Exercise therapy is probably the most effective treatment of patients with non-specific low back pain (NSLBP). One type of exercise program that has been increasingly used for patients with NSLBP is the Pilates method. While Joseph Pilates himself believed in using Pilates to treat and prevent back pain, it has only been in the last decade that it’s become more recognised as a treatment for back pain by physiotherapists and other health professionals.
Every Pilates exercises have a focus on recruitment of the core muscles, which make up the muscular centre that is responsible for the stabilisation of the body, both while it is moving and at rest.
During dynamic exercises in Pilates, co-contraction of the following muscles is observed:
– Multifidus (a deep back muscle)
– Transversus abdominis (a deep abdominal muscle)
– Pelvic floor and diaphragm
The goal of the co-contraction of these muscles is to reduce joint compression and to correct the position of the pelvis and lumbar spine.
The reported benefits of Pilates exercises include improvements in:
– Range of motion
– Muscle tone
– Proprioception (awareness of body position)
– And overall health.
The exercises are adapted to the condition of each patient, and the difficulty is gradually increased while respecting individual abilities and characteristics. The Pilates method has been proven by research to improve pain, disability and quality of life in individuals with NSLBP.
One rationale for how Pilates exercises might provide these benefits is based upon the idea that stability and control of spinal muscles are altered in people with NSLBP. Two motor control impairments are proposed to occur:
– First, the onset of activity of deep muscles, such as the multifidus and transversus abdominis, is delayed when the stability of the spine is challenged in dynamic tasks.
– Second, patients with NSLBP tend to compensate for this lack of stability by increasing the activity of superficial muscles, which increases the stiffness of the spine.
The exercises advocated by the Pilates approach target these two factors (i.e. improving the stability of the spine by improving the motor control of the deep muscles and reducing the activity of superficial muscles), as well as improving posture and body awareness.
Ideally, your Pilates program should be individualised, especially if you are still in pain. However, if you are no longer in pain, a generalised Pilates program will be beneficial to return your body back to full strength so you are able to return confidently to your usual daily activities and sports.