Pilates and Chronic Low Back Pain - Part III: Progression of Pilates Exercises
Pilates and Chronic Low Back Pain Part II discussed the initial Pilates and Physical Therapy exercise approach to chronic low back pain – these exercises teach you submaximal activation of the deepest core muscles that stabilize your back and teach you how to separate or dissociate movement of your extremities from movement of your spine. The next progression is to do similar exercises but with less support for your spine.
Lying on your side is still supportive but less of your trunk is in contact with the mat. As well, in this position, you tend to “sag” into the mat at your waist because your shoulders and pelvis are wider than your waist. This requires you to use your core muscles to maintain the alignment of your spine. An example of an exercise in this position is side lying leg springs. In this position you submaximally engage your core muscles and move your leg in the leg spring, moving only the hip joint while keeping the spine and pelvis stable. Once again, we may start with smaller range of motion and progress only when you have gained enough core control to work into larger ranges of motion.
Other examples are the all 4’s position (on hands and knees), sitting and standing. In these positions, the spine is no longer supported on the mat so you have to maintain the core control “in space”. Sitting and standing are challenging because you have to stabilize the spinal alignment against the downward force of gravity.
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