For over a decade Pilates has been deemed a viable method for treating chronic lower back pain that can be compared in effectiveness with physical therapy. Several studies were focused around measuring the effectiveness of the method as compared to other forms of exercise or no exercise at all.
- A Pilates-specific exercise program produced a significant decrease in lower back pain and disability as compared to usual care (visits to healthcare professionals and general recommendations) over a 12-month follow-up period (study published in the Journal of Orthopedic & Sports Physical Therapy, 2004)
- Certain populations of people are more likely to benefit from a Pilates-specific rehabilitation program. The factors that might predict the effectiveness include the duration of symptoms, body mass index and range of motion of the trunk and hips (the Journal of Orthopedic & Sports Physical Therapy, 2012)
- Clinical Pilates produced similar results in treating symptoms of lower back pain as general exercise (Medicine and Science in Sports and Exercise, 2012)
- A Pilates-based rehabilitation program with the focus on body awareness, breathing, movement control, posture, and education is an effective way in treating and preventing chronic lower back pain (based on the responses of 30 Australian physiotherapists, published in the Journal of the American Physical Therapy Association, 2013)
There is still a lacking number of clinical studies that give a thorough overview of Pilates as a method to treat back pain. Some of the results are conflicting and it can be safely assumed that conflicts arise from the different styles of teaching Pilates.
However, if you go to any Pilates studio you will find a growing number of people who ascribe their back health to a regular Pilates practice.
The Conflict in the Pilates Teaching
Joseph Pilates in his book Return to Life through Contrology said that “spine should be flat like a newly-born infant even throughout adult life.” This idea sparked teachings that emphasize flat back and a lot of trunk flexion exercises. Just think about The Hundred, Roll Up, Roll-Over, The Ab Series, Short Spine on the Reformer, Tower on the Cadillac and dozens more.
The question of the spine position during exercises can cause a heated debate in the Pilates circles based on the training that the teachers went through. There are a lot of teachers today who adhere to Joseph Pilates’ original vision and emphasize the importance of a round back (“deep C-curve”) and a flat back during the majority of the exercises.
The idea of this article if not to start a heated argument about which teaching style is better or more accurate but rather to show Pilates in the light of modern research about spine safety.
Modern scientific studies have proven that the normal kyphotic and lordotic curves of the spine are essential to overall health as they absorb compressive forces in vertical position and help maintain balance and stability during any movement.
Modern Pilates teaching is structured around a neutral spine and neutral alignment. The core musculature is strengthened to maintain maximal stability and mobility of the spinal column.
Joseph Pilates developed a flexion-biased method due to his belief that the spine had to be flat as a plumb-line. Modern research shows that this vision is outdated and has to be changed to reflect the changes in the lifestyles of most people (sedentary lifestyles spent mostly behind the computer, at the desk or in the car.)
Most people already have a flattened lower back and are predisposed to lower back injuries like disc hernia or nerve impingement. Let’s take a look at an average sedentary person (not an athlete or a dancer like Joseph Pilates mostly worked with in his studio) and put them through a routine that emphasizes this already faulty posture through numerous repetitions of trunk flexing exercises. What will be the result of this program? You guessed it, back pain or even back injury.
It’s definitely not the result that Pilates students are looking for.
What Is Wrong with Spinal Flexion?
Spinal flexion is a necessity in our everyday life. We need to tie our shoes, pick up something from the floor, reach forward when sitting or standing or even lean over a sink to brush our teeth. We perform hundreds of forward flexion moves every day and our spine is built for that.
Things change significantly when we add a load to this forward flexion.
A Canadian-based professor of spine-biomechanics Stuart McGill, is the pioneer of safe spine movement. His thoughts and ideas have appeared on the pages of New York Times and are often sought after by international government agencies, corporations and elite athletes. Professor McGill is also the author of Ultimate Back Fitness and Performance and Low Back Disorders: Evidence-Based Prevention and Rehabilitation, the must-read companions of any exercise professional.
Professor McGill explains the biomechanics of the spine as well as the most common myths about back health in the video below.
The damage to the spine during spinal flexion is not immediate. It can take years to develop but eventually it will cause disc deterioration or a hernia. If a person who starts a Pilates program already has signs of disc damage (the majority of people with sedentary lifestyles) then their condition can only be worsened with a repeated spinal flexion that is taught in some Pilates classes.
Safe Pilates for a Healthy Back
Professor McGill’s opinion might seem like it’s ruling out any necessity of a Pilates program and yet the studies mentioned at the beginning of this article prove the efficacy of the method in treating and preventing back pain. How is it possible?
According to Joseph Pilates himself the goal of the Pilates Method (Contrology as he called it) lies in
“… the attainment and maintenance of a uniformly developed body with a sound mind and the ability to perform life’s daily activities with zest and ease.”
Pilates is not focused around creating washboard abs or emphasizing unnatural body development. Joseph Pilates emphasized the importance of LENGTHENING the spine during every move and using the newfound core strength to control the movements of the body at any point of time and during any activity. Once this core strength is obtained, a Pilates student can advance his/her practice by doing intermediate-advanced exercises that involve inversions and loaded spinal flexion.
If a Pilates student is weak in his/her core, they can’t do the Work the way Joseph Pilates intended it. They will collapse in their lower backs during Roll-Ups, Short Spine and etc, thus reinforcing the already faulty body alignment.
Joseph Pilates believed in developing the body uniformly and maximizing both the mental and physical potential of a person. This concept is what separates Pilates from a regular exercise regimen and brings amazing benefits.
Rebecca Leone, a classically trained Pilates instructor, is a Pilates educator whose mission is teaching safe spinal flexion techniques during a Pilates session. She has taken the work of Professor McGill and applied it to Pilates. In her video The Why and How of Safe Spine Teaching Technique she explains the problems that arise from teaching traditional Pilates exercises with an emphasis on rounding the lower back and shows safe ways to teach these exercises.
Rebecca’s #1 rule during any Pilates exercise is
Distribution of the movement and load over the longest length of the spine.
It means that every exercise must be performed with an elongated back instead of collapsing in the lower back region.
Here are a few highlights of Rebecca’s video mentioned above:
- Forward trunk flexion is a natural movement that our bodies were designed for. But this movement also wears out our spines faster.
- Flexion is safe if we use deep back and abdominal muscles to support the weight in front of our spines and resist forward bending.
- Deep lower back stretches are restorative to the spine if they are done with support. Use a stable base of the floor, a Pilates Ladder Barrel or Arc or all-fours position to unload the spine and then safely stretch.
- A safe way to strengthen the spine: We intently put the body in a slightly forward bending position but only to the extent that the anti-hinge muscles can resist and then we add load, movement and repetition. This way we have an opportunity to build significant strength and develop good posture.
- Joseph Pilates emphasized the importance of lengthening the spine and resisting the resistance. These are the principles that must be focused upon during a Pilates session.
- Inverted Pilates exercises are a reward for consistent training and a strong muscular corset that can safely support these movements.
Listen to the Pilates Bridge Professional Podcast featuring Rebecca Leone to learn more about the safe ways to teach spinal flexion in a Pilates lesson. The Professional Podcast is available only to the members of the Pilates Bridge community.
Pilates Cues To Avoid
A lot of common Pilates cues emphasize the exaggerated sucking in of the stomach and curving of the lower back. However, it might not be the safest way to engage the core, according to professor McGill.
Think of the spine as a fishing rod supported by muscular guy wires. If all of the wires are tensed equally, the rod stays straight. “If you pull the wires closer to the spine,” McGill says, as you do when you pull in your stomach while trying to isolate the transversus abdominis, “what happens?” The rod buckles. So, too, he said, can your spine if you overly focus on the deep abdominal muscles. “In research at our lab,” he went on to say, “the amount of load that the spine can bear without injury was greatly reduced when subjects pulled in their belly buttons” during crunches and other exercises.
It is easy to feel the engagement of abdominal muscles in a flexed position. Let’s do a little experiment.
Stand up and try to voluntarily flex your abdominal muscles starting from the lower portion and all the way up to your ribcage. Take a second to remember the sensation in your body.
Now, still standing, bend forward slightly (as if you were doing an ab crunch on the floor) and tuck your tailbone under. Without even thinking about tightening your abdominals you will feel a little tone in the front of your body. Now think about bringing your navel to your spine. Wow, now you can really feel it but it’s a lazy way of engaging your abdominals.
Do you actually use this position in your daily life? Are you going to crunch and suck in your belly if you are picking up a child or if you are twisting in the car to look in the back seat? This position will also cause discomfort in your lower back and make it more difficult to breathe.
The first way of tightening the abs is much more effective for our daily lives but it is also harder to do because it makes you work by engaging every muscle of your core.
The cues that are commonly used during Pilates sessions are “Flatten your lower back”, “Create a deep C-curve in your lower back”, “Suck your tummy in”, “Bring your navel to your spine”, “Scoop your belly out” etc. These cues are an inefficient way to strengthen your core and can cause potential damage to the spine according to Professor McGill.
Pilates Cues for a Strong Core and a Safe Back
In his article Why Everybody Needs Core Training, Professor McGill talks about the importance of stiffening the core which requires the harmonious engagement of all core stabilizing muscles including the rectus abdominis and the abdominal wall, quadratus lumborum, latissimus dorsi and the back extensors of longissimus, ilioicostalis and multifidus.
Core stability comes from a symmetric stiffness developed by the muscles around the spine. Activating just one abdominal muscle would create just one source of stiffness but would also result in an interruption of the force linkage. Consider that the entire abdominal wall has its anterior connection to the rectus abdominis muscle. The forces in the oblique muscles are directed to the rectus and its sheath, and then transferred to the rib cage and pelvis to enhance torque production and stability. As the three layers of the abdominal wall contract, a superstiffness is created to enhance stability. Teaching activation of the entire abdominal wall to patients and to performance athletes alike, is important.
Stuart McGill, Complete Abdominal Raking
All of these muscles can be engaged and strengthened during a properly cued Pilates session. Rebecca Leone offers several valuable cues in her video mentioned above but here are more ideas to get you started.
- During every forward-bending exercise focus on the length in the front of the body. Lift up the chest to create the longest distance between the pelvis and the ribs.
- Focus on keeping the neutral curve of the lower back in any front supported exercises (including Elephant, Front Support, Knee Stretch etc.)
- Imagine that your ribcage is a helium-filled balloon that is trying to float away from your hips.
- Imagine that your spine is a spring. Use your muscles to separate the coils of this spring. Maintain this elongated spring-like position during forward bending exercises. Don’t let the coils in the front of the spring (the front of the vertebral column) collapse, keep them separated at all times.
- During Spine Stretch Forward maintain the length and shape of the lower back as if you are going up and over a cactus growing between your legs and reaching as high as your xiphoid process.
- During rolling exercises keep the pubic bone as far away from the sternum as possible.
- Imagine a big smile across your hip bones to engage your Transversus Abdominis instead of just pulling the belly button in.
- Imagine a high corset that wraps around your middle and that is tightened in the back along your spine. Let this corset lift your ribcage up and equally tighten the muscles of your stomach, sides and back.
Pilates is a “full-package” program for the entire body and if done safely and correctly is effective in treating and preventing back pain. The efficacy of the Pilates program increases with the use of creative Pilates cueing that aids in the engagement of the core musculature and maintenance of the neutral alignment of the spine throughout most of the exercises.
It’s important to progress slowly during a Pilates session and use advanced moves only as a challenge for the students who have mastered the art of body control, the art of Contrology.
Concentrate on the correct movements each time you exercise, lest you do them improperly and thus lose all the vital benefits of their value.
Listen to the Pilates Bridge Professional Podcast with Rebecca Leone (click here) to learn
- safe ways that Pilates can strengthen the back and cor muscles;
- how to modify intermediate Pilates exercises (like Roll-Up, Teaser etc.) for safety;
- how to cue core activation without overengagement of Rectus Abdominis or Transverse Abdominis;
- cues to reinforce elongation of the spine
- best basic Pilates mat progression
The Professional Podcast is available only to the members of the Pilates Bridge community..
- No-Risk Abs: A Safe Workout Program for Core Strength, Blandine Calais-Germain
- No-Risk Pilates: 8 Techniques for a Safe Full-Body Workout, Blandine Calais-Germain
- Ultimate Back Fitness and Performance, Stuart McGill
- Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Stuart McGill