Pilates for back painPilates is an excellent form of exercise that will help you increase your strength and flexibility. An extremely common statement heard in the clinic when talking to people with low back pain is that someone who has had back pain in the past told them that you need to strengthen your core. Whilst there is nothing wrong with this statement (I certainly agree and there is a lot of good evidence surrounding this), the problem lies in the how….

Let me show a cycle that is both common and troubling for the general population who have had a flare up of back pain:

  1. An individual experiences an episode of back pain (e.g. Spending a day digging out the backyard)
  1. “I know, I’ll do some core work to fix this” – Person decides to perform some sit ups
  1. Sit ups (or crunches) can increase the pressure on the lumbar spine especially if that person has had an acute flare-up of back pain.
  1. Sit ups further exacerbate the initial flare up (back to no. 1)

 

Low-Back-Pain

What is actually required is that you need to improve your transverse abdominus strength. I have written a post in the past here explaining the importance of pilates for back pain.

Top 3 Reasons Pilates Can Fix Your Back Pain

Transverse Abdominus (Tra Ab) is a deep abdominal muscle that directly supports your lumbar spine. People who experience episodes of lower back pain can have very weak Tra Ab that essentially equates to a lack of support and stability of the spine when completing everyday tasks such as standing up from a lying position or picking something up and carrying it.

 

The Psoas Major and the Transverse Abdominis Muscle

 

Layout of core musculature

The abdominal wall has 4 layers of muscles of which 2 are critical in supporting the spine.

  1. Multifidus is a network of small muscles that run close to the centre of the spine and vertebra. It limits the poorly controlled movements of the spine that have the potential to cause serious injury. A popular way to re-train multifidus is to perform exercises whilst lying on your stomach (see below).
  2. Tra Ab is a muscle akin to a corset wrapped around the body to brace and support the back.

When Multifidus and Tra Ab are trained properly and thinking about the core as a whole (working different sections in order to stabilise the spine), the core is transformed into a strong, rigid cylinder. Females who have recently had a baby are also in need to retrain pelvic floor muscles to add to that cylinder effect of a strong and effective core.

“Good” core muscles equates to these muscles are working effectively and efficiently to keep the spine rigid and to prevent future injuries. For athletes, it is critical to have good core stability as almost all sporting techniques and movements come from this basis known as the core.

Research indicates that without guided exercises from a trained health care professional to re-set the core muscles, you are more likely to either exacerbate the injury or place undue stress on the core muscles.

 

Benefits of pilates

  1. Increase the strength of your spinal stabilizer muscles that directly takes the pressure off the lower back
  2. Improve the tone of your musculature
  3. Increase your abdominal strength
  4. Can improve incontinence problems as well as improve post-pregnancy stomachs
  5. Act as a preventative from future lower back pain

 

Clinical pilates is a form of supervised exercises that incorporates stabilisation of the core muscles to increase flexibility, tone, muscle strength and endurance. Posture and balance each play critical components ass well, that is why it is not uncommon to be performing some of these exercises standing up. During mat classes (what we offer here at our Gungahlin and City West practices), participants are either on their back, side or stomach depending on what particular muscle group you are targeting. This also involves the use of gravity to help challenge that core even more. We only run small class sizes of between 4-8 people to really evaluate your technique and when to move to the next level of progressions. Through this model, you can safely progress your core strength whilst minimising the harm that could arise to your lower back.

Before I introduce the best pilates exercises for your lower back, it is important to remember to start at a basic level to learn the movement first. Once the skill becomes easier then it is time to progress and challenge yourself further.

Breathing is another important component of pilates. By taking a deep breath in before you commence the movement, you are actively moving the ribcage upwards and outwards to properly prepare yourself for movement. As you exhale and subsequently begin the movement pattern, you are engaging your diaphragm muscle as well as the ribcage relaxes downwards and inwards (limiting flaring of the ribs). I encourage you to practise this concept at home whilst lying on your back in order to get sufficient oxygen to the working muscles.

 

Top 5 pilates exercises for your back

1. Bridge

I like to incorporate this exercise into classes early on in the piece as it has a lot of dimensions in place. Firstly by getting a sense of your pelvic positioning in being aware of how movement forces you to work strong lower limb musculature in unison. Specifically, getting gluteals and hamstrings to work in a strengthening and stabilising capacity. A segmental bridge is a classic pilates exercise in which it retrains global muscle activation and mobilises the lumbar and thoracic spine.

The movement: Lying on your back with bent knees shoulder width apart, cross your arms across your chest. Thinking about tightening your gluteal muscles as you begin to gently tilt your pelvis towards you. In the same movement, start to slowly lift you backside off the ground. Once you safely bring bone by bone in order (your thoracic spine) you stop at the top of the movement as you are resting on your shoulder blades. To lower, draw your breastbone downwards towards the floor; continue to peel your spine back onto the floor bone by bone until the tailbone connects the mat.

Progressions (to focus on further stability of lower limb musculature):

a) Add in a theraband around both legs (just above the knee)

b) Place a rolled up towel between your knees (good amount of pressure through the towel).

2. Roll Down

A roll down in pilates is an excellent warm up and warm down exercise. It challenges postural muscles, increases proprioception (body awareness of movement) and retraining the order in which movement should occur. Furthermore, a roll down allows you to focus your mind and to gain a good sense of turning your core muscles on. A roll down has similar properties to the popular gym exercise known as the roman extension. I often ask people to demonstrate a roman extension where they will simply bend at the hips. By adding in a roll down as a warm up activity, they can get a true sense of utilising the whole spine and to decrease the pressure placed on the lumbar spine.

 

The movement: Standing with feet shoulder width apart, have both arms out in front to start with (think of making your hands heavy). Stand up tall, with good posture. Starting at the neck, slowly start to curve each segment in order as you progress towards the ground through your thoracic spine. If you are restricted by tight hamstring muscles, just bend your knees ever so slightly to be able to touch the ground with your fingers. Inhale at the bottom, then as you exhale reverse the movement (keep the hands out in front and heavy) and slowly ‘stack’ your lumbar, thoracic and cervical spine until you come up tall into standing.

 

Progressions (to challenge your balance and core further):

  1. a) Start in tandem stance (left leg in front of right BUT widen your stance to maintain balance). Alternate sides
  2. b) In the fully flexed position, you can place hands underneath toes to stretch out your hamstrings and neural tightness

 

3. Oblique Supine

With a more stretch-orientated approach to this exercise, I like to introduce this exercise to people who partake in a lot of rotation exercises such as swimming or throwing sports. The premise of this exercise is to engage your core as you safely rotate your thoracic spine. In turn this will turn on your oblique muscles and help you to twist further. Let me tell you right now that it saved my cricketing season after all of those (slow-)medium pace deliveries!

 

The movement: Lying on your back with a rolled up towel in between bent knees (ankles remain on the ground), have your right arm directly out to the side. Inhale, and then as you exhale, tighten the towel between your knees and slowly drop both legs out to the left hand side. Hold at this end position to stretch out your side, and then come back up to your starting point. Reverse the hand position to the left hand side and then drop knees out to the right. Maintain the stretch for 20 seconds.

 

Progressions (to increase the stretch):

  1. a) Have one ankle off the ground (in tabletop position)

 

4. Breaststroke Preparation

Breaststroke preparation is a different exercise in comparison to the aforementioned movements as it is performed in prone (on your stomach). Crucially here, do not start with this exercise when you are cold or not warmed up properly as it can stress the lumbar spine. The idea of this exercise is to progress your deep neck flexors against gravity as well as increasing your awareness of your postural muscles being recruited.

 

The movement: Begin on your stomach whilst resting your forehead on a folded towel. Ensure the back of your neck is elongated. Your arms should be resting by your side. Your legs need to be straight, hip distance apart. To initiate the movement, slide the shoulder blades gently downwards and reach from the shoulder blades to the fingertips towards the feet and allow the arms to hover 2 inches off the ground. Simultaneously lengthen the upper body to hover the breastbone 1 inch off the ground. Slowly come back down to the starting point.

 

Progressions (to increase multifidus strength):

  1. a) Introduce leg movements coming off the ground in sync with the chest movement.

 

5. Clams

Clams are a very useful exercise to strengthen the gluteal muscles and to improve timing of muscle activation around the hip. Furthermore, rotary control of the pelvis is emphasised. To put a real world term onto this last point, clams helps your walking as proper gluteal control is required to control pelvis rotation, therefore activating your gluts is necessary to act as a stable base to work off.

 

The movement: Lying on your side (pick any side to start- it is important to perform this exercise both sides). Place your underside arm outstretched in alignment with the trunk with a rolled up towel between your ear and your shoulder. Start with your hips bent up to 45 degrees and knees bent to 90 degrees. Shoulders and hips should be stacked on top of one another. Once in this position, gently draw your sitting bones together to engage your glut muscles. Lift your top knee upwards with your ankles rolling on top of one another. Lower the top knee onto the bottom leg.  After repeating this exercise, you should feel the muscle working close to your backside. Repeat to fatigue and then change sides. I always like to perform a glut stretch after fatiguing this muscle.

 

Progressions:

  1. a) Use a theraband to work the gluts against resistance
  2. b) Have your ankles in the air to further challenge the gluts (ensure you are performing the level 1 efficiently before you progress).

 

 

These 5 exercises are a good introduction to get into our core work without exacerbating you lumbar spine condition. Whilst I admit that they are gentle to start with, I feel this is a really good combination of stretching and strengthening the core and lower limb musculature. By progressing through these exercises and adding in the aforementioned progressions where appropriate, the stress on your lumbar spine will be reduced and you will start to activate your core a lot better. As always, if you are feeling significant pain with any of these exercises, stop and review the literature. I encourage stretching first, and then come back to it once you have reviewed your technique. As well as this, your physiotherapist can help to let you know any actions that may need modifying or when to progress.

About Jim Fuller

Jim graduated from the University of Sydney with a Masters of Physiotherapy after completing his Bachelor of Health Science. He has special interests in sports injuries particularly of the lower limb, soccer injuries and pilates. He also pays particular focus to prevention of future injuries. Jim enjoys all outdoor activities with his family and friends as they are often out camping, cycling, hiking and sailing.

2 Comments

  1. Paula on May 16, 2016 at 4:18 am

    This is a very useful article. The videos make the exercises really easy to follow. Thank you!



    • Jim Fuller on May 19, 2016 at 2:08 am

      Hi Paula, glad you found the exercises and videos helpful.