What is it?
85% of people will experience lower back pain (LBP) at sometime in their lives.
A diagnosis may show that LBP is due to:
- A disc problem (disruption or bulge)
- Degenerative changes
- Spondylosis or Spondylolisthesis
- Scoliosis
- Facet joint irritation
- Canal stenosis
- Muscle imbalance or poor posture
Most commonly lower back pain is described as non-specific, that is, there is no diagnosable cause.
The relationship between diagnosis and pain levels does not always correlate.
What looks serious on a scan may not always be painful, and what appears harmless may cause considerable pain.
The Two Muscle Systems
The body has two separate muscle systems each with their own function. The two systems need to be working in synergy with each other to ensure efficient, safe movement. If one is overactive or underactive, the other will compensate for this. This over use and underuse creates muscle imbalances that lead to stiffness, pain and uncomfortable movement.
The Local Muscle System: Deep inside the body this muscular system sustains a continuous low level contraction designed to stabilise the skeleton while it does its thing. This systems role is to function to hold your skeleton together when a predictable (lifting a shopping bag) or unpredictable (dropping off the kerb suddenly) movement takes place.
The Global Muscle System: These are the muscles you can see and recognise. They are designed to move the skeleton. When they contract they pull on the bones to move them and then they release again eg, quadriceps, biceps and gluteals. The level of contraction will be dependent on the load or weight the joint is moving (ie: It increases with demand).
Possible Issues
If you have a specific diagnosis there may be different exercise prescriptions and treatment protocols based on that diagnosis. For instance, exercises that are good for someone with a disc problem would not necessarily be appropriate for someone with spondylolisthesis.
However regardless of the diagnosis or cause of LBP, there is one thing common to all sufferers. Research has shown that in the presence of pain the recruitment patterns of the deep stabilising muscles becomes scrambled, ie the local muscles. They may switch off completely or become delayed in their activation. This typically leads to global muscles taking over their job resulting in poor recruitment patterns, which often continue even after the pain is resolved.
Global muscles are responsible for movement. If we are stabilising with our global muscles and need to move what is going to support our spine?
Why Pilates?
During Pilates sessions, we can observe the muscle recruitment patterns of your body and retrain these patterns where necessary. Good recruitment patterns enable our bodies to work efficiently, giving good support to the spine and joints, and thereby reducing strain caused by overworking muscles.
The aim is to get the local core stabilisers switching on in a functional way and working well. We also want to learn to switch off any overworking global muscles that may have taken on a stabilising role, or become overactive out of habit, ie tight upper shoulder muscles that over work.
To achieve this aim, Pilates begins slowly and with very low loads. If you are used to a hard workout, this may seem a little strange. Local feels very different to global.
Once a good foundation of core stability is achieved, load is gradually increased to a level that is functional in your daily life and any special activities (golf, tennis, skiing etc).
Other Treatment Options
Sometimes in order to get the most out of Pilates it is beneficial to get some hands on treatment from an allied health professional.
Chronically overworking global muscles can cause pain and discomfort. Getting them to switch off or relax can sometimes be difficult, and you may benefit from massage treatment. Any unresolved back, neck or joint pain may require attention from a physiotherapist or other allied health professional to get your body to a point from which it will respond to, and benefit from Pilates.
Melissa Turnock
Pilates Instructor
I teach, I educate, I blog
www.PilatesScene.com - for the teaching community
www.PilatesSource.com.au - for us all
