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Pilates and Chronic Low Back Pain - Part II: Neuromuscular Control

Our spine is very complex – comprised of 31 vertebrae stacked on top of each other in our natural spinal curves.  Our spine has to be “stable” and “mobile” at the same time.  We have 2 “systems” of muscles that contribute to the stability of our spine.  One system is comprised of our deep muscles: the shorter muscles of the spine that each cross only 1 to 4 vertebrae, the deepest abdominal muscle, our pelvic floor and diaphragm.  The other system is comprised of our superficial muscles: the long muscles in our back, our more superficial abdominal muscles, and other muscles such as “QL” (quadratus lumborum), our buttocks (gluteus maximus) and our “lats” (latissimus dorsi).  With chronic low back pain, some of these muscles may be weak.  But more importantly, it is thought that they have lost the ability to coordinate this combination of stability and mobility (neuromuscular control).  In other words, one or more muscles may not contract the right amount or at the correct time to allow both mobility and stability of our spine.  One or more muscles may be compensating and doing a job they weren’t originally meant to do.  Pilates works to re-train this coordinated control.

 

Example of a first level Pilates exercise:

We start lying on your back with your feet on the bar, and hopefully no pain (or at least no more pain than your resting level).  In this position, your spine is supported on the mat, allowing you to engage the deepest abdominal and spine muscles in a submaximal way.  This is the way these muscles should work in the body.  Doing an exercise that is too difficult or painful sometimes causes other muscles to help, which fails to re-train the coordinated control.  Next you push the carriage away using your hips and knees while maintaining the “stable” position of your spine.  Many people with back pain have difficulty isolating the movement to the legs, while keeping the spine still.  It’s subtle, but learning this movement pattern will transfer stress to the legs and away from the spine.  At first we may keep the movement of your legs small, not going through your full range of motion.  Once you learn the correct core muscle control with no pain, you move your legs through their full range of motion.  Similar exercises are also done moving the arms while keeping the spine still.

Pilates and Chronic Low Back Pain Part III will discuss the progression of exercise.

 

1.        Bruno P. The use of "stabilization exercises" to affect neuromuscular control in the lumbopelvic region: a narrative review. The Journal Of The Canadian Chiropractic Association [serial online]. June 2014;58(2):119-130. Available from: MEDLINE, Ipswich, MA. Accessed October 8, 2015.

2.        Jull G, Richardson C. Motor control problems in patients with spinal pain: a new direction for therapeutic exercise. Journal Of Manipulative And Physiological Therapeutics [serial online]. February 2000;23(2):115-117. Available from: MEDLINE, Ipswich, MA. Accessed October 8, 2015.

3.        Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. The Journal Of Orthopaedic And Sports Physical Therapy [serial online]. July 2006;36(7):472-484.

Matt Seltzer