If you’ve struggled with chronic back pain and gone through a rehabilitation program, then you may be familiar with the work of Dr. Stuart McGill. Dr. McGill is a professor and researcher at the University of Waterloo (Canada) and studies the spine. He’s authored several books, including Low Back Disorders and Ultimate Back Fitness and Performance.
Dr. McGill has made many contributions to the injury prevention, corrective exercise and strength training communities regarding our current understanding of how the spine works and how to best rehabilitate and prevent spine injuries.
His approach to back rehabilitation, spinal stabilization and injury prevention includes what he coins “the big three” (1). These three key core exercises are the curl-up, the bird-dog and the side-bridge. Each exercise is designed to increase the endurance of the muscles around the spine. They are low in intensity with a focus on building endurance and control of spinal movement.
One way an athlete can incorporate the big three movements into their regular training program is including them in the warm-up, on active recovery days or adding a weekly Pilates practice.
As a Corrective Exercise Specialist and CrossFit®-L1 coach, I have a lot of CrossFit® and competitive athletes who implement a weekly Pilates session into their regular training program. Pilates emphasizes core strength and stability and is well known to help eliminate chronic back pain. Not only is it great for helping an athlete breathe better but the basic principles can be directly transferred to athletic pursuits and aid in improving performance and reducing injury.
For over 10 years, there have been researched studies focused on measuring the effectiveness of Pilates as a viable method for treating chronic lower back pain, as effective as physical therapy and other forms of exercise. Some findings:
- A Pilates-specific exercise program produced a significant decrease in lower back pain and disability as compared to usual care (visits to healthcare professionals and general recommendations) over a 12-month follow-up period (2).
- Certain populations of people are more likely to benefit from a Pilates-specific rehabilitation program. The factors that might predict the effectiveness include the duration of symptoms, body mass index, and range of motion of the trunk and hips (3).
- Clinical Pilates produced similar results in treating symptoms of lower back pain as general exercise (4).
- A Pilates-based rehabilitation program with the focus on body awareness, breathing, movement control, posture and education is useful in preventing and treating chronic lower back pain (5).
The three Pilates exercise movements that correspond to Dr. McGill’s “big three” are the Ab Prep, Swimming Prep and Side Plank — although they are just a few of the core strengthening exercises Pilates can offer. When performed well, these can help contribute to strengthening the core, and aside from a mat, can be performed anywhere without any additional equipment.
When you do Pilates properly, you are learning to decompress and lengthen the spine by recruiting muscles that stabilize the pelvis on the spine. As with all forms of exercise, things can get easily lost in translation. The movements should never increase symptomatic pain. If you’re trying these on your own and experiencing any difficulty, I advise you partner with a certified instructor (look for a comprehensive certified instructor who specializes in injuries and rehabilitation) who can help guide and direct your positioning while assessing your biomechanics. There’s a big difference between doing Pilates on your own versus with guided instruction. Pilates taught from a rehabilitative and proper postural alignment perspective should not aggravate old symptoms.
3 Pilates Moves for Back Pain
1. Ab Prep
Lay on your back, with the pelvis and spine neutral — knees bent, with feet flat on the mat and heels aligned directly underneath the hips (or slightly wider as needed). The arms are long along the side of the body with the palms down. Stabilize the scapula and align the head and neck in a centered and neutral position. (If the chin is poking up or you experience neck strain, use padding under the head to get the head, neck and shoulders into proper alignment in the side view.)
Inhale: lengthen the back of the neck to create a slight head nod to drop the chin down, so it is about a fist distance from the sternum.
Exhale: maintain the length of the neck, keep the pelvis neutral, stabilize the scapulae, then contract the abdominals to bring the rib cage toward the pelvis. Then flex the thoracic spine as the arms reach up from the mat, staying level with the shoulders.
Inhale: hold the thoracic spine flexion by maintaining the abdominal contraction. Try to direct the breath into the rib cage with the emphasis on the ribs expanding three-dimensionally.
Exhale: Roll the thoracic spine down to the mat, returning the neck and head to the floor. Restore the neutral positioning once the head is back down. At the same time lower the arms.
Complete five to 10 repetitions.
2. Swimming Prep
Get on your hands and knees, with the pelvis and spine neutral, the knees hip-distance apart, hands directly under the shoulders. Feet should be approximately six inches apart and aligned directly centered with the knee joint. The head and neck are neutral, shoulder girdle stabilized.
Inhale: to prepare for movement, breathe three-dimensionally to expand the rib cage.
Exhale: keeping your abdominal engagement, extend one hip to reach the leg away from the head. Maintain the shoulder girdle stabilized and the torso engaged with a neutral abdominal contraction. The body weight should be equally distributed by the three remaining limbs, without the pelvis flexing, rotating or tilting.
Inhale: return the leg to the start position while maintaining core stabilization of the torso.
Complete five repetitions on each side.
3. Side Plank
With the knees slightly bent and stacked on top of one another, sit down on your right hip. If your body doesn’t do that yet, place the top leg slightly forward of the other with the feet hip width apart to help maintain position and balance. Align the right arm with the shoulder, fingers pointed forward away from the hips. The elbow is bent to begin. Shoulders should be stabilized and the opposite arm is elongated on the left side of the body. Head and neck are neutral, with your gaze forward.
Inhale: draw the shoulder blades down as you lift the rib cage, hips and thighs up off the mat. Balance body weight equally on the right shoulder, arm and bottom foot/ankle complex. The top reaches up toward the ceiling creating a T-shape. Both arms reach energy away from the center mass of the body to help stabilize the torso and activate the serratus and lat muscles to support the lifted position. Abdominals contract in a neutral position. To help stabilize the pelvis, recruit the muscles along the outside of the bottom supporting leg to keep the hips lifted.
Exhale: hold the body lifted up off the mat and maintain torso stabilization.
Inhale: stay in the position.
Exhale: bend the bottom elbow and pull the elbow down first. Then with control, begin lowering the hip back to the mat. Complete five 10 repetitions per side.
- “Low Back Disorders: Evidence-Based Prevention and Rehabilitation.” McGill, S. (2002)
- Journal of Orthopedic & Sports Physical Therapy. (2004)
- Journal of Orthopedic & Sports Physical Therapy. (2012)
- Medicine and Science in Sports and Exercise. (2012)
- Journal of the American Physical Therapy Association. (2013)