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Past to Present: Low Back Pain, Core Stability and Pilates


With the high proportion of adults now working in sedentary office jobs, the incidence of lower back pain (LBP) has grown significantly and statistically speaking, the vast majority of us will at some point suffer from it. Previously, those with back pain would be encouraged to rest which unfortunately often made things worse. By not moving, our joints stiffen and our muscles tighten. This increase in stiffness and tightness can exacerbate back pain and thus forms part of a vicious cycle of increased pain limiting activity thereby increasing stiffness and tightness, further increasing pain.

Let’s briefly consider the anatomy of the human spine (Figure 1). Compared to many other species, the human spine is specifically designed to facilitate a wide range of movement. Each of the Cervical, Thoracic and Lumbar regions of the spine favours movement in a specific plane. For example, the Lumbar vertebrae mainly enable flexion whereas the thoracic vertebrae enable rotations. The discs and facet joints at each and every intervertebral joint contribute a set amount of movement which in sequence together, all adds up to global flexion, extension, lateral flexion (or side bending) and rotation (or twisting) of the spine and torso.


Thankfully, we now know that guided return to activity and exercises to stabilize and strengthen the back are much more effective in the management of lower back pain than rest in otherwise healthy adults. There is also strong evidence to show the importance of the deep abdominal muscles (your “inner core”) in stabilizing the spine and pelvis. Relying purely on your spinal and pelvic ligaments for stability is often not enough. Along with pain, poor spinal stability is a precursor for many lower back injuries. Discogenic flare ups and joint sprains can all be aided by improved spinal stability. Improved core stability can reduce pelvic instability that underlies osteitis pubis in many footballers and soccer players. In addition, pelvic pain experienced by women during and after pregnancy can be greatly reduced with improved core stability.

Over the last decade, the concepts of core stability and postural awareness have seen significant growth in the health and fitness world. One of the most popular exercise modalities used in the treatment of these is Pilates.


Originally developed in the early 20th century by a German gymnast, Joseph Pilates. In his childhood, Joseph, suffered from a number of health conditions and was introduced to different forms of exercise by his father in an effort to improve his health. Based on his broad exposure to the different types of exercise at that time, Joseph began to formulate and practice his own Pilates exercises. The underlying principles of the exercises Pilates developed were to improve flexibility and universal strength and stability1,2 of the body rather than target isolated muscle groups. This ‘universal’ approach specifically relates to the inner core as the universal base of all movement. He also formulated his exercises with the belief that mental and physical health are related; trying to come up with exercises that would strengthen both mind and body. Along with mat based exercises, Joseph Pilates incorporated a variety of equipment into his exercises that were specifically designed to help facilitate the stretching, strengthening and body-alignment.

Since then, Pilates has exploded in popularity and is now practiced by millions of people in Physio clinics, Pilates studios and gyms across the globe.

Pilates with a Physiotherapist

Pilates is quite a technical exercise that requires discipline and guidance to make the maximise the benefits of this exercise modality. Learning to activate your muscles correctly is quite a precise skill. Doing pilates watching a YouTube clip at home does not provide you with the right cues and feedback to ensure you are performing the exercise correctly – or safely for that matter! This is particularly relevant if you have had spinal or other musculoskeletal conditions in the past. Although Pilates has been shown to be beneficial in the management of conditions such as spinal scoliosis3, as with any exercise, improper execution can lead to injury.

With the increase in popularity and publicity and the lack of regulation of the use of Pilates, how do you ensure that the Pilates you are paying for is in fact Pilates and not just a combination of general exercises?  The answer is quite simple, ensure that you only attend a class instructed by a professional. With a solid understanding of anatomy, muscle structure and function, your Physiotherapist will be able to guide you through the exercises with an emphasis on correct activation and recruitment of the target muscles. At Flexed, our 45-minute Fitness Pilates classes are designed to optimise the benefits of Pilates exercise in a supportive yet challenging work out. With a maximum of 6 people in each fitness class, the Physiotherapist is able to observe each client and ensure that postures and techniques are correct with each exercise.

If you are undertaking treatment for a spinal, pelvic or any other musculoskeletal injury, talk to your Physiotherapist about whether Clinical Pilates would help you. Once your Physio has ensured that pilates is suitable for you they can develop a tailored individual program for your condition. Starting with one or two 1:1 sessions to develop and familiarize yourself with your program, you can go into our group Clinical Pilates sessions. With a maximum of a 1:4 Physio to client ratio in our clinical stream, you know that you will get the physiotherapist attention and guidance you might require.

With both Fitness and Clinical Pilates classes running daily at Flexed, you can view the timetable and book online, alternatively call us on (03) 9509 5718.



  1. Phrompaet, S., Paungmali, A., Pirunsan, U., Sitilertpisan, P. (2011). Effects of Pilates Training on Lumbo-Pelvic Stability and Flexibility. Asian Journal of Sports Medicine, 2(1); 16-22
  2. La Touche, R., Escalante, K., & Linares, M.T. (2007). Treating non-specific chronic low back pain through the Pilates Method. Journal of Bodywork and Movement Therapies. 364-370.
  3. Alves de Arau´jo, M.E., et al. (2011). The effectiveness of the Pilates method: Reducing the degree of non-structural scoliosis and improving flexibility and pain in female college students. Journal of Bodywork & Movement Therapies; 1-8



Vatche Douzmanian


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