Pilates for Back Pain

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What is Pilates?
Back pain
How does core stability relate to back pain?
Is Pilates useful for people with back pain?
Is Pilates safe for people with back pain?
What are the risks of Pilates for people with back pain?
How do I modify Pilates if I have back pain?

What is Pilates?

Pilates for back pain Pilates is a form of exercise that is designed to improve posture, balance, strength, flexibility and muscle tone. Pilates exercises aim to create a ‘stable core’, which provides support to the back and a strong base for movement. A wide range of Pilates exercises are available. Strength is improved using small pieces of equipment, including exercise balls and resistance bands, gravity, or studio Pilates equipment such as a reformer or trapeze table.

Throughout Pilates exercises, the lower abdominal and pelvic floor muscles remain contracted, increasing their strength, and helping support the back.

Back pain

Back pain is extremely common. In Australia, 15–20% of the population report having back pain or disc problems, roughly equal to four million Australians. It is estimated that 85% of the population will experience back pain at some point in their lives. Those most at risk of developing back pain are people who are overweight or inactive; who spend a lot of time sitting at work; or whose jobs require them to lift, twist and bend. Stress and smoking also place people at risk of developing back pain. People with conditions such as arthritis, scoliosis, and cancer are more likely to experience back pain. Back pain becomes more common as people get older, with the first episode occurring most commonly around 30 to 40 years of age.

Back pain can drastically reduce quality of life. Many people who experience back pain become less involved in work, exercise and social activities. Back pain, especially when it is chronic, often has a large impact on an individual’s relationships, sex life, and role in the family and the community. A combination of these effects, and the back pain itself, can have an enormous impact on psychological health. Many studies have shown that for the vast majority of people with back pain, it is essential that they ‘keep moving’ in order to effectively manage their condition. Carefully monitored exercise programs that are designed to allow improvements in mobility, strength and flexibility without worsening back pain are an integral component of the effective treatment of back pain.

How does core stability relate to back pain?

People with back pain tend to have weaker abdominal muscles than people without back pain. The deep abdominal muscles (transversus abdominis) are responsible for helping to provide support to the back (they work like a corset). Strength in the deep abdominal, pelvic floor and back muscles, providing support to the spine and a strong base for movement, is known as core stability. If the deep abdominal muscles are weak, the back is vulnerable to injury.

Is Pilates useful for people with back pain?

Pilates is a particularly good exercise for many people with back pain as it is designed to strengthen the deep abdominal and pelvic floor muscles, which provide support to the back. Pilates has been found to reduce chronic back pain and the disability associated with back pain. These improvements are maintained over a long period of time.

Exercising in certain positions can make back pain worse. Pilates exercises can be modified so that aggravating positions are avoided and relieving positions are emphasised. The level of difficulty of the exercises can be modified according to the irritability and severity of pain. Physiotherapists who have specialised in clinical Pilates may use Pilates equipment and exercises specifically to help treat back pain.

Before starting a clinical Pilates program, most physiotherapists will take photos of your posture to identify problems, and will use ultrasound to see how well the lower abdominal muscles and pelvic floor are working. This is useful for identifying areas that need improvement, and for deciding on the exercises that will focus on these areas.

Posture and muscle strength can be reassessed following a period of Pilates to see how much progress has been made.

Is Pilates safe for people with back pain?

Check with your doctor or specialist before starting any new exercise program, particularly if you have any back problems. Any exercise performed incorrectly may make your back pain worse, so it is essential that you receive individual attention from a physiotherapist or qualified Pilates instructor. Don't try exercises on your own until a professional has assessed your performance and understanding of the basics.

In order to effectively improve support for your back, and to prevent injury, you must be able to perform an effective pelvic floor and deep abdominal contraction. The basic Pilates exercises are designed to achieve this contraction. If you cannot contract your pelvic floor or deep abdominals muscles effectively, more advanced exercises may place too much strain on your back and other joints. This is why it is important to be assessed by a Pilates instructor or physiotherapist before continuing with exercises to make sure your technique is correct.

Certain exercises will not be appropriate for people with back pain. Depending on the cause of the pain, and other factors, each person with back pain has individual ‘aggravating’ and ‘relieving’ positions. Exercises can be modified to avoid any positions that will make pain worse, and focus on exercises that will improve the pain. For example, back pain due to a bulging disc may be made worse by sitting and bending positions, while extension exercises may be helpful. In other individuals, the opposite will apply. This is why it is essential that people with back pain are thoroughly and carefully assessed by a physiotherapist or health professional before starting Pilates.

General Pilates classes tend not be suitable for people with back pain. They may involve positions that are not appropriate, and may progress too quickly. Clinical Pilates (in small groups of around 4, with a physiotherapist) or studio Pilates (in small groups of around 4) are more appropriate. These classes tend to be based on equipment, which will provide a greater variety of exercises.

What are the risks of Pilates for people with back pain?

Any exercise performed incorrectly may exacerbate back pain.
Certain positions may make back pain worse. These vary according to the individual. Although good assessment from a health professional before starting Pilates aims to identify the positions that make pain worse, some aggravating positions may not be discovered until they occur during Pilates exercises.
It is possible to ‘over-do it’ during any exercise, particularly as pain settles down and confidence improves. It is important to keep your progress gradual, and to be constantly reassessed by your instructor.
Certain conditions that cause back pain may be worsened by exercise. This is why it is essential to be assessed by your doctor before starting Pilates.
It is possible to lose your balance, fall, or jar your back during Pilates exercises, which could make back pain worse.

How do I modify Pilates if I have back pain?

Modification of Pilates exercises will vary according to the cause of your back pain and the positions that make it worse. Your Pilates instructor will guide you to exercises that are appropriate and those that are not.
Any exercises that cause a ‘niggling’ back pain should not be continued. This pain indicates that the abdominal muscles are not yet strong enough to support the back during that exercise.
As with all exercise, let your instructor know if you do not feel comfortable or confident. You know your back best, and you need to listen to your body.
Time any medication you take for your back pain around your Pilates classes according to your health professional's advice.
Make sure you provide your Pilates instructor with detailed feedback about how your back responded to previous sessions. This will help them to modify and progress your program appropriately.
Apply the principles of core stability and good posture that you learn during your Pilates sessions to your everyday life. This will maximise the benefit you obtain from Pilates, particularly if you have back pain.

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