Who says exercise has to be fun?
Don’t get me wrong- I really enjoy pilates.
Since I first started in PT in 2007, I have been surrounded by pilates. Many of the instructors I have worked with are both Physical Therapists and certified pilates instructors. I have taken my fair share of pilates mat and reformer classes. For two years, I even practiced out of a pilates studio/ physical therapy clinic where much of my continuing education was in pilates movements. I also got free classes there- booty barre was my jam.
Plus, I am such a sucker for the ballet aesthetic associated with pilates. I really enjoy getting to pull on a pair of leg warmers over leggings- it soothes something in my 80s soul.
There are more functional aspects of pilates that I find intriguing, like the ability to sense and move the spine in a myriad of ways. As far as developing motor control and sensory awareness of the spine, I think pilates can be super helpful. Plus, the focus on breathing, and use of the abdominals and pelvic floor during breath exercises is something I wish everyone knew.
But that is essentially where my enjoyment ends.
I am stunned by the ongoing popularity of pilates (and other fitness practices like hot yoga). Within the 30 minute drive from my city over to my mom’s house, I pass 7 (7!) new pilates studios- most of them owned by large corporations, charging $45 per group class.
One of my good friends who is a brilliant physical therapist recently described a pilates class where her teacher instructed the class to sit on a pilates box, knock their knees together (into genu valgum) and plantar flex. My friend who is particularly gumby and hypermobile, immediately felt gapping and strain in the structures of her medial knee (a notorious path of destruction for women’s knee joints), and when she told the instructor, the instructor told her it would get better over time/ practice.
Why are people- women specifically- so driven to this practice developed 100 years ago by a personal trainer who struggled with childhood ailments?
Pilates was started by Joseph Pilates, a German citizen living abroad in England (1883-1967). Joseph was a sickly kid and suffered from a myriad of physical issues- rheumatic fever, ricketts and asthma. His pops exposed him to various forms of martial arts (notably jiu jitsu!) and gymnastics as well as body building to help him build strength. He continued to explore movement and practiced yoga asana as taught by BKS Iyengar, and came to believe and teach his own flavor of movement which he originally termed Contrology.
At the foundation of Pilates beliefs, were that most diseases could be traced back to poor posture and poor breathing habits- I think this holds true to this day! Joseph moved to New York and his practice of Contrology became popular among performance artists and ballerinas.
As people have continued to practice the movement of pilates, spinal science has evolved. Our understanding of the component parts of the spine, as well as movement science of the spine, has evolved over the last 100 years. Most notably, Stuart McGill has spent his career researching and exploring which exercises are safe for spinal structures and which movements break down spinal structures. His science is redefining how we rehabilitate and educate.
Many of the movements originally encouraged by Joseph Pilates excessively load the intervertebral discs, potentiating break down cartilage and the ligamentous supports of the spine. In addition, is it challenging to identify functional movements within a pilates class. So how useful are these movements?
There are many ways over the course of a 60 minute mat or reformer class that the spine can get exposed to unwanted forces. But let’s take a peek at three of the common spinal biomechanical mistakes made in pilates mat practices.
1) Flexion Bias During Supine (face up) Exercises: “Imprint your back into the floor”
Imprinting the low back into the mat/ floor is often cued when pilates students are loading their intervertebral discs – such as when moving into a crunch, a table top position or a pike.
Flexing the spine while elevating head or legs off the floor is known in spinal science to excessively load the intervertebral discs toward the posterior (or back), where they are at greatest risk of herniating and compressing on nerve tissue.
Not only is this movement rough on the soft tissues, it is a set up for compression fractures within women experiencing osteoporosis (especially with thoracic kyphosis).
In osteoporosis, spines can change such that the anterior (front) vertebral bodies become susceptible to fractures with flexion loads. Imprinting the low back and then loading the spinal structures gaps the posterior (back) spinal structures, and compresses the anterior vertebral bodies- which can lead to super painful compression/ wedge fractures of spine (most often at the thoracic level).
Despite these spinal safety issues, flexion and loading of the spine is promoted again and again during the 100, and many of the supine movements associated with pilates.
Cervical and lumbar flexion combined with high intervertebral loads within "The 100" make for an unsafe exercise. This is the anti-Stuart McGill.
Try this instead: neutral spinal alignment could be taught, with preservation for the curve at the small of the back, and instruction on how to engage the abdominals and pelvic floor without loading the intervertebral discs unnecessarily.
2) Rolling bridge: “Peel your vertebra off the floor, bone by bone while lifting into a bridge”
A bridge is a functional hip extension movement, which everyone can benefit from. I see the movement as an important step toward developing a healthy squat.
The focus on moving into flexion, or a posterior pelvic tilt, and deeply flexing while unloading the pelvis off of the floor, places the discs and ligaments at back of the spine under a tremendous amount of load.
Additionally, students lose the ability to discern where hip motion ends and low back motion begins- something they can start to learn when practicing from a neutral spine.
Try this instead: move into hip extension from neutral spine, sensing the limits of hip extension and maintaining spinal control in the sagittal plane.
3) Side lying leg series (propped up on the elbow)
*I know not every pilates instructor teaches side leg series with the elbow propping up the head, and my apologies to those of you who teach in neutral spine
When the side leg series is taught with students propped up on the elbow, the entire spine is bent into lateral flexion. Students lose the ability to sustain neutral spine, or perform glute medius activation with the spine in neutral (what is needed for walking).
Try this instead: a super easy modification is to bring the head back down, using a rolled up sweatshirt to support the concavity of the neck while performing the side lying leg series.
Pressure on the L3 vertebral disc with common positions encouraged in pilates/ core strengthening. Specifically note the intradiscal pressures that exceed the pressure to stand. The teaser (as pictured above in that super draconian black and white image) would be well over a traditional sit up as both the upper and lower extremities are elevated.
Perhaps most importantly, pilates does not include biomechanically sound training for the spine OR for the lower extremity.
Because of this, many people training pilates continue with poor lower extremity movement habits that lead to injuries from walking, hiking and running.
It is important to look at pilates as a single food group, rather than a complete meal. You will still need to learn strength training, and biomechanical strategies that improve your walking/ hiking/ agility performance.
When choosing how you spend your fitness energy (your time, your financial investment, your energy) it is important to recall the Centers for Disease Control and Prevention's (CDC) and American College of Sports Medicine's weekly exercise recommendations for adults: 150-180 minutes of moderate to vigorous cardiovascular training and two whole body strength workouts. If we are participating in pilates 180 minutes weekly, how are we able to meet the above recommendations?
When I was checking out information on the history of pilates, I was moved by Joseph’s persistence to push beyond his childhood ailments and develop a life enriched by movement- and one in which he gave back to his community. I was also struck by the cross pollination between yoga asana and pilates- many original pilates postures reflect BKS Iyengar postures- and both men were developing their practices in the 20s-30s.
At the present, I feel that pilates' cult like following contributes to and perpetuates spinal misinformation in the movement community. I genuinely do not understand the willingness of people to pay so much money for classes that are not sound for their back health.
There was a quote I stumbled across at the bottom of the Wikipedia page about Pilates that gives insight into why so many may practice pilates:
“Soon after it became known that ballerinas were attending the Pilates gym on 8th Ave (in New York), society women followed”.
This quote made me pause. Is this (yet) another example of how our movement selection has been defined by how women look who practice, rather than the actual potential health benefits? Maybe I fall prey to this myself with my affection for the clothes involved in pilates- the little toe socks and those sweater ballet wraps.
So, for all of these reasons I will no longer pay for pilates. Don’t get me wrong, if you give me a free class (or, Booty Barre pass if that class even still exists!) I will go and modify the heck out of the practice. I will push those pilates boxes but only in genu rectus!
I do not want to see pilates go away, but I do hope in my heart that it evolves. We know that spines break down from a combination of excessive loading plus excessive mobility. Pilates instructors can take a cue from recent spinal science and seek to evolve their beloved tradition.
The practice/ pilates clinic I worked out of had a brilliant class created by a whip smart PT which entailed neutral spine mat and reformer work. I envision a day where this is the norm- when we can keep both our disc integrity, and our cool leggings.
Until next time, safe and happy moving!
xxx Trina
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