5 reasons why your back hurts DURING Pilates.

If you’ve ever had a sore back and have sought treatment for it, then no doubt you’ve heard something along the lines of:

“You need more core strength to reduce your ‘back pain’, you should go do Pilates”.

Yep every Physio and Osteo and Allied Health professional out there will likely say some version of this. 

And it’s true. 

Your spine is surrounded by what we call in Pilates, your Powerhouse, ie, the house or the area where all the power should be drawn from. You can think of it a bit like a cylinder around your trunk/middle, 360 degrees, front to back, side to side, top to bottom, each part or muscle plays a role in supporting the spine. When you can access and use each component equally and effectively (I have a whole other blog on the muscles that make up the powerhouse and how and what it means to use them equally and effectively), this then creates and improves stability, which allows you to generate power to build strength and improve mobility without pain or injury. 

If your powerhouse is not stable, then back pain can occur (among other things). 

Ok ok, you get it, you’ll go do the Pilates. BUT you’ve tried Pilates a few times and actually, in some things, your back pain is worse?! 

WTF is up with that? 

So you give up. 

Pilates has left a bad taste in your mouth and you just end up ‘putting up’ with back pain.

Does not sound like much fun really. 

This is a story I hear from time to time and it’s not ok. 

Here are some common things that might be going on:

1.You go to a group class.

When really you should be doing privates or semi-privates (at least initially anyway). You hear Pilates is great, your health professional tells you you need to do it, you know there’s a place down the road that Joe Blow goes to, so you think, ‘yep that’ll do, I’ll try that one too’. It’s got bright lights, loud music, seems fun with 20 reformers, but there’s no personal instruction, no modifications or amendments made for you and chances are instructor got their certificate over one weekend.

Yes it’s more expensive, yes it may have to mean you budget for it or have to figure out a way to afford it. Eg, maybe you only go out for dinner once a weekend instead of twice. But this is your health and wellbeing and longevity we’re talking about.  

If this is you, and you think Pilates is too expensive, then read this blog on Why Pilates Is Expensive.

2. You're doing too much.

You’re taking the optional progressions in group classes but you shouldn’t be (again, maybe you shouldn’t be in a group class in the first place). Remember Pilates is good for you, but only if you are working within your means and doing what YOU can do on that day and not trying to force yourself to do something you’re not ready for.

The grace we give ourselves when we are working out, is practice for the grace we give ourselves when we are doing life, business, family, friends, kids, husbands, wives and all the other things that can be hard but also rewarding.

3)  You’re doing too little. 

You expect that you can just go to your class, switch off from the world, mull over the problems you’re having at work and ponder what you’re going to cook for dinner while getting a workout done. So you go on autopilot mode, going through the motions and then wonder why you’re not making any progress or seeing any improvements. 

A central theme of Pilates is Concentration. You need to be focused in Pilates. You need to be present and in the moment. When you can focus your attention to the exercise at hand or what the teacher is trying to get you to do, you have a better chance at being successful in the movement. 

When we are concentrating and focusing our attention towards getting the right muscle engagement, then you learn to feel the muscles, you learn what it feels like when a muscle (or a group of muscles) is engaged.  Therefore your body awareness will increase and you can translate that into more mindful movement in every day life, like how you sit at your desk all day long. And how that does or does not contribute to the  back pain you’re experiencing and then you can draw on what you learnt in class when you were paying attention  to rectify it!

4) You’re not doing your homework.

Does your teacher advise you to get up from time to time from your desk and roll your shoulders out, or to bend or to twist? They’re not telling you that to fill up space in a conversation. They’re telling you that because your body needs it. Maybe they tell you to work on some rolling of the feet on a spikey ball because you get foot pain, which impacts the hip alignment and therefore your back.

What ever the extra curricula activity they are asking you to do between classes, try and do it. It will make your life easier and your time in class more rewarding as you will be able to move though more exercises that help build your strength and increase your mobility. 

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5) It’s not actually your back that is the source of the real problem.

Ever heard of referred pain? Sometimes, we feel the pain somewhere (eg your back), but that pain is actually referred from somewhere else in the body. 

It’s because of our nervous system and the mixed messages of the wiring to and from the brain about the source of the pain. 

Sometimes back pain can actually be caused by the pancreas, kidneys or colon. If you’ve tried Pilates, Physio, Acupuncture and all the things, it could be time to go and see your GP. 

So there you have it. 5 common reasons why you might still be experiencing that annoying back pain even though you have started a Pilates class. 

Personally, I am a huge advocate for Pilates and back pain. It’s something I live with every day. Or I should say, I manage it everyday. I have a spinal condition called Spondylolisthesis,  which is a minor disc slippage in the lower vertebrae. Most likely caused from all those years of gymnastics as a child when my spine was developing. I’ve written a blog on it, you can read it here (PS I give away free Pilates exercises in this blog too!). Pilates is literally the magical glue that keeps me together, so I will forever continue to sing its praises. 

Pilates Pelvic Floor & Perifit

So I never really thought I would be writing about products or recommending products on my IG feed. However, this one is a doozy. If you have ever had a baby, are thinking about having a baby, are pregnant or have had any sort of pelvic floor weakness/disfunction, then you’ll wanna keep reading. Below is a breakdown of my experience with the Perifit device that reads pelvic floor strength and stamina directly from your lady bits via bluetooth games on your mobile phone! Intrigued? Yep, I was too. 

29 weeks pregnant with my first baby.

It all started with this blog I wrote a while back. It was about my experience of Pilates and pregnancy and birth and the after affects of birth on my pelvic floor and how Pilates helped me recover.

Recently a company, Perifit, contacted me to say they had read my blog and thought I might be interested in their product. Having no idea who Perifit was, I was totally dubious about this so called company wanting to give me free stuff to try. After a Google search and a brief read of the excellent reviews this company was getting, I was more inclined to respond positively to their request for trialling their product. So, what is Perifit? Well this is straight from their website: ‘Perifit is a Kegel exerciser that lets you control video games with your pelvic floor. When you contract your pelvic floor the bird goes up. When you relax it, the bird goes down. These games were designed by doctors to help properly strengthen the pelvic floor. It works so well that more than 1000 doctors already recommend Perifit to combat incontinence and prolapse and other pelvic floor disorders.’ 

Once it arrived, it sat on my bedside table for weeks. Partly because the unknown is a bit terrifying and that’s always a good excuse to procrastinate, party because I thought it might take ages to set up, read the instructions and just generally figure out. But I was wrong. Well, the unknown is always a little terrifying, but it was straightforward to read about and set up. First tick! 

When I decided to give it a go, opening the box and noticing it’s uncanny resemblance for a vibrator, I all of a sudden felt like I needed to excuse myself from the living room couch, ha! ‘It’s for work’, I was telling myself.. and my partner wink, wink. 

Once you have downloaded the Perifit app, turned on the device and activated bluetooth  on your mobile, you’re all set for insertion. It’s only mildly uncomfortable initially, if I had to compare it to a pap-smear, where a pap-smear is an 8 or 9 on the discomfort scale, this is about a 1 or 2. Totally manageable.

You can target your pelvic floor training based on your needs, simply take a short test and it will calculate which training program is best for you eg postpartum, incontinence or intimate wellbeing. Once you have your program, your games will be targeted to getting the best outcome from your program. 

So the game itself… well, think of a rudimentary Mario Cart meets Angry Birds type scenario. Where you (or your pelvic floor to be more specific) are the object that has to fly (by contracting your pelvic floor) to capture the floating items in the sky. And then brought back down (again, with the controlled release of of your pelvic floor) along a specific pathway of floating objects to capture either in a linear angled line or something a bit more adhoc. The point being that you want your pelvic floor to be able to do both, steady increasing contraction with steady decreasing release as well as short sharp contract and release muscular control.  

After the game you receive your results on an intricate biofeedback screen, this helps to break down the difference between your deep vs superficial muscles. It tells you how you rate in terms of Force, Frequency, Stamina, Release and Accuracy. The stats you get are so interesting and really help to target the specific areas of improvement.

There’s a manual mode, which I love! Its designed to record the muscular behaviour of your pelvic floor in its functionality. So, pop it in while your vacuuming or carrying the baby and see how your pelvic floor naturally reacts in these situations. Fascinating! 

Why is this relevant to Pilates and my work?

Some would argue that historically, Joseph Pilates would not have cued pelvic floor engagement. His writings indicate that he believed his exercises would activate the neuromuscular system in its natural “correct” patterns, like those of the "newborn babe" or animal. We also know that he believed in the importance of breath…"Before any real benefit can be derived from physical exercises, one must first learn how to breathe properly." Joseph Pilates. 

Picture from Pinterest courtesy of Dani Menesis at Studio Pilates

These two points give us an insight into what makes Pilates so effective. When we breathe as we should, physiologically, we can distribute our intra-abdominal pressure in a balanced way throughout the thoracic, abdominal, and pelvic cavities. When we can balance intra-abdominal pressure (IAP) distribution, we are creating muscle balance in our “core muscles". Our core muscles include the diaphragm, all the abdominals, the deep intersegmental spinal muscles, and the pelvic floor. To facilitate ideal distribution of IAP, the diaphragm has to be able to move up and down freely, which requires that ALL core muscles, including those in the pelvic floor and abdominal wall, can work in both concentric (shortening) and eccentric (elongated) contraction. When we breathe correctly, we are using these muscles in a balanced way, and our spine can stabilise due to the correct distribution of IAP. 

Picture from Pinterest courtesy of Healthwise, Incorporated

 So this is why I rate this device. Although Pilates works the body as a whole, understanding how and where we need to build stability and that our muscles need to be trained in both eccentric and concentric function (pelvic floor being one of those critical areas), is an essential tool to building overall strength and mobility. 

I would describe childbirth like a semi-trailer has rail-roaded you from the inside out,  so it’s not hard to imagine the imbalances and dysfunctions that women can experience after such an event. We are often told to do our ‘Kegels’ before and after childbirth to prepare and rebuild the pelvic floor muscles, this is often interpreted as just focusing on the concentric contraction in an isolated activity. As already mentioned we don’t just want the shortening of the muscle, we want the eccentric or elongation of the muscle as well. So thank you Perifit for making a device that helps with the both, and therefore setting the groundwork for successful, whole body Pilates conditioning! 

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Me in action! Getting my clients to switch on their core, with the help of the Magic Circle.

Even Pilates Teachers Prolapse

My experience with birthing big babies and how Pilates helped my pelvic floor ‘come back’

Ah, the ‘P’ word. Prolapse. More specifically, vaginal prolapse. A word that expectant Mothers fear, and new Mothers don’t want to hear. When the pelvic floor is strong, it supports the pelvic organs to prevent problems such as prolapse. If you’re not familiar with what a prolapse is, emedicinehealth.com define it as ‘a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel or the vagina itself -may begin to prolapse, or fall out of their normal positions’. Yikes. No one wants to imagine their bits hanging between their legs, unless you’re male, in which case, the more hang the better, right?! So, you can imagine my state of disbelief when the Pelvic Floor Women Physio examined me 6 weeks after the birth of my second child and told me I had stage 1 prolapse. Now I knew things were a bit dicey down there, but I didn’t know things were that bad?!

Image courtesy of womenshealthadvice.com

So how does a vaginal prolapse happen?

Damage to the pelvic floor occurs particularly:

1) when there is a long second stage labour (tick- both of my boys), 

2) during instrumental deliveries – vacuum extraction or forceps (tick- both of my boys), and 

3) in the delivery of large infants (tick- second baby 4.1kilos; Womhealth.org.au). 

I guess looking at the history of both births I had a fair chance of a prolapse.

After birth, I distinctly remember having a feeling of detachment - not to my baby, but to my body. It was like my organs and insides were just floating around aimlessly inside my skin, not quite sure what to do, where to be or how to behave, especially my bladder. I was wetting myself for a good week after baby number 2. Highly annoying! Don’t even get me going on having to sneeze or having a laugh at this time. I really had to tune into my bladder, the moment I needed to go to the toilet, there was no waiting,  I had to go right then!

I don’t blame you if you’re thinking, ‘but she’s a Pilates teacher, she must do her pelvic floor exercise ALL the time?’ Well yes, and no. 

When I was pregnant (and subsequently immediately after birth for the next little while), I would specifically carve out some time in my day to activate my pelvic floor. Usually I was doing a routine, mundane task like, waiting for the kettle to boil in the kitchen or having a shower- anything that happened daily and more than once a day where I would get in the habit of doing them while I waited (more on those specific exercises later).

When I’m not pregnant I don’t really think about my pelvic floor all that much. Sure, I do Pilates and part of doing Pilates is having an awareness of how to engage those muscles in order to stabilise them while another body part is mobilised. But this ‘internal stabilsing’ is something that has become second nature. So, when I do my everyday tasks (e.g., bending down to pick up the many things sprawled across the floor- clothing, toys, mess, towels, animals, children) I first stabilise internally through my pelvic floor, and low abdominals before I mobilise my torso in the direction of the ‘thing’ I’m picking up. Pilates in this way has been a savior. When you can use your pelvic floor and deep abdominals, you are less likely to have low back pain, and I know how inconvenient and restricting back pain is when you have small children who want to be hugged and chased and comforted.

Another important aspect of pelvic floor activation is pelvic floor release. Especially for me, as a Pilates teacher, I’m constantly thinking of drawing ‘in and up’. I do it along with my clients, so, when I’m telling them to do it, I’m unconsciously doing it along with them! If the pelvic floor becomes difficult to relax, it’s constantly in a state of being semi-flexed. Imagine flexing your bicep constantly and never fully letting go, after a while this would cause your arm to lose flexibility, strength and the ability to relax. That is similar to what happens to the pelvic floor (goop.com).

After birth, the body naturally starts to restore and repair. After a week of wetting myself, I could start to hold my bladder slightly longer, after a few weeks, sneezing wasn’t so scary. Still, after the confirmation of stage 1 prolapse at 6 weeks postpartum, I knew there was some further work to do.  When I went back to the Pelvic Floor Women Physio at 12 weeks postpartum, I had another internal and was relieved to hear everything was back to ‘normal’. 

So what are the actual exercises I did while pregnant and post pregnancy for strengthening and releasing the pelvic floor? Here are 2 simple things that I did:

1. Sitting down with a pillow or folded up towel between the bottom of your inside thighs, sit yourself towards the edge of the couch or chair (no kickin’ back in a slump!). Feet flat on the ground, lift up tall out of your pelvis up to the top of your head. Take an inhale breath to prepare, then on the exhale breath, gently squeeze the pillow or towel while thinking about stopping a wee mid-stream as well as holding in a fart. This will lift the hammock of muscles at the base of the pelvic floor from your front passage to the back passage in and upwards. Try and hold for 5 seconds (you can build up to 10, 15, 20, 30 secs etc.). Make sure that when you let go, you feel a proper distinction between the contraction and the release. If you feel like you couldn’t distinguish between holding the pelvic floor up and letting it go, try reducing the amount of time you hold on for. I was starting at about 3 sets and worked up to around 8-10.

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2. Standing up, slightly bent over (kitchen bench is usually a good option), with your legs hip width apart (it’s harder to squeeze your glutes together in this position so you have a better chance of isolating the pelvic floor muscles), draw up and in through the pelvic floor when you exhale (remember, this should feel like you are holding a wee and fart). I often put my hand on my low tummy when doing this. You want to feel that your low tummy is pulling away from your hand towards your spine. Repetitions and durations are the same as the sitting variation.  

A couple of pointers to be aware of:

·         Don’t hold your breath. Breathe normally over the contraction of the pelvic floor muscles,

·         Don’t squeeze your bum cheeks together (can be tricky to isolate pelvic floor and the surrounding muscles- if you find it hard to switch off the glutes try the version standing up), and

·         Tune in to your shoulders- make sure they don’t creep up to your ears and start overworking.

Image courtesy of @neetaphotography on location at Authentic Pilates Melbourne, Hampton, Melbourne.

Upon reflection, I think the odds were always going to be against me given my birth scenarios, regardless of my job and pelvic floor abilities!  However, I’d hate to think what state my insides might be in without the exercises I did during and after pregnancy… who knows?!

I credit Pilates as setting the baseline of my fitness and strength before I fell pregnant. Being attune to my body allowed me to work safely through exercise to maintain my strength and flexibility while I was pregnant, making the road back from the birth of my boys not as daunting as I initially expected.

I recently made this little video demonstrating the sitting down pelvic floor exercises. In the video I’m using a Pilates Magic Circle, however, a rolled-up towel or cushion would be fine.

For those of you interested in starting Pilates prior to, during or after your pregnancy in the comfort of your own home check out my website for more information and contact details.

Please note: This is not intended to be specific advice; pelvic floor muscle training is not necessarily one-size fits all. I recommend being evaluated by a pelvic floor specialist if you are experiencing difficulties.

You should also be sure to gain clearance from your Obstetrician/GP after the birth of your baby before you undertake/begin any exercise.