Does Pilates Cause Or Treat Back Pain?

Photo: State Archives of Florida

Yes, Pilates can cause back pain. And yes, it can treat back pain.

Pilates and Core Strengthening

Pilates has many great benefits, including core strengthening. Core strengthening is beneficial, as it incorporates deep muscles of the abdominals and back that often are weak, especially among individuals with back pain. Having a strong core is one piece of preventing back pain, but other components include postures, body mechanics and proper treatment of present back pain.

Pilates vs. Physical Therapy

Pilates and core strengthening alone will likely not eliminate present back pain. It may play a role in preventing future episodes of back pain, but alone it is not the solution to low back or mid-back pain. If Pilates could treat back pain, I would not have a job as a Physical Therapist. Clearly, there is more to your back pain than weak core muscles, so proper treatment/prevention is urgent. If your back pain comes and goes, get it treated now, and you can learn why it happens and how to decrease the pain and prevent future episodes.  

Pilates Exercises to Avoid

There are some Pilates exercises that can actually produce or aggravate back problems, and these should generally be avoided. Any Pilates exercise that puts your back into a forward-bent (AKA flexed or rounded) position is not ideal for most individuals and can be harmful if you have back problems. Which forward-bending exercises are safe? Cat/camel (on your hands and knees and you arch your back up and down) and abdominal crunches are fairly safe for most people. 

Preferred Pilates Exercises

The Pilates exercises that bend your spine backwards (AKA extended, as in the photo above) are safe and highly recommended for most healthy people. This includes positions such as lying face-down and pressing up onto your hands or lying on your back and lifting your hips. Likely there are many extension exercises incorporated into your Pilates class, so these are generally beneficial and less likely to be harmful.

If either direction of spine movement aggravates your back pain, stop Pilates workouts, and get medical attention.

Core strength position Part 3

If you are ready for more challenging core exercises, here are some ideas.

Quadruped (hands and knees): Once you can do arm lifts and leg lifts with good technique and long hold times, you are ready for opposite arm/leg lifts. Get onto your hand and knees. Find your neutral spine position, then draw in your abdominals. Lift one arm and the opposite leg and hold for 5, 10 or up to 30 seconds. There should be no movement in your spine as you hold the arm/leg lift and as you lift and lower the arm/leg. Also, do not lift your arm/legs any higher than your trunk (you do not want your back to extend but to remain neutral). Once you lower the R arm/L leg, then lift the L arm/R leg. Repeat with alternating lifts for a total of 1-2 minutes. To challenge your core, increase your hold times. Then you can do fewer reps.

Plank: This is even more challenging! Lie face-down on the floor, mat or firm bed. Lift your hips upward and push up onto your forearms and toes, to form a plank position. Be sure to find your neutral spine position (you do not want your back arched up or downward). Hold the position until the point of fatigue and then rest down onto the floor/surface. Try to hold for at least 5 seconds. Do not hold any longer than you can maintain the neutral spine position. Work up to longer hold times progressively by practicing for 1-2 minutes/day. Here is an example of how to progress. If you practice consistently, you should be able to hold for >30 seconds within a few weeks.

Day 1: 5 seconds x 5-10 reps
Day 2: 5 seconds x 10-15 reps
Day 3: 10 secons x 6 reps
Day 4: 10 seconds x 10 reps
Day 5: 15 seconds x 4 reps
Day 6: 15 seconds x 7 reps

If you really like core strengthening, I highly recommend Pilates! A DVD or class at the gym can get you started. Once you learn the positions, you can easily transition to doing them by yourself as part of your workouts.

Core strength position Part 2

From yesterday's post we know what the strong core position is, so let's rename it "neutral spine." Now we can talk about some more challenging exercises for your core. Before you begin, make sure you can find your neutral spine position whether you are sitting, standing or squatting. Also be sure to draw in/contract your abdominals without holding your breath. If you cannot do these, look back at "Core strength position" from yesterday.

The two keys of core strengthening as I have instructed so far are the neutral spine position and the abdominal contraction. If you have trouble with either one of those, spend some time practicing until you can do them both properly. The tendency with the abdominal contraction is to hold your breath and to tighten other muscles (such as buttocks, pelvic floor, etc). But work on isolating the deep abdominals, which are so important for your core strength and low back pain prevention. Here are some more core exercises.

Quadruped (hands and knees position): Get onto the floor or bed on your hands and knees. Find your neutral spine position. Draw in your abdominals. Slowly lift up one arm (it does not have to be very high) in front of you. Hold it for 5, 10 or up to 30 seconds. Repeat for the other arm. If it is easy, hold for 30 seconds. Only hold as long as you can maintain the proper back position. Alternate arm lifts for 1-2 minutes. If it is really easy, skip to the next step. Just make sure it is done with perfect technique first.

Next, try lifting one leg by kicking it backwards (do not kick so high that you lose your neutral back position). Hold for 5, 10 or up to 30 seconds. Repeat for the other leg. Alternate leg lifts for 1-2 minutes. If you need more of a challenge, increase your hold times with each kick. Do not forget to focus on your neutral spine position and your deep abdominal contraction. Technique is the most important part of these exercises. Practice for a few minutes per day until you can do them properly with 30 second hold times

To be continued!

BALANCE for Pain Prevention

Balance exercise helps to strengthen your legs and core, which helps to decrease your risk for joint pain and injuries. So here is one way I add balance exercise to my usual routine.

First, pick a standing activity that takes you at least one-two minutes (for me, it is blow-drying my hair, which takes much longer). Next time you do that activity, do so by standing on one leg. See if you can hold that position for at least 30 seconds before you switch legs. If you do not have good balance, be sure to stand close to a table or counter so you can catch yourself. Be careful not to fall. If you lose your balance, you can always touch your other foot down and then start again.

Once you are good at balancing on one leg and can do so for 30-60 seconds easily, here is the next step. Stand on your left leg and slowly kick your right leg straight out to the side. Kick slowly (about 1-2 seconds up and 1-2 seconds back down). Do not kick very high (about 2 feet). Repeat at least 10x on each side (try to not use arm support if you can do so safely). This exercise is great for improving balance and hip muscle strength!