According to research, it is estimated that 80% of people will experience low back pain at least once in their lives. For 40% of these cases, the pain will become chronic, meaning that it will last for more than 12 weeks. This means that over 2 million people in Hong Kong will struggle with persistent low back pain, requiring effective and targeted care to not only treat the immediate pain and disruption to their lives, but to also to get down to the root cause of the problem to help prevent the pain from recurring.
While low back pain can be a complex issue with many different causes and contributing factors, having an imbalance between the flexor and extensor muscles of the trunk is a common problem that increases the likelihood of low back pain due to its effect on the stability of the lumbar spine. This is where Clinical Pilates can make a big difference - using evidence-based movements to activate and strengthen the stabilising muscles of the trunk. Research shows that:
- Working to actively strengthen the trunk is effective for helping manage low back pain (compared to no exercise)[1]
- Both core stabilisation and strengthening exercises reduce pain while improving proprioception, balance, muscle thickness, and reducing functional disability and fear of movement in patients with low back pain.[2]
- Systematic reviews and meta-analyses of studies that aimed to assess the effect of exercise to prevent low back pain show that exercise is effective in reducing the risk of low back pain and associated disability, recommending a combination of strengthening with either stretching or aerobic exercises performed 2–3 times weekly as part of a prevention strategy.[3]
- A systematic review of another 75 randomised controlled trials found that compared with conventional rehabilitation, core or stabilisation exercises (as well as Pilates specifically) significantly improved chronic low back pain in terms of pain and function.
Simply put: completing specific exercises and physical activity can have a significant impact on both the symptoms of lower back pain, as well as a person’s function and quality of life. In order for exercise to have optimal outcomes and maximum benefits, however, specific areas of weakness, imbalance or dysfunction should be identified by a qualified physiotherapist. This is done through a comprehensive evaluation, allowing your physio to prescribe specific, targeted exercises. This is where physio-led Clinical Pilates is one way of delivering this exercise safely and effectively.
What Is Clinical Pilates?
Clinical Pilates is a precise and purposeful type of exercise designed to optimise function and recovery by focusing on your individual core stability, strength, balance, control - and how any variances or dysfunction in these are linked to any injuries or dysfunction you’re experiencing. One primary focus of Clinical Pilates is your core - as it’s our core muscles that help add stability to support our torso, spine and pelvis throughout the day. Clinical Pilates also looks at your overall posture, flexibility, balance and breathing, as well as strength.
Clinical Pilates can leverage a range of equipment - from spring-loaded Pilates equipment (reformers, Wunda chairs and the like) to mat work. These are used to challenge your body safely and effectively, with careful consideration of the pains you're experiencing, including any specific symptoms and limitations from your low back pain. Another benefit of Pilates is the recognition that even after the pain from an injury has settled, the effects on the body can linger. This is where Clinical Pilates also helps to rebuild or gain strong foundations, which sets you up for optimal movement going forwards, helping reduce the risk of re-injury, and helping prevent the development of new injuries.
We have two options for Pilates at PhysioCentral:
One-on-one physio sessions
Our one-on-one sessions are taught by a fully qualified physiotherapist who conducts a comprehensive assessment to understand the nature of your low back pain, examining the potential causes and understanding where any weaknesses lie. This really is key - doing the right targeted exercises in the right way for your body, your biomechanical vulnerabilities, and your unique circumstances. This is where having a physiotherapist who has extensive knowledge of how your musculoskeletal system works is vital to help you get the best long-term outcomes.
Our one-on-one, or small group sessions (3 people maximum), taught by Certified Pilates Practitioners
Once you’re on track with your recovery and understand how to move in a way that is best for your body, these sessions can help you reach goals - like correcting imbalances to reduce your likelihood of future injury. These sessions are also tailored to you and your symptoms, and are delivered carefully to help you with body awareness, mindfulness and control. The main difference is that these sessions aren’t focused on treating an injury or rehabilitation, but on refining and optimising how you move and use your body. These sessions are often accompanied by a personalised exercise plan to help you with your recovery goals, and are typically the next step after successful injury rehabilitation.
Generally speaking, Pilates also has a range of other benefits, including helping:
- Relax tight, stiff muscles - like those that may be promoting a hunched shoulder position, which then affects back posture and can increase a person’s injury risk. Here, Pilates promotes flexibility which enables optimal movement.
- Strengthen weakened muscles - giving you the strength to comfortably maintain optimal back posture, instead of reverting to poor postures when your muscles fatigue, which may contribute to low back pain
- Improve your core strength - with a strong core helping to optimise all your movement
- Your breathing control - by mindfully taking longer and deeper breaths, we can ease the tension on the chest and neck muscles which are often engaged in shallow breathing, which can lead to tension and dysfunction
- Learn better body alignment - as the moves you perform are taught and reinforced with healthy postural principles, you learn how to best control your postures in a range of circumstances and positions to best support back health
Evidence For Pilates For Low Back Pain
Clinical Pilates is described as one of the “best exercise techniques in managing chronic low back pain” that helps achieve clinical outcomes faster, according to literature.[4] It has good evidence for its efficacy in helping manage various aspects of low back pain. A review and analysis of 79 randomised controlled trials found that Pilates had significant effects and benefits for pain reduction over no intervention or minimal intervention, with some studies even showing Pilates being superior over other exercise types.[5] The same was found for measures of disability.
Pilates has also been found to be a safe and effective rehab strategy for certain vulnerable populations such as pregnant women, helping increase their lumbopelvic stabilisation, reducing pain and disability, improving physical mobility - and even improving sleep problems.[6]
Moreover, clinical Pilates is something our physio team has great success with as part of an overall management plan for low back pain. We see clients with low back pain attributed to a wide range of causes, and under various circumstances - from postural pain to accident-related injuries, degenerative changes and more. Pilates also has a strong focus on any musculoskeletal and biomechanical contributing factors to low back pain, including:
- Erector spine muscles force and incorrect activation
- Decreased trunk and gluteal muscle strength
- Strength imbalance in the trunk and gluteal muscles
- Poor behavioural habits such as prolonged postures, spikes in activity loads
- Other psychosocial factors such as increased life stresses, work stresses, and the like
Pilates offers fantastic support and outcomes for all of these cases, while being suitable for anyone with no experience or knowledge of Pilates needed to get started as your physiotherapist takes the time to guide you through everything, step by step.
If you’re experiencing low back pain, start by booking in with one of our experienced physiotherapists across our Hong Kong Central or Wong Chuk Hang clinics by clicking here.
References
[1] https://www.sciencedirect.com/science/article/abs/pii/S0161475405003763
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630919/
[3] https://academic.oup.com/aje/article/187/5/1093/4557909
[4] https://www.mdpi.com/2079-7737/10/11/1096
[5] https://pubmed.ncbi.nlm.nih.gov/20671099/
[6] https://pubmed.ncbi.nlm.nih.gov/32986655/