Often people ask me “Is Pilates good for Low Back Pain?”
YES, BUT there are many things to consider. Not ALL Pilates exercises are great for ALL back pain sufferers. And not all low back pain comes from the same structures. Much of what exercises to choose depends on a few variables. For example, How recent is the flare up of the low back pain? What is the extent of the injury? What is age of the person with low back pain? What is the health status of the person?
The origin of the low back pain
My first question would be…What is nature of the low back pain?
There are many structures in the low back that may cause pain (Muscle, ligament, disc, facet joint, facet capsule, articular cartilage). Some of these structures are very pain sensitive, some of them heal rapidly (muscle), and some take a long time to heal (disc, ligaments). This is because of the availability of blood supply to the area and loads placed on them on daily basis (long periods of sitting).
For a muscle strain, most Pilates exercises can be done after the client is pain free, which might be only a few days. But for other structures more time will be necessary.
Differences in who gets the Low Back Pain
There is a difference between a healthy 21 year old that pulled a muscle in the low back playing tennis and has a flare up, and a 48 year-old sedentary, desk bound, overweight individual that is diagnosed with an acute lumbar spine herniation accompanied with nerve root compression and severe radicular pain going down the leg.
While the 21 year old will be fine with loaded lumbar flexion Pilates exercises, the herniated spine will not be. Recovery time will vary with age. The health of the person will also play a major role on how the tissues will heal.
One Size Does not Fit All
Although Pilates exercises would be beneficial for both cases above, Not all injuries are the same, and Pilates exercises are “One size fits all” In the case above, different exercises would be suitable for each individual.
There are contraindications to many lumbar spine pathologies and there are recommendations to certain low back pain problems too.
For example, for an acute lumbar spine herniation with referred pain and neurological symptoms present, (meaning numbness, loss of power, etc) lumbar flexion may not be the best indication, and many Pilates exercises would be contraindicated. However, in the subacute phase There are fantastic ‘flexion free’ Pilates exercises that are actually highly recommended. These exercises aim to retrain the deep local spinal stabilisers and should be introduced as soon as the individual is relatively pain free. Flexion should be gradually introduced after the person has been symptom free; first non-loaded (as in a cat stretch) and far along the line, loaded (as in a half roll back).
The general rule
Generally, for non-specific low back pain, Pilates exercises are highly recommended. However, considerations need to be made for certain types of low back pain. If in doubt, seek advise from a qualified Pilates professional. This can and often time should include manual therapy sessions, such as osteopathic treatment * see below NICE recommendations.
Pilates for prevention of Low back pain
This is where Pilates exercises are absolutely fantastic. Prevention is the key. Especially for those people who have had spinal injuries or chronic problems and wish to prevent recurrences.
Find knowledgable instruction, someone who knows their anatomy, physiology and that teaches contemporary Pilates.
The National Institute for care and Health Excellence guidelines recommend:
*Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica
Book an assessment now and find out how Pilates exercise can be good for your low back pain.