Pilates exercise and back pain
The important principles of Pilates are consistent
with an exercise program that promotes back health.
In particular, learning awareness of neutral alignment
of the spine and strengthening the deep postural
muscles that support this alignment are important
skills for the back pain patient.
Patients with pain stemming from excessive movement
and degeneration of the intervertebral discs and joints
are particularly likely to benefit from a Pilates exercise
program. In addition, postural asymmetries can be improved,
thus decreasing wear and tear resulting from uneven
stresses on the intervertebral joints and discs.
Pilates
improves strength, flexibility and suppleness of the
muscles of the hip and shoulder girdle. Fluid
and supported movement through these joints helps prevent
unnecessary torque on the vertebral column.
The Pilates
program also teaches awareness of movement habits that
may stress the spine, and helps the patient
change these habits to those that preserve neutral
alignment. Awareness of excessive tension and the use
of proper focus helps the patient use the body efficiently.
Pilates considerations for back pain patients
Before starting any new exercise system, it is always
advisable to check with a physician or other healthcare
provider. Before starting a Pilates exercise program,
it is important to check that the potential instructor
has received training in the Pilates exercise system,
and that he or she understands any specific back problems.
If a patient starts Pilates after physical therapy,
the physical therapist should outline the exercise principles
identified as particularly important for his or her
rehabilitation.
Individuals with significant back problems may benefit
from several one-on-one Pilates sessions with a qualified
Pilates instructor. While more expensive than a group
class or mat class, the time, money and effort devoted
to learning the exercises correctly can be well worth
the investment, as exercises performed incorrectly can
make a back problem worse. Initially, twice-a-week sessions
tend to be helpful to learn the program more quickly.
After that, weekly Pilates exercise sessions may be
enough if the individual practices between sessions.
The principles of movement important for back
health are taught in some of the simplest exercises
of the
Pilates system. One cannot underestimate the benefit
of simple exercises that support the deep postural
muscles of the trunk, awareness of neutral alignment,
and supple use of the shoulders and hips. It is best
to learn exercises that can be practiced at home between
scheduled Pilates sessions.
Given its roots in ballet
and dance, some of the movements in the Pilates system
are very difficult and challenging.
Many of the exercises should be avoided for individuals
with significant back pain or degenerative disc disease.
Remember, it is always advisable to first see a physician
prior to starting any exercise program.
As a general
rule, back patients should avoid exercises that push
the spine into extremes of flexion or extension,
or combine flexion with side bending or twisting the
spine. These motions place excessive stress on the
intervertebral discs. Also, it is important to avoid
fatigue - either mental or physical - which is when
proper form is lost and injuries more likely to occur.
The exercises in the Pilates system should be challenging
(both mentally and physically) but not so difficult
that they cause anyone to struggle. If an exercise causes
pain—it is best to stop and tell the instructor.
The exercise may be too difficult, or the person may
need additional help to do it correctly.
Finally, it
may take awhile for the full benefits of a Pilates
exercise program to be realized. Just as
problems that create most back pain problems happen
gradually over time, learning to use one’s muscles
in a way that support - rather than stress - the spine
takes time and commitment.
By: Beth
Glosten, MD, Certified Pilates Instructor
March 21, 2003
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