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How can Clinical Pilates Help Lower Back Pain?

"Body in Common works with Back Pain sufferers every day. The key is to properly diagnose the underlying causes, and then fix them through targeted exercises."

Lower Back Pain Affects Everybody

Are you suffering from lower back pain? Life can be extremely difficult when even the smallest movements cause pain and slow you down.  Reaching for the keys on the coffee table; trying to sleep; carrying the groceries: everything is harder, and your quality of life suffers.

 

That’s no way to live your life, and luckily Lower Back Pain is usually one of the easiest ailments to fix without the use of drugs or dangerous surgery. 

 

Lower back pain can trouble people of all ages.  It’s not just a condition for old people! The “National Institute of Neurological Disorders and Stroke” states that around 80% of the adult population experience lower back pain at some stage of life. [4]  The truth is, with our increasing hours spent in front computers, our bodies are seated for longer and longer each day, and over time this causes a number of subtle changes in the body:

 

  1. Your Hip Flexors begin to shorten.  These small, and crucial muscles are connected directly from your upper inner thighs to your lower spine.  As they shorten, they start to pull your lower spine out of alignment, causing constant pain.
  2. Your Glutes and Hamstrings (the big muscles at the back of the leg) also shorten, causing additional compression in your lower spine.

 

Needless to say, these two conditions, and many other small changes can have big effects in the body!  But the good news is, that these causes are mostly muscular-skeletal, and that means with appropriately prescribed exercises, stretches, and muscle releases, you can reverse the effects and get back to living your life at 100%.

 

Clinical Pilates is, without a doubt, one of the most effective methods for solving lower back pain. [1,2,3]   Drawing from Australian Physiotherapy, and combining it with the low-impact Pilates system of exercises, we’re able to precisely target what your specific body needs, and treat the underlying causes of the issue.

Contents

But First, How Does Lower Back Pain affect your Quality of Life, and Why is it so Important to Act Now?

“Much like a shiny sports car, your body is the most complex machine you will ever own. If you do the maintenance, you will be the envy of your neighbours. If you don’t, prepare for embarrassing breakdowns!”

The lower back area comprises of the five vertebrae, with L5 being the one lowest down, and L1 being just above the small of your back.  This area is called the lumbar region, and plays an important role in supporting much of the upper body weight. It acts as a shock absorber, protecting your organs, and it also acts as structure for your muscles to pull against.

 

 

Every week Physios have new patients with back pain. Although the number of new patients is high, the vast majority of cases are chronic, and haven’t been caused by a specific incident. [5]  Most people simply wake up one day and realise that they’ve had back pain for years, and can’t remember every being without it!

 

It’s important to get on top of the issue as soon as possible, as the body will start to compensate in subtle ways, and these compensations exacerbate the issues in the longer term:

 

  1. You will slowly do less activity, and this can harm your social life.
  2. It will be more difficult to focus at work.
  3. Your posture will get worse, leading to stress in the neck.
  4. As the lower back progresses, other areas of the body will commonly work harder to compensate.  This leads to eventually having other ailments such as Knee Pain, Shoulder Pain, or constant headaches.
  5. In some cases, lower back pain can progress into slipped discs or spondylitis (arthritis).
So before it becomes a real issue, take control of your body!

So How Does Clinical Pilates Solve Your Issues?

While many services out there only treat the symptoms, Clinical Pilates helps in reducing lower back pain by targeting the underlying causes of the pain.  The interesting thing about this is that the causes are usually above or below the lower back – not the lower back itself.

 

Specifically, we fully assess the body, find out which muscles groups have shortened, which have weakened, and which have become too strong.

 

Muscles that are too strong can be just as dangerous as muscles that are too weak, and this is one of the common pitfalls people encounter when they hit the gym in search of pain-relief.

 

While each body is different, nearly all lower-back-pain clients need to work on lengthening their Hip Flexors, Glutes, and Hamstrings.  Most clients also need to strengthen their Transverse Abdominus (known as the ‘core’) to improve spinal support. Clinical Pilates is great because each exercise is specific and targeted, allowing us to work only what is needed, while leaving other muscles alone.  The end result: by strengthening, lengthening, or weakening these specific muscles, you tend to put less strain on your lower back and can get back to the life you deserve without drugs or surgery.

1 - Clinical Pilates Selectively Improves your Muscle Strength

Clinical pilates uses low-impact resistance training to strengthen muscles and alleviate lower back pain. [9,10] We use specialized instruments called ‘Reformers’, ‘Trapeze Tables’, ‘Ladder Barrels’, and ‘Combo Chairs’ to train your muscles.  

 

One of the major issues with many types of strength training is that they target every muscles at once – whether you want to to or not!  This causes problems, because you may be strengthening the right muscle, but you’re also over-strengthening other muscles that are already contributing to your back pain.  If you do this, you won’t find improvement. A lot of our clients come to us after having tried weights programmes, only to find that their lower back pain has gotten worse – not better!

 

For Lower Back Pain, we specifically target core strength and lower-back posture muscles to alleviate stress on the lower spine, while avoiding over-strengthening the Glutes and Hamstrings – common causes of the pain.

2 - At the Same Time, Clinical Pilates Improves Mobility, Flexibility, and Functional Movements.

While some muscles need to get stronger to support the lower back, any muscles that are aggravating the issues needs to do the opposite: they need to become longer, more flexible, and more functional.  In particular, most people suffer from shortened Hip Flexors, and Tight Glutes. These tight muscles cause compression through the lower spine, and can also pull it out of its optimal alignment. 

 

Yoga-like stretching is not the answer.  If you weaken muscles without providing strength, the body becomes unstable and you are at a higher risk of injury.  The answer lies in working on functional flexibility, and improving safe range of motion.

 

Clinical pilates improves your functional movement by reducing muscle stiffness and tightness. [11,12] It also works on abdominal [13] and hip muscles. This improves your flexibility [14] and body coordination and helps you avoid pain from long periods of inactivity.

3 - It Enhances your stability

Clinical pilates gives you an added benefit of improved stability. [14] Hips, shoulders and core are essential in supporting your lower back. When you work on them in clinical pilates, you start strengthening these muscle groups. This takes off the strain from muscles and helps you get along with your daily routine.

 

As you age (and eventually we all do!), this added functional strength and stability will reduce your risk of falls – vastly improving your quality of life.

4 - Lastly, Being Fit and Pain-Free Improves your Mental Health and Happiness.

Prolonged lower back pain can make you nervous and depressed. We regularly receive new clients who have increased anxiety and depression as a result of their lower quality of life.  After doing the Clinical Pilates programme, it is common to see a significant improvement in happiness levels, because you’re able to get out there and do the things you want to do.[15,16]

Best 4 Pilates Exercises for Lower Back Pain

Obviously, nothing beats the silver bullet of seeing a highly qualified professional, getting a personalised assessment, and a targeted programme to suit your exact body.  But we also understand that you want to do something today. The good news is that there are some home exercises you can do to get started.

 

While getting started with pilates, it is necessary to first master the basic level before moving on to the more challenging progression of the exercises.

Exercise 1 - Pelvic Tilts

At first glance, it is easy to think that this exercise is doing nothing at all.  But that extremely subtle feeling is exactly why it’s so successful: it’s only targeting the muscles you want to target, and nothing else.

 

In particular, with this exercise, we want to target your core: the Transverse Abdominus.  This is a muscle that sits underneath your six pack and is responsible for providing stability, safety, and strength for you entire lower back system.

 

Exercise:

Lie on your back with your hands by your gently on your hips.  Bend your knees with your feet on the ground so that your legs make about a 90 degree angle.

 

First, tilt your pelvis (your hips) down and away from your ribs until you create a small arch in your lower back.  The key here is to keep your upper back firmly glued to the floor – don’t let your upper back join in on the arching, or you will compress the lower spine.

 

Now rock the pelvis back in the opposite direction slowly until your lower back is fully flat on the floor.

 

Continue to do this exercise 10-20 times, and try to feel your core as you move.  You want to be able to touch your belly and feel a light tension deep under your six-pack: that’s your core.  Don’t let your six pack take over – it does not help much in supporting the lower back, and its aggressive movements are often the cause for lower back aggravation.

 

Why:

 

Do this three times a week to build up core strength to help support your back and create a stable platform to work off.

Exercise 2 - Supine Spinal Twist

This exercise has a more stretch-oriented approach coupled with core activation, as you rotate your thoracic spine.

 

Exercise: Lie on your back and hold a rolled-up towel between your bent knees. Place your hands directly out to the sides.  At first, your feet can be gently on the ground in a similar position to the pelvic tilts above. 

 

While keeping knee pressure on the towel, slowly let your knees roll over to one side without letting your shoulders leave the floor.  This will cause your Thoracic Spine (upper back), and Lumbar Spine (lower back) to rotate and improve overall mobility. It will also help to stretch out the glutes if they are too tight.  Roll slowly between each side, but make sure to keep the exercise gentle to maintain safety and a focus on functional mobility: any jerky motions or pushing too hard will aggravate your lower back.

 

Progression: Instead of having your feet on the ground, raise your legs into a tabletop position.

 

Why:

 

Do this two to three times a week to improve spinal range of movement, reduce tightness in your lower-back-to-upper-leg connections, and reduce the aggravating compression on your lower spine.

Exercise 3 - Roll Down

A Roll Down pilates exercise is ideal for warming up or cooling down your body. We Physiotherapists have a fun phrase for spinal movements:  “Motion is Lotion”.  In essence, you have to keep movement each spinal segment in order to properly lubricate them and keep them healthy.  If they stiffen up, they also get less fluid movement, causing extra stiffness and pain.

 

The Roll Down exercise challenges your body posture and increases your awareness of body movements.

 

Exercise:

 

Keep both your arms in front of you with your feet shoulder-width apart. Keep a good posture.

 

Beginning at the very top, slowly look down, flexing through the upper-most spinal segments.  Once these segments are flexed, continue by rolling further down through your upper back. Segment-by-spinal-segment, continue to flex through the back gently until your entire upper back is now rolled over. 

 

If you feel tightness or stiffness at your hamstrings, slowly bend your knees to relieve that tension and continue to flex through your lower spine.  It doesn’t matter whether you can reach the floor or not. The purpose of the exercise is to mobilize each spinal segment and try to achieve more equal stiffness/looseness across the entire system.

 

Once you’re full rolled over, take in a deep breath, and slowly reverse the movement.  Start by extending your lower back – only one vertebrae at a time. Then the upper back, and finally the neck.  The key is to stay gentle, and never force anything.

 

Why:

 

It’s quite common for some segments of your spine to get stiffer than others.  To compensate, other segments become looser so that you can retain the same overall range of movement.  The looser segments then become over-used, more heavily worn, and more painful. Regaining spinal balance is key in living a long, pain-free life.

Exercise 4 - Foam Rolling

While we’re strengthening important supporting muscles, it’s also equally important to improve flexibility in muscles that are aggravating your lower back pain.  In particular, your Glutes are a common source of stress. As they shorten, they pull more on your lower back system, aggravating the area.

Every muscle in the body is actually surrounded by a type of ‘sock’ that holds it all together.  This sock is called the fascia, and you can see it clearly at the Butcher when you look at lamb shanks and other thigh meat. 

The issue with the fascia is that over time it tends to tighten up and ‘stick’ to the muscles it encapsulates.  This causes excessive tension and shortening of the muscles. Foam rolling is the act of rolling a muscle over a foam rolling pin – much like kneading dough.  This is the solution to improving length and function.

Exercise:

Ideally you will have a 90cm x 15cm foam roller.  Smaller ones are ok, but can’t be used for other exercises.  Start by sitting one of your glutes (‘bum muscles’) on the roller and putting your weight on that leg.  Slowly roll back and forth over the entire length of the muscle – from the lower back, down to just above the knee.

For most people this will be painful – only do 30 seconds to 1 minute, three times a week.  Take it slowly, and keep safe.

Why:

To relieve the tension on the lower spine caused by tight upper leg muscles.

What's next?

Clinical pilates is an excellent rehabilitation tool for lower back pain. As you gradually progress with clinical pilates, the strain on your spine will be relieved.

 

Of course, every body is different, and just like you probably don’t do your own car repairs, it’s best to leave serious body issues to the professionals (that us!).  Body in Common is an Australian Physiotherapy and Clinical Pilates centre in Kuala Lumpur, and we offer the highest quality assessments, and build personalised programmes for every client. 

 

Please take your body maintenance seriously, and live pain-free, drug-free, and surgery-free, by fixing the underlying causes of your pain with Clinical Pilates.

“Body in Common is an Australian-Style Physiotherapy Studio in Bangsar, Malaysia. We provide Physiotherapy and Clinical Pilates services in our studio, as well as online Telehealth services. Feel free to get in touch and look after yourself.”

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Backed by Evidence. References.

  1. Miranda, I. F., Souza, C., Schneider, A. T., Chagas, L. C., & Loss, J. F. (2018). Comparison of low back mobility and stability exercises from Pilates in non-specific low back pain: A study protocol of a randomized controlled trial. Complementary therapies in clinical practice, 31, 360-368.
  2. Lin, H. T., Hung, W. C., Hung, J. L., Wu, P. S., Liaw, L. J., & Chang, J. H. (2016). Effects of pilates on patients with chronic non-specific low back pain: a systematic review. Journal of physical therapy science, 28(10), 2961-2969.
  3. La Touche, R., Escalante, K., & Linares, M. T. (2008). Treating non-specific chronic low back pain through the Pilates Method. Journal of bodywork and movement therapies, 12(4), 364-370.
  4. “Back Pain Fact Sheet”, NINDS, Publication date December 2014.
  5. NHG Standard Non-specific lower back pain (Second revision) Bons SCS, Borg MAJP, Van den Donk M, Koes BW, Kuijpers T, Ostelo RWJG, Schaafstra A, Spinnewijn WEM, Verburg-Oorthuizen AFE, Verweij HA.
  6. Kamioka, H., Tsutani, K., Katsumata, Y., Yoshizaki, T., Okuizumi, H., Okada, S., … & Mutoh, Y. (2016). Effectiveness of Pilates exercise: A quality evaluation and summary of systematic reviews based on randomized controlled trials. Complementary Therapies in Medicine, 25, 1-19.
  7. Stieglitz, D. D., Vinson, D. R., & Hampton, M. D. C. (2016). Equipment-based Pilates reduces work-related chronic low back pain and disability: A pilot study. Journal of bodywork and movement therapies, 20(1), 74-82.
  8. Kresal, F., Roblek, V., Jerman, A., & Meško, M. (2015). Lower back pain and absenteeism among professional public transport drivers. International Journal of Occupational Safety and Ergonomics, 21(2), 166-172.
  9. Vieira, N. D., Testa, D., Ruas, P. C., de Fátima Salvini, T., Catai, A. M., & Melo, R. C. (2017). The effects of 12 weeks Pilates-inspired exercise training on functional performance in older women: A randomized clinical trial. Journal of bodywork and movement therapies, 21(2), 251-258.
  10. de Oliveira, L. C., de Oliveira, R. G., & de Almeida Pires-Oliveira, D. A. (2015). Effects of Pilates on muscle strength, postural balance and quality of life of older adults: a randomized, controlled, clinical trial. Journal of physical therapy science, 27(3), 871-876.
  11. Laws, A., Williams, S., & Wilson, C. (2017). The Effect of Clinical Pilates on Functional Movement in Recreational Runners. International journal of sports medicine, 38(10), 776-780.
  12. González-Gálvez, N., Marcos-Pardo, P. J., & Carrasco-Poyatos, M. (2019). Functional improvements after a pilates program in adolescents with a history of back pain: A randomised controlled trial. Complementary therapies in clinical practice, 35, 1-7.
  13. Cruz-Díaz, D., Bergamin, M., Gobbo, S., Martínez-Amat, A., & Hita-Contreras, F. (2017). Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain, function and transversus abdominis activation. A randomized controlled trial. Complementary therapies in medicine, 33, 72-77.
  14. Phrompaet, S., Paungmali, A., Pirunsan, U., & Sitilertpisan, P. (2011). Effects of pilates training on lumbo-pelvic stability and flexibility. Asian Journal of sports medicine, 2(1), 16.
  15. Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complementary therapies in medicine, 37, 80-95.
  16. Küçük, F., Kara, B., Poyraz, E. Ç., & İdiman, E. (2016). Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial. Journal of physical therapy science, 28(3), 761-768.
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