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Back Pain and Pilates

Updated: Sep 6, 2019

Many, many people, including myself, have turned to different forms of exercise or therapy because of back pain. It was a big reason I and many of my colleagues started doing Pilates. Most Pilates teachers can point to several clients who start because they are battling back pain and continue to return because Pilates manages the issue. So let's talk about how Pilates helps.

First let me be clear on what back pain I refer to. Here we talk about non-specific back pain as described by a doctor. This is pain people suffer that a medical professional has been unable to attribute to anything.

Pain can include intermittent or chronic aches, shooting pains up and down the leg or back and neck or lower back pain. WHO estimates 60-70% of people in industrialised nations suffer non-specific back pain to some degree, where medics have been unable to find a cause.

The research of exercise and back pain

Structured exercise is increasingly used as a way through back pain. Studies in Canada and the US have developed a consensus that it helps. This has lead to institutions like the NHS recommending GP's refer people to Pilates classes because of the relationship between pain and a lack of strength and flexibility. While other exercise programs can also relieve pain, this study shows only Pilates is effective in developing the muscles to improve the situation. I am a Back4Good certified instructor exercise and offer back pain classes using Pilates. This is endorsed by the BackCare Charity and adheres to the NICE guidelines for back care.

Pilates' accidental benefit

The accidental benefit of Pilates is that it slowly reduces and relieves back pain for many people. This is probably related to Harvard Healths belief that back pain develops because of what we do during the day.

Pilates is not a cure all for back pain. It is a movement discipline helping people improve their mind-body connection. To achieve this many of the exercises are repetitive movements balancing breathing and movement to attain the most functional skeletal alignment. Movement comes from the centre - what many call the core - and stillness of the pelvis, spine and skull, often in neutral, are obligatory to the exercise. This provides greater control when moving so certain movements don't utilise the lower back unnecessarily.

We exercise your back extensors, hip flexors, lateral obliques and abdominals quite a lot. We also ensure deep postural muscles get a lot of attention rather than prime movers. The result is that you stand and sit straighter and taller from hips to neck. Your back improves as control and consciousness of your posture and movement improves, particularly the the muscle recruitment to do the movement. There we arrive at the accidental benefit of clearing back pain.

Lifestyle is identified as a big contributor to the issue in most back pain journals, posture is a primary issue. When Joseph Pilates set out to develop the method, he was developing something that improved the whole person. It is my belief this is at the root of it's benefits.

The inherent spinal safety of Pilates movements

As we move the spine in Pilates we emphasise sequential movements. We consciously allow each bone to move completely before the next bone begins. We also emphasise alignment - moving from a neutral position or through the correct movement plane - and only to natural ranges of movement. This creates full movement without injury.

Safety however also comes through centring which ensures support of the spine through opposition - antagonistic muscles - those not making but controlling the movement. As a result we only allow full range where that range is supported by engaged muscles.

Take a common exercise between Yoga and Pilates - Bhujangasana pose or Swan movements - a back bend many call Cobra. In yoga you push through the palms bending upward to gaze high, passively allowing the hips to lift slightly. The spine comes into full extension with the head back. In yoga this is held as the body relaxes into the pose. There is an emphasis in flexibility, meditation and release, to increase the extension.

In Pilates we follow the head up sequentially lifting the spine, shining the collarbone forward, and actively engage the core to support a higher hip lift and less lower back bend. We come into slight extension with the chin level to the floor. We momentarily hold then sequentially return and repeat. Our emphasis is support through opposition in order to control the movement - no stopping and releasing - and find conscious equilibrium between backline and frontline muscles.

The difference in movement and range means Pilates gives more back protection from gravity through engaging stability and support muscles. Joints at their maximum range are at their weakest so extending the spine completely and releasing muscles is potentially hazardous for many people. Pilates Swan may not look as cool as Bhujangasana, but the emphasis on support means greater safety.

Over time, this type of movement Pilates ensures the smaller muscles to develop improved innervation, something we need desperately for our modern sedentary lifestyles. Spinal range of movement improves because muscles lengthen so the combination of flexibility and control reduces injury risk and removes postural caused pain.

I'm sold how long does it take?

A while.

It took me 3 or 4 classes before I started to notice the effects of redeveloping the support and stability muscles. It was 3 months before I was pain free. What is also true however, is that maintaining this requires practice. Muscles that are unused become inactive again.

Luckily I love Pilates so I'm very happy to practice as often as I can. I know that if I keep it up, Pilates has my back.

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