Pilates
Adding Pilates for Chronic Low Back Pain, Injury Prevention, and You
Pilates has come up a lot lately in the medical literature with studies suggesting benefits for those suffering from chronic low back pain. My general understanding of the exercises seemed to mesh well with how we try to help patients to activate and use their deep core stabilizing muscles to prevent the recurrence of certain kinds of back pain, but the fancy equipment and movements still sounded a bit abstract to me. I wanted to learn more and reached out to a local leader in the Pilates method, Dan Walton of Studio Blue, who offered to meet with me for a first-hand experience.
Pilates exercise is a mind-body intervention that focuses on core stability, posture, flexibility, strength, breathing, and movement control.1
Joseph Pilates, a German national stuck in England at the outbreak of WWI, began developing exercise programs for sick/injured people by rigging springs and pulleys to hospital beds. His designs allowed people to experience the health benefits of gentle resistance exercises while they were bed-ridden. He moved to New York to continue working as a physical trainer, and, with the help of his wife (a nurse), developed the Pilates exercise method and equipment.
Pilates continues to grow and evolve, but the focus on spinal stabilization and emphasis on “quality” over “quantity” remains. Trained instructors guide clients through movements on either specially designed spring-resistant apparatuses (most commonly the Reformer) or simply the floor (mat work).
Why it works well with Physical Therapy
Pilates is a low impact total body workout that can be tailored to fit a wide range of physical abilities. In some cases of chronic low back pain, the home exercises prescribed by your doctor of PT may be the most strength training they’ve done in years, and the idea of getting thrown back into the fitness world when PT ends is overwhelming. Taking classes at a Pilates studio is a nice progression to your core strengthening where you’ll continue to receive individual attention and feedback for safe, correct form.
The Evidence
In healthy people:
– Pilates can improve flexibility, dynamic balance, and muscular endurance.2
For those with chronic low back pain…
– Pilates can improve functional ability, movement confidence, body awareness, posture, and movement control.3
– Pilates-based exercise + PT provides greater improvements in pain and disability than traditional care (physician or specialist consultation, medication, or anything else the person was already doing for treatment).4
– Pilates on the Reformer was more successful than mat Pilates at decreasing disability and fear of movement.5
Benefits for Runners and Athletes
The importance of including lower extremity and core strengthening exercises into your training regimen cannot be overstated- it is crucial for both improving performance or for simply maintaining a strong stride that lowers your risk of injury. One major benefit of Pilates exercises is developing multisegmental stability similar to how plank variations might, but where I believe the Pilates method adds a unique layer to a well-rounded program is body awareness and precise control. For example, during my session with Dan I followed subtle, but clear cues such as “roll your thighs in to stabilize” during certain positions/movements. I remember the movement becoming 10 times harder to perform, but this minor correction dramatically improved my posture and made me aware of a weakness (hip internal rotators) that I had been overlooking in my regular cross-training routine. In a private session, this weakness could then be addressed by incorporating more tasks requiring activation of the internal rotators. Or in a mat class, a vigilant runner might make a mental note to practice the move on their own for the next couple weeks.
Load your Gun
From low back pain to plantar fasciitis to the common cold, our current healthcare system and the people in it often act as though there are (or eventually will be) perfect treatments to quickly fix problems when they eventually get bad enough to address. In reality, magic bullets rarely exist. Injury prevention is about keeping a gun loaded with strength, adequate mobility, balance and wellbeing. For those seeking to take an active role in staying healthy, Pilates is a fantastic option to fill a few of those chambers.
By: Dr. Nicholas Chamley DPT
References:
1. Wells, C., Kolt, G. S., & Bialocerkowski, A. (2012). Defining Pilates exercise: A systematic
review. Complementary therapies in medicine, 20(4), 253-262.
2. Cruz-Ferreira, A., Fernandes, J., Laranjo, L., Bernardo, L. M., & Silva, A. (2011). A systematic
review of the effects of pilates method of exercise in healthy people. Archives of physical
medicine and rehabilitation, 92(12), 2071-2081.
3. Wells, C., Kolt, G. S., Marshall, P., & Bialocerkowski, A. (2014). Indications, Benefits, and
Risks of Pilates Exercise for People With Chronic Low Back Pain: A Delphi Survey of Pilates-
Trained Physical Therapists. Physical therapy, 94(6), 806-817.
4. Rydeard, R., Leger, A., & Smith, D. (2006). Pilates-based therapeutic exercise: effect on
subjects with nonspecific chronic low back pain and functional disability: a randomized
controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 36(7), 472-484.
5. da Luz, M. A., Costa, L. O. P., Fuhro, F. F., Manzoni, A. C. T., Oliveira, N. T. B., & Cabral,
C. M. N. (2014). Effectiveness of Mat Pilates or Equipment-Based Pilates Exercises in
Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Physical
therapy, 94(5), 623-631.
