Ironically, your low back pain may be persisting due to the very exercises that you're doing in an effort to get rid of it.
You may have started doing Pilates on the advice of your doctor. You may have hired a personal trainer to help you 'strengthen your core'. Or you may have been given a program of 'stretches for low back pain' by your physical therapist.
I currently have different clients who have experienced each of the examples above and who weren't able to start winding down their pain until we removed the offending exercises they were prescribed from their programs.
The problem is that if you haven't undergone a thorough low back pain assessment to identify your individual pain triggers then it's impossible to know what you should do and what you shouldn't do. This is why generic programs should be avoided until you've been assessed.
I'm not saying that Pilates is bad for everyone. It offers many health benefits to many people, including my Mum who practices it regularly!
However, making the recommendation that 'Pilates is good for low back pain' and expecting them to get better is like making the claim that 'nuts are good for you' and then being surprised when the person you just handed a Snickers bar to has an anaphylactic shock from their peanut allergy.
Just as some people are allergic to some nuts, some people shouldn't do certain exercises. For example, if you have a posterior disc bulge or herniation and you do either of the following exercises from Pilates, you'll increase the stress on the already damaged disc in your spine and most likely make your pain worse.
You may find you can do the rest of your Pilates routine without any problem, and switch out these exercises for other exercises that stimulate the same muscles without stressing the discs in your spine, for example, the modified McGill Curl Up.
Bodybuilders have known for decades that taking muscles through a full range of motion is more effective for stimulating muscles growth than doing partial range or isometric exercises (where the muscles stay the same length during their contraction, e.g. while doing a plank).
However, if you're concerned about longevity, specifically the longevity of the intervertebral discs in your lumbar spine you should heed caution applying this principle to training your abs.
Exercises such as crunches and sit-ups train the rectus abdominus (your 6-pack muscles) through a greater range of motion than doing a plank, but, this comes with a risky trade off.
Subjecting your lumbar spine to repeated flexion and compression increases your chances of developing a disc bulge or disc herniation in your lumbar spine. It does this by gradually delaminating the outer fibrous annulus of the discs, as described in the video below.
Exercises like the McGill Curl Up, shown above, or the RKC plank, shown below, target the same abdominal muscles while keeping your spine in a neutral position. If you want to reduce your chances of injuring a disc in your back, these exercises would be a better choice for developing a six-pack.
Najma was advised by her doctor and physical therapist to do various mobility exercises and stretches for her low back pain. She did these regularly for over 4 years. She didn't see any improvement of her symptoms during this time but kept doing them because she found that sometimes they would give her some short term relief from her pain.
This is because stretching tight muscles triggers a 'stretch reflex' which is a neurological phenomenon that can reduce pain sensitivity for about 15 to 20 minutes. However, if you have a disc bulge, the stretches shown in the image below increase stress on the discs in your lumbar spine. If you already have a damaged or injured disc that has become delaminated, this additional stress can cause the disc to become a pain generator.
Najma's medical team told her that back pain is something that many people just have to live with, and she should persist with the mobility program. On top of that, whenever she stopped doing the stretches (which she intuitively knew weren't helping) her well-meaning family encouraged her to keep following the medical advice.
When I carried out an assessment on Najma, it was immediately clear that the likely source of her pain was a previously undetected disc bulge in her lumbar spine that was being aggravated by the mobility program she was doing. As soon as she stopped doing the offending stretches her pain reduced significantly.
Najma's testimonial:
'I call Andy a miracle worker. Without even being in the same room or running any tests, he was able to diagnose the chronic lower back pain I’d been suffering from for four years. I had tried every conventional method to relieve my pain—medication, physiotherapy, chiropractic care, acupuncture, deep tissue massages, yoga—you name it. Nothing worked. As it turned out, I had undiagnosed herniated discs. Remarkably, just by stopping the stretches I’d been doing for years, I experienced immediate relief.
Andy’s thorough approach and easy-to-follow program have made a huge difference in my life. I now feel empowered, in control of my pain, and hopeful about my future. Moreover, I understand my condition and trigger points better, so I am able to work around it. Although there’s still a long road ahead, I finally see a silver lining. I fully recommend working with Coach Andy and following his program.'
—Najma Khan
In summary, to get rid of your low back pain it's just as important to understand what not to do as well as what to do. The best way to establish this is to get a thorough low back pain assessment.
