I get questions often in practice centered around Pilates and how it can help with spinal rehabilitation and spinal health. All exercise is good for our bodies and minds if it is performed properly, challenges us physically/mentally and does not cause physical pain. Pilates, specifically, can be an outstanding form of exercise in general and in-terms of spinal structure, stability and health. The caveat is that it is great if you have a healthy spinal structure to start with. It is not good if the spine is already structurally compromised and injured.

The way to conceptualize this thought is that much of Pilates is predicated on strengthening and stabilizing spinal structure.

If the spine is already structurally compromised and injured, then Pilates will strengthen that structural compromise. It is analogous to building a structurally compromised house and then to keep fixing the structure with patches while it continually degrades and falls apart (gravity and physics always wins). What is needed is the restoration of the proper structure and then the reinforcement of that proper structure so that it does not just continue to degrade.

When a structural spinal issue is present, two things must happen before the Pilates phase can be embraced and used for the patient’s overall benefit. In physical therapy circles, chronic conditions with scar tissue infiltration, loss of proper neuromuscular function and structural deformity are approached with a loose three phase pattern depending on the area of the body affected.

1) Stretching/Breaking Scar Tissue Deposition –

After injury and loss of structural integrity of the spine, the body naturally implants scar tissue in the soft tissues (ligaments, discs, fascia, muscles and joints) that surround the bone itself. All of these tissues provide the structural integrity and the amazing flexibility that our physical body possesses. Scar tissue causes impaired soft tissue function(neuromuscular), which leads to more injury (chronicity, “my back just goes out sometimes”) + more scar tissue deposition = advancing loss of structural integrity (degeneration).

And repeat, over years. A vicious and insidious cycle, because it comes and goes so it does not seem to be “urgent”. I address this phase with specific spinal adjustments, specific postural adjusting/postural exercises and a specific spinal traction protocol to the affected area. This breaks down the scar tissue deposits, retrains the soft tissue to restore structure and provides neuromuscular retraining to provide proper muscle balance/function. This is the most challenging phase for the patient and the practitioner.

2) Stabilizing –

After the scar tissue and structural issues have been addressed along with the drastic improvement in pain and disfunction, we transition to this phase. This is the continuation of all of the above + the beginning of mild and very specific core spinal muscle strengthening. Attention to form is important. Stability will return with patience, proper small muscle firing patterns and proper form. Near the middle of this phase, re-engaging with Pilates should begin. Gradually.

3) Strengthening –

This has Pilates written all over it. This is where you end up completing the spinal rehabilitation process and maintaining yourself. The key thing to know is that maintenance is FOREVER. This will always be a part you of life. Once a chronic injury has manifested it will always be a weak area. You keep it from progressing by disciplined maintenance.

If you skip the first two steps of rehabilitating your spine, you might feel strong over a short period of time. In the long run, however, you are accelerating the accumulation of degenerative processes in the soft tissues and eventually, in the bone (vertebra) itself. Changes in the bone are called “spinal arthritis”. This process occurs when spinal structure is degraded, causing abnormal pressure on all of the tissues including the bone. Bone builds in places like the joints, discs and ligaments because of this abnormal pressure by a process that is explained by “Wolff’s Law”. Which states “that bone in a healthy person or animal will adapt to the loads under which it is placed”.

Because there is abnormal structure, this leads to abnormal load to the bone, which leads to abnormal bone growth (arthritis). Arthritis will grow and remodel into tissues and places that create more pain, degeneration and dysfunction. The more spinal arthritis and soft tissue degeneration accumulates, the harder it is to rehabilitate the problem. Once the spine has reached a high level of degeneration, surgery becomes the only option. Spinal surgeries have bad long-term outcomes and should be avoided if at all possible.

In conclusion, Pilates is great, as long as you already have a healthy spine or if you have been through the first two phases of spinal rehabilitation. It is a great long-term solution to maintaining the healthy spinal structure you have achieved through the rehabilitation process.

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