Pilates has been used by many to prescribe “core stability" for low
back pain. Specifically, this approach promotes core muscle contraction
and maintain it while lmovements are performed. Recently, there is a
growing mass of research showing that this approach is not beneficial.
Clinically, encouraging these heightened contractions and rigid postures can reinforce unhealthy beliefs around movement, and perpetuate pain. (Nijs et al., 2013).
Over the years, with new emerging evidence on back pain, Physiotherapy and Clinical Pilates has evolved to move beyond this stability approach.
In particular, Clinical Pilates explores movement rather than promote rigidity. Instead of focusing on isolated contractions, it concentrates on factors (evidenced based) contributing to pain.
Below listed are a
few areas in which Clinical Pilates can be helpful to people with low
Altered body schema has been observed in people with low back pain (Mosely, 2008) such as lack of awareness of body position with movement.
Performing movements with tools such as mirrors for visual feedback can
help reconnect body with movement and improve co-ordination.
Evidence has shown that one's pain experience can be linked to tissues perceiving danger during movement (Mosely & Flor, 2012). Meaning, if you subconsciously fear movement will hurt, it can amplify pain, whether there is any damage occurring or not.
Therefore clinical pilates
can be used to explore safe movements initially before progressing
movements back towards the perceived "harmful" direction
Tissue loading with exercise can have an several positive effects. Firstly, loading muscles, tendons and joints around a painful area can initiate a neurophysiological response to reduce pain similiar to manual therapy.
Secondly, loading can initiate tissue repair, strength and
conditioning in muscle, tendon, cartilage and bone. This is done through
a process called mechanotransduction (Khan & Scott, 2009), where
unhealthy weaker cells are replaced with healthy stronger cells.
In summary, discouraging rigidity and being liberal with movement is good for low backs. As always, chatting to your Physiotherapist about the benefits of an exercise programe for your problem is the best place to start.
Khan K. M., & Scott A. (2009). Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 43, 247-251.
Mosely G. L. (2008). I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain, 140, 239-243.
Mosely G. L., & Flor H. (2012). Targeting cortical representation in the treatment of chronic pain: a review. Neurorehabilitation & Neural Repair, 26(6), 646-652.
Nijs J., Roussel N., Paul van Wilgen C., Koke A., & Smeets R. (2013). Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Manual Therapy, 18, 96-102.
Smith B. E., Littlewood C., & May S. (2014). An update for stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders, 15, 416-437