I am often asked by my patients what type of exercise is the best to ease or prevent lower back pain, or rather the questions usually sound something like this:
“Should I do Yoga or Pilates for lower back pain?”
“I know I should be doing Pilates, but I find it sooo boring and the breathing confuses me. Should I go back to it?”
“I tried Yoga and Pilates for a while but I found that it hurt my back.”
I’ll try and answer these questions in a series of three blog posts:
Part 1: Pilates for lower back pain - does it really help?
Part 2: Does Yoga help lower back pain?
Part 1: Pilates for lower back pain - does it really help?
What is Pilates?
Pilates is an exercise method where you focus on developing your body control, strength and flexibility. Yes, Pilates increases your core strength, but more importantly it also teaches you how to move your body in a coordinated way.
If, for instance, you have poor control and strength in your back and trunk and move you back every time you use your arms or legs, you are more likely to injure it. If, however, you are able to control your back’s position while you are using your arms and legs, you are less likely to strain it.
By control, I do not mean brace your body as hard as you can so that your back does not move at all. What I mean is that you are actually aware of the position of your joints and control the movement of the back as you move rather than just allowing it to go wherever it wants to go.
Having a well-controlled and strong trunk will also improve your accuracy and performance during sport and is one of the main reasons why different sports teams (including our tough rugby boys) have integrated Pilates classes into their training regimes.
I attended The Young Athlete Conference held by the ACPSEM over the weekend and the physiotherapist from Southampton football club presented data that showed how they have decreased the incidence of groin injuries in their footballers through Pilates exercises that were aimed at the lower back, pelvis and hip.
Pilates is named after its founder, a German by the name Joseph Hubertus Pilates. He developed the exercise regime for himself and incorporated several elements from other exercise forms e.g. Yoga into it.
“In 1912 Joe went to England, where he worked as a self-defence instructor for detectives at Scotland Yard. At the outbreak of World War I, Joe was interned as an “enemy alien” with other German nationals. During his internment, Joe refined his ideas and trained other internees in his system of exercise. He rigged springs to hospital beds, enabling bedridden patients to exercise against resistance, an innovation that led to his later equipment designs. An influenza epidemic struck England in 1918, killing thousands of people, but not a single one of Joe’s trainees died. This, he claimed, testified to the effectiveness of his system.” From http://www.pilates.com
It was only after his release when he moved back to Germany that the method gained popularity under the dancing community due to its ability to improve body strength and control. It is only in recent years that it has been advocated as a cure for lower back pain.
Does Pilates exercise actually help lower back pain?
Yes, a recent review of the literature has found that Pilates based exercises are effective in decreasing pain as well as improving flexibility and function in people with chronic lower back pain.
“So, why did Pilates hurt my back?”
Pilates exercises can come in various forms and intensities and your experience can be heavily dependent on you instructor’s skill to understand your condition and adapt the exercises for you.
It has also been shown that exercise programmes that are specifically designed for a specific person is more effective in decreasing lower back pain and increasing function.
Not all exercises and positions are appropriate for all people. I always steer my patients towards classes taught by experienced physiotherapists. They have a much better understanding of the different health issues and are better placed to provide exercise in the beginning stages.
They may even conclude that Pilates is not the appropriate form of exercise for you and prescribe something totally different!
But I find Pilates sooooo boring!
My answer to this is: “You are attending the wrong class.”
While it is important to get the basics right at the beginning, you should progress on to more challenging and complex exercises as you get stronger.
There is, however, no getting past it – you have to master the simple, low level breathing combined with move-this and move-that exercises first, before you can get to do the more exciting stuff.
You will not work up a sweat in the first 2 months. You may very well leave your first class feeling a bit confused and overwhelmed by trying to activate muscle groups you never knew existed!
I usually advise my patients to do the following:
Attend 1 to 1 classes with an experienced Pilates instructor (preferably with a physio background) for 6 weeks.
Make sure that the instructor provide you with an exercise sheet and things to do at home. Doing these exercises once is week is not enough!
Do these exercises EVERY DAY.
Then join a class. Choose the intensity of the class according to your ability and pain. There is no use in attending a high intensity class just because you like to sweat, if you are unable to control your body under those circumstances.
Use the key concepts that you learn during the Pilates classes in everything you do, from work to sport.
Still bored of Pilates? Go and try something else, but apply the Pilates principles that you have learned. It has been shown that while Pilates is effective in decreasing chronic lower back pain, it is no more effective than other types of exercise e.g. cycling. (3) Word of caution: The type of exercise has to be appropriate for your injury, so please consult your physiotherapist before embarking on a new exercise plan.
Let’s face it, if you do not enjoy the exercise you are doing, you are not going to stick to it. SO CHOOSE SOMETHING YOU ENJOY!
Next week we will look at whether Yoga is effective in treating lower back pain.
Patti, A., Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., et al. (2015). Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review. Medicine, 94(4), e383.
Hayden, J. A., van Tulder, M. W., & Tomlinson, G. (2005). Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain. Annals of Internal Medicine, 142(9), 776-785.
Mostagi, F. Q. R. C., Dias, J. M., Pereira, L. M., Obara, K., Mazuquin, B. F., Silva, M. F., et al. (2014). Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Journal of Bodywork and Movement Therapies.