Four out of five adults experience back pain during their lifetime. The problem becomes chronic for five to ten percent of sufferers. Back pain can result from being overweight, sleeping on an uncomfortable bed, or incurring an injury. The best way to alleviate back pain, according to Timothy J. Gray, DO, in his book Back Works, lies in a solid exercise program.

Our body's core consists of all the muscles in the stomach, the lower back, and along the spine and hips. These muscles work together to maintain a strong trunk and provide a stable base from which movement occurs.

We have no bones in the abdominal area. Because this cavity is supported only by the muscles that cover it, strong abdominal muscles are a must. (They also give the appearance of a smaller midsection.)

The abdominal muscles are a group of four different muscles. One rests in the center of the stomach. Another runs around the stomach, holding it in place and supporting posture. The remaining two muscles cross over each other along the sides, as if they are inserting themselves into our front pockets and back pockets. To prevent back strain, it is important to keep these muscles strong.

According to a study published in Diabetes Care in March of 2005, a twice-weekly workout program decreases abdominal fat in older men with type 2 diabetes. Whenever muscles are challenged to improve, the body's metabolism speeds up. The faster the metabolism, the more weight loss occurs. This is good news for people trying to remove abdominal fat in an effort to reduce back pain.

A proven tool in strengthening the core is the stability ball. The stability ball activates the core in every movement, creating improved posture, less back pain, and a flatter stomach. Because the stability ball challenges the muscles to maintain their alignment and hold the body upright, its greatest benefit is the balance factor. Using the ball also helps build postural endurance.

Stability balls go by many different names, including fitness ball, exercise ball, and Swiss ball, but they are all the same. Most health clubs have these colorful balls available for use. The manufacturers also vary from those who provide commercial grade balls to those who supply them for at-home users. The main difference between these two is the maximum weight that the ball will support.

It is important to use a ball that is designed to hold your body weight and is appropriate for your height. As a general guideline, for those under 5 feet tall, a 45 to 55 cm ball will provide the correct base. For those between 5 and 6 feet tall, a 55 to 65 cm ball will provide the correct base.

If a ball does not list its dimensions, you can gauge whether it is the proper size by sitting on it. While sitting, the angle of your hips and the angle of your knees should be 90 degrees. If your knees are bent too much, the ball is too small. If your knees are too straight, the ball is too large.

One of the greatest benefits of improving core strength is that the results are seen quickly. After only a few workouts, you will begin to perceive enhanced stability around your spine, which will improve your posture, assist in lifting activities, and reduce back pain.

When you become more attuned to feeling the muscles of your core, you will notice them in your everyday movements, such as turning the steering wheel of your car, closing the refrigerator door, reaching for a book, or rolling over in bed. Another nice benefit of core strengthening is that you will feel like holding your stomach in, which will instantly make your stomach appear to have lost inches.

Exercise Guidelines

• Perform 10 to 12 repetitions of each exercise.
• Begin with 1 set and gradually increase to 2 to 3 sets of each exercise.
• Perform the exercises every other day.
• Keep the neck in line with the spine to maintain good posture.
• Tighten the muscles of your abdomen as if trying to fit into a tight pair of pants.
• Maintain proper breathing.

Sit-Up

Sit on the ball and walk your feet forward until the ball is beneath the small of your back. Place your hands behind your head or crossed on top of your chest (easier option). Press your lower back into the ball. Exhale and curl your rib cage towards your pelvis. Inhale and release to starting position. Repeat for each repetition.

Ab Roll

Kneel in front of the ball. Touch the ball with your legs. Place your hands in a prayer position. Place your fingertips on the part of the ball closest to you. Inhale and roll the ball away from your body, using your arms to guide it. In the extended position, slightly lower your hips towards the floor. At this point, only your hands will be touching the ball. Exhale and roll the ball toward your body to return to start position. Repeat for each repetition.

Jack Knife

Kneel on your hands and knees over the top of the ball. Walk your hands away from your body, rolling the ball toward your feet. Straighten your legs with the ball positioned between your knees and ankles. Exhale and bend your knees, rolling the ball toward your chest. Inhale and release the ball to start position. For an increased challenge, straighten your legs and raise your hips toward the ceiling while rolling the ball toward your chest. Repeat for each repetition.

Leg Lift

Lie face down with the ball in the center of your abdomen. Place your hands on the floor and straighten your legs slightly so your toes touch the ground. Exhale and lift one leg to hip level. Inhale and lower the leg to the floor. Repeat the lift with the opposite leg. Repeat for each repetition. For a more challenging exercise, lift both legs at the same time.

Spinal Balance

Lie face down with the ball in the center of your abdomen and with your hands and knees a shoulder-width apart on the ground. To maintain this position, you may need to adjust the ball size accordingly. Keep your spine in a neutral position by holding your abdominal muscles tight. Slowly raise one arm while raising the opposite leg to hip level. Return to the starting position and repeat, using the other arm and leg. Concentrate on reaching away from your body through your fingers and toes. Repeat for each repetition.

Hyperextension

Lie face down with the ball in the center of your abdomen. Straighten your legs behind your body and press your toes into the floor. Begin with your arms straight out in front of you. From this starting position exhale and lift your chest off the ball while keeping your arms in the same position. Inhale and return to the starting position. Repeat for each repetition.

This core exercise program can be repeated every other day for a maximum of three times a week. Remember to take a day of rest between workouts to allow for muscle recovery. With consistent practice, you will see results within six weeks.

Lisa M. Wolfe has been focused on fitness for the past 18 years. These exercises and more can be found in her book Women with Balls-Using Your Exercise Ball, published through Wish Publishing. For more information or for answers to your questions, visit www.lisamwolfe.com and www.yogaband.com