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Therapeutic Pilates for a strong, healthy spine
Eight out of every 10 people will suffer from some form of back pain throughout the course of their lives. Most sources of back pain can be traced back to poor mechanics of the spine and to a weak core. Since completing several courses in Therapeutic Pilates, it is more clear to me than ever that effective strengthening, (and in many cases re-training), of the deep "local stabilizers", along with finding and being able to maintain neutral spine, is the key to a healthy back.
The local stabilizers are those muscles that lie closest to the spine giving the spine its’ stability. They include the Transversus Abdominus, the Pelvic Floor, the Lumbar Multifidus, (a deep back muscle controlling segmental stability of the spine), the diaphragm and the deep fibers of the Psoas Major, (a hip flexor muscle). These deep postural muscles have a slow speed of contraction and are designed to be "fatigue resistant". Injury can leave the muscles responsible for spinal stability weakened and less functional. A study comparing trunk muscle activation in healthy subjects to those with chronic low back pain found that while performing single arm raises, the back pain group experienced a consistent delay in the firing of the transverses abdominus, leaving the spine vulnerable to further injury. In the healthy subjects however, the transverses abdominus fired prior to other muscle groups thus stabilizing and protecting the spine from injury, (Richardson – 1996).
With chronic back pain there is dysfunction of the local stabilizers and overwork of the global stabilizers and global mobilizers, (the more superficial muscles). These "outer" muscles try to substitute for the local stabilizers but are poorly equipped to do so. When they try to do the job of stabilizing the spine, they begin to "fire" or contract too easily. The result is that they often become hypertonic, (in a constant state of contraction), and tight regardless of the amount of stretching done. Chronic musculoskeletal dysfunctions require strengthening of stability and postural muscles. These local stabilizers are not addressed through a regular fitness program, which normally focuses on strengthening and stretching the phasic or outer muscles, but rather through slow careful activation. Therapeutic Pilates, unlike Fitness-based Pilates or regular fitness programs, focuses on re-educating and strengthening these deep local stabilizers at low loads, (less than 25 % of your strength). This allows them to begin to do their job of stabilizing the spine and pelvic girdle once again, allowing the larger, more superficial muscles to relax and come in to play only when we need them. This type of slow, focused, low intensity training takes patience, consistency and concentration, but the payoff is well worth the effort. The other key ingredient to maintaining a healthy spine is to monitor your posture throughout the day. Try to establish good postural habits, focusing on maintaining a neutral spine as much as possible.
The good news is that through careful program design and attention to good posture and proper lifting techniques most conditions will see improvement. Therapeutic Pilates can work to optimize joint stability, correct muscular imbalances while restoring structural integrity to the spine, pelvic and shoulder girdles. As with any exercise program, be sure to consult first with your doctor, physiotherapist or chiropractor before you begin.
Debbie Ross is the owner of Ross Pilates and Conditioning, a Certified Medical Exercise Specialist, Certified Post-Rehab Conditioning Specialist, Personal Trainer and Certified Pilates Instructor.
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