Every once in a while, the debate about how much and whether to flex the spine resurfaces and students have questions about where Pilates fits into this discussion. In recent weeks, it has come to our attention that physical therapists have recommended that clients avoid flexing their spine, referring clients to the writings of Dr. Stuart M. McGill, a professor at the University of Waterloo (See https://uwaterloo.ca/kinesiology/people-profiles/stuart-mcgill), who has written much about back pain and spinal injury. It is true that some clients with certain injuries and conditions should not flex their spine, but there is no need to feed into fear and avoid all movement or flexion altogether. In short, be less afraid, but more aware.
For those with healthy spines, the gentle Pilates program generally fits well into an exercise regimen. The key is proper, lifted movement guided by the touch cues and verbal cues of your instructor. For those clients with back pain, there are a variety of approaches that can minimize current pain and address the specific issue to guide the client to a healthier back.
There are many clients who must approach flexion exercises with caution, especially in a group setting. Exercises like Rolling Like a Ball may not be suitable, at least initially. Thus, clients should proceed with caution and always trust their instincts. When in doubt, leave it out! Slow and steady progression of the Pilates method, leaving out any exercises that do not feel right for the body, often is the key for alleviating back pain. In fact, Pilates has shown to decrease low back pain and disability as opposed to usual care over a 12-month follow-up period. (See http://www.ncbi.nlm.nih.gov/pubmed/16881464, “Pilates-based therapeutic exercise; effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial;” Journal of Orthopedic and Sports Physical Therapy, July 2006.)
To address the point that flexion is detrimental to all spines, that is an oversimplification of a complicated question. For example, the point that, like a credit card, the spine can only bend so many times before breaking, is an unfair comparison. A credit card, while it may have some flexibility, is not designed to bend. In other words, bending a credit card does not serve any function. The spine, of course, is designed to bend and, indeed, must bend in order for us to do our daily activities. How can we tie our shoes without flexing our spine? Or pick up something we dropped?
Pilates trains our bodies to move in a supported position that allows for the natural flexing, extending, laterally (side) bending and rotating of the spine that is required to live full lives, resulting in stabilized, yet mobile bodies. We do this by exercising all sides of the body and all of the muscles in the core. You may be surprised to learn that the core muscles include the abdominals, pelvic floor, latissimus dorsi (lats), back muscles, gluteals and the diaphragm!
As with many debates, there is a middle ground. The idea, for example, that we should work the core isometrically in a neutral alignment is sound reasoning. This is one of the many reasons we do planks in Pilates, as well as cue the tailbone down while lying supine (face up), lengthening the spine and breathing into the back ribs. It also explains why we cue oppositional movement and resistance. If we put the body in a forward bending position, but only to the extent the opposing muscles can resist, then we can slowly add load, movement and repetition. This way, we simultaneously build strength and good posture. As with everywhere in life, there is no slouching in Pilates! If you have further questions about this topic, please ask!