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Pilates and Back Pain
Pilates and Back Pain: How can pilates help people with back pain? Issues like lack of core support, pelvic instability, muscular imbalances, poor posture, and lack of body awareness all effect your back health. The Pilates method specializes in helping people improve these issues.  The second article below explains, "Individuals with significant back problems may benefit from several one-on-one Pilates sessions with a qualified Pilates instructor. While more expensive than a group class or mat class, the time, money and effort devoted to learning the exercises correctly can be well worth the investment, as exercises performed incorrectly can make a back problem worse."

Pilates and Back Pain

Why Pilates Helps People with Back Pain

By , About.com Guide

Updated June 13, 2010

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

back muscles

Pilates Supports the Spine

Medioimages/Photodisc/Getty Images

Pilates exercises are commonplace at physical therapy centers, chiropractors are recommending Pilates, and "My back used to hurt all the time and now I don't feel it anymore" is a phrase we hear a lot from people who do Pilates consistently. So what is it about Pilates that works so well for back pain relief?

What makes Pilates so effective is that it addresses the underlying structural imbalances in the body that lead to back pain. Issues like lack of core support, pelvic instability, muscular imbalances, poor posture, and lack of body awareness all effect back health. They are also issues that the Pilates method specializes in helping people improve.


Pilates Helps Correct Posture

In Pilates, we pay a lot of attention to how our body parts are lined up in relation to each other, which is our alignment. We usually think of our alignment as our posture, but good posture is a dynamic process, dependent on the body's ability to align its parts to respond to varying demands effectively. When alignment is off, uneven stresses on the skeleton, especially the spine are the result.  Pilates exercises done with attention to alignment, create uniform muscle use and development, allowing movement to flow through the body in a natural way.

For example, one of the most common postural imbalances that people have is the tendency to either tuck or tilt the pelvis. Both positions create weaknesses on one side of the body and overly tight areas on the other. They deny the spine the support of its natural curves and create a domino effect of aches and pains all the way up the spine and into the neck. Doing Pilates increases the awareness of the proper placement of the spine and pelvis, and creates the inner strength to support the natural curves of the spine. This is called having a neutral spine and it has been the key to better backs for many people.


Pilates Develops Core Strength

Good posture that goes beyond the "look" of being aligned requires core strength. Having core strength means that all of the muscles of the trunk of your body are strong, flexible, and working together to support and stabilize the spine.

Core strength is deeper than the big surface muscles that we are used to thinking of as those of the trunk of the body, like the rectus abdominis, the infamous 6-pack abs muscle or the beautiful big muscles of the back, like the lattisimus dorsi, popularly called "the lats." The core muscles include the muscles that are below the surface musculature.

So while many forms of exercise focus on strengthening the big surface muscles, Pilates trains the body so that all of the core muscles work together to support and stabilize the back. Part of developing effective core strength is to train the body to know when to release, as well as activate, its core muscles. So while core strength is the catch-all term, we might say that the core coherence that Pilates teaches is essential for back health.

Some of these less obvious but very important core muscles are the muscles of the pelvic floor; the psoas, which play a huge role in keeping us upright and in hip bending; the transversospinalis, which are small muscles that weave along the spine; and the transverse and oblique abdominal muscles. The diaphragm, our prime breathing muscle, is right in the middle of the core. All of these muscles play crucial roles in the support and stability of the spine.

...the only real guide to your true age lies not in years or how you THINK you feel but as you ACTUALLY are as infallibly indicated by the natural and normal flexibility enjoyed by your spine...
Joseph Pilates, Return to Life Through Contrology


Pilates Promotes Flexibility

A healthy spine can curve forward and backward, twist, and move side to side, and do so in a way that reveals all the subtle articulations that our many vertebrae allow us to have. As core strength develops, the back muscles learn to work in harmony with the abdominal muscles, forming protective support for the spine that increase the potential range of motion of the spine. Pilates exercises are easy to modify so that we can develop spinal flexibility at our own pace. This is one of the things about Pilates that makes it easy for people with back pain to work with.


Pilates Increases Body Awareness

Whether the cause of pain is from an injury or as is often the case, a culmination of the effects of poor posture and inefficient movement habits, back pain is a messenger letting us know that we have to pay more attention to how we live in our bodies. The Pilates method is full attention exercise. You can't do Pilates without becoming extremely aware of your alignment and the energy you bring to movement.

This kind of awareness practice is extremely powerful for people with back pain because we not only improve physical functioning, but as awareness increases, we move beyond the physical and mental holding patterns that back pain can create. Then, there is more room in one's whole being for positive change.

Learn Pilates Exercises for Back Pain:

Pilates Fundamental Exercises
Pilates for Back Pain Exercise Series
5 Back Strengthening Extension Exercises

Back pain has many causes and Pilates may not be right for all of them. If you have back pain, especially serious or chronic back pain, please check with your health care practitioner before you begin a Pilates program. If you do choose to begin Pilates, it is important to work with a fully certified instructor who is aware of exactly what challenges you are working with.

Pilates Exercise and Back Pain

By: Beth Glosten, MD

The important principles of Pilates are consistent with an exercise program that promotes back health. In particular, learning awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment are important skills for the back pain patient.

Patients with pain stemming from excessive movement and degeneration of the intervertebral discs and joints are particularly likely to benefit from a Pilates exercise program. In addition, postural asymmetries can be improved, thus decreasing wear and tear resulting from uneven stresses on the intervertebral joints and discs.

Pilates improves strength, flexibility and suppleness of the muscles of the hip and shoulder girdle. Fluid and supported movement through these joints helps prevent unnecessary torque on the vertebral column.

The Pilates program also teaches awareness of movement habits that may stress the spine, and helps the patient change these habits to those that preserve neutral alignment. Awareness of excessive tension and the use of proper focus helps the patient use the body efficiently.

Before starting any new exercise system, it is always advisable to check with a physician or other healthcare provider. Before starting a Pilates exercise program, it is important to check that the potential instructor has received training in the Pilates exercise system, and that he or she understands any specific back problems. If a patient starts Pilates after physical therapy, the physical therapist should outline the exercise principles identified as particularly important for his or her rehabilitation.

Individuals with significant back problems may benefit from several one-on-one Pilates sessions with a qualified Pilates instructor. While more expensive than a group class or mat class, the time, money and effort devoted to learning the exercises correctly can be well worth the investment, as exercises performed incorrectly can make a back problem worse. Initially, twice-a-week sessions tend to be helpful to learn the program more quickly. After that, weekly Pilates exercise sessions may be enough if the individual practices between sessions.

The principles of movement important for back health are taught in some of the simplest exercises of the Pilates system. One cannot underestimate the benefit of simple exercises that support the deep postural muscles of the trunk, awareness of neutral alignment, and supple use of the shoulders and hips. It is best to learn exercises that can be practiced at home between scheduled Pilates sessions.

Given its roots in ballet and dance, some of the movements in the Pilates system are very difficult and challenging. Many of the exercises should be avoided for individuals with significant back pain or degenerative disc disease. Remember, it is always advisable to first see a physician prior to starting any exercise program.

As a general rule, back patients should avoid exercises that push the spine into extremes of flexion or extension, or combine flexion with side bending or twisting the spine. These motions place excessive stress on the intervertebral discs. Also, it is important to avoid fatigue - either mental or physical - which is when proper form is lost and injuries more likely to occur.

The exercises in the Pilates system should be challenging (both mentally and physically) but not so difficult that they cause anyone to struggle. If an exercise causes pain—it is best to stop and tell the instructor. The exercise may be too difficult, or the person may need additional help to do it correctly.

Finally, it may take awhile for the full benefits of a Pilates exercise program to be realized. Just as problems that create most back pain problems happen gradually over time, learning to use one’s muscles in a way that support - rather than stress - the spine takes time and commitment.

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