Emphasize strength, flexibility, coordination and adaptability when working with people who have nonspecific low-back pain.
Many clients come to you with low-back pain, a condition that affects 80% of Americans at some point in their lives (Andersson 1999). For many, the pain occurs only occasionally. In contrast, chronic low-back pain—defined as persistent pain and disability lasting longer than 3 months—affects approximately 2%–8% of Americans (Andersson 1999). And it’s one of the leading causes of disability and work absenteeism for adults aged 45 and younger in modern, industrialized societies worldwide (Miyamoto et al. 2011).
Pilates has grown in popularity among healthy individuals and athletes, as well as people seeking recovery and rehabilitation from injury. It’s not surprising, therefore, that researchers are interested in examining the effectiveness of Pilates for helping people with low-back pain. In addition, many doctors and physical therapists recommend Pilates to their clients as a way to maintain a healthy back.Always advise clients with back pain to consult with their healthcare providers. If clients are following an expert’s guidance, ask specifically what movements their health professional has recommended or advised against. For a person with a herniated or bulging disk, extension movements may be contraindicated while flexion is permitted. For someone else, the reverse may be true.
Research and Practical Application
When determining which moves could promote back health in your clients, consider what researchers have learned. Cristina Maria Nunes Cabral, PT, PhD, led a randomized controlled study at the Universidade Cidade de São Paulo, Brazil (Miyamoto et al. 2011). The study recruited 86 subjects with chronic, nonspecific low-back pain and found that Pilates promoted improvement in pain and function in those who completed 12 individual sessions over 6 weeks. “These benefits are not maintained if the patient stops [the Pilates training],” says Cabral.
Cabral says the most beneficial Pilates exercises for people with low-back pain involve movements in every plane of motion—flexion, extension, side bending and rotation—and are moves that improve muscular conditioning and flexibility. She emphasizes, however, that exercise programs should be tailored to the individual. In general, she recommends the following:
- shoulder bridge preparation (core and lower-body conditioning)
- breast stroke preparation (prone spinal extension)
- mermaid (side bending)
- criss-cross (rotation, conditioning for external obliques)
- spine stretch forward (flexion)
Cabral believes Pilates is effective for low-back pain because Pilates activates the deep abdominal muscles—and there is evidence that patients with back pain may have a strength deficit in these muscles.
Gisela C. Miyamoto, PT, MS, of the Universidade Cidade de São Paulo, the physiotherapist responsible for the treatment protocols in the study, offers the following advice on how to help clients who want to improve their back strength:
“Perform a posture evaluation, [and] consider posture and back mobility. The exercise program must include exercises in all planes of motion [assuming that none of them are contraindicated for the individual]. Each program must be individualized and progressive. Instructors should also note pain and disability.”
Both Cabral and Miyamoto point out that targeted muscles are components of the powerhouse, popularized by Joseph Pilates. Researchers have identified powerhouse muscles as those that have a primary role in stabilizing the lumbopelvic system. These include the transversus abdominis, internal obliques, diaphragm, lumbar multifidus and pelvic-floor muscles, among others. The Pilates method of breathing and movement stimulates these muscles.
When it comes to preventing and managing back pain, Pilates practitioners have much to offer clients. Clinical practice guidelines issued jointly by the American College of Physicians and the American Pain Society do not yet recommend Pilates specifically as a complementary therapy for individuals with chronic low-back pain, but they do include recommendations for exercise and the practice of Viniyoga-style yoga, among other options such as acupuncture, massage, progressive relaxation and cognitive-behavioral therapy. As research evidence grows, the many benefits of Pilates are being realized; as such, its practice may be recommended on a wider scale in the future. Invest in education about this issue and make a difference.