Pilates with back pain

Pilates is nearly a hundred years old, and so far has been a useful tool in different kinds of health rehabilitation scenarios. At our clinic we use Pilates techniques with nearly every patient, and over the years have seen how Pilates routines have helped hundreds of our clients in their various injuries’ rehabilitation.

In the context of the spinal health, Pilates maybe one of the most effective and straight forward methods for the direct spinal health restoration. It addresses spinal mobility, stability, nourishment, flexibility, balance, coordination and strength.

In the essence, Pilates is a CORE WORKOUT, and all spinal dysfunctions (except some traumatic accidents) are the result of some sort of weakness or imbalance in the core muscles (diaphragm, pelvic floor, abdominal and lower back musculature, and hip flexors and extensors). The core of all spinal problems is in the core musculature (pun intended), and Pilates is one brilliant approach for dealing with that!

However, not all Pilates forms are suitable for spinal rehabilitation, and not everything in Pilates is safe for your spine. Some of the forms are not advisable for beginners, and should only be practiced at a higher level of experience in a controlled and safe manner.

Pilates evolved over years and branched out into many forms and directions. In this article we are not aiming to overview all of the latest Pilates trends, but only go through the classic 36 forms, and name the ones that could pose a risk for you if you are recovering from some sort of spinal problem. We will also briefly mention the ones that can improve your spinal health. So here comes the ‘small print’…

How can Pilates cause or aggravate the existing spinal problem:

  • THE HUNDRED. To perform this exercise safely you need substantial core strength and endurance to begin with. The perfect form of it involves hollow abs, spine ‘imprinted’ into the floor and legs at 45” off the floor for the entire duration of your hundred pumps. Lose that form at any time and your legs will start lowering down, pulling on your Psoas muscles attached to your lumbar spine. Weight of your legs, transferred onto your lower back by forward pull of the Psoas, will make your lumbar spine painfully arch, making it more uncomfortable and dangerous with every ‘pump’. If you persist – pain strengthens, and you are risking flair up that will take you out of business for few weeks – you’ve been warned! Also, a very easy form to strain the muscles of the front of the neck, or send them into spasm – this won’t feel good…
  • ROLL-UP. Again, not a beginner material – experience, strong core, and flexible back is needed to execute it perfectly. Ideally, you are starting with hollow abs and spine imprinted into the mat. Then, like a bicycle chain, one link at a time, starting from the neck, you are rolling your torso up and extending hands towards your toes, before rolling back on the floor in the same controlled manner. What could possibly go wrong? If your abs aren’t strong enough, or your back doesn’t like to flex forward (or both), you’ll try to lift your straight torso up (instead of rolling) – using the force of your Psoas muscles. The ‘pull’ is substantial so will be the pain in the lower back.
  • ROLLOVER. Involves you lifting your two straight legs off the floor, and taking them up through a 150” range, so they point over your head for a moment before returning all the way back on the floor. If you can do it in a smooth controlled movement pattern with hollow abs (navel to spine type of engagement), and spine imprinted into the floor throughout the entire range – you’ve nothing to worry about. Simple! If you, on the other hand, fail any of these conditions on the first 45” of the lift (or on the last 45” of lowering down), you’re likely to combine the problems of the first two exercises above, and spend next few weeks shivering every time anyone mentions the Pilates to you.
  • ROLLING LIKE A BALL. No, this one poses no risk for your spine. In fact, it is actually quite good to roll out the stiff and tight back muscles once in a while. Suck the tummy in hard, round your back into a ‘C’-shape, and roll away. When initial achiness wears off it feels ok (bitter/sweet type of a feeling). Use good padding on the floor, and the good form of execution – watch video here.
  • DOUBLE LEG STRETCH. Keep the tummy hollow (pulling navel to spine) and have your spine imprinted into the floor. Do not lower your legs below 45” if you’ve had a back problem before or have some pain in the back now. Do not strain the muscles of the front of the neck (don’t flex it forward, but have a fixed space between your chin and the chest throughout the movement). You are only allowed to lower your legs all the way to the floor when you can do it without arching your lumbar spine (i.e. spine imprinted into the mat) – probably not feasible for a beginner. If you fail the perfect form of execution, expect troubles similar to the ones you get with improper form of ROLL-UP and
  • DOUBLE STRAIGHT LEG STRETCH. Effectively, a harder version of DOUBLE LEG STRETCH, everything what was said above is even more relevant here, including the ‘punishment’ for improper form. Master the DOUBLE LEG STRETCH first, before moving on to this one, so you will have enough core strength and control to do it safely. Also do not pull your neck forward with your arms – that may cause serious damage. (Tip: do not interlace your fingers behind the neck; instead have those at the temples – so you can’t pull your neck even if you tried).
  • OPEN LEG ROCKER. Generally a good fun. Avoid if you’ve had a strain or sprain in the lower back recently, as you may pull your legs with your arms too hard as you gather the momentum in the roll.
  • DOUBLE LEG CIRCLES (CORK SCREW). Needs really strong core and abs, plus full control of all the body parts involved (which are the whole body). The danger is in the weight of the legs on the eccentric phase of the movement (when you’re lowering them down). If you lose control, or your eccentric core strength isn’t up to the task, you’re risking picking up the speed (momentum) as you lower your legs. That can cause a nasty strain, or even sprain in the lower back or Iliopsoas muscle group. This pain is sick (for long).
  • SWAN DIVE. With healthy back, low to moderate risk, and ‘illusive’ benefit. With any type of lower back arthritis, facet joint inflammatory issue, or spasticity of the lower back muscles – risk to aggravate the existing condition is higher, benefit… still illusive.
  • SINGLE LEG KICK. Another ‘semi-effective’ exercise – doesn’t have much of a tangible benefit (doesn’t carry any serious risks either). If you going down this road firmly imprint your forearms into the floor, strongly engage the abs, and never lose your core control during the kicks.
  • DOUBLE LEG KICK. Semi-effective, no real benefit in terms of health or fitness, but with a much higher impact on the lower back’s spinal joints (i.e. it is easier to hurt your back doing it).
  • NECK PULL. First things first: NO NECK PULLING!!! Have your fingertips at the temples and elbows wide to ensure that. Also have your spine imprinted into the floor and slowly roll it up (segment by segment) starting with your upper back. Smooth controlled movement forward until your elbows are at the level of the knees, and even more controlled eccentric phase, when you’re rolling (unfurling) your spine back onto the floor. It is an advanced move requiring strength and skill, lose control, let the movement become jerky, and see what happens…
  • SCISSORS. Requires solid control, balance, and coordination. Abs and core muscles should be fully engaged to prevent the lumbar spine from overarching due to the pull of the weight of the ‘back leg’. Palms are under the glutes, supporting the hips (not the lower back), and elbows with the backs of the upper arms, shoulders, and shoulder blades are firmly on the floor supporting the weight of the body. If, alternatively, the weight of the body falls on the upper back/lower neck region – the exercise will become too harsh on the neck. Other than that, no serious risk for the spine, frankly, you are more likely to strain your wrists here than anything else – take notice.
  • BICYCLE. Everything said for the SCISSORS (above) is 100% relevant here.
  • SHOULDER BRIDGE. A really useful tool in spinal rehabilitation and is used in our clinic quite often. Gets technical and not easy to grasp – learn it from a coach (or book with us) to ensure the proper form and full benefit from it.
  • JACK KNIFE. Requires strength, power, core control, balance, and coordination. Not a beginner material. Neck is easiest to hurt here, then lower back. If you are beginner, do it with a coach (or spotter), if you’ve had any lower back issues recently – give yourself a couple of months working on less advanced movements to build up strength and confident control and balance. In case of any neck issues – avoid altogether.
  • TEASER. You need solid static balance, core/trunk strength and control, and flexible lower back. If you have the fitness components just outlined you should be fine: start with smaller amplitude (even few inches is good enough, as long as it is a fully controlled movement), then proceed with reaching your hands farther, then lowering your trunk lower. At no point allow your legs to go down lower than 45” – your lumbar spine will be under strain from the pull of Iliopsoas muscle group, and this fun exercise may become really uncomfortable. If you are recovering from some spinal problem at present, you probably won’t have enough of freedom (flexibility) in your lower spine anyway – leave this exercise out for a while (until you can comfortably do sit ups would be a good guideline).
  • HIP CIRCLES. Generally OK, however, avoid for few months if recovering from a back injury or flair up at the present moment. Come back to it when you can comfortably do THE HUNDRED.
  • SWIMMING. Generally OK, we often use it in some of our back rehab programmes. Wouldn’t be in a hurry to do it first thing after back pain flair up, but a nice one for when you’re already on the mend. To avoid straining the neck, stare at the floor while doing it.
  • LEG PULL FRONT. One of the ‘popular’ exercises in our back rehabilitation programmes – make sure the execution is flawless (for the full benefit), and off you go!
  • LEG PULL BACK. A great posterior myokinetic chain of muscles enhancement exercise. What makes it dangerous is lowering the head back and extending (back-flexing) the neck to its extreme from this awkward position. If your posterior chain muscles are in good form and you are in full control in this pose, then the risk is minimal. However, any weakness in trapezius, rhomboids, triceps, or posterior deltoids won’t let you to squeeze the shoulder blades and lift the chest out providing for the smooth entrance into the pose. In this case you are likely to lead your body into the pose with powerful neck extension movement which will jar the facet joints of your cervical spine, and with time, cause permanent damage to your neck. If you recognise yourself in this situation – keep the chin tucked in throughout the pose and don’t attempt any backward movement of the neck until you are done. Really small compromise and removes the risk completely.
  • THE TWIST. Often used in our back rehabilitation scenarios, but on the later stages – when pain is long gone, and trunk control restored. Requires strength, balance, and coordination (also builds these factors, if performs regularly). The correct positioning of the wrist of the weight-bearing hand is crucial. Strain the wrist, and it will take about a month for it to recover enough, so you can come back to enjoy THE TWIST again.
  • BOOMERANG. It is as sinister as it sounds (good fun though). If you are recovering from any spinal problem, or have had one in the last year and a half – avoid completely.
  • SEAL. Another variation of the ROLLING LIKE A BALL – nothing is wrong with it. Requires better core control and gets deeper than ordinary roll, may be useful in back rehabilitation. Worth a try when ROLLING LIKE A BALL becomes too easy.
  • ROCKING. Is there safe way of performing it? No. You might be getting away with it for a while, if you are naturally (genetically) bendy backwards. But if you’re recovering from any type of a back problem at the moment (or have had one in the past) – wait for trouble. Because it will come. Avoid completely.
  • CONTROL AND BALANCE. Teaches balance and coordination. Improves hip flexor flexibility, and enhances the core strength. Wouldn’t be the first choice straight after the injury, but may be useful on the later stages of recovery – when pain is largely gone. May be harsh on the neck, if experience neck troubles while performing this form, consult with us to modify the exercise so we can spare the neck any further trouble.
  • PUSH UP. Generally a good whole body conditioning exercise, but not suitable for the first 2 months after the back pain episode. As a rule, you can proceed to this form when you can comfortably do the Toe Touches (or Flexion in standing)
  • Deep muscle stretch in the side trunk flexors, enhances mobility throughout the spine, and at the hip joints. Can be useful in physical therapy. In case of a disc bulge (or protrusion, or herniation, etc.) consult with us to modify this exercise to your condition.
  • SPINE CURLS. Effective for back pain and stiffness, not a classical Pilates mat exercise. Good for segmental spinal alignment, enhances the segmental control in the lumbar spine (lower back), activates the intrinsic para-spinal muscles involved in the fine spinal coordination. A little technical, not easy to grasp at times, watch the video with explanations here: Pilates spine curls

So here was a brief overview of some Pilates forms that we thought would be worth mentioning in the context of spinal rehabilitation. Most of the forms can be performed safely and benefit your spinal health, but if you are recovering from a spinal injury, or have some chronic back problem – we advise you to come and see us, so we can design your own Pilates routine, that is going to strengthen your back, eliminate the back pain, and make you fitter and healthier in the long run.

Pilates for lower back pain and sciatica


Your own physical condition and diagnosis may require specific modifications or precautions. Before undertaking any course of self-treatment you should consult a doctor or physiotherapist.

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