Back Fitness Physiotherapy

Pilates for (p)rehab

For nearly a year now I have been a trained pilates instructor. I did the APPI course which is tailored to physiotherapists. I teach a few classes a week at my clinic on the mat, reformer, cadillac and chair. I started pilates classes when I was sitting my A-Levels as my netball season had finished and I could feel myself mentally becoming incredibly stressed and uptight from not having an outlet to destress. So I started pilates for the first time back then and ended up doing 3 classes a week as I fell in love with it. Reformer pilates has always and will be my favourite. It is ten time more difficult than people think and I use it as a form of rehab with my patients as not only is it a good workout but it is incredibly versatile.

I constantly get the mick taken out of me as when I am at rugby and someone is complaining of a chronic problem (especially lower back pain) my answer is always “You should do pilates”. It is an incredibly underrated form of activity and I believe a lot of people tend to think it is quite airy fairy (which it can be), but if you do something like reformer pilates, you will come off those machines will a sweat on for sure.

So what is the difference between pilates and yoga? 

Although yoga and pilates can cross-over in their exercises, it is more what you are aiming to achieve from the class that differentiates them. Yoga tends to focus more on stretching, flexibility and can incorporate meditation as well. Pilates tends to focus on strengthening exercises, activating the core and improving the neuromuscular connections within the body. So already you can see why pilates would be more beneficial to someone who is in pain rather than yoga.

In the physiotherapy setting, 95% of the time I will use pilates based exercises for someone with lower back pain. The reason behind this is that your core muscles are made up the 80% of the front tummy muscles (your abs) and then the 20% are your back muscles. The front core muscles are further divided into the local stabilising and the global stabilising muscles. The local group are the deeper muscles which are involved in activate a co-contraction mechanism that stabilises the segmental parts of the vertabrae but then also maintains the spine within a neutral zone. The global muscles are used more for counteracting large forces that could impact the spine. There is a huge correlation between a weak core and back pain, however, this is not the sole reason.

I am not saying pilates alone is an effective treatment for chronic lower back pain. But I think using it as an adjunct with hands on treatment can be great for decreasing pain and increasing function.

There are lots of different types of pilates; matwork, reformer, yogalates, hot pilates, HIIT pilates, kettlebell pilates… the list is endless. Therefore, you are guaranteed to find one type you prefer. Including it into your weekly workout routine could not be any easier to help prevent any back pain setting in (especially if you have a desk based job).

The basis of all pilates is contracting your pelvic floor (and as you get better at it, you keep this activated throughout all the exercises). Most people probably hear the pelvic floor and think of either post-partam or incontinence, but it is so much more than that. The pelvic floor is one of the deeper core muscles. The easiest way to activate your core is:

  1. To lie on your back and find your pelvic floor by placing your fingers on your hip bone, then move them an inch inwards and an inch down.
  2. If you cough with your fingers in this position, you should feel a small tightening underneath – this is your pelvic floor.
  3. What you want to do is have that muscle contract slowly, so to do this you imagine that either
    1. You are going for a wee and you are trying to stop midflow (odd cue, I know, but effective)
    2. Or that you have a belt around your waist and you are doing it up one notch tighter
  4. And this is your pelvic floor contraction. Once you have got the hang of doing this in lying, you can then start to do it in standing, on the tube, on the bus, anytime. You want to aim to hold it for 10secs and do it at least 10 times a day, but do it as much as you can!

If you are suffering from lower back pain and it is affecting your day to day life, you should go see a GP or physiotherapist in order to help manage your pain from a medical point of view as well as personalising a program depending on your goals. But the worst thing you can do is to stop moving, you need to keep moving as much as possible and seek advice ASAP.

Studies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395677/

 

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