Pilates Exercise System to Promote Back Health

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Fig 1a: Reformer: arms
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Fig 1b: Reformer: legs
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Fig 2a: Cadillac: leg springs
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Fig 2b: Cadillac: roll back
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Fig 3a: Wunda Chair: arms
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Fig 3b: Wunda Chair: leg lunges
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Fig 4a: Mat: stretch
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Fig 4b: Mat: stretch
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Fig 4c: Mat: leg circles
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Pilates is an exercise program that focuses on the core postural muscles that help keep the body balanced and are essential to providing support for the spine. In particular, Pilates exercises teach awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment, which are important to help alleviate and prevent back pain.

The Pilates Exercise Program

Pilates is an exercise system named after its originator, Joseph Pilates. Mr. Pilates developed this system in the early 1900’s to improve his health and to support the health of fellow World War I internees. Later, he incorporated the resistance of springs into rehabilitation programs for hospitalized patients, and then translated the use of springs into machines and created the unique equipment now used in the exercise system.

Important principles of the Pilates exercise program include:

• Use of mental focus to improve movement efficiency and muscle control

• Awareness of neutral spine alignment, or proper posture, throughout the exercises
• Development of the deep muscles of the back and abdomen to support this posture
• Use of breath to promote mental focusing and centering
• Creating length, strength, and flexibility in muscles

Initially the Pilates exercise program was primarily used by professional dancers, who appreciated improved strength, balance and flexibility. In the 1980s Pilates was re-discovered and has now become a popular form of exercise for anyone interested in its health benefits.

The exercise system is usually taught in one of two formats:

• Using the unique Pilates equipment in private, or semi-private, sessions
• Group mat classes not using equipment

Pilates Equipment

The Pilates equipment uses the resistance of springs to create effort. The principle piece of equipment is called the Reformer and consists of a sliding platform anchored at one end of its frame with springs. The platform can be moved by either pulling on ropes or pushing off from a stationary bar. Thus, exercises include the challenge of moving the platform and maintaining balance on a moving surface (if sitting or standing). See figure 1a and figure 1b to view examples of some exercises done on the Reformer.

Another Pilates machine is called the Cadillac and consists of a padded platform with a cage-like frame above it. From this frame various bars or straps are attached by springs. See figure 2a and figure 2b to view photos of exercises done on the Cadillac.

A third piece of equipment, the Wunda Chair consists of a small bench-like platform with a bar attached with springs. Exercises are done by pushing on the bar while either sitting or standing on the bench, or standing or lying on the floor. See figure 3a and figure 3b for photos of chair exercises. Several other pieces of equipment unique to the Pilates system are likely to be encountered at Pilates studios.

Mat Exercises

Usually taught as part of a group class, mat exercises primarily focus on strengthening the muscles of the trunk and hip and increasing the flexibility of both the spine and hips. While the scope of the mat program is limited compared to the machines, there are many mat exercises that illustrate the Pilates principles. See figure 4a, figure 4b, and figure 4c for photos of some simple mat exercises.

Lately, Pilates has merged with other movement techniques, such as yoga, or use of an exercise ball. This promotes creative integration of the Pilates principles into a greater range of exercises in the mat class setting.

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.

Pilates Considerations for Back Pain Patients

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.

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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.

Video: Why is Exercise Important for Lower Back Pain?

Many people will experience some kind of lower back pain at some point in their lives. An ounce of prevention by doing a few simple exercises daily to keep the back nice and healthy will go a long way to alleviate lower back pain problems.Learn why exercise is so important for a pain-free, healthy back in this video.

Video presented by Grant Cooper, MD