Pilates – A Self-management Guide to Lower Back Pain
Low back pain (LBP) is reported to be one of the most common musculoskeletal health issues globally, with estimates from the World Health Organisation suggesting that almost everyone will experience a period of LBP at some point during their lifetime (1).
In 85% of cases, LBP experienced by the patient cannot be clinically diagnosed or associated to a specific pathology or nerve condition (1). And so, without establishing a clear diagnosis these cases are referred to as non-specific lower back pain (2). Periods of LBP can be short lived, experienced by all age groups, and can be influenced lifestyle factors, such as being increasingly more sedentary at home and at work, increasing rates of obesity and also smoking (2).
The National Institute for Health and Care Excellence guidelines advises that pain and disability from non-specific LBP usually lasts up to a few months and can recur again causing longer-term discomfort (3). However, there are a number of ways you can help ease and manage your pain and improve your symptoms in your every daily life, following these golden rules (4):
1. Your back is stronger than you think – LBP is very common and rarely anything to be worried about, 98% of LBP is due to a simple sprain or strain and will recover on its own fairly quickly.
2. Avoid bedrest, stay in work and gradually resume normal activities – try and remain as active as possible, research shows that long periods of rest can actually cause an increase in levels of pain, discomfort and disability.
3. Don’t be afraid of lift or bending – it’s not how we lift or bend, but the weight or load of what we are trying to lift that causes the problem. Don’t avoid doing it, just get your body used to lift different weights comfortably without over exerting.
4. Exercise and movement will reduce and prevent pain – with anything the key is to start off gently and build up your level of activity, to strengthen your postural muscles to prevent future episodes. The best exercise is something you enjoy and will stick to such as, going for a walk, a cycle or trying the Pilates exercises below at home.
5. Massage and manual therapy can provide relief – unfortunately at this present time due to COVID-19, we can’t offer our usual hands-on massage therapy techniques, but some self-massage or the use of a foam roller (see our previous blog) can help encourage blood circulation and reduce muscular tension.
6. Painkillers can help but aren’t the answer – you might find they ease your symptoms but should only be used short-term and alongside other methods such as exercise.
7. Good quality sleep – reduces stress and helps overall wellbeing, so you are less susceptible to pain in the first instance and are able to cope with it better when it does occur.
8. Back pain can happen without any damage or injury – it isn’t always just physical factors that cause pain, but it can be due to other things such as psychological, social, health and lifestyle factors. Try and monitor what aggravates your level of pain and what eases it.
9. Scans or surgery is rarely needed – scans can show degeneration of the spine which is perfectly normal for most, but it may cause undue concern and sometimes deter people from doing certain activities, which is the exact opposite to what they should do! Surgery often doesn’t provide any better results than non-surgical methods such as exercise, which should always be the first option.
10. If in doubt seek advice – if symptoms persist longer than 6-8 weeks then don’t worry, but it is always best to seek professional advice. If you have any of the following symptoms, then it is important to call your GP for advice:
- Difficulty passing urine or having the sensation to pass water that is not there
- Numbness/tingling in your genitals or buttocks area
- Loss of bladder or bowel control2
- Impaired sexual function, such as loss of sensation during intercourse
- Loss of power in your legs
Over the past decade there has been a huge increase in the popularity of Pilates used in healthcare for patients with musculoskeletal issues, especially LBP. You can read all about the history of Pilates and its pioneer Joseph Pilates in one of our previous blog posts.
Utilising the simplified Pilates method involves isometric contractions of the core muscles with the aim of improving strength, flexibility, posture and lumbar spine stability, predominantly performed in lying on your back on a mat (5). The body weight movements follow the six basic principles of: centering, concentration, control, precision, ﬂow, and breathing. You don’t need any equipment so it’s easy to do at home.
Read through the first Pilates blog post now if you haven’t already and watch the videos of the key principles before following the movements below. Try and do each movement for 8-10 reps at a slow and controlled pace, leading the movement as you exhale. If it is too difficult to start with do fewer reps and build up to it.
Hip Twist 1
Hip Twist 2
One Leg Stretch Level 1
Single Leg Slide Arm Raise
Following the important self-management guidelines above and working on your strength by completing theses Pilates exercises, you are one step closer to reducing your back pain and avoiding future episodes. You may feel some discomfort to begin with but start off gently and gradually challenge yourself in order to progress a little further - consistency is the key!
All of our exercise prescription photos and videos in this blog came from our clinical software Rehab My Patient.
- Mesner, S.A., Foster, N.E. and French, S.D. (2016). Implementation interventions to improve the management of non-specific low back pain: a systematic review. BioMed Central Musculoskeletal Disorders, 17(258), pp.1-20.
- Hartvigsen, J., Hancock, M.J., Kongsted, A., Louw, Q., Ferreira, M.L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R.J. and Underwood, M. (2018). What low back pain is and why we need to pay attention. The Lancet, 391, pp.2356-2367.
- National Institute for Health and Care Excellence. (2016). Low back pain and sciatica in over 16s: assessment and management. [Online] Available at: <https://www.nice.org.uk/guidance/ng59/chapter/Recommendations> [Accessed 9th April 2020].
- Chartered Society of Physiotherapy. (2017). 10 things you need to know about your back. [Online] Available at: <https://www.csp.org.uk/publications/10-things-you-need-know-about-your-back> [Accessed 9th April 2020].
- Campos, R.R., Dias, J.M., Pereira, L.M., Obara, K., Barreto, M.S.T., Silva, M.F., Mazuquin, B.F., Christofaro, D.G.D., Fernandes, R.A., Iversen, M.D. and Cardoso, J.R. (2016). Effect of the Pilates method on physical conditioning of healthy subjects: a systematic review and meta-analysis. The Journal of Sports Medicine and Physical Fitness, 56(7-8), pp.864-873.
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