Want Back Pain? Try Pilates

5 Comments

1. Oct17

   Anisa

   Great Blog Dewey. You made some great points.
   I would be interested to hear what you think of Yoga, and is it in anyway comparable to Pilates?

   Proud of you little brother!
2. Oct21

   dewey nielsen

   Yes, there are movements I see in yoga to be of concern. The biggest would be trying to increase rotation of the lumbar spine. A big NO NO!!
3. Oct28

   Don J

   Just happened upon your Blog when performing a search and found your comments on Pilates and back issues/mechanics. Whew! Where do I start?
   I guess perhaps by saying that my perspective was similar to yours earlier on in my career when I commented on Pilates without truly understanding the methods laid down earlier by Joseph Pilates and standardized by innovative thinkers and integrators since his passing. Now there is a lot of very bad teaching (and understanding) out there in all disciplines,which can cause misleading points of view. I see this profoundly within the Personal Training arena. This is something dear to me and I would love to see this noble advocation become a respected profession. I wander, sorry.
   A basic tenet in Pilates is that body control + body or part awareness equals Precision of Movement. This is in itself a brilliant statement. Pilates was not called Pilates during his life, he termed it “Contrology” originally and was pretty brutal in his brilliance. He trained his clients crushingly hard yet his intuitive genius into the movements of the body were decades ahead of there time. The equipment he pioneered is astounding to this day. So let’s take a look at one of your statements;
   -”The big problem I have with pilates is the fact that it requires bouts of repetitive flexion.”
   Well yes there is flexion within many of the Pilates movements as there are movements in all the six degrees of freedom (and the infinite combinations therein). What most people do not realize is the inordinate amount of control that (should) goes into the teaching and execution of the movement. For example, a basic but not easy to properly achieve C-curve position where the head, shoulders and first part of the thoracic spine/shoulder girdle complex curls off the mat from the supine position. During this maneuver an enormous amount of volitional control is being applied. Just a few to mention would be that the lumbar spine is kept in a neutral position defined by that individuals excursion ability defined by their anterior to posterior tilt ROM(and vice versa). Neutral spine and neutral pelvis are different as well. Many would believe that the c-curve is initiated and accomplished by the upper pole of the rectus abdominals but not true. There origin is too short upon the costochondral cartilage, sternum and ribs. Yes they do do the work in a gross (not ugly!)movement like the crunch but they cannot control the upper thoracic flexion that constitutes the C-curve. That must be accomplished through bilateral contraction of the latissimus dorsi or as we fellows of the iron like to call them, the lats. There insertion in the humerus allows for this action, all the while maintaining non-movement of the chondral rib borders toward the ASIS’s. The intrinsic/extrinsic lumbar muscles of the lumbar spine MUST be kept on actively against the forming c-curve (a key volitional engagement and not the willy, nilly unopposed flexion that many believe occurs) and natural or dysfunctional inclination to lose the anterior lumbar curve and allow for a flat back to occur. IT IS HERE that we would see movement toward what you see as an over abuse of lumbar, and point in fact, spinal flexion. The vast majority of practitioners of Pilates have never really understood this but make no mistake there lack of recognition makes the concepts no less true or valuable. It does however add to poor perspectives.
   There’s just too much to talk about.
   Back problems, specifically in the lumbo-pelvic area are mainly manifestations of dysfunctional loss of unconscious systems (intrinsics, mainly with overuse and asymmetries of compensation by the extrinsics often leading to atrophy or non-exercise induced hypertrophy) and even this is more a manifestation of loss of functional brain based neurolgy not local lower neuron/joint neurology dysfunction. Yes we can have disc disease and degeneration from aberrant mechanics mainly do to intrinsic muscle control issues of the motor segment from the contractile, non-contractile (lengthened/shortened ligaments,etc), intra-joint function (intervertebral disc and facet joints [synovial fluid viscosity change (within the facet) due to restriction/fixation of movement, poor action of the synovial pump mechanism from movements such as flexion/extension, etc]) but we would have to have had, without trauma, a timely period of poor nutrition, perhaps some familial genetic weaknesses,and movement dysfunction/static overload of area. Sitting too much (in flexion) without counterbalanced extension or the extension placed into the system by (proper) walking mechanics. This is one reason why Mckenzie extension therapy is so powerfully effective in treating disc issues. Just a thought it is flexion/rotation with uncoupling in the spine that is often seen as directly damaging the Intervertebral disc tissue. Theoretically occuring through changes in IAR’s (instant axis of rotation) from a probability clous in bone to a disseminated cloud within the annulus fibrosus. I know too much info. but it was just a throw in.
   So another cool look at what Pilates can offer when truly understood and examined within the thoughtful execution of the movement and as we evaluate it within the light of the last 20 years of biomechanical/engineering research. Consider a simple prone extension. Lying prone upon a mat with arms extended forward an individual maintains feet upon the ground and begins to lift the head and upper trunk/shoulder girdle w/projected arms off the floor all the while attempting to lengthen through the spine (this is where those long lean muscles come in and yes YOU CAN utilize eccentric contraction lengthening along with directed imagery to render a gestalt lengthening thereby forcing load over a longer contraction period of the levered muscle length. I like this far better than CRAC, PIR techniques, active release etc. except where there is scarring, fibrosis or functional/pain related inability to achieve the movement. You are correct though on the lean part. Eat like a pig and do pilates and you may end up a longer pig.
   Now back to the prone extension. If you don’t examine the INSTRUCTIONS given in order to achieve this maneuver you can never appreciate the revelations that lie within. As you know when you contract your bicep muscle the tricep must relax in order for the joint to move. We have no control over this and it is called reciprocal inhibition. However, in the spine we can over-ride this through conscious control and allow a dynamic system of opposition to occur. When the back muscles are engaging up to lift the upper trunk, neck and arms off the floor the individual has (should have) been taught to continue active participation of the rectus abdominus against its antagonist. So while the trunk extensor muscles shorten the rectus are being creamed as they eccentrically lengthen begrudgingly in what I call a “tug of war” of the spine. The back muscles will win because they are inherently stronger but what occurs during this stunningly difficult to achieve movement is a resetting of both neurology and counterbalancing of mechanics while strengthening against the antagonist. Much back dysfunction comes from uncoordinated activities between antagonists or even synergists. There is so much more here but I’ll have to let it go at this small window. Remember there is usually more than what we believe to be true. Investigation and sometimes immersion are the only ways to become aware whether it’s knowledge based, experiential or both.
   Before I sign out, and thank you for the opportunity to speak, I want to address the Stuart McGill and the navel to spine controversy. This has been such a burr in my side and I should have wrote the NY Times and others but alas I did not. First let me say two things, I am a BIG fan of Mr. McGill and have had the fortune to be in his presence at least one time in seminar. He is perhaps the leading figure in biomechanics of the lumbar spine in the Western World. Unfortunately I think there is a grand mistake being made here. In McGill’s books as well as the articles we see references to the abdominal vaccum and he associates this with transverse abdominus (TA)activity (which there is of course)but it also involves the diaphragm and rectus muscles, rib intercostals, etc, etc. There is also the poor term (in my humble opinion) of “scooping” the lower abdominals to involve the TA that is used within the Pilates arena by its practitioners. It’s not a bad term but needs to be defined better for use, I believe. The problem here is not performing “discreet” contraction of the TA by itself. Unless taught, most people engage both the RA and TA together and it is here we see that earlier definition I used come back to us. If you are not aware you cannot control (be discreet)the body (part) and have PRECISION OF MOVEMENT. We can visually observe TA activation by the slight drawing in of the abdominal wall because of the TA attachments to the lateral raphae of the RA. THE KEY is that the RA are soft(not contracted) and NOT ENGAGED. As Stuart points out the rectus abdominus will bulge out, normally, during concentric contraction of the muscle group. The reason I believe there has been an oversight is that the original research of McGill fly’s in the face of others who have researched the role of the TA. Also the participants used in the EMG study were good old Americans used to sitting around and even if exercise were a part of their lifestyle proper core dynamic training and integration was not a part of it. So we may assume there TA was poor to begin with and concluding that the TA was not strong enough to create a posterior pelvic tilt based upon its ASIS attachment was interesting but I believe it took us away from the real roles of the TA. First that this “trip-wire” thin muscle is tree like investing itself into so many parts of the lumopelvic core from the lateral raphae of the RA, to deep penetration in the spinal muscles, connections to the thoraco-dorsal fascia, intercostal musculature and ribs,diaphragm(!), yikes!. Secondly due to its trip wire like nature I view the TA as a neuro-mechanical feedback and feed-forward system. Not only by its tethering to the muscles of the core from a purely mechanical perspective when it is functioning normally allowing for a “heads-up” scenario when movement is about to and also while it occurs but from a purely reflexogenic feedback to chord level responses and upper neuron, cerebellar and higher functions. It is a massive and sensitive coordinator but when it is weak, lengthened and/or dysfunctional our core must lose performance parameters. I believe in the article (I’m doing this all by memory)it talks about personal trainers conditioning there runners with exaggerated navel to spines that appear more like vacuums but either way would (with 50% TA contraction or more) lock up the core and DECREASE PERFORMANCE. Of Course!!! There teaching knowledge shows itself poorly here, unfortunately and the whole idea of the TA goes into the drain with the bathwater!
   One simple way of integrating TA with core dynamics is to engage TA (minimally, just bring it up to awareness, and let the client feel the ventral wall pull in {By the way I never teach a straight draw into the spine because it’s wrong. This is yet another example of something that is not being taught. That exercise/training is about re-programming the command or put another way choosing how we tell our brains how to perform a movement instead of leaving it up to the evolutionarily calorie sparing and what works easiest portion of the very important jelly inside our head!} Remember it’s all about the contraction. But that discussion would be for another time (if I haven’t bored all to death yet!) Ok, back to the TA. By engaging the TA thusly we have made a controlled region of steady intra-abdominal pressure, that same area by the way that decompresses and blows out discs by over-pressurizing the intrathecal space of the spine! If I have a client perform some spinal flexion utilizing the RA and I have them maintain or increase there TA activity in order to limit the loss of the abdominal wall to popping out I have achieved not only a strengthening of the TA but also a maintenance of the ventral abdominal wall under pressure (just like those weight and ergonomic belts out there)and to a minor degree (movement is not complex) created a concerted harmonic with other core constituents. Additionally if I engaged pelvic floor muscles simultaneously I would strengthen them through there need to resist increasing intra-abdominal pressure. If I had the client inhale also, driving the diaphragm deeper into the cavity I would have increased the pressure further (like a French coffee press)AND engaged another dynamic player within the core.
   So little to do and so much time! Wait reverse that. (W. Wonka)

   I am a firm believer and teacher of these and other principles both well known and those perhaps not yet appreciated. I don’t know if this was helpful but I tried. It certainly was not meant to spread hate but hopefully some open discussion.
   Just to know something about me. I have practiced as a Chiropractic Physician for almost 20 years (though I have not had a traditional “practice” now for 7 years) with post-doctoral education in physical rehabilitation (studied with Vladimir Yanda, etc), brain based functional neurology, clinical biomechanics, advanced functional nutritional medicine/diagnostics, etc. etc.
   Though for the last 7 years I have developed both an integrated Wellness Model and Life Model(book coming). I developed a Wellness Center in NJ that ran for 5 years (high end area) but we are now going to implement the Wellness Model within a specific type of medical practice (top secret)and hope to branchize this template throughout the US. We sorely need a unifying Wellness Model many believe this is it from all fronts, knowledge, financial, integration, standards, etc.
   I mainly work with private clients (CEO, business, etc types)from training, to rehabilitation, to nutrition/dietary lifestyle, Life Model coaching, etc. I have developed some patents, new businesses, lots of innovative concepts, proprietary training methods, New Golf swing Model (some believe I have figured out the missing links (pun intended) of the Golf Swing. It’s pretty cool stuff and I don’t play golf!, etc. I HAVE yet to write about any of it though perhaps because I have never had the correct platform or perhaps I just want to stay innocuous. But I think it’s time to begin after so many years of developing in a vacuum. I have never written in a fitness related blog before so that’s something.
   Some call me a Wellness Guru and my one partner, an MD and great friend, calls me a Physical and Spiritual Guru. I’m not sure what the hell I am anymore but I do know that after many, many years I and those around me are moving these applications from the rich to the masses where it is truly needed.
   Thank you again for the opportunity to ramble. Feels good.

   If you want to reach me for further discussion, which I would enjoy, then send to DrDon@livelifetobecome.com or livelifetobecome@gmail.com

   Thanks again and Create a great day.
4. Oct28

   dewey nielsen

   Don J,

   Thanks for posting. The length of the post was a bit shocking. I did not take any of it as hate. I do think there is some confusion on my opinions.

   I DON’T think we are on 2 completely different pages here?? I agree with most of what you said. I do think we need to recognize eachothers jobs. I think in doing so, we can have a clearer view on eachothers opinions. I am a strength coach. I see you are a Chiropractor. (Very cool you got to work with Janda!)

   First let me congratulate you on being a Guru. I will be honest, I am not a Guru nor do I have any friends or colleagues that refer to me as such. So I guess there is no pressure on me here

   I don’t think of blogging as writing a book. I feel it is current thoughts, short and sweet. Hence why I said not everything in Pilates is bad.

   I am not a fan of repetitive lumbar flexion exercises. Risk/Reward?? “Repetitive flexion-bending of the spine is necessary to cause herniation”, Pg.69 Ultimate Back Fitness and Performance third edition Stuart McGill. I feel it is far more necessary to teach someone how to anti-extend and anti-rotate at the lumbar spine. I am not referring to Mckenzie protocols here. For lack of a better term, I am talking about “core training”. Core stability with progressions towards stabilizing within dynamic movement patterns is of the most importance to me. I do not feel repetitive flexion exercises deem a place in my programming.

   Just like personal trainers………show me one good pilates instructor and there are 1,000 poor ones that follow. Obviously this is where the big problem is.

   I can’t see where I said “you cannot eccentrically lengthen a muscle”………..That would be ludicrous. The statement that you will build long lean muscles is echoed throughout group fitness (pliates being one) is a rediculious marketing statement. It is false to tell someone that *insert training style here* is going to change the insertion and origin of their muscles.

   There may be tools in pilates that present value. But as a whole I don’t see it useful. I cannot see how one of my athletes could ever become a better athlete by exercising in place for an hour.

   With the TA conversation………I am familiar with the Queensland studies, Hodges research, McGills research, etc. Much of the TA info is misunderstood in the fitness arena. Focusing on one muscle (TA) to stabilize the spine in a healthy individual is a mistake. There is a big difference between training a healthy athlete and a back pain/rehab patient. McGills co-contraction makes much more sense to me. If I were to have an athlete squat a significant load and asked him to draw-in, there is a good chance his spine would buckle………or like McGill would say “ It WOULD buckle”.

   I will be spending some time with McGill in a few weeks. I will discuss the subject with him.