PILATES FOR LOW BACK PAIN

The mantra “don’t take back pain lying down” (which came into vogue in the late 90’s) could not be more accurate.

Back pain types and causes vary hugely from person to person, but one thing they have in common is by adopting the approach ‘Movement is Medicine’ when treating Low Back Pain, you will get the best functional non surgical outcome. Of course there are exceptions to this rule (eg: trauma and the initial phases of acute back pain) which may force complete rest initially, but once ready the benefits of mobility, strength and core activation for rehabilitation is what gives the best long term results.

*Enter the main protagonist: PILATES

 It's no secret that Pilates is very fashionable in the Health and Fitness Industry. It's a great workout and is seen in hundreds of thousands of studios around the world. BUT! Pilates has so much magic to offer in the rehabilitation/injury management world. This is in fact where Pilates made its debut as a means to treat serious injury and help regain mobility and function. Pilates was initially designed in the 1920’s for REHAB. The equipment as we know it now was basically “hotted up” hospital beds with pulleys and levers to help WW2 soldiers with their injuries. So whenever I hear a client say: I will do Pilates “when I am fit” or “un-injured” they are waiting too long and missing the best part of Pilates!

Pilates was built EXACTLY for injury management and treatment. Using Pilates as an injury prevention tool is also where I think the real wizardry lies (especially if you are someone who has had back pain in the past.) Once you have gone through the Clinical Phase of injury management using Pilates principals, there is incredible power in maintaining your form through Pilates as a preventative. Sure, we can progress to more athletic fitness styles of Pilates once we have our back pain and symptoms under control, but there is absolutely no point in holding off on Pilates till you are better. I would say you are missing the prime time to get stuck into spinal rehab!

Low Back Pain is complex and can stem from many sources. Disc bulges, facet joint degeneration, scoliosis, kyphosis, sacroiliitis (just to name a few) can cause pain and have significant impact on quality of life and physical function. The spine is the epicenter of our human form so anytime we have spinal issues, there is often a snow ball effect elsewhere into the limbs. This ripple effect may be due to pain referral from the nervous system, muscle imbalances from the musculoskeletal system or mechanical side effects due to compensation patterns. It's crucial to think of the spine in regards to the entirety of our form. All of our anatomy is connected. Low Back Pain is best approached as a “global project.” A holistic approach to getting the body strong, mobile and functional is the ultimate aim. The spine is more than a solo entity.

Back pain can be debilitating, unpredictable and persistent. It's important to get the pain to a tolerable level before commencing a rehab program (I advise less than 4/10 if 10 is the worst pain imaginable) and then the exercise treatment plan can commence!  Once the acute inflammatory signs have settled and you are able to slowly ease into gentle movement, a combination of specific isolated core and pelvic stability exercises and then progressing to whole body functional movements gets best results. Pilates will offer this slow and steady approach and can honestly nurture you the whole way through the back rehab journey. 

Gaining resilience in all planes of movement and through all the limbs means the spine can withhold the fun that life throws at us without being frequently stalled by pain and spasm when you spend too long in the garden, run too far or unpack groceries. Not just approaching the spine as a single entity but as the epicenter of our form is how we get the body moving without pain and with higher function.

Pilates 2x a week for increasing core strength and reducing Low back Pain has been well researched and has certain benefits. Back pain is a tricky beast to get under control and the core can be stubborn to “come into action” after a period of low back pain. Clinical mat work is what I find works best with clients to get them moving safely and effectively while building trunk, spinal and pelvic stability. Starting with basic activation and then progressing to more global functional exercises as the core and back strengthens is how to make steady linear progress in spinal rehab. It’s a slow, steady but fun approach that I give all my back pain clients to the point that I rarely see them for hands on treatment once they are in a stable exercise routine.

There has been plenty of studies out there assessing the efficacy of Pilates as a treatment for Low Back Pain. Hundreds in fact. This systematic review Published in pub med is an extensive study which surmises the results of 'Pilates for low back pain' data.

‘Effects of Pilates exercise programs in people with chronic low back pain: a systematic review:’128 studies were considered and 29 were considered eligible. The comparison groups were divided into: Pilates vs other forms of exercise.

The objective of this study was to describe and provide an extensive overview of the scientific literature comparing the effectiveness of the Pilates method on pain and disability in patients with chronic nonspecific LBP.

In patients with chronic low back pain, Pilates showed significant improvement in pain relief and functional enhancement when compared to other forms of exercise. The other forms of exercise were aerobic activity or low level strength/gym routines (which is not to say these are in anyway BAD for treating Low Back Pain) but clinical Pilates had better pain reduction results. Moving forwards I always recommend a variety of exercise as the best approach to gaining health and fitness on the background of Low Back Pain but the other forms of exercise come later once you have established a good core base. Literally.

I approach Pilates to overcome back pain like having your veggies. You need to get your salad in before you can have all the dessert you like so long as it is not aggravating your symptoms. 'Dessert' (life without back pain) could simply be driving long distances without pain, running/exercising with full function, sitting, standing and walking without back spasms…. The parfait list goes on.

To keep with the veggie analogy, Pilates doesn’t have be steamed, raw or boring. It should be challenging but nurturing, tough but fun and should adapt weekly to how your body is feeling. You can add salt n pepper and condiments to exercises and sessions so they stay entertaining, effective and just a little spicy.  

With chronic low back some days/weeks may be different and it is important to find an exercise rehab routine that can help your symptoms and your personal pain variability. This means you can be consistent with your rehab even if you have an “off day”. Exercises can always be modified/advanced if you have any flare ups or you are feeling great and need to be pushed a little to keep progressing. The road back to full function with back pain can be tedious but it can be smoother if you find a Pilates class/daily exercise sequence that suits your symptoms. The goal is to firstly reduce pain, then fire up your deep core and then increase global strength and function. It’s never quick or easy, but I can assure you it can get better!

What does Pilates for Low Back Pain look like?!

It will vary from person to person depending on the nature and causes of their own specific Low Back Pain, but a holistic Pilates program to reduce pain symptoms and gain function would look like this:

1)    Deep core activation: The most important area to strengthen in treating/preventing Low Back Pain. The deep abdominals decondition with low back pain but are incredibly important to work on as they surround the lower spine and give structural stability. They are subtle to switch on but once you have it, you are already leaping ahead.

2)    Prone strength work (upper and lower back muscles): Lying face down and strengthening into an extension plane of movement builds muscular strength in the deep posterior aspect of the core giving spinal stability directly around the vertebrae. It starts off gently as often there is lots of stiffness here but you can quickly build really strong back extensors over a 4-6 week period.

3)    Oblique strength (lateral core muscles): Lateral and rotational strength to support the trunk and pelvis so the back stays strong in all planes of movement. This can be done side lying, high or low kneeling or even supine by adding some twists when able.

4)    Pelvic stability- Hip strength (glutes- abductors, inner thighs- inner thighs): The pelvis supports the lumbar spine so a strong pelvis (glutes and hip musculature) means more the spine will be optimized in terms of mechanics and stability. This can be done side lying, supine, standing and even kneeling. Glute strength in particular makes a big difference for helping Low back Pain

5)    Hamstrings: Weak and tight hamstrings are very common adjuncts to Low back Pain. Pilates really helps target the posterior chain of the body (everything at the back). Calves, Hamstrings glutes need to be strong to help support the lower back. Once the hamstrings are strong, they are less likely to shorten and tighten and this is a big help in offloading the lumbar spine.

6)    Balance (single leg and single arm work) This is a great way to be challenged in a global functional way. Single leg work makes use of MANY muscle groups, (particularly the core to keep you upright). It is challenging at first but improved VERY quickly with weekly practice.

7)    Global compound exercises -function specific The fun part! Once the basics are down, you can start to add some more global movements which means you use several groups of muscles to challenge the whole body. This may be standing lunges with rotation, planks with shoulder taps, squats with arm work etc. the list goes on. This is the fun part and also the more advanced stage of Pilates. It’s the best feeling when you start adding these wild moves.

This all sounds like a lot of hard work BUT these exercises put into a flow sequence turn into a thorough and effective workout without it feeling like an excel spreadsheet of homework. These can be done easily in 20mins at home by yourself, or in a 30-45 min class if you want the group camaraderie and live interaction.

I find it best to warm up with a deep abdominal floor sequence (toe taps, dead bugs), and spinal mobilisation (articulated bridges and roll downs), then move into isolated glute and oblique work (to get the lateral parts of the pelvis and trunk strong), then get into some more global work: plank (half or full), squats, lunges, elevated bridges, modified push-ups and bicycle floor core work. The functional exercises are broken up into a balanced flow (arms, legs, core and repeat) and finish with some mobility and stretching. Particularly through the upper and lower back and hips as this leaves you feeling limber after getting in the strength work. This program is always modified depending on the stage of back pain and general conditioning.

In short I am biased, but feel the best long  term approach (and research supports this) for Low back Pain is clinical Pilates with progressions and modifications made to suit the back pain symptoms and history. I am yet to have a client not do well with a consistent Pilates program. It’s a game changer.

Not quite a Pie n Latte, but Pilates is definitely better in the long run in terms of pain management and regaining function. We only have one spine so it’s crucial to feed it with safe exercise that doesn’t have to be tedious, boring or painful. You just need to ask for the specials board, not use the main menu.

Feel free to email me as to how to try a clinical class or have a 1:1 session to discuss how to tackle your low back pain effectively!

mailto:alice@alicebaquie.com.au

* The study is based on the data from the following sources: MEDLINE-NLM, MEDLINE-EBSCO, Scopus Elsevier, Cochrane, DOAJ, SciELO, and PLOSONE.