Is Pilates good for Low Back Pain?
Is Pilates good for Low Back Pain?
When people ask if Pilates is good for low back pain my answer is a resounding YES.
However, there are many important variables to consider. To clarify, not ALL Pilates exercises are great for all back pain sufferers because not all low back pain originates from the same structures. Therefore, your choice of Pilates exercises will depend on specific individual variants. Find our more…
How much do you know about your injury?
In order to understand whether you’re doing the right thing for your back you need to think about the following.
- How recent is your flare up? Obviously, a very recent injury, will have inflammation and a chronic injury will not necessarily have it. Therefore the onset is important.
- What is the extent of your injury? For example, a large acute disc herniation may press on the nerve roots and may take longer to heal. A small annular tear will not press and will take less time to heal. Likewise, a facet irritation could resolve sooner.
- What is your health status? Generally, people who have healing problems, like diabetics, will heal slower. Similarly, people who are cardiovascularly fit might heal sooner, as the tissues get more oxygen in the blood.
While the answers to these questions are important to your exercise regime, the approach will greatly influence your prognosis. For instance, a 65 year-old client with lumbar facet OA might react differently to loaded lumbar flexion than a 38 year-old client with an acute disc herniation.
In other words, the following factors must be considered:
The origin of your low back pain
What is the nature of your low back pain is?
Various structures in the low back may cause pain; muscle, ligaments, discs, facet joints, facet capsule, articular cartilage. In fact, some of the structures in the spine are extremely pain sensitive like the outside potion of your disc, for instance.
Namely, some spinal structures heal more rapidly than others. For instance, muscles are metabolically more active compared to ligaments or tendon. As a result, muscles take significantly less time to heal, so for a muscle strain injury most Pilates exercises can be done soon after the client is pain free. On the other hand, structures such as a disc or nerve injury require longer healing periods as blood supply to them is meagre.
Who gets the Low Back Pain
Anyone can get low back pain. However, there is a difference between an active healthy 21 year old who pulled a back muscle playing tennis vs. a sedentary, overweigh 48 year-old desk bound individual with a disc herniation. Although the source of the pain differs among the two, the healing time and the exercise programming will too.
Wheras the 21 year-old with a pulled muscle will be fine with loaded lumbar flexion Pilates exercises, the client with a disc herniation will not be. Thus, the second individual is more likely to have a diagnosis of wear and tear, so his recovery time will be longer. After all, tissue healing time varies significantly with age. In short, the health of the person also plays a major role on how the tissues will heal, including high stress levels.
Although Pilates exercises would be beneficial for both cases above, not all injuries in the above examples are equal, and not all Pilates exercises are “One size fits all”. In the example above, different exercises would be suitable for each individual.
While there are specific recommendations to non specific low back pain, some lumbar spine pathologies carry contraindications. Whereas spinal flexion is not ideal for lumbar disc herniations, spinal extension is contraindicated for someone with spondylolisthesis. In other words, fracture of the pars interarticularis.
Generally speaking, loaded flexion is unequivocally contraindicated during acute and sub-acute lumbar spine herniations. Indeed, for herniations when referred pain and neurological symptoms are present, lumbar flexion is discouraged. This is because the load pushes the disc further outwards. So, sit-ups are definitely not appropriate during this period.
Certainly, Pilates offers fantastic alternatives and ‘flexion free’ workouts are widely recommended in rehabilitation practices. In addition, these exercises aim to retrain the deep local spinal stabilisers and should be introduced as soon as the individual is relatively pain free.
After the person has been symptom free, spinal flexion should be gradually introduced. Firstly, non-loaded flexion as in a cat stretch, and much later in the remodelling phase, loaded flexion as in a half roll back.
The General Rule
As a general rule, with acute injuries, if it’s painful stop. In other words, exercise should be performed under pain free, discomfort free conditions. However, in chronic pain, 3 months or more, it is possible to exercise under slight discomfort.
Generally speaking, for non-specific low back pain Pilates exercises are highly recommended. But, considerations need to be made for certain types of low back pain. If in doubt, seek advise from a qualified medical professional.
Pilates for Injury Prevention
“Improving the ability of muscles to respond to perturbations that potentially disrupt spinal stability is important in protecting the motion segments against repetitive microtrauma (1), (2) that potentially leads to low back disorders”
In the field of sport rehabilitation achieving abdominal muscle strength and proper order of activation of the abdominal muscles are major considerations. Especially, for improving performance and functional movement, as well as for preventing musculoskeletal lower back pain (3).
Pilates exercises help people improve spinal stability and abdominal strength. Most importantly, prevention is always the key. In particular for those who have had previous spinal injuries or chronic problems and wish to prevent recurrences.
Accordingly, the best recommendation is to find knowledgable instruction, so search for someone who knows their anatomy and physiology. At the same time, a scientifically based Pilates method is unequivocally recommended.
In conclusion, the body forms scars when a tissue has been injured. The scar is weaker than the original architecture of the tissue. This will need time to heal and then remodel. Exercise is crucial to the remodelling phase of tissue healing.
Core Kensington offers knowledgable and highly qualified instruction in Pilates and spinal rehabilitation.
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 now an assessment now and find out how Pilates exercise can be good for you.
- McGill, S.M. Stability (from biomechanical concept to chiropractic practice) . J Can Chirop Assoc. 1999;43:71–86
- Richardson, C., Jull, G., Hodges, P., and Hides, J. Therapeutic exercises for spinal segmental stabilization in low back pain. Churchill Livingstone, Toronto; 1999
- Cho KH, Beom JW, Lee TS, Lim JH, Lee TH, Yuk JH. Trunk muscles strength as a risk factor for nonspecific low back pain: a pilot study. Ann Rehabil Med. 2014;38:234–240.