How pilates can make your bad back worse: It can help reduce pain and improve posture, but as one woman's story shows, there are hidden dangers
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Sophie Barnes slipped a disc while doing pilates
Like thousands of women, Sophie Barnes decided to do Pilates to get back into shape after giving birth.
While driven by the desire to lose her post-baby belly, Sophie, 38, was also keen on it for medical reasons.
She was born with scoliosis, an abnormal curvature of the spine, and her doctor had warned that the extra weight of the baby could put added strain on her fragile back and muscles.
A maternity nurse told her that Pilates — a series of stretching exercises to improve physical strength and flexibility — was excellent for women post-birth.
The classes are particularly good for back problems because the exercises strengthen the muscles that support the spine.
‘Seven months after the birth I felt ready to start exercising,’ says Sophie, who lives in North-West London with her husband Martin, 42, a building company manager, and their three children — Jonathan, seven, Helena, five, and Melody, three.
‘I told the instructor about my scoliosis and the pregnancy, and he nodded and told me to join a class.
‘I went once a week for three months as part of a group of 12 people, and everything was fine — but then overnight my left leg went numb.
‘I mentioned this, but the instructor didn’t seem concerned and just told me to take it easy. I didn’t think to question it.’
But within a few weeks the numbness worsened and Sophie had excruciating pain at the base of her spine. Concerned, she went to the doctor.
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Share‘I was referred to a specialist and given an MRI scan. The results were irrefutable — I’d slipped a disc.
'The increased pressure and strain of the exercises had aggravated my weakened spine, causing the disc to rupture, so it was pressing on my nerve.
‘Worse still, the damage was so extensive they thought the only way round it was surgery to trim the disc.’
Pilates is considered to be the best exercise for improving back pain and posture.
‘It’s recommended to those suffering from back pain because participants are taught how to target the core muscles,’ says Mushtaque Ishaque, a spinal surgeon at BMI Priory Hospital and the Royal Orthopaedic Hospital, Birmingham.
These are the transversus abdominus (the muscle that runs between the ribs and the pelvis), the multifidus (next to the spine in the lower back) and the pelvic floor muscles.
Pilates, practised by an estimated one million Britons, was devised 80 years ago by Joseph Pilates, a German sportsman, to improve muscle strength
‘Together, they play a pivotal role in protecting the back,’ says Mr Ishaque.
Unfortunately, more and more people are suffering problems as a result of the exercises. The problem is how Pilates is being taught.
‘I’m seeing an increasing number of patients who have muscular strains or aggravated degenerate discs after attending Pilates classes because they thought it would help with their back problems,’ says Stewart Tucker, an orthopaedic and spinal surgeon at the Royal National Orthopaedic Hospital, London.
‘While I recommend it for back pain and after injury, if exercises are carried out incorrectly they can weaken the back and cause existing conditions to deteriorate.’
Pilates, practised by an estimated one million Britons, was devised 80 years ago by Joseph Pilates, a German sportsman, to improve muscle strength.
He did this by working on the deep abdominal muscles; one of the main exercises involves drawing in the tummy to the spine and lifting the pelvic floor.
‘In layman’s terms, focusing on this area strengthens the muscles from within — giving the back an internal brace, so to speak, which can be helpful for degenerate disc disease or rehabilitation from any back surgery,’ says Mr Tucker.
However, when it isn’t tailored to an individual or taught correctly according to the patient’s back diagnosis, problems can occur.
‘With the celebrity endorsement of Madonna, Gwyneth Paltrow and Pippa Middleton, Pilates is a popular way of keeping toned and slim with good posture,’ says Priya Dasoju of the Chartered Society of Physiotherapy.
‘But its popularity means it’s sometimes looked at as nothing more than a gym class, which isn’t necessarily good for those with back problems.
‘Traditional Pilates incorporates exercises that can be challenging — particularly if you have an existing back problem.
'Indeed, even if you carry them out correctly, they can put excess strain on the spine and surrounding muscles.
‘Classes of more than 12 people don’t help. There’s no way the teacher can keep a close eye on every person’s moves, and a student won’t know whether they are doing an exercise correctly, which can lead to problems.’
Unfortunately, this puts the 80 per cent of Britons who suffer from back pain at some time in their lives in a Catch-22 situation: their orthopaedic surgeons, doctors and physiotherapists may recommend Pilates, but not all classes on offer will be beneficial.
Check if your teacher has an appropriate qualification, such as one from the Pilates Foundation
Experts say seeking a specialist Pilates teacher is the key.
One type, APPI (Australian Physiotherapy and Pilates Institute), created ten years ago by two Australian physiotherapists, has adapted the exercises so anyone can do them whatever their ability.
‘There are several key differences that make APPI better — and safer — for those with back pain,’ says Mr Tucker.
‘All of the instructors are trained physiotherapists. That medical knowledge means they have a real understanding of anatomy — in particular, back conditions and the strengths and weaknesses you may have.’
All new students also have a 30-minute one-to-one assessment.
Rudi Taguri, 29, was recommended to do APPI by her orthopaedic surgeon in the UK after a skiing accident in France two years ago.
The film producer from London fractured the base of her spine and needed an eight-hour operation, during which French surgeons put in six screws and three rods to support the bone.
‘My surgeon told me Pilates would be ideal for strengthening my core muscles, benefiting my back, and that APPI was particularly good,’ says Rudi.
‘Initially, the exercises seemed mundane — I was lying on the floor working my pelvic floor muscles for what seemed like weeks on end.
'But it was all about connecting the dots and not pushing things too much.
‘I was taught to do things at home, such as lying on my back and raising each leg an inch at a time, three to five times a day.
‘My surgeon in France had said I’d need two years of recuperation before things would be back to normal, but after just three months a scan showed my spine was healing amazingly.
‘After eight months I was jogging on a treadmill and doing exercises in a pool.
‘Two years on, I still get back pain, but that’s only to be expected. The plus point is I am the fittest person I know.’
There are plenty of excellent Pilates classes, but you need to ask some basic questions before signing up.
Check if your teacher has an appropriate qualification, such as one from the Pilates Foundation.
You can find out if your teacher is trained in APPI by searching for them on the institute’s website.
Make sure you are offered an initial one-to-one assessment where you can go through your medical history.
‘And tell them everything — even that niggle you get in your lower spine once in a while can be relevant and alter the regime they devise for you,’ says Mr Ishaque.
‘Check whether you will be carrying out exercises tailored to you, not generic ones for an entire class.’
And if you feel any pain during a class, let the instructor know immediately.
‘Pilates is not a “no pain, no gain” exercise regimen,’ says Priya Dasoju.
‘If you feel a twinge in your back while doing something, stop and tell your instructor.’
This is information Sophie wishes she’d been told about.
'Five years on, I’m still living with the legacy of those few months of Pilates classes,’ she says.
‘I have managed to avoid an operation, but only with a combination of steroid injections to reduce the inflammation, hefty painkillers and physiotherapy.
‘But the operation could still be on the cards if the pain returns, which I want to avoid at all costs.
‘Pilates may be good for back problems, but I know better than most that it depends on which class you attend.’
Back To Life With APPI Pilates, £16.99, by Elisa and Glenn Withers. For more information, log on to: appihealthgroup.com.
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