We all have been exposed to the mind-blowing statistics when it comes to low back pain (LBP). Between 2004-2008, there were 2.06 million episodes reported at emergency departments in the United States, which breaks down to 1.39 incidences per 1000 people.1 An estimated 150 million workdays are lost each year due to our 3-lettered friend, which puts the costs for treatments, worker’s compensation claims, and lost wages into the several billion-dollar range.2 As a physical therapist, it is easily the most prevalent complaint that I see in my patient population, as well as being one of the trickiest issues to treat. Why? In short, all LBP is not created equal.
The causes for low back pain are numerous, including mechanical, degenerative, and muscular possibilities. The mechanical category refers to injuries and irritations to non-contractile (or non-muscle) spinal structures, such as discs, facets (which are the joints that your spine bones use to move on each other), or ligaments. These can happen with a single traumatic event or from strain added up over a period of time (sit up straight, people!). The degenerative category houses such apocalyptic terms as stenosis and arthritis, and let us not forget the dreaded “degenerative disc disease”, which sounds like your spine has been invariably sentenced to topple over like a shoddy Jenga stack. It is true that these diagnoses refer to the degradation of the quality of tissues in the spine and can lead to real problems, but (as you can probably tell from my tone), I think that their presence on an x-ray or MRI can be overemphasized and sometimes cause patients unnecessary despair in regards to their health (sounds like a future blog topic to me!) The muscular category contains your true muscle strains due to overload as well as pain caused by things called myofascial trigger points, which, due to their chronic nature and neurological involvement, can be (in scientific terms) real stinkers.
Despite these many causes for LBP, one thing seems to be constant in regards to their treatment and control: exercise. Now, this is a very general term that can refer to seemingly countless possibilities – from simple motions to pretty complex and vigorous activities. But I would bet my bottom dollar that nearly every PT you asked would, at some point, plan to introduce exercises that focus on the muscles that move, support, and control the lumbar spine and pelvis. Like any joint in the body, this region requires coordinated, strong musculature that will allow proper motion and stability when necessary. So it is really not shocking that the Pilates method, which has promoted “lower core activation”, “abdominal strengthening”, and “lumbopelvic stability” as foundational exercise principles ever since Joseph Pilates (yup, he was an ACTUAL guy) brought it here in 1926, is proving to an effective weapon in the war against LBP.
Yeah, I would say Joe was in decent shape.
As I began my Pilates certification, I had already been working as an orthopedic physical therapist for several years. However, I was surprised at how many exercises that I had learned over the years and been using effectively with my patients seemed to have their roots in the Pilates method. First, the activation of the transversus abdominus, the deepest layer of abdominal muscles that circles around the body like an internal back brace, is something that therapists often introduce early into a plan of care. Likewise, it is one of the earliest muscular concepts to be taught by the Pilates curriculum. Next, exercises teaching stability of the pelvis are emphasized in many of the protocols of the PT “gurus”, and it does not take long to notice that a majority of Pilates exercises also demand a very quiet pelvic base. Plus, there are certainly other muscles vital to a healthy low back, including my favorite, the multifidus, that are the focus of several exercises, such as Swimming and Double Knee Kicks. So looking at the Pilates method from a rehabilitation specialist’s point of view, it is easy to see why it is proving to be so helpful in treating this tricky problem.
Research involving Pilates exercises’ effect on LBP is finally starting to be published over the last 5 years, and the results are quite encouraging. A study in 2014 assigned 40 business women with chronic LBP to either a Pilates mat or apparatus exercise regimen (3x/week for 8 weeks), and the subjects exhibited significant improvements in both pain ratings and balance measurements.3 Another study published just this past year found that Pilates exercises, an intervention with no harmful side effects, were effective in improving pain, function, and quality of life scores for subjects with chronic LBP.4 I could list several other studies, but I think you get the picture. And in the future, I could see us at Relevation contributing to this field, as we are in an ideal situation to combine our clinical expertise, Pilates training, and access to participants into research that could hopefully advance the understanding and usage of this great method in treating maladies of the spine.
Despite its omnipresence in our modern world, LBP is something that, for the vast majority of people, can be controlled through activity modification, work station ergonomics, good health practices (weight management, smoking cessation, etc.) and, above all, consistent exercise. Pilates, though developed nearly 100 years ago for full body balance, has qualities that seem to fit perfectly into a program looking to maintain a healthy spine. So if you are looking for something new to try in 2016 to fulfill your resolutions or just plain feel better, I suggest you give this method the old college try. Your back may just thank you.
David J Skrajner, PT, DPT
1. Waterman BR, Belmont PJ Jr., Schoenfeld AJ. Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine. 2012 Jan;12(1):63-70.
2. Tate RB, Yassi A, Cooper J. Predictors of time loss after back injury in nurses. Spine, Sept. 15, 1999: Vol. 24, No. 18, pp1930-36.
3. Lee CW, Hyun J, Kim SG. Influence of Pilates Mat and Apparatus Exercises on Pain and Balance of Businesswomen with Chronic Low Back Pain. Journal Phys Ther Sci, April 2014, 26(4): 475-477
4. Natour J et al. Pilates improves pain, function, and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical Rehabilitation. 2015 Jan; 29(1):59-68.