Finding Back Pain Relief Through Pilates
I met a new client yesterday, and she told me a story that is not new to me. She explained how she had been suffering from chronic back pain for months. She had done the rounds with her doctors, done a round of physical therapy. Moved on to MRI and surgical consult. Her surgeon told her to spend three months doing “something to strengthen her core”, and then they would reassess. And that is how she ended up contacting me. Like I said, this is not the first time I’ve heard a story like this, and here’s why:
Back Pain is (annoyingly) super common.
Most adults will deal with back pain at some point in their life (statistically it’s about 80%), so if you’re working through it right now - you’re not alone! I know how frustrating it can be - pain that comes and goes, flares with stress, sitting, exercise…or no clear reason at all. I understand how overwhelming it can be, not knowing how to move or sit or stand without it hurting when it’s flaring. It feels like anything you do might make it worse. I understand the fear that comes with that. Because what’s at stake is everything. The way you move through your life every day is affected by back pain. Even when the pain is not super severe, the chronic pain over long periods of time can take a toll, physically and emotionally. So I want you to understand - I see you, you’re not alone, and most importantly - even if it feels like it - you’re not broken.
In recent years, I meet more and more people who are being referred to Pilates by medical professionals, from physical therapists to surgeons. It’s extremely encouraging to me, as I know from first hand experience how much Pilates can help with back pain. So let’s talk about what’s actually going on with back pain and why more and more doctors are recommending Pilates to help treat it.
Why does my back hurt?
A simple question, without a simple answer. First, not all back pain = injury. The reality is, there is a laundry list of reasons your back could be hurting, and your personal reason is likely a combination of factors. But here are some common culprits:
Sitting at a desk or for long periods of time
Weak deep core
Lack of spinal flexibility
Tight hips and hamstrings
Irritating movement patterns, repeated over long periods of time
Sedentary lifestyle
Spending too much time in poor posture
A lot of these can be related, too. For example, sitting for long periods can cause your hips and hamstrings to become tight. Having weak core muscles contributes to poor posture. You get the idea. Here’s the good news: Pilates was designed literally to improve these things.
Here are the real reasons physical therapists love Pilates:
1. It builds and strengthens your deep core muscles.
When you think of core muscles, you probably think abdominals. While abs are part of the picture, they're not the whole picture - and there are probably more abs than you think. We typically think of the “6 pack” abs, which are the most visible ones because they are closest to the surface. This is the rectus abdominis, and its main function is to help you bend forward. But the rectus is not alone. You also have internal and external obliques, which help with side bending and twisting. And underneath it all, you have the transverse abdominis. I like to compare this with a fitted sheet on a bed. It’s underneath everything else, and plays a big role in stabilizing your spine and literally holding all your organs together. You can have a nice 6 pack rectus abdominis (like a pretty comforter), but without a strong transverse everything is falling apart underneath. I also include all the muscles of the back in the core muscles, because to me the deep core is doing the work of moving and stabilizing the spine. So the back muscles would definitely be included in that, and there are plenty of them. There are the bigger, more superficial, ones that you’re probably familiar with, like the latissimus dorsi (or lats) and trapezius (traps), and there are much smaller ones as well that are deeper and closer to the spine, like the erector spinae (which is actually a group of muscles). I don’t want to get too deep into the weeds of the anatomy, but suffice it to know there are a lot of muscles going on back there. I also loosely include the glutes in my definition of the core, even if it’s technically a lower body muscle, because it plays a role in moving and stabilizing the pelvis - which is going to affect the spine. (Turns out, your whole body is connected and so it’s actually really hard to isolate one part or section).
Pilates was designed to prioritize the work of these muscles while working the rest of the body - working them on purpose instead of as a side effect. By strengthening all of the core muscles, you will be able to use them to create a strong muscular brace around the spine - a literal support system that protects your spine from external loads and sudden movements as well as maintaining good positioning and alignment in the spine. This is what we mean by stabilizing the spine.
2. It teaches spinal mobility and articulation
While stabilizing the spine is important, being able to move it is equally important. The core muscles are not done with their work once they can successfully stabilize the spine - they must also work to move the spine. We want our spine to be stable but not rigid, meaning holding it still is a choice - not a place we are stuck in.
Spines can move in many different directions, but if we don’t practice moving them they can become stiff and sticky and lead to back pain. Pilates will train you to bend your spine forward, backward, side to side, and twist. By using the muscles of your deep core (and a bit of concentration), you will start to find more articulation in your spine.
Articulation means making each piece clear. In this case, the “pieces” are each individual vertebrae. If we think about bending (forward, for example), we might start at the top of the spine and try to bend forward from each vertebrae, one by one. You will need your core muscles to make your spine bend, and to stabilize what isn’t bending yet. Articulation means each bone waits their turn! By articulating the spine, rather than just bending it all at once, we find the areas of our spine or surrounding muscles that aren’t as mobile. Working in that specific area will help strengthen the core muscles in that spot, as well as increasing the flexibility of the spine in that spot. Plus we get the added strength of the muscles that we are using to stabilize the rest of the body simultaneously.
3. It improves alignment without forcing posture.
I think everyone agrees that having good posture is important. But that doesn’t mean you must always be in good posture (I’m absolutely slouching right now as I type this, and I’m not worried about long term consequences). Moreover, what even is good posture?
My sense when talking to people about posture is that most people think it has something to do with the shoulders. I hear a lot of “I’m working on keeping my shoulders back”, or “I really must remember to keep my shoulders down”. While the shoulders are definitely part of the alignment we are looking at to assess posture, they're definitely not the whole picture.
Posture is really about the entire spine, and the spine is connected to and affected by the pelvis - meaning that is where the foundation of your posture begins. The shoulders respond to what is happening to the spine. In Pilates, we will start by looking at the placement and movement capability of the pelvis. If there is tightness or weakness that prevents you from accessing a neutral position, or is causing you to be stuck in one position, the exercises done in Pilates will help restore it. This doesn’t mean there is one exact, perfect position that is Neutral, and everything else is dangerous. We just don’t want to be stuck anywhere.
Let’s look at sitting as an example. Many of us tend to sit with a little bit of a posterior pelvic tilt, or what I like to think of as a “tucked” position. It’s where you’re not sitting all the way on top of your sit bones, you’re a little behind them. Your butt is probably a little forward on the chair while your back rests against the back. It creates a flattening of the lower spine (which is typically slightly arched, which then causes the upper spine to round forward more than usual to keep the body balanced. This will in turn encourage the shoulders to round forward. It’s how I’m sitting right now, and it feels fine.
But if we sit like this for hours at a time, day after day (sorry, desk job people), the muscles around the spine will start to get used to it. The hamstrings and hip flexors can become tight because they are being held in a shortened position. The back muscles will become more used to rounding forward, and become weak as they’re not asked to pull back. So yes, we will notice that shoulders need to go back, but they can’t go back (and be able to stay back), until we look at the whole chain. If we can upright the pelvis, the natural curves will return to the spine without overexaggeration, and then the shoulders will be able to slide back into place. Depending on which muscles are tight and weak, this might be a process that takes some work. But Pilates is where you go to do the work.
4. It strengthens the whole body, not just the core.
In Pilates we have a saying: “work what works”. Sometimes it is our efforts to try to directly “fix” the problem that end up making the problem worse. We have to remember that the body is an interconnected system, so the other areas of the body will impact the affected or painful parts of the body. When we ignore the rest of the body and just give exercises to work the injured area, we may end up making the pain worse because we are neglecting the rest of the body and possibly overworking and irritating the painful part. Pilates takes a holistic approach to the body, working systematically through each joint of the body and moving through the different planes of motion. By shifting more focus to the areas outside of the injured or painful area, we can create a larger base of support for the injury, giving it the time and space to do its own healing thing. This will also ensure that all the muscles are participating in the work as they should be. Sometimes things hurt because they are compensating for weakness in other muscles that should be helping carry the load. This philosophy can be applied to any injury, but is especially effective for back pain.
5. It’s low impact but still challenging.
Pilates is designed to start each session in the most supported position (usually lying on the back) and gradually working its way to more vertical and less supported positions (like standing). Your instructor will be able to pick the appropriate positions and exercises for you that will challenge you while still supporting you. Designing the workout this way allows you to work each area of your body and each range of motion with more support at first, and then gradually less support as the body is able to tolerate it. The apparatus can also be incredibly supportive - a place where you can physically be supported and introduce load from springs as it becomes available. This is a great way to begin to add load without over stressing the back. This is why it’s a great place to start if you are working toward getting back into other activities. It allows you to strengthen without going too hard too fast, which would ultimately set your recovery back. Working a progressive Pilates program will give you the strength, flexibility, coordination, and confidence you need to get back to whatever it is you love to do.
Why Classical Pilates is especially effective:
Not all Pilates is created equal, and if you’re looking for the Pilates that will actually do what I’ve been describing so far, you need Classical Pilates. Many methods out there call themselves Pilates, but what they teach varies broadly. The best way to know that you’re truly doing Pilates is if it is explicitly classical.
Real Pilates (classical) follows a progressive, thoughtful order of exercises. This means that within each session, each exercise is preparing you for the next. From session to session, you will repeat exercises, building strength and skill, and add new exercises as your body becomes ready for them. This decreases the chance of further aggravating your back pain, and creates the change needed in your body to reduce your pain.
Real Pilates keeps the focus on your body and the skills you are learning - rather than focusing on how creative you can be with exercise choreography or how to use the apparatus. Each apparatus is used for a specific purpose, offering the body support and resistance in a controlled way. When the focus is on creativity, you are more likely to do something your body isn’t ready for.
The reality is, addressing lifestyle factors and body imbalances that are causing back pain isn’t a quick fix. It takes time and consistency with the right program. This is why going to the doctor or even physical therapy often doesn’t solve the problem and can leave you frustrated and unsure where to go next. Pilates can give you guidance and a plan without an expiration date. Unlike physical therapy, you can continue PIlates for as long as you like!
When Pilates is (and isn’t) appropriate:
First and foremost, Pilates is not a substitute for appropriate medical care. If you are feeling pain, it is best to check in with your doctor first to rule out more serious injury. You should also have a doctor’s clearance before beginning any workout program, including Pilates. All further advice operates on the assumption that you have seen a doctor and have clearance to practice Pilates.
If you are in acute, severe pain, you may want to wait until it has calmed down some before starting Pilates - but just enough to make it feel tolerable. When we’re in pain, our instinct is often to just rest and wait for it to feel better. But too much rest can actually make it worse. Our bodies are made to move and sitting still can make us even tighter and weaker, leading to even more pain.
Given you have a doctor's clearance, Pilates can help improve all types of back pain. Pilates can be especially helpful for:
General low back pain
Chronic tightness
Postpartum back pain
Disc issues/spinal stenosis
Post PT strengthening
Back surgery preparation and recovery
How Pilates helps long term (the part most workouts miss)
Pilates can help manage back pain long term by improving the alignment and function of your body. It retrains how you move throughout the day. It builds endurance in the postural muscles, allowing you to spend more time in better posture. It makes bending, sitting, standing, and lifting easier. The strength, flexibility, and stamina that you gain through your Pilates practice stay with you even as you resume your normal activities.
Pilates is also a practice that you can stay with or return to over time. The best way to retain the skills you learn in Pilates is of course to keep practicing. But even if you take a break from Pilates, it’s always there for you to return to if you’re starting to notice little aches and pains creeping back in.
How to get started:
If you’re beginning Pilates with back pain, start gradually and focus on quality over intensity. Here are some things to keep in mind:
1. Begin with a 1:1 session or beginner friendly class.
A 1:1 session is the best place to start because everything, from exercise selection to the pace of the session, will be tailored to you. Your instructor will be able to focus all their attention on you and ensure that you are doing the exercises correctly. If a 1:1 session isn’t available to you, a class that is specifically geared toward beginners can be a good option (go for the beginner level, even if you have prior Pilates experience).
2. Look for a classically trained instructor.
The classical system is structured, progressive, and designed to support healthy movement patterns. An instructor with classical training will also have training specific to back pain and injuries.
3. Communicate what you’re feeling.
There isn’t a cookie-cutter, one-size-fits-all approach to back pain, even with Pilates. Your instructor will modify your session, exercises, and cues based on your experience. Don’t be afraid to say if something hurts or feels strange, or feels good! What works for you might be different than what works for someone else.
4. Stay consistent.
With any physical practice, you will see the best results with steady, repeated practice. Pick a frequency that you can stay consistent with, even if it’s only once a week. Consistency matters more than intensity.
If you’re looking for a comfortable starting point, I offer virtual 1:1 sessions that will meet you wherever you are. Contact me for more info or to schedule a session.
Back pain is common, but it doesn't have to be permanent - and you probably have more control than you think. Pilates can be a great place to begin the journey of becoming pain free.