Pilates & Low Back Pain

Pilates & Chronic Low Back Pain

Not all pain is mechanical:

Many people are advised by their doctors or physical therapists to try Pilates as they are aware that it can really help manage low back pain. Within the therapeutic community there have been numerous models and theories of how and why back pain strikes and many of these relate to mechanical or structural sources. In the low back area on an anatomical level there are many, many structures that have nerve endings and if compromised are therefore capable of being the source of pain. Usually there is a structural diagnosis for someone’s pain and a treatment plan is then devised to alleviate it. For example the structural reason could be a bulging or prolapsed intervertebral disc or a sprained ligament. Both of these limit movement, cause a great deal of acute pain but have very different recovery times and treatment and rehabilitation programmes. As a precaution any back pain should first be assessed by a qualified professional who will advise which movements may or may not be suitable for an individual at that time.

Chronic back pain:

However, not all back pain is acute such as the examples above. Many people suffer from nagging chronic pain and do not have these conditions. The unfortunate truth is that past thirty years old most of us are beginning to show some signs of wear and tear in our spinal structures. Pilates really seems to help with these types of client but it can not reverse the wear and tear that is already present so what is it that makes the difference?

Posture and core stability:

Many people have come to Pilates over the years having been told that they need to work their core. Many Pilates websites will draw clients in with the quite reasonable claims of improving core stability and posture. The mechanical model of lower back pain is where pain results from poor posture and stability placing inappropriate loads on the tissues of the lower back. The correlation of improved posture and less pain is a logical one to make but I would also argue that there are also other factors at work. Remember pain is a complex and still not completely understood mechanism and there will always be multiple factors influencing it, far more than this brief article covers.

Movement, breathing and low back pain:

I think that what has a huge impact on people’s chronic pain is the fact that Pilates gets them moving and breathing in a way that they were very likely not doing before. Hang in there as this is where it gets more than a little bit anatomy geeky.

As I mentioned previously there are hundreds of structures in your back that can generate pain signals, in fact anything with a nerve supply can. Our blood vessels even have a nerve supply and there is is a very interesting group of blood vessels in and around the spinal canal called Batson’s Plexus. This is a network of valveless veins that drain many thoracic and abdominal organs and provide an alternative route to get blood back to the heart to be pumped to the lungs and re-oxygenated. One of my osteopathy tutors described it as a storm drain, there to take the brunt if the typical route back to the heart is compromised.

One of the principles of osteopathy for over one hundred years has been “The rule of the artery is supreme.” In order words your health is dependant on every cell in your body receiving its nutrients from an unimpeded blood supply. When we live in poor slumped posture we create a great deal of congestion in our bodies. If there is resistance to the return of blood to the heart via this mechanical pressure our storm drain will take the brunt. The veins of Batson’s plexus are fighting for space amongst many other structures and if swollen the stretch on the associated nerves can potentially be a pain generator.

Pilates helps to improve our fluid mechanics in two ways:

  • Through movement, the compression and release of tissues of moving literally pumps fluid through your tissues. Remember those ankle flex and point exercises you are encouraged to do on a long haul flight?
  • Deep breathing creates pressure gradients between the abdominal cavity and the thoracic cavity which also helps to draw blood back to the heart. This is a tall order as by now the blood has lost nearly all of the pressure the pump of your heart had generated and it has to get back uphill against gravity.

Pilates works you deeper:

Pilates is all about lengthening and finding space in your body. One cue that has really spoken to me recently is from Amy Taylor Alpers, “Be the spring.” Your muscles support much more than just your bony framework and if we open those springs within ourselves we open the channels that run through our body. Joseph Pilates’s “internal shower” not only flushes the “accumulated debris” from our bloodstream but also returns us to life by evenly distributing the load of the bloodstream through some pain sensitive areas.

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