Back pain continues to be the one of the top motivators that drives people to exercise. Spine pain can occur for many reasons. Intervertebral disks may degenerate, vertebrae can slip pinching nerves, the spine may be misshapen, the sacroiliac joint may be misaligned, etc. People suffering from these conditions often seek out specific types of exercise such as Pilates and Yoga. Except for extreme cases, these two forms of exercise can be an easy and inexpensive way to reduce pain.
The spine is composed of 24 vertebrae, seven in the cervical spine or the neck, 12 in the thoracic or upper spine, and five in the lumbar spine or lower back. Furthermore, the pelvis contains the sacrum which is composed of five fused bones and the coccyx which usually contains four bones which are fully or partially fused. The sacrum meets the spine at the sacroiliac or SI joint. The central nervous system, CNS, travels from the brain through the central opening in each vertebra, the spinal foramen. Peripheral nerves branch away from the CNS and exit into the body through the lateral spinal openings, the intervertebral foramina. Intervertebral disks, IVDs, are located between each vertebra and contain a center, nucleus pulposus, and the encapsulating annulus fibrosus.
Herniated disks are often a cause of back pain. An IVD absorbs compression by transferring it across itself. But the nucleus is composed of 70-90% water and water is incompressible. Hence, if the spine is overloaded or overly rotated, nuclear material is pushed out against the anulus fibrosus, irritating the nerves in that area. If the nucleus pushes past the anulus fibrosus into the neural canal or out of the ring, we say a herniation has occurred. In mild cases the nucleus may be reabsorbed, reducing pain. (Wininger, 2010)
Pilates has a great record of ameliorating back pain. This form of exercise focuses primarily on strengthening the core and stabilizing the pelvis and the spine. Exercises are mostly performed on a non-moving trunk and often in a supine or seated position. Learning how to isolate specific muscles, elongate the spine, strengthen the abdominal wall and spinal muscles, are all necessary components of a training program for people with herniation and a large part of a Pilates program. While Yoga can also be very helpful for this condition, its very nature of creating movement and opening may prove counterproductive. Back problems will require that the Yoga practitioner puts extra focus on alignment, has good awareness of the body and its movement, and stabilizes at the correct places as the body goes through its motions. The stationary trunk and strong isolating exercises of Pilates are safer and easier to practice.
Pain may also be localized in the lumbar spine. Injury in the lumbar spine is often caused by excessive rotation or side bending. Such movement can impinge peripheral nerves causing neuropathic pain and instability. The lumbar multifidus muscle is important for the integrity of the lumbar spine. Sonograms show differences in the size of this muscle in healthy individuals and those with low back pain. Since the lumbar joints carry 20%-40% of the spinal load, strong abdominal and multifidi muscles would help support its work. (Wininger, 2010)
A Yoga practice can be beneficial for this type of pain by loosening up the muscles of the lower back, creating space between those vertebrae, and stretching the hamstrings which contribute to low back pain. If the pain was caused by incorrectly twisting or side bending, these movements should be avoided. In this case stabilization work is recommended again in addition to teaching the individual how to properly elongate and move the spine. While stabilizing work is part of Yoga as well, the largest body of a Pilates is to stabilize as opposed to Yoga which puts a lot of focus on mobilizing. In addition, Pilates is rich in exercises which strengthen the multifidi muscles. In this case, both can be beneficial with a little extra attention paid to the Yoga practice due to its nature and more complex movements.
Healthy SI joint alignment between the pelvis and sacrum is paramount to preventing back pain. Due to the positioning of the composing parts of the pelvis, forces due to weight bearing run obliquely through the joint. This translates to strange pain referral patterns in places such as buttock, low back, groin, lower extremity, knee pain, and foot pain. SI joint malfunction is usually caused by pelvic torsion, such as when doing unilateral leg work. It is important to note that the SI joint is also vulnerable to age-related changes and malfunction should be diagnosed correctly. Activation of the transversus abdominis was found to have the greatest effect on increasing SI joint stability. Studies show that exercise protocols which focus on the strengthening of these muscles by precise contractions and stretches which focus on the hamstrings and hips are necessary to acquire and maintain healthy lumbar-pelvic alignment and a neutral spine. (Wininger, 2010)
Yoga is rich in hamstring and hip stretches. However, care must be applied since there are many postures which are performed on one leg or put more weight on one leg than the other. This can of course actually lead to SI joint malfunction. Assuming mindfulness, the actual true point of the practice, the practice can and does help when performed properly. Pilates is of course famous for its activation of the transversus abdominis. It is the foundation of the entire practice. Therefore, Pilates is strongly recommended.
Pain also occurs in a misshapen spine. Scoliosis, for example, describes a spine which has one or more curves when viewed from the back. This happens due to an abnormal rotation in the vertebrae, creating a twisting of the spine; a side bend may also be present. A body with this condition may display a ribcage which is more prominent on one side, off center positioning of the head, uneven shoulders or hips, a leaning body, and even difficulty breathing and fatigue. (Carlon, 2009) Besides the aforementioned causes, poor posture and aging can also create back problems. Maintaining a neutral spine during daily activities reduces the chance pinching nerves or overly compressing the IVDs. Recruitment of the core abdominal wall is best at supporting a neutral spine. (Wininger, 2010)
Again, Yoga is beneficial here. Knowledge and training becomes especially important when trying to improve pain that stems from scoliosis. But if the instructor understands where and how the spine twists and bends, where to stretch and where to strengthen, Yoga can safely improve the shape of the spine and reduce pain. A Yoga session would be enhanced if followed by the slow, stabilizing, elongating, and strengthening exercises of Pilates. Most Pilates exercises emphasize and aim to strengthen the neutral shape of the spine.
Other methods may be employed when the condition is serious enough to be unresponsive to exercise alone. Acupuncture, chiropractic care, massage are just a few. Applied Kinesiology is also used by chiropractors to alleviate pain. In addition to determining if the spine is misaligned, they can also determine if the patient has a chemical imbalance that may be improved via nutrition or lifestyle changes. Applied Kinesiology may also use combinations of chiropractic adjustments, massage, and cold laser therapy to improve even conditions like mild degenerative disk disease. (Wellness Week, 2011)
While surgery may be the only option for some people, this is not the case for most back pain sufferers. Most people experience reduction in back pain due to the practice of Pilates and Yoga. This may be due to the importance both place on alignment and balancing out the strength with flexibility. Both practices are endeavors worth engaging in not only to alleviate back pain but to prevent it as well.
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