Most people live with low-level back pain all the time and avoid activities which make things worse. The problem is that chronic back pain signals a muscular and postural imbalance that can get worse and leave you open to a greater injury. These imbalances don’t simply affect your back, but can cause imbalance and injury to your other joints leaving you with aching hips, knees, ankles, toes, shoulders, and elbows.
Acupuncture helps back pain by balancing out energy and promoting healing. Adding a Pilates exercise program to your back pain regimen may help keep you pain-free and functional. Pilates can help by strengthening the muscles that stabilize the pelvis and increasing mobility in the other areas of the spine and torso. Pilates focuses on breathing and abdominal stabilization as its basis, moving out to the rest of the body from a strong stable center of gravity.
Most of us have heard that we need to strengthen our abs to help our backs, or strengthen our core, but when I ask my clients what that means most of them have no idea. Even the classical abdominal and back strengthening exercises such as crunches and superman extensions will make your pain worse if they are not done correctly.
Did you know that your lower back is not supposed to move a lot, but that your neck, shoulders, and ribcage should have plenty of free motion in many directions? For most of us our necks and shoulders are too tight and our lower backs are too loose, and that is a big part of the pain problem.
The ability to maintain a neutral pelvis, only moving the lumbar spine with intention, support, and control, is crucial to living and exercising without back pain. When the pelvis is neutral, the muscles in and around it are able to function at their best.
Here are six simple but effective pre-Pilates fundamentals that will help you with your back pain. Try doing them once or twice a day for about six to eight weeks.
Pre-Pilates Fundamentals for Lower Back Pain
1. Conscious Breathing
Part of the pain response is that we tend to stop breathing, which when you have back pain makes everything much worse. Here is a simple breathing exercise that will start the process of getting your ribcage to move more and feeling how you abdominal muscles assist in breathing.
Lie on your back with your knees bent, your feet hip bone width apart, and your arms by your sides. Pay attention to your breathing and to the muscles in your torso. The abdominal muscles are not just in front, they actually wrap around your torso from your spine to the front, around your ribs, waist, & pelvis, forming the round sides of a cylinder.
Feel your ribs move to the front, side, and back as you breathe--the abdominals are helping to move your ribs! Now pay attention to your pelvis. Make sure that you are not pushing your lower back into the floor; your pubic bones should be in the same horizontal line as your hip bones--you may have an arch in your lower back and that's OK, you are supposed to!
Now as you inhale let your ribcage, abs, and pelvis relax. As you exhale contract your pelvic floor as though you had to stop peeing, feel your abs wrap tighter around your ribs and waist like a corset, and feel your diaphragm under your ribcage pull up and under the ribs. Make sure again that you are not flattening your lower back into the mat. Do this conscious breathing a few times.
Put your hands on your belly and notice that now it pulls in (it may feel soft, but you are going for width and depth, not for tightness!). Repeat 10-15 times.
2. Pelvic Rocking
Add a small rocking movement of your pelvis - tipping it back as you exhale (hipbones back and tailbone up) and forward on the inhale (arching the lower back). Repeat the tilt/ arch 10-15 times.
Then try to move side to side without moving your knees or rib cage. Pretend that someone dropped a hot ash on your right hip bone so that it drops towards the mat a little, and then the left. Breathe as you need to and go between the right and left hip 10-15 times.
Finally, combine these movements into a small circle. Pretend that your belly is a big bowl of thick batter and you are trying slowly to move the batter all around the bowl without spilling any. Begin by tilting your pelvis back and then go around to your right hip, your tailbone (arching the low back off), the left hip, and back to the beginning. Repeat 3-6 times and then reverse the direction. Breathe constantly and slowly.
3. Ab Curl
First do some small nodding movements of your head/chin keeping the back of your head on the mat and trying to move from the base of your skull. After 5-10 nods do some small circles in the same manner (pretend you are drawing circles in the air with your nose) 5-10 times in each direction.
Then bring your hands behind your head and allow the back of your head to really sit in your hands. Nod your head and then pretend you are holding a large egg or small orange under your chin (in other words keep space between chin & chest). Exhale fully and let your ribs drop in and down (don't shove them down!) as you curl your upper body towards your pelvis (do not pull forward from your head at this point--use the ribs). This is more about curling your ribs up than straining your head forward.
Stay there for a moment and consciously breathe as above, making sure that you have not tucked your hip bones back to the floor--get your pubic bones back down towards the mat and see if you can get as deep and wide in your belly as when your head was down. Always work with pulling the belly in and not pushing out! Repeat 5-10 times.
4. Arm Circles
Still on your back with the pelvis neutral, bring your arms/hands back to your sides. Slowly lift arms up to ceiling as you inhale. When arms are at shoulder level exhale as you reach them towards the ceiling (keep head down) allowing your shoulder blades to lift and spread as wide as they can; then inhale as you drop the shoulder blades down and squeeze them together in your back while your arms stay in position towards the ceiling.
Repeat 5-10 times.
Keep your arms up but allow your shoulder blades to relax. Keeping your ribcage down and plenty of space between your hands, exhale as you stretch your arms back overhead, and inhale as you circle them around to the sides and back to your hips. It is important that your ribs stay down; it is not important that your hands touch the floor. This should not hurt your shoulders. Stay in a pain free range of motion. Do 4-6 in each direction.
5. Prone Hip Extension
Lie on your stomach with your forehead resting on your hands and breathe. It is harder to breathe here, but think about expanding your ribs to the side and back more and contract your abs in towards your waist with each exhale.
On an exhale press your pubic & hip bones into the mat and as you inhale lift one straight leg off the ground. Keep your hips still and do not move your back. Think about lengthening between your hip bone and the top of your thigh bone.
Remember that we only have about 15 degrees of hip extension, so this should not be a huge movement. Exhale to lower your leg. If your legs separate, that is OK at the beginning. Strive to keep them together. Alternate legs 5-10 times and then do both at the same time 5-10 times.
Lay prone on your stomach and place arms by your sides with palms down and forehead resting on the mat or a folded towel. Set up your pelvis the same way as above as you exhale, contracting your abs and pressing your hips and pubic bones into the mat.
This time as you inhale lift and lengthen your head & chest off the mat while at the same time reaching your hands towards your feet. Exhale, contract your abs deeply and lift your hands/arms. Don't overarch your lower back or your neck! Keep chest open & feet down. Repeat 5-10 times.