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It is common knowledge that calcium is good for our bones, but do we know why it’s important to keep our bones healthy? Well the simplest way to think about bone health is how hard our bones are, so the harder our bones the healthier it is. The hardness of the bones is called bone mineral density (BMD) and it can be measured using a machine called a DEXA scanner. As our bone mineral density lowers it causes our bones to become more brittle and susceptible to fractures, this disease is called osteopenia/osteoporosis.
Our Bone Bank
Our bones are constantly in a state of change from the day we are born till the day we die. It is constantly remodelling, with bits of old bone being removed and replaced by new bone. You can think of your bone as a bank account, where you deposit and withdraw bone tissue. Most of the deposits are made from the day you are born till when you’re about 20 years old, with girls peaking a little bit earlier at 18 years. To ensure the most deposits are made it is paramount that your child has a healthy and balanced rich in calcium and vitamin D, and engaging in regular physical activity.
As we hit adulthood our deposits dramatically take a nosedive and we withdraw more than we deposit, this causes our bones to become brittle overtime. This is normal, however for those who’s ‘bone bank’ is low this constant withdrawing can cause them to develop osteopenia and soon osteoporosis at an earlier time than intended.
Is there any other way I can make more deposits?
There are many ways we can impact our BMD in our later years. There are lifestyle changes you can do to drastically improve your BMD and reduce the risk of developing osteopenia or osteoporosis. Currently exercising is one of the best methods to help maintain and improve our BMD.
Like muscles, our bones react to exercise, when we put load through our muscles it can get stronger, same thing goes for our bone. Matter of fact our bones love being under stress so much that NASA is currently having an issue with their astronauts in space where there is no gravity, meaning no stress on the bones, causing them to rapidly lose their BMD and not being able to be mobile back on earth.
That is why it is important for not only kids to participate in sports or regular physical activity but people of all ages. Here are some great examples of sports that are good for our bone health:
- Basket ball
- Lifting weights
- Jump ropes
Early-onset osteopenia and osteoporosis
Even though osteopenia and osteoporosis are considered a disease that older people get, it can occur in younger people as well. This is due to several factors such as:
- Life style factors
- Eating disorders
- Excessive alcohol consumption
- Certain rheumatic diseases
- Inflammatory diseases
Take home message for today is to try and constantly deposit as much as we can into our bone bank to ensure we keep our bones and strong as possible, so that in the future if there was any trauma we can rest assured that our body’s will be protected.
Scoliosis is a condition that causes a curvature of the spine, the classical look of a scoliotic spine is where it is curved from side to side forming an ‘S’ shape, compared to a straight line.
There are two types of scoliosis one detected at birth which is called congenital scoliosis and the other is called idiopathic. The most common type of scoliosis is idiopathic which means the exact cause is unknown. Idiopathic scoliosis is generally picked up between the ages of 3-10, with most idiopathic scoliosis being rarely painful, since the angle of the curvature of the spine is small.
Children who present with mild scoliosis are monitored regularly with X-rays to make sure that the curvature isn't increasing, usually treatment is simply wearing a brace to prevent the curvature from worsening.
Functional scoliosis is another subset of scoliosis that occurs during adulthood, often in response to an injury or asymmetrical activities such as playing tennis or baseball. The curvature of the spine develops due to one side of the body being over used and the other side under used, usually functional scoliosis can be corrected with appropriate treatment and exercise since it is muscular based.
Signs and symptoms of scoliosis?
- Uneven shoulders
- Pain around areas of imbalances
- Bending to one side (listing)
- One shoulder blade being more prominent than the other
In severe cases of scoliosis it can cause drastic issues to our heart and lungs since it compresses our thoracic cage not allowing us to breathe properly and making harder for our heart to pump.
Early detection of scoliosis is vital for a growing child, diagnoses in its early stages ensures a wider range of options for treatment and slowing the progression since children’s bones are not yet fully calcified, allowing a more conservative approach, instead of surgical ones.
Treatments for scoliosis:
- Medical intervention – Experts say that with congenital scoliosis best practice involves early surgical intervention to prevent the development of severe local deformities and secondary structural deformities that would require more extensive surgery later. Most of the surgery for congenital scoliosis happens during adolescence but there are newer techniques being developed that allows better spinal alignment at an earlier age.
- Physical therapy – Physiotherapy is used to treat milder forms of scoliosis, mainly idiopathic scoliosis to maintain aesthetic appearance and avoid surgery. The main role of physiotherapy in idiopathic or congenital scoliosis is to:
- Maintain muscular endurance and strength
- Increase range of motion throughout not only thoracic spine, but shoulder, neck and hips
- Improve or maintain respiratory function due to thoracic restrictions through education or breathing techniques
- Educate on ergonomical corrections and positions
- Build good neuromuscular control of the spine
So far there is good evidence for an early intervention program for children, adolescents or adults that have mild scoliosis. The ‘wait and see approach’ for children is not recommended and getting professional help from a quailed movement specialist is always recommended.
At BPS we specialise in the diagnosis and treatment of all of the above mentioned forms of Scoliosis, if you have any questions or concerns please don't hesitate to give us a call on (02) 8544 1757
Did you know that lower back pain is the 5th most common reason for people to visit their doctor! This always strikes me as weird as generally speaking your Physio is a better bet when you have musculoskeletal pain than your GP. Did you also know that lower back pain will affect around 70% of people throughout their lifetime. That a lot!
Low back pain is usually categorized into 3 categories: acute, sub-acute and chronic. Acute low back pain is an episode of back pain that is less than 6 weeks, sub-acute is between 6-12 weeks and chronic is anything more than 3 months. However it is often not so clear cut as this. Many episodes of lower back pain feel as though they might run together, or 'flare up' at different points throughout the year. Its important to understand your body - your back and what factors are contributing to your symptoms, in order to best prevent forte episodes.
The prognosis for anyone with an acute episode is fairly good, with most resolving in 8 weeks, with around 50% of people resolving spontaneously in the first two weeks.
The exact cause of low back pain is often very difficult to identify, in fact there are numerous possible causes of back pain from muscles, soft connective tissues, joints, ligaments, cartilage and even blood vessels. Depending on the circumstances chronic stress, depression and obesity has been linked with the onset of acute and even chronic back pain. However, just because it is difficult, doesn't mean it should be overlooked. It's important you work with your Physio / healthcare professional to ensure a clear picture of what is causing your back pain is established.
Managing back pain:
The best advice for the treatment of acute back pain is to continue to remain active as tolerated. Continuing everyday activities may sound counterintuitive but if we stay at home and cooped up in bed we tend to get more stiff. By being active we can promote blood flow and nutrients flowing to the area and reducing muscular tension. Here are some things we can do to manage an acute episode:
1. Stretches – There is no reason not to completely avoid stretches. All stretches if done correctly are good. However stretching should not cause more severe pain.
2. Heat or ice – Local application of heat or ice can reduce pain. Neither is better or worse for the situation, all dependent on your preference
3. Medication – Paracetemol or anti-inflammation drugs can be used to help ease the pain. These classification of drugs are known as analgesics which dampen the central nervous systems ability to pick up pain signals. These medications should be used only as prescribed by your doctors since some anti-inflammatory drugs can have some side effects.
4. Physical therapy – Physical therapy can give you great relief and advice on how to further manage your pain. A good physio will diagnose the pain generating structure. Possibly use some manual therapy early on to help relieve symptoms. They can cater a specific stretch and exercise program to help you get through it. They can also identify possible triggers and help devise a plan to prevent another episode from occurring.
If you or someone you know is suffering with lower back pain, encourage them to seek help. It doesn't have to be a debilitating injury and with the right advice it can be overcome!
I remember reading a statistic that up to 70-90% of people will experience back pain at some point in their lives and when you think about it, that’s a lot of people! Unfortunately due to our modern lifestyles we often don’t move our spine through its full range of movements, causing our spine to become stiff and our bodies more susceptible to injury. Our spine is the thing that literally keeps us upright, so it is essential that we show it tender loving care to ensure it has the flexibility and strength for us to move through our lives efficiently and carefree.
This is where Yoga can be a great tool in providing a safe and fun way to allow our spines to become more flexible and build strength. The thing I love about yoga is that it uses a combination of stretching, strengthening and mindfulness in all its poses to give you an awesome, all round workout. Having experienced back pain myself, I have found great benefit from incorporating Yoga into my exercise routine.
Before we get into the yoga poses I want to quickly go through the 5 main movements of the spine that will allow us to understand why these yoga poses are so great for our spine. The 5 main movements of the spine are:
- Flexion: Bending of the spine
- Extension: Arching of the spine
- Rotation: Twisting of the spine
- Lateral flexion: Side bending of the spine
- Axial extension: Lengthening of the spine (think of a slinky stretching)
Now that we understand the movements of the spine let’s get into some yoga poses that will have our spines feeling great.
Child pose is an excellent way to improve the bending of your spine and stretch the muscles at that extend your spine. Simply start by kneeling on the ground, folding at your hips and bring your head towards the floor keeping your bottom over your heels. You can have your arms by your side or extend your arms if you want to add a shoulder stretch as well. Hold this pose for 1-2 minutes taking deep breaths as you do so.
Sphinx pose is an ideal way to improve the arching/natural curve in your spine and stretch the muscles at the front of your hips. Start by lying face down on your mat/floor, prop onto your elbows keeping your elbows underneath your shoulders and arch the spine keeping your hips in contact with the floor. Make sure you go to a point which is comfortable for you, if this position is not comfortable you can modify it by bringing the elbows slightly forward. Hold for 1-2 minutes taking deep breaths as you do so.
Performing cat/cows is a great way of improving the way your spine moves into bending and arching. Start off on all fours making sure your knees are under your hips and your hands are underneath your shoulder. Begin by dropping your belly and arching your spine and lifting your head as you do so (cow pose) and then rounding the spine and dropping the head (cat pose). Repeat 10-15 times in each direction and to further add to the practice, time your cat/cows with your breath by taking a breath in as you go into cow pose and breathing out as you go into cat pose.
This is an awesome way to improve the strength and flexibility with rotating movements in your spine. Start by lying on your back and bring yours arms out to the side in a T-shape. Next bring your knees toward your chest whilst maintaining the natural curve in your spine. Practice bringing your knees to one side as far as you can, ensuring your shoulders stay in contact with the ground and that you keep your gaze upwards. Repeat 10-15 times to each side breathing in as you bring your knees to the side and breathing out as you bring your knees back to centre.
Standing side bend pose:
As the name suggests, standing side bend pose is a fantastic way to develop the side bending motion in your spine and stretch the muscles in your side body. Start by standing with your feet hip width apart and reaching your arms towards the sky. Start by bringing your right hip to one side and arching your spine towards the left side, you can add to the stretch by holding onto your right wrist with your left hand and gently pulling down on your right wrist. Hold for 1 minute taking deep breaths as you do so and repeat on the other side.
There’s a reason why Downward Dog is one of the most well-known yoga poses, it’s a great all round pose and a fantastic way of enhancing the lengthening motion in your spine. Begin on all fours with your knees over your hips and your hands slightly in front of your shoulders. Lift your knees away from the floor and reach your bottom towards the ceiling by bringing your weight onto your hands and feet. Try to think of length in your spine as you reach your tailbone away from your head, keep your knees as straight as possible without locking them and don’t worry if your heels don’t touch the ground. Hold for 1-2 minutes taking deep breaths as you do so.
So why not add these yoga poses to your morning routine, pre/post exercise workout or night time ritual to ease your back pain and get your spine moving in the way it was meant to be moved. If your lower back pain does persist, then it might be a good idea to see one of our great physio’s at BPS to get a thorough assessment and of your spine and get you moving pain free again.
Back pain is an increasingly 'common' symptom in a wide variety of the populations. From adults to kids, male to female, active to sedentary it seems this insidious and costly symptom is increasingly creeping into our daily lives and very few people actually know what to do to get rid of it!
Rest & Panadol for Back Pain?
Back pain has long been treated with 'rest and panadol' by our friendly GP, however many people who have tried this approach will tell you, it is not all that effective and certainly in the long run it does nothing to prevent the pain returning often with vengeance!
At the other end of the spectrum is the surgical approach which, worryingly, is increasing at an alarming rate. While both these options have their merits in certain subsections of the population, the best cure (and yes I mean real cure) is to improve the quality of the structures which are causing the pain in the first place. That's right, I mean fix the problem from the source!
The frustrating part for many back pain suffers is the frequency and unpredictability of when their next episode will occur. The continual increase in frequency and severity after someone has their first back pain episode is commonly due to the adaptive behaviours they begin to adopt. By starting to worry about when and how they might 'injure' their back again, they often subconsciously make choices which eliminate certain movements and activities from their lives. The negative impact of this is that by reducing the frequency and variability of their movement's they are actually increasingly the likelihood of re-injury and the back pain cycle carries on.
Alleviating Back Pain
The only true way to stop back pain from coming back is to work at improving it. Work on your movement patterns, understand your pain generating structures, your weaknesses and your strengths and then get to work on optimising them! It is not the quick fix path, but trust us, it's the path that is proven and long lasting. True resolution of your symptoms and the return of the freedom to your life!
Surfing is a sport comprised of an infinite number of complex skills which require a unique set of biomechanics and motor patterns to ensure optimal performance can be achieved. At an elite level it tests every factor known to human performance - strength, power, flexibility, proprioception, balance, fear and knowledge and awareness of the surrounding environment in which the surfer is competing.
Pilates offers the perfect environment to train and develop the physiological requirements of the sport.
Surfing needs the body to move freely without restriction of tight muscles and joints especially when performing tasks such as vertical snaps, roundhouse cutbacks and aerial maneuvers. If the body cannot move freely into the desired ranges of motion of these tasks, the body is forced to create compensatory movement patterns that will affect your timing and performance.
When we think of flexibility we usually limit our thoughts to the muscles and joints surrounding the upper and lower extremities but Pilates also specifically mobilizes the spine into flexion, extension and rotation so that load can be dissipated more effectively throughout the whole kinetic chain.
The ability to move the thoracic spine (mid/upper back) into extension efficiently and the muscular endurance to sustain this technique is a key requirement of surfing. If this is lacking, ie, the thoracic spine is stiff, the lumbar spine (lower back) and cervical spine (neck) often compensate by hyper-extending when paddling on a surfboard. With repetition, this compensatory mechanism will overtime lead to pain and injury to these structures - a common problem as our 21st century lifestyles have left us with stiff thoracic spines. Optimal spinal extension is a key principle in Pilates training and is an integral part of each session.
When we consider rotation of the spine, which is probably the most key element in surfing performance, we can apply the same principles as we just discussed. If the thoracic spine cannot move into rotation segmentally, with the appropriate motor control, you will for example not be able to counter-rotate your trunk and hips into a bottom turn without compensating with your hips, knees and lumbar spine causing overload on the tissues with repetitive activity. Optimal rotation also allows more force and power to be produced as the individual can move over greater ranges of motion. For example who do you think is going to be able to throw the most spray in critical surfing maneuvers – the guy with the stiff spine OR the guy who has been working specifically on his spinal mobility and stability into rotation using Pilates training?
Another way in which Pilates can improve surfing performance and decrease the risk of injury is to ensure optimal biomechanics of the shoulder. In surfing, the shoulder joint is moved through a large range of motion under high levels of muscular force and therefore requires efficient mechanics, to withstand such a load. Pilates can re-train the correct mechanics, through first using the assistance of the Pilates equipment and by placing the body in a environment foreign to the one in which they have developed their current motor patterns so that new, more efficient ones can be developed. From here we can move to more surfing specific bodily positions where resistance can be applied to strengthen the new desired motor patterns under higher loads. From my experience the Pilates studio offers the best environment for this process to be undertaken. Thoracic extension is also a crucial element in shoulder mechanics as it allows shoulder joint to move optimally in a functional pattern known as scapulo-humeral rhythm and as discussed earlier thoracic extension is a core component of every Pilates training session.
Stay tuned for part 2 of Pilates for surfers where we will discuss core strength and surfing.
Look out on our Instagram and Facebook page in the coming weeks for videos on how to improve your sporting performance and in particular your surfing performance using Pilates training!
If you want to improve your surfing performance today book an appointment with us on 8544 1757 or you can book online NOW!
Coming soon – Surfers Pilates Classes!
Can you use the Pilates reformer for lower back pain? The answer is an overwhelming YES! The Pilates reformer is one of the most well known and traditional pieces of equipment in the Pilates studio. Its' secret to success lies in its' adaptability and the plethora of Pilates exercises it allows you to perform. With its movable carriage, spring resistance and hand/feet loops, the Pilates reformer is one of my favourite pieces of equipment in the Pilates studio, especially when it comes to rehabilitating lower back pain!
Lower Back Pain
The difficulty with lower back is that no two lower back pains are the same. If your a regular reader of our blog, you will understand that every body is different and there are no two pains or injuries which are the same (learn more about this here). Many people, health and medical professionals alike, try to group patient symptoms into categories and then treat all people in the one category the same way. The truth is that each and every body's pain has differences, is driven from different places and thus needs to be treated individually. This is where the Pilates reformer comes into it's own! Because you can vary the spring resistance almost infinitesimally and change a persons set up from standing/sitting/lying on their back/lying on their front/lying on the side etc, the most appropriate position for rehabilitative movement can be achieved, what ever that might be for you and you lower back pain!
The thing many people don't realise when rehabilitating an injury is the power of our brain and our motor patterns (meaning the hard wiring our brain has created to perform certain movements without conscious thought, like being on auto pilot). These motor patterns are incredibly difficult to unwind, once you have been doing a particular movement pattern for a period of time (for many people with long standing back pain this is years or even decades!) this way of moving becomes like a highway for the brain and any attempt to use the side streets requires an incredible amount of conscious effort. This is where the Pilates reformer is a god-sent. It makes use of 'unfamiliar environments' to enable the body to learn new ways of moving without having the same software played out over and over again. Essential its like a 'control / alt / delete' for the brain and its motor patterns, an invaluable tool!
What do you mean by 'Unfamiliar Environments'?
The secret of training in an unfamiliar environment is akin to driving a car. When you are driving a route that you are very familiar with your brain switches over to autopilot to free up extra 'mental RAM' for you to use thinking about other more important issues. However, when you a driving a road for the first time, at night in a car that's not yours, you don't experience that same feeling of ease and thoughtless driving, in fact it's the total opposite. Your brain is concentrating on what lies ahead, where the peddle is, how the steering wheel turns with these new wheels and you are totally conscious about the process. The same principals apply to when your trying to change an old or faulty movement pattern. If you try to change it in your every day lifestyle, as you sit in your regular office chair or stand brushing your teeth at your bathroom sink, it is very difficult to persuade your conscious brain to stay focused on the task at hand and you inevitably slip back into your old faulty motor patterns which led to your lower back pain in the first place. However, if you can begin to train your postural muscles in a non familiar environment (eg the on the Pilates reformer) you have total access to your conscious brain as it tries to perceive how best to move in this new way and before you know it you have translated these movement patterns into real life and so too disappears your back pain.
How to get started?
At BPS we are proud to provide a comprehensive and unparalleled service to our clients (with and without back pain). With a variety of Pilates reformer classes, private sessions and rehabilitative services, we guarantee you will reach your movement goals. We are so confident you will love our services you can come to a free trial class by leaving your details here.
Lower back pain is one of the top 5 'most common symptoms' we treat at BPS. It's an incredibly common complaint and something we treat hundreds of times per month. Today's blog post aims at helping you determine what the true cause of your lower back pain is but more importantly how best to fix it and stop it from coming back!
Yes, your right, I said 'symptom' not 'diagnosis' when describing lower back pain ... because lower back pain is NOT a diagnosis in itself, it's only a symptom that you are experiencing. Painful stimuli can occur in many places in the body (learn more about how pain works here) but unfortunately with lower back pain, the pain generating structure (i.e. the thing that is painful) is often poorly diagnosed. So the first important question to answer is what is causing the painful stimuli which you are experiencing as lower back pain? Once you know the cause your half way there!
Possible Pain Generating Structures around the Lower Back Pain
- Long Sacro Dorsal ligament inflammation
- Facet Joint
- Nerve Root
- Muscles (eg Quadratus Lumborum, Erector Spinae, Psoas, Gluten Max)
- Period Pain or Menstrual Pain
- Visceral Pain
So the important thing when looking for ways to improve and ultimately eliminate your lower back pain is to get the correct diagnosis first! Once you know what is causing your lower back pain, you are half way there to fixing it! All too often we treat clients in the BPS studio who have had lower back pain for years and years and the only reason their symptoms have lasted so long (despite them doing everything they have been told by their health care professional) is because they have never got an accurate diagnosis! Imagine that, trying to fix a problem when you don't have the foggiest of where to start or what is causing the pain in the first place! Madness ...
Now, there is no substitute for getting a thorough diagnosis by a BPS professional in clinic, but I know that many of you reading this blog don't live in Sydney and can't get to either our Caringbah or Ashbury practices. So to help you out I want to start by clarifying where about your lower back pain is, this often tells us a lot about what the cause of the injury may be.
Lower Back Pain Locations
The first place to start when figuring out the cause of your lower back pain is to start with its location. We have created the following infographic to help you decipher what the pain generating structure might be in or around your lower back. Check out more helpful diagnostic tool on our Instagram page below! You may have a few of these areas involved it doesn't have to be isolated to just one in particular.
Does Movement affect your Lower Back Pain?
Once you know the particular area thats involved, the next thing to understand is if movement makes your pain better, worse or has no real impact. We created the following flow chart to help you narrow down what movements may be aggravating your back pain and make the path to deciphering the cause one step closer.
We hope that from the information above, you have a better understanding of what may be causing your lower back pain as well as what movements may be aggravating and elevating it. At this point you have two choices, we always recommend that you seek out a health professional close to you to help you with your diagnosis. If you live in the Sutherland Shire or Inner West why not book an appointment online with one of our BPS Physios and allow them to help you with your treatment plan.
If your not a Sydney local, the following tips will help you on your way to elevate your lower back pain...
Treatment for Lower Back Pain
Disc pain is a tricky one (and not as common as you might think). It is very much dependant on the direction of the pressure which is causing the disc pain, for example is the disc being pressed forwards or backwards or maybe to the side. If you have had an MRI and you are aware of the direction of your disc pressure/protrusion you best bet for reliving your symptoms is to position your body in a way which unloads the disc. For example if you disc is bulging forward (most common) then you will probably find that gentle back bending will alleviate your symptoms where as if your disc is bulging backwards maybe forward bending will be alleviating. The below videos shows you some examples of how to flex and extend your spine depending on which direction feels good for you!
Facet Joint Pain
Facet joint pain is pain caused by compression or irritation of the facet joints in your spine. Facet joints lie at the back of your spine and are generally more irritated when you bend backwards. Thus the best way to alleviate your symptoms is by bending forward. The below video shows you some examples of how to bend forward and unload your facet joints.
- Standing Roll Down for lower back pain
Nerve pain, now this is a 'scary one'. Not really, unfortunately many people have an exaggerate understanding of what nerve pain is and how to get rid of it. Like all of these pain generating structure, its important to know where and what level the nerve pain is coming from, once you know this you can move your body into positions which unload the nerve. We often do rotational exercises with our patients to help them unload the nerve root and take the pressure is pain caused by compression or irritation of the facet joints in your spine.
SIJ pain stands for Sacro Illiac Joint pain, it is pain that is caused from your SIJ not so much from your lower back (although these areas are very close to one another). The most common pain generating structure in the SIJ is a ligament called the long scare dorsal ligament. The easiest way to unload this ligament and alleviate your symptoms is with a release of piriformis. The following video shows you how to release this your self!
- Piriformis Release for lower back pain
Muscle pain often called DOMS (delayed Onset Muscle Soreness) often occurs after a muscle has been worked to a load it is not used to and for the next 48hrs the lactic acid circulating in that muscle can feel tender. There are many ways to help alleviate DOMS but mostly it comes down to time and waiting for your body to break down the lactic acid and repair the muscle. Gentle stretching and heat can help, so can epsom salt baths. Check out the following videos for some ideas on how to stretch the following lower back muscles.
This one often gets poorly diagnosed for musculoskeletal lower back pain, the biggest give away is the time of the month it occurs in! There are a variety of pharmaceutical products (ponstan, neurone etc) which will help alleviate these symptoms, I often find that a good hip flexor and adductor stretch does the trick too!
- Good Stretches for Period Pain lower back pain
Serious Lower Back Pain
In the medical world there are things we term 'red flags' meaning they are serious and could be potentially highly danger if not seen to appropriately. It is important you see you medical professional if you experience lower back pain in conjunction with one of the following symptoms;
- A fever (high temperature)
- Redness or swelling on your back
- Pain down your legs and below your knees
- Numbness or weakness in one or both legs or around your buttocks
- Loss of bladder or bowel control (incontinence)
- Constant pain, particularly at night
- Pain that's worsening and spreading up your spine
Evidence Based: The Research Study
A couple of weeks ago I read a very interesting article about the value of a general mat Pilates program given to people with low back pain. In particular the purpose of this randomised control trial was to evaluate the efficacy of the addition of Pilates based exercises to a standard intervention in people with non-specific chronic low back pain.
Once the eligibility criteria and exclusion criteria of the study population was determined, 86 patients were divided by a simple randomisation method into 2 groups: Booklet group and Pilates group.
Every participant was assessed by a researcher once before the randomisation of the groups and again after the 6-week intervention and after 6-month follow-up period. The researcher evaluates the pain intensity, the global impression of recovery, the functional capacity, which indicates the activities people are not able to do because of the back pain, and the kinesiophobia, which is the fear of re-injury due to movement. Furthermore the expectations of the participants about the treatment were evaluated before the randomisation. Finally after the first treatment session for both groups, they evaluated the patients’ level of confidence in the treatment and in the improvement of their symptoms.
The Booklet Group received a booklet containing information about low back pain, anatomy about spine and pelvis and descriptions of postural orientations. On the other hand, the Pilates Group received the same booklet and also a specific treatment protocol which consisted of individual mat Pilates exercises, with progressions in difficulty in response to individual reduction in the postural compensations of the patients.
Because the study started in 2010, the results are not yet available but I expect the patients in the Pilates Group will experience a greater improvement in global perceived effect, general and specific functional capacity and a greater reduction in pain intensity and capacity to perform activity of daily life without fear of hurt themselves.
My Personal Experience
Honestly this article got me interested from the beginning to the end, because low back pain is such a common symptom nowadays and I’m really curious to know how Pilates-based exercises can positively affect this musculoskeletal problem. It has been estimated that from 11% to 84% of adults will have a low back pain episode at least once in their lives and that approximately 40% of these patients will develop chronic low back pain, which is defined as persistent pain and disability lasting longer than 3 months. Different studies demonstrated that low back pain is the main cause of disability and work absenteeism in adults younger than 45 years in industrialised societies.
In particular I found this paper very stimulating because 3 years ago I conducted a similar research for my final exam at university. In particular, my thesis aimed to evaluate, through randomised controlled trials, the validity of a rehabilitative intervention based on the reinforcement of the deep stabilising muscles of the spine in the treatment and prevention of low back pain in young gymnasts. At the end of the 12-weeks treatment period, the data analysis showed that lumbar stabilisation exercises have allowed athletes to improve their sportive performances and above all a reduction of back pain during the practice of gymnastic and daily life activities.
3 Years ago I didn’t know the basis of Pilates, in fact during that research study I provided general exercises to improve strength and endurance of the major stabilising muscles, which are transversus, abdominus and multifidus, but without any particular cuingor individual modifications. Now that my knowledge regarding Pilates, core and neutral spine is improved, it would be interesting to see how all this information could improve the quality of the treatment. Undoubtedly in my opinion Pilates is an amazing tool that can add extra value to any Physiotherapy practice. That’s why at BPS Tensegrity we use specific manual techniques, bio-mechanical retraining and the Pilates studio equipment to assist our clients to return to optimal function, and back to the types of exercise they enjoy!
Principle 3 - Spine Articulation
Joseph Pilates is often quoted, but this gem sums up principle 3 wonderfully!
"If your spine is inflexible and stiff at 30, you are old; If it is completely flexible at 60, you are young."
The spine's capacity to support us through which ever plane of movement we choose is only as good as it's ability to articulate! Our spine has 24 articulating (movable) vertebrae. When all 24 of them can articulate fluidly, our spine is able to transfer loads up and down the body. However when vertebrae become immobile and movement is decreased to only a few segments, the body's ability to transfer loads suffers. The vertebral levels which have more movement often get 'overloaded' trying to compensate for the immobile segments and it is at these levels that damage often occurs. Don't want to keep reading, watch our 'how to' video here ...
This is one of the key benefits of Pilates over other 'core' and 'strengthening' types of training. The ability to train elongation and articulation of the spine, facilitating the control and strengthening of the small stabilising muscles of our spine. A group of muscles which is often over powered by the bigger and more rigid spinal movers (see the photo below).
Small Stabilising Muscles - strengthened by spinal articulation work, such as Pilates bridging.
Big Moving Muscles - strengthened by heavy loaded, stationary work like 'planks'.
Practising Spine Articulation with a Roll Up
The traditional Pilates exercise 'Roll Up' is a great spinal articulation exercise!