As a physiotherapist, I know that I will never stop learning. When I did my degree (2006-09) I don’t remember learning much about persistent (also referred to as constant / chronic / long-standing) pain. It’s something I’ve learnt more about as my Physiotherapy career has progressed. I’m not sure if it’s something that wasn’t as prevalent or it just wasn’t as acknowledged those few years ago?
Alongside the assessment and management of pain, there are other things that have changed. Evidence tends to be much more focused around rehab and strength and conditioning, rather than manual therapy. And some things that we used to educate patients about, like posture and stretching now seem much less relevant.
My passion in Physiotherapy has developed into taking ‘Physiotherapist led Pilates’. I feel like some of the evidence that has been discussed as a ‘hot topic’ in the Physio world has tried to go against pilates being something that can be very good for you. Which has made me feel a bit frustrated as I know what I do helps a lot of people.
So one topic I wanted to discuss was around ‘core exercises’, with there being evidenced recently discussed showing that doing exercises involving ‘bracing’ is not likely to help those with back pain. And the other topic was that there have also been some studies into posture, which showed similar outcomes – forcing and overworking yourself into a ‘good’ posture is also likely to exacerbate symptoms.
Let’s look at these points in relation to pilates: in pilates, it is likely that we will mention ‘posture’ and ‘core’. Does this mean the these cues are no longer helping you if we refer to them when you come to a class? Of course not. The reason for talking about this is not because we want you to be tightening areas of your body that are already tight and sore. We want you to perform exercises (like any you would at a gym) in a posture that does not cause harm, and that means you get the most out of the exercises. We want to encourage you to stand, sit, lie and move comfortably. We want you to improve your strength (be it ‘core’ or otherwise) because we want you to feel stronger, so that you find it easier to do every day tasks and activities, or perform better at sport. We want to reverse some of the stiffness and tightness caused by that prolonged sitting pattern so many of us overdo, whether it’s at a desk at work all day, sitting in front of the TV most evenings, or even spending too much time riding your beloved bike. We want you to feel like your movements are becoming easier, and your body is becoming stronger, yet at the same time you’re feeling more relaxed. Remember, motion is lotion!
With regards to pain management, negative feelings and stress can make pain worse, so it’s important to see if there’s anything you can do to reduce those negative feelings and stress. In pilates we will often combine exercises with controlled breathing and include relaxation techniques, which we hope will help you better manage any pain or stress you may be experiencing. Distraction can also help with reducing negative thoughts and feelings. So to think about what your muscles might be doing, or to think about your posture is distracting you from focusing on whether your back hurts or not, or any other stressful thoughts about anything else that may be going on in your life. In a pilates class, ans as an experienced physio, I will never ask you to perform a movement your body isn’t meant to or designed to do, so although it may feel difficult at first, remember ‘motion is lotion’ and ‘movement is medicine’. So pilates or any exercise may feel uncomfortable at first, and some movements unfortunately may always feel uncomfortable for you. But it is important to remember that your body is designed and meant to do the movements and exercises I instruct in my classes, so do not worry, they will not be causing you any damage. The more you avoid uncomfortable movements, the more your body learns to ‘dislike’ them, and so the more sensitive you become to them. Therefore the more you can ease yourself into returning to do these movements, even if they remain uncomfortable, they should – with regular and consistent practice – start to feel easier for you to complete.
Lastly, you just can’t go wrong getting strong! As I mentioned earlier, a lot of Physiotherapy treatment has moved to a greater focus on rehab programmes (rather than hands-on stuff like massage), and we have been encouraged to push our patients harder with these, as although it’s tougher on you as a patient at the time, the outcomes are shown to be better. Pilates is a great form of exercise as there are different levels to the exercises, and I also use several different pieces of equipment to add resistance to many of the exercises. Therefore, progressions and regressions of exercises can be given, and resistance can easily be added or reduced depending on the strength, pain levels, and confidence of the class attendees. So you’re encouraged to push yourself if you can, but at the same time to listen to your body and do what feels right for you.
So if you’re looking for a type of exercise that you will be able to do no matter what your current level of fitness, that will make you feel stronger, more flexible, and mentally refreshed, then come and give pilates a go! All spaces in my classes must be prebooked as it is essential I know your medical history before you turn up so I can help you get the most out of each class. To do this or if you’d like more information about 1:1 sessions or classes, or to know more about anything discussed above, please don’t hesistate to email me at [email protected]