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Clinical Pilates
Doing more for low back pains than ‘core stability'



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 back pain.

Body Awareness

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.

De-threateningc Movement

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 (De-threatening).

Tissue loading

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.

References

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



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