Intoduction To Pilates

Back pain is one of the most commonly encountered health related problems in the United Kingdom. Life time prevalence rates range from 49 to 70 % and a government statistical report states 40% of adults surveyed reported back pain in the previous year, 15% of whom said they were in pain throughout the year.

The direct health care costs (GP and therapist referrals) amount to £1632 million. Furthermore, the economic burden in lost productivity and sickness benefits is estimated at £10 668 million per year, with 5.7 million days lost in 2001. Clinical outcomes are becoming increasingly important as health care expenditure rises.

Clearly the need for effective, affordable treatment for low back pain is essential. Panjabi's model of spinal stability proposes that there is a relationship between abnormal intervertebral motion and low back pain and therefore a decrease in this motion may decrease pain. It is the local musculature (multifidus and Transversus abdominus) that controls movement at the intervertebral segment within the range of the load tolerance of the spinal structures.

Abundant evidence suggests that a specific exercise approach to improve the dynamic stability of local muscles may reduce CLBP, and focus should be on activating TrA independently of superficial abdominal muscles but very little specifically into the efficacy of the Pilates method. Pilates an exercise technique developed since the 1920s by Joseph H Pilates, with standardised language and exercise terminology Since the 1960s these exercises have been adapted and modified by rehabilitation professionals and integrated into many clinical practices.

Fundamental to the Pilates method are the principles core stability, mind-body awareness, precision of movement and control of posture. These principles are supported by the aforementioned theories of Panjabi and Bergmark. Furthermore, Pilates has been shown to have beneficial effects upon other aspects of rehabilitation evidenced to improve low back pain. For example, pelvic floor strengthening and postural stability. Pilates-based exercises can be performed on the floor, termed "mat work", or on a variety of machines, termed "equipment work". Equipment includes the Reformer and the Cadillac.

The Reformer is a single bed frame with a carriage that slides back and forth using springs to regulate tension and resistance. The Cadillac is a single bed frame with cables, bars, straps, and pulleys to allow a variety of Pilates-based exercises to be carried out. The equipment allows for the training of the core muscles in a variety of postures for carryover to function.

Three RCTs have been published which show promise as to the efficacy of Pilates for the treatment of CLBP. Those that have been conducted, also state that it is important to do more research on which exercises should be prescribed to treat LBP, and if Pilates is more beneficial carried out on mats or equipment.