I just tried an internet search for “pilates low back pain” and Google returned 1, 380, 000 results. Google scholar also offers hundreds of ‘scholarly articles’ that touch on the subject. Amazon offers several DVDs of Pilates for low back pain, but their offerings are dwarfed by the hundreds of YouTube videos on the same subject. Another Google search for the same terms but in the News section suggests that in the last month English language newspapers and magazines have also had hundreds of articles on this subject. Coupled with my own experience of Pilates ‘fixing’ my low back pain, is it any wonder that I’ve spent years believing that Pilates offered the best solution for anyone suffering from this nearly ubiquitous affliction?
The Dummies.com website has a page, attributed to Ellie Herman on: ‘Easing Your Back Pain with Pilates‘ in which she explains that the causes of back pain are “faulty posture” and “sedentary lifestyle”. While we might like to suggest some other possible causes, I don’t suppose that many Pilates teachers would disagree with her – it seems like pretty basic stuff: you sit and/or stand badly, your postural muscles get lazy, you ability to stabilise your spine is compromised, and from there you’ll be very lucky if you don’t wind up in pain.
So, why is Pilates so good at helping relieve low back pain? Well, of course, it targets your ‘core’, deep postural muscles that give your lower back its stability. The less uncontrolled movement that you have in your lower back, the less likely it is that you will have pain. As your stability improves Pilates can help to develop efficient movement of the whole of your spine, encouraging good posture during a variety of activities. In addition, helping areas of relative stiffness to become more supple, and areas of relative ‘looseness’ to become more stiff (stable) can help to bring more balance to our structure, and integrate our limbs into our trunk.
I was lucky enough to receive a pretty high level of training as a Pilates teacher (certainly by UK standards), and to work with some truly brilliant teachers from the UK and the US. I hope that I can reasonably consider myself to be well steeped in the principles of Pilates, and how to apply them when faced with clients with chronic pain and/or injury. I know about ‘working away from the pain’, and I’ve particularly enjoyed Ron Fletcher’s anecdote on that subject in his conversation with Kathy Grant (I referred to this DVD in a previous post) – Fletcher (a dancer at the time) explains that he went to see Pilates for help with a knee injury. Every time he went to Pilates’ studio he would be given exercises to do that had nothing to do, and Pilates would ignore Fletcher’s protestations that it was his knee that was the problem. After a few sessions Fletcher discovered that his knee was better.
So, I think my training has equipped me to help clients deal with back pain fairly well. I also believe that I understand a lot of the potential causes of back pain, as well as the importance of posture in maintaining a healthily functioning spine. I’ve been fixated (in my teaching) with hip mobility for years, and ‘get’ its importance relative to spinal stability and functional movement. I know, too, that most of us could do with working on upper back extension (and probably rotation and side-flexion too), and that the consequence of that will be less pressure on our necks. The list could go on, and that’s not really the point. In short, I felt that I had the basic understanding that I needed to do my job well, and that Pilates taught well was the ideal solution for all manner of problems. I certainly didn’t imagine that the world of strength and conditioning would have much more to offer in that regard.
More recently my perspective has been challenged. First of all by learning some of Mike Boyle‘s ideas (if you follow the link you’ll see just the kind of website that fit my prejudice completely – all it’s missing is advertising for protein powder) from his book ‘Advances in Functional Training’. (Actually this info is second-hand since it was my wife who bought the book and then explained it to me – I am nothing without her.) Boyle explains the body from the ground up as a series of joints that require, alternately, mobility then stability: ankle joint needs mobility, knee needs stability, hip needs mobility, lumbar/pelvic joints need stability, thoracic spine needs mobility, cervical spine (neck) needs mobility. Genius!
Being peripherally involved in a Pilates teacher training programme I understand how tricky anatomy and physiology can be to get to grips with, not least because it rarely seems to be straightforward, and how often students crave some dependable, simple answers. I’ve suffered the frustration, and seen it in many students too, of different books giving different answers for muscle functions. I know now that anatomy is an evolving subject, not a science in which all the answers have been found and set in stone. Thus, an explanation of what we need from our joints, expressed as simply as Boyle does, feels like a wonderful breath of fresh air. Mobility: stability: mobility: stability….It also seems to fit perfectly with ‘working away from the pain’ – you leave the problem area alone, and look for the adjacent compensations/weaknesses/stiffnesses. I think I had learned the same thing previously, but perhaps in a way that meant I didn’t see the wood for the trees – I knew it in pieces, and had never heard it said so succinctly. Lots of bits of information fell into place as I mused on this idea, and it’s become a constant reference point when I’m teaching.
Following that I was listening to a podcast recently in which the two hosts (one a strength and conditioning coach and the other an olympic weightlifting coach) were answering a question about exercising with a herniated lumbar disc. In discussing the question they came up with an equation something like: “If your hip joints are mobile, and your thoracic spine is mobile, you probably won’t have low back problems. If your hip joints aren’t mobile, and your thoracic spine isn’t mobile, you probably will have problems with your lower back at some point”. More genius!
It’s just like Mike Boyle said! (Mobility, stability, mobility, stability….) Again, I knew already what they were saying, in fact I’ve probably been saying the same thing to clients for years, just not in such a clear and straightforward way. Perhaps I’ve just been lagging behind all these years, thinking I knew more than I did – certainly I need to view other disciplines with a little more humility than I have in the past. In any case, when trying to learn more about what I do for a living, casting my net wider has definitely been rewarded.
To return to the Ellie Herman piece on http://www.dummies.com, posture may well be a part of the picture, but there’s more to it, and you may be able to make a significant difference to your risk, or management of back pain, by going beyond her advice to: “sit and stand up tall, keep your belly pulled in, and keep your shoulder blades pulling down your back”. Maybe even by listening to the advice of weightlifters.
paleolates 
After years of back pain pilates is the only thing that helped me. I was also inspired to become a teacher because of it. Great article!
I’d love to know if you have any comments on this: http://www.liberatedbody.com/eyal-lederman-myth-core-stability-lbp-033/
Haha, I wrote about this a while back for a different enterprise, at time when Lederman’s article was being used as means to ‘bash’ Pilates in the UK press. He accuses the proponents of ‘core stability’ of being self-serving, and I think his article is a perfect example of what self-serving looks like. He doesn’t provide any precise definition of core stability, or quote an explanation/definition from one of the proponents that he derides – it’s not difficult to undermine something that you haven’t defined.
Overall, what he writes has no relevance to Pilates teachers, as far as I can see, since I don’t believe that we teach ‘core stability’. The only reason it deserves any comment is because Lederman himself drags Pilates teachers into it.
Oh wow, I’m so glad I sent you this! I thought there was something wrong with my understanding of the whole post. Like he was trying to say something but never actually saying it.
Let me just say Mike, like many people have already, I really appreciate what you’re doing here, you’ve really helped me clear out my thoughts with many of your posts–and also restore my faith in what we’re doing. So thanks! And keep it up. If you ever visit Greece give me a shout!