Pilates exercise system to promote back health

By: Beth Glosten, MD
March 21, 2003

Pilates is an exercise program that focuses on the core postural muscles that help keep the body balanced and are essential to providing support for the spine. In particular, Pilates exercises teach awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment, which are important to help alleviate and prevent back pain.

The Pilates exercise program

Pilates is an exercise system named after its originator, Joseph Pilates. Mr. Pilates developed this system in the early 1900’s to improve his health and to support the health of fellow World War I internees. Later, he incorporated the resistance of springs into rehabilitation programs for hospitalized patients, and then translated the use of springs into machines and created the unique equipment now used in the exercise system.

Important principles of the Pilates exercise program include:

• Use of mental focus to improve movement efficiency and muscle control

• Awareness of neutral spine alignment, or proper posture, throughout the exercises

• Development of the deep muscles of the back and abdomen to support this posture

• Use of breath to promote mental focusing and centering

• Creating length, strength, and flexibility in muscles

Initially the Pilates exercise program was primarily used by professional dancers, who appreciated improved strength, balance and flexibility. In the 1980’s Pilates was re-discovered and has now become a popular form of exercise for anyone interested in its health benefits.

The exercise system is usually taught in one of two formats:

• Using the unique Pilates equipment in private, or semi-private, sessions

• Group mat classes not using equipment

Pilates equipment

The Pilates equipment uses the resistance of springs to create effort. The principle piece of equipment is called the Reformer and consists of a sliding platform anchored at one end of its frame with springs. The platform can be moved by either pulling on ropes or pushing off from a stationary bar. Thus, exercises include the challenge of moving the platform and maintaining balance on a moving surface (if sitting or standing). See Figure 1a and 1b to view examples of some exercises done on the Reformer.

Another Pilates machine is called the Cadillac and consists of a padded platform with a cage-like frame above it. From this frame various bars or straps are attached by springs. See Figure 2a and 2b to view photos of exercises done on the Cadillac.

A third piece of equipment, the Wunda Chair consists of a small bench-like platform with a bar attached with springs. Exercises are done by pushing on the bar while either sitting or standing on the bench, or standing or lying on the floor. See Figure 3a and 3b for photos of chair exercises. Several other pieces of equipment unique to the Pilates system are likely to be encountered at Pilates studios.

Mat exercises

Usually taught as part of a group class, mat exercises primarily focus on strengthening the muscles of the trunk and hip and increasing the flexibility of both the spine and hips. While the scope of the mat program is limited compared to the machines, there are many mat exercises that illustrate the Pilates principles. See Figure 4a, 4b, and 4c for photos of some simple mat exercises.

Lately, Pilates has merged with other movement techniques, such as yoga, or use of an exercise ball. This promotes creative integration of the Pilates principles into a greater range of exercises in the mat class setting.