Pilates is an excellent modality to combat back pain.  The slow pace of the exercises, the emphasis on proper breathing and the focus on alignment make Pilates a practice that is both therapeutic and strengthening in design.

Pilates for Relief
The routine presented is made up of Classic Pilates exercises with modifications as well as simple stretches.  They will not only help during an acute exacerbation but can also reduce the likelihood of the pain becoming a chronic condition. It is indisputable that each and every body is different and that are various causes and origins of back pain.  However, working with people of all ages and limitations over the past four years, I have discovered my “go-to” exercises to alleviate discomfort in most of my clients.  The following are five Pilates exercises which have been modified to remedy the common problem of back pain.

Before you start
I have found that starting supine is the safest way for your client to start their back care exercises.  In this position, the client should keep their knees bent and their feet flat on the mat.  This will mitigate any arching in the back and allow the lumbar spine to naturally fall towards the floor.   If this is still uncomfortable for him or her, place a large exercise ball underneath their legs for full support letting the calves rest on top of the ball.   Take this time to check in with your client.  Ask how they are physically feeling and how strong the pain or discomfort is. I will often use the scale (1-10) of pain to get a sense of how they are feeling.   Most importantly, allow a few moments here to educate (or reeducate!) on the importance of breathing.  The Pilates principle of breath is fundamental in releasing pain.  By helping your client learn deep lateral and abdominal breathing you are giving them a tool they can use anywhere during a backache, flare-up or little twinge of pain.   Learning to properly use the muscles of the diaphragm will also act as preventative care to avoid future back distress.

The program
For the following exercises you will want to provide a firm but comfortable surface for your client.  Often the floor or even the Cadillac may be too hard on the spine. In this case a thick mat or pad can be used for support.   Have a rolled towel nearby to place under the neck.  This is essential if kyphosis is present and there is an extra large gap between the neck and the mat.

Exercise 1: Modified Hamstring Pull with resistance band
-Tight hamstrings are often a culprit of low back pain.  When these muscles are short (often due to prolonged sitting) they can pull on the back and cause discomfort.

Start supine with the knees bent and the feet on your mat.  Place the resistance band around the bottom of the right foot.  Straighten the leg upwards towards the sky holding each end of the resistance band in each hand.  Feel the stretch in the hamstring and back of the knee.  For a more intense stretch, lengthen the left leg out along the mat.   Hold for at least thirty seconds.  To switch, place the left foot in the resistance band, remove the right foot, and place the right foot to the floor.  Again, stretch the right leg out for a stronger sensation and hold the stretch for thirty seconds or longer.  Always aim for a stretch not a strain!

Exercise 2: Windshield Wipers
-Though “Windshield Wipers” is not a Classic Pilates pose, I have found it to be a consistently effective stretch with back pain sufferers.  The exercise stretches the low back, glute, and hip while also opening up the rib cage and shoulders.

Start supine with the knees bent and the feet flat the width of the mat.  Inhale and drop your knees to the right.  Exhale and stretch your left arm back behind you.  Take a few moments here (again, about thirty seconds) breathing into the left side of the rib cage and encouraging the knees gently towards the floor. Bring the knees and arm back to center.  Repeat on the other side.

Exercise 3: Modified Supine Spine Twist with exercise ball
-I love this exercise as a safe abdominal strengthener.  The ball holds the weight of the legs allowing the transversus and obliques to do the work.

Start supine with the legs completely supported on an exercise ball. Bend the knees so the ball is close.  Take the arms out to the sides with the palms facing down.  Inhale and lower the legs to the left, gently hugging the ball with the hamstrings and calves. Exhale and draw the ball back to center.  Repeat on the other side.

Exercise 4: Modified Pelvic Curl with exercise ball
-Though pelvic tilts may seem like the more appropriate pelvic exercise for back pain, in my experience the subtle movement of a pelvic tilt is often difficult to grasp resulting in clenching of the glutes and overarching of the back.  Try this pelvic curl for a more fluid movement.

Start supine with the legs in table top over the exercise ball so they are fully supported. Inhale to prepare, exhale while slowing lifting the hips off of the floor while simultaneously straightening the legs.  Pause at the top for another inhale, exhale and slowly roll down vertebrae by vertebrae.  Repeat 3-6 times.

Exercise 5: Modified Rest Position
-This version of rest pose is a contribution from Faith Hsu, NP, MSN.   Late in her third trimester, Faith experienced low back discomfort that was alleviated with this pose.  It can also be done over a chair or couch.

Transition on to your knees and place the ball in front of you.  Fold your arms on top of the ball and rest your head on your arms.  Let your back gently arch by allowing the belly to relax towards the floor.  Take several moments here to breath and relax.

Though I feel this sequence is safe enough to do with most back pain sufferers, never forget the importance of checking-in and LISTENING to your client.  No one wants to be in pain! Allow your Pilates sessions to be a conversation with your client – finding the poses and stretches that feel best for them. Honor the work and the process and use it to educate your clients to feel and move in the most beneficial way possible.

By isolating different muscle groups, Pilates exercises develop strength in the body’s “core” muscles in the abdomen and back, and increase overall flexibility and coordination. Pilates exercises can be done with no equipment but a mat, moving just the body in a series of movements with focused attention on breathing and muscle control. Pilates exercises also emphasize concentration and breathing, making it very relaxing, with benefits similar to other low-impact exercises like yoga.

The National Cancer Institute explains that exercise in general has been shown to be beneficial to cancer patients undergoing treatment and in recovery. However, many forms of exercise may be too high-impact for those suffering from fatigue and muscle weakness as a side effect. Pilates is a viable option for cancer patients because it is low-impact and features exercises that can be easily modified to suit a patient’s needs and abilities.

Pilates can be a powerful aid to cancer patients during any stage of treatment. Pilates expert Mari Winsor, interviewed for Gaiam.com, explains that patients currently undergoing chemotherapy may experience an energy boost from Pilates. Winsor also explains that Pilates can help patients feel stronger, have better circulation, and at the very least can help relieve the stress of treatment and recovery.

The Stanford Cancer Center offers a Pilates class as part of their Cancer Supportive Care Program because of their understanding that Pilates can be highly beneficial for the healing process. Their class covers modifications to Pilates exercises designed for cancer patients or survivors. Similar classes are available at other cancer treatment centers, gyms, and specialized studios throughout the country.

For patients with mesothelioma or other cancers, Pilates offers the benefits of stress reduction as well as gentle strengthening and flexibility training. Engaging in Pilates following a mesothelioma prognosis or similar cancer diagnosis can help create an increased quality of life and promote faster recovery for current patients and survivors.

And my response is:
“If you’re doing it correctly and there’s no medical reason why you shouldn’t be exercising, then Pilates is probably one of the safest and most effective forms of exercise you could possibly do while you’re pregnant.”

Here are just a few of the benefits of Pilates during pregnancy. Pilates exercises are purposefully designed, to:

• re-align your posture
• tighten your tummy muscles
• strengthen your pelvic floor
• diminish back ache
• challenge your balance
• tone your arms, legs and bum
• keep your cortisol (stress hormones) levels in check
• eliminate sciatica
• help reduce water retention
• produce results
• ease the labour
• contribute to a faster recovery after your baby is born
• give you the confidence to enjoy your body.

To me, it makes perfect sense when all the changing areas of your body – breasts are getting bigger, posture changing, tummy growing, lower back starting to curve, pelvic floor taking a hammering to name but a few, for women to do Pilates.

The midwife at the birth of my first child put down the fact that I managed to give birth to my daughter who was posterior (facing the wrong way) naturally, without intervention to Pilates.  The muscles required to ‘push’ the baby out are the transversus abdominis which is the main muscle trained in Pilates, and if those aren’t strong then you may not last the distance. She was also astounded at how tight my tummy muscles were pretty much immediately after the birth – again, a result of a three times a week Pilates regime. I worked my pelvic floor morning, noon and night and was very aware of my postural changes at every step.

It’s not about slipping back into a size zero 10 minutes after the birth, Pilates just keeps you toned, focused and gives you the tools to birth confidently. It is also very handy to use the shoulder scapula stability exercises when you’re breastfeeding as the majority of women will find they automatically start to roll their shoulders forward, creating a ‘hunch’ in their back.

It is very important that you find an instructor who is trained specifically in pregnancy. Your body changes throughout each trimester, so it makes perfect sense for your workouts to do so too.

Tasha is a highly qualified Pilates instructor and TV presenter specializing in pregnancy. She is also an established writer in the field of pregnancy and exercise, and during her pregnancy with her second child, she decided to create (what has now become) a world first set of trimester specific Pilates workouts which are available from www.pregalates.com

There are many different kinds of runners. There are marathoners and other distance cravers who may or may not be competitive; there are short distance runners who also may or may not compete and then there are casual runners who just try to fit in a few miles a week to keep their cardiovascular systems in good working order. No matter which type of runner, the same muscle groups are used to propel the body forward. Primarily the hip flexors to pull the top of the leg forward, the quadriceps to extend the knee then tibialis anterior to flex the foot and prepare to plant the forward foot. Once down, that leg is pulled back using the glutes and hamstrings. The big issue here is that while in that running gait, the runner’s body is moving in the sagittal plane therefore the muscles that support movement in the horizontal and frontal planes are not challenged specifically.

You may see the effects of the imbalances if you have a client who loves to run. They may exhibit great strength in their legs but have real issues with tightness in the hips, with low back or knee pain, and/or problems with balance. As an instructor it is very important to work the client in the horizontal and frontal planes. Pilates can also help runners with core strength so they can be more upright in their posture as well as breath control. Below are a few Pilates exercises that can benefit runners.

Mat Work Exercises

• Side lying leg series (strengthen glute medius & stabilize hips)
• Leg circles (stabilize hips and move legs through rotation)
• Swimming (thoracic extension, hip stability)
• Side bend (strengthen abductors, adductors and obliques)

Reformer Exercises

• Feet in Straps; medially and laterally rotated (hip rotation, mobility)
• Footwork; medially and laterally rotated (hip rotation, mobility), heel lower and lift (calf strength and flexibility)
• Side splits (lateral hip strength and stability, abductor and adductor strength)
• Long Box series (thoracic extension, hip stability, core strength)
• Seated twist with or without ring (hip stability, obliques)

Of course there are many other Pilates exercises that can complement a runner’s program.

The benefits runners have by using Pilates

• Increasing core strength and correcting postural imbalances
• Increasing balance in the muscles of the back and hips
• Reduce the risk of injury
• Assist with breath control

Make sure your runners know they need to work other muscles besides those for running. They’ll be really happy if you can keep them out on the road, track or treadmill.

Romana trained with both Joseph and his wife, and committed to them to continue their teachings. She and her daughter still train the classical method today.

Mary Bowen started training with Joseph in 1959 because of her bad back. After improving in two sessions, Mary hasn’t stopped yet. She still trains and holds workshops through her studios in Connecticut and New England.

Ron Fletcher was drawn to Joseph because of a bad knee from dancing. He continued training with Clara after Joseph’s death. He opened his studio in Beverly Hills in 1971, and continues training Pilates instructors today.

Kathy Grant also trained under Joseph and now works full time in the Department of Dance at the Tisch School of the Arts, New York University. She and Lolita San Miguel are the two people that were actually given a degree in Pilates by Joseph himself. Lolita San Miguel now trains Pilates instructors through her studio Pilates Y Mas Inc.

The elders were drawn to Joseph because of their own personal story, but still today, 50 years later, they still practice the Pilates exercises and teach them to the world. More information on Pilates elders can be found at www.easyvigour.net.nz.

Pilates can prevent back pain, muscle aches and joint stiffness. Pilates is low-impact and when done with a well-trained instructor the moves will be precise, controlled, fluid and graceful. Form is essential during the exercises.

The basic principles of Pilates, which are learned when you begin your Pilates practice, are necessary for the safe and effective results. When performed correctly and consistently, posture will be enhanced, deep core strength will develop, tension will decrease and joint mobility and muscle imbalances will improve.

Common causes of back pain are poor posture, improper lifting techniques, and weak core muscles to name a few. Back pain frequently occurs during everyday activities. As a result of Pilates, enhanced posture and body awareness gives you the ability to avoid injuries and pain in your daily routine, whether you are unloading laundry or playing golf.

Lengthening your body with Pilates will also help soothe muscle aches. Blood and nutrients will move through the entire body to the muscles and tendons, which help keep them healthy and minimize the risk of injury. As circulation increases, joints are lubricated and your hips, back, neck, and shoulders loosen up, relieving aches and stiffness. Start Pilates today and prevent the pain tomorrow.