Is Pilates as good to relieve back pain as many instructors advertise? Back pain is very complicated issue and there is no only one way to get rid of it. Many treatments fail because they only treat symptoms of back pain – not the real underlying problems. For 80% of back pain sufferers the most typical underlying problems are poor posture and muscle imbalance. Pilates is a well-known exercise form which is claimed to improve posture, core stability and strength. It is true that Pilates works better for back pain sufferers than other exercise forms, but results are often as good as the Pilates instructor is.
Pilates is a wonderful tool to strengthen deep stabilizer muscles (transverse abdominus and multifidus muscles) which support your spine. Studies have found that weak spinal muscles are typically found from people with back pain. Unfortunately, improving back stabilizer muscles is not enough. The pelvic and hip region muscles are also important and when they are unbalanced, they tend to impact back and spine function as well. For example hamstring, piriformis and hip flexor muscles tightness put tremendous pressure to the lower back and changing the pelvic alignment. Many Pilates exercises involve hamstrings, hip flexor and piriformis muscles which may actually further add imbalances and tightness of those muscles. Pilates focuses stretching by lengthening extremities and aiming the joints full range of motion. Unfortunately, just Pilates “lengthening” is probably not enough for a person who has back pain and extreme tightness of these muscles. So, it’s a good idea to add also some traditional stretching to help better reduce tightness and relieve back pain.
Body alignment is a Pilates foundation which is very important for people with back pain. It’s a big help for back pain sufferers to know what alignment they have to keep and carry themselves, because with the optimal posture the pressure of the lumbar spine is minimal. Neutral pelvic & spine position is important but also the rest of the body’s proper alignment – from head to toe. Pilates instructor who teaches the back pain clients only on the supine position (lying on back) can’t improve much the clients’ posture. It’s important to teach spine and pelvic alignment in both standing and sitting positions where the muscles are working as a daily basis. Pilates improves posture and muscle balance if the Pilates instructors have a good eye and good knowledge of anatomy & biomechanics. Unfortunately, many Pilates instructors lack the knowledge of these areas.
Compensation, Muscle Recruitment
Always when pain is persisting, the muscles work differently. The other muscles “shut down” when the other muscles have to overwork by taking care of the others job. Researches have shown that of the people who has back pain the muscle recruitment changed. Deep spine stabilizer muscles are not working correctly and efficiently and superficial muscles take over, unfortunately with poor outcome. This often makes the back very vulnerable for re-injury. Back pain clients lose the control of deep stabilizer muscles -transverse abdominus and multifidus muscles – and so it’s very important to re-educate these muscles working correctly to help support spine. Pilates is a great tool to re-educate those muscles working correctly because all the movements start by contracting transverse abdominal muscles. Also many back pain clients overuse piriformis, hamstrings & hip flexors muscles and superficial back muscles and under use glutealis muscles. To identify and correct faulty movement patterns as well as faulty muscle recruitment needs again a knowledgeable and experienced instructor who has more in-depth anatomy and body mechanics education than a basic comprehensive Pilates education program can offer.
Fear of Re-Injury
Biggest fear for people with back pain is a chance of re-injury. There are many movements in Pilates which are not suitable for people with back pain and are even contraindicated. Every back pain clients are different, and so are Pilates programs. The biggest mistake is to teach too difficult movements too soon, which can cause even more pain and client is definitely not coming back after that experience. One-on-one Pilates sessions with an experienced instructor are essential! Clients have to have full trust to instructors skills so that they can get over their fear and let the movements heal. As a Physiotherapist I do not recommend group mat Pilates class or reformer class for anyone who have back pain!.
Pilates repertoire has many good exercises for back pain sufferers and it’s a wonderful exercise regimen to improve postural muscles strength and stability by giving more support for spine. Unfortunately, even that Pilates is a good exercise method, it does not mean that it’s completely correct to all problems and issues the back pain sufferers might have and very often good results depend on how good, knowledgeable and skilled the Pilates Instructor actually is. Working with back pain clients needs a more carefully designed program and much more knowledge about suitability of movements, rehabilitation and healing process. And in addition to Pilates it is a good idea to add some classical stretching exercises to loosen tight muscles. The tight muscles (hamstrings, hip flexor, piriformis) might cause the back pain or caused by back pain and they might be the reason why some people’s back pain is continuing or returning later.
Our Active Back Pain Rehabilitation is combination of Pilates and Spinal Stabilization training. Spinal stabilization training and Pilates are both clinically proven to be effective and safe way to rehabilitate back pain and prevent future injuries. Our program is available for clients in San Diego North County. Our studio is located in Carlsbad, just short driving distance from Oceanside, Encinitas, Vista, San Marcos, Leucadia, Solana Beach. Please click HERE and read more about our programs.