
  • You should notice a light inwards curve in your lower back (adjust your pelvis accordingly so that your lower back curve remains ‘neutral’) shown right

When you can stand with correct standing posture, practice walking and moving well using this upright posture.

Posture Mistakes to Avoid

  • Chest raised too far forwards
  • Excessive inwards curve in the lower back
  • Standing with knees locked
  • Allowing the abdomen to bulge forwards
  • Tightening the upper abdominal muscles too strongly

C. Retraining Abdominal, Spinal and Pelvic Floor Core Muscles

When your breathing and postural muscles are working together well, you have the foundations to progress training the muscles around your core.

If you suffer from pelvic floor problems such as prolapse or incontinence, your main training focus will usually be your pelvic floor muscle exercises and deep abdominal core muscles.

If you’re trying to recover from spinal or pelvic pain, your training may progress to training specific spinal, pelvic floor and/or deep abdominal muscles according to the assessment and guidance of your Physiotherapist.

Most importantly you’ll need to continue using your corrected breathing and posture while progressing your core muscle training to permanently treat and overcome core dysfunction.

D. Incorrect Core Exercises

The ‘Real’ Core Muscles

The real core muscles are all the muscles that surround the middle and lower parts of the trunk, not just the abdominal muscles.

The core muscles 3 are:

  • Diaphragm at the top of the core
  • Pelvic floor and hip muscles at the base of the core
  • Abdominal muscles at the front and sides of the core
  • Spinal and buttock muscles at the back of the core

The Dangers of Incorrect Core Exercises

Core exercise is often confused with abdominal muscle exercises. This confusion often leads to intense core muscle training usually without addressing the 2 key underlying core problems.

Research tells us that repeated intense exercises such as abdominal curls cause spinal damage 1 and load the pelvic floor 2. This type of training can make core dysfunction problems worse by causing core muscle imbalance and damaging the spine and or pelvic floor in the process.

Further Reading

» Pelvic Floor Exercises Guide to Pelvic Floor Strength Training

» Safe Abdominal Exercises – Pelvic Floor Safe Core Exercises (Video)

» Beginners Back Exercises Routine for Safe Back Strengthening (Video)

» Breathing Exercises – Diaphragmatic Breathing Exercises Boost Your Core


1 Solomonow, M. (2012) Neuromuscular manifestations of viscoelastic tissue degradation following high and low risk repetitive lumbar flexion. J. Electromyogr. Kinesiol. 22 (2).

2 Barton A, Serrao C, Thompson J, Briffa K. (2015) Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. International Urogynecology Journal. Volume 26, Issue 12, pp 1789–1795.

3 Akuthota V, and  Nadler S. (2004) Core strengthening. Arch phys med rehabil. 85(3 Suppl1):S86-92.

4 Anderson, B  and Huxel Bliven, K. (2016). The Use of Breathing Exercises in the Treatment of Chronic, Non-Specific Low Back Pain. Journal of Sport Rehabilitation. 26. 10.1123/jsr.2015-0199.

5 Key J, Clift A, Condie F, Harley, C. (2008) A model of movement dysfunction provides a classification system guiding diagnosis and therapeutic care in spinal pain and related musculoskeletal pain disorders: a paradigm shift e part 2. J. Bodyw. Move. Ther. 12, 105e120.

6 Key J. (2013) ‘The core’: Understanding it, and retraining its dysfunction. Journal of Bodywork and Movement Therapies Volume 17, Issue 4, Pages 541-559.

7 O’Sullivan P, Dankaerts W, Burnett A, Farrell G, Jefford E, Naylor C, et al. (2006a) Effect of different upright sitting postures on spinal-pelvic curvature and trunk muscle activation in a pain-free population. Spine 31(19):E707-12.

8 Sapsford R, Richardson C, Stanton W. (2006) Sitting posture affects pelvic floor muscle activity in parous women: An observational study. Australian Journal of Physiotherapy. Volume 52, Issue 3, pp 219-222.

9 Roussel, N, Nijs, J, Truijen, S, Vervecken, L, Mottram, S., Stassijns, G. (2009) Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case control study. Eur. Spine J. 18 (7), 1066e1073.

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