Here at JennyPhysioPilates we want to make Physiotherapist-led Pilates accessible to all. You do not need to go out and buy fancy Pilates bits and bobs - everything we use is general household equipment.

The one essential you will need for all classes is an exercise mat. I have often been asked if using a towel is okay. Unfortunately a towel does not give you any support nor does it provide much cushioning from the floor!

Other household equipment we use:

Play around with a few cushions you have in your house to see which one works best for you. The thicker the cushion the more support it will give you however as it is soft it can affect your balance and make you a little wobbly with certain exercises. Aim to use a cushion which gives you enough support without throwing you completely off balance!

You need something round with a little bit of give in it, for example:

• A roll of kitchen paper wrapped in a towel
• A foam roller (not one with ridges in it!)
• A rolled up Pilates mat
• A soft ball

You can use:

• A pair of tights
• An exercise band (if you happen to have one!)

You have a few options here:

• Tins of beans, corn etc
• Water bottles
• Travel mugs
• Light dumbbells (if you happen to have some!)

1. Rest

Long gone are the days of bed rest for low back pain! Prolonged rest is associated with higher levels of disability due to the disuse of our joints and muscles. Movement is encouraged, even when in pain – even if this means just pottering around the house at the beginning. Often we fear moving when we are in pain and wait until the pain is gone before commencing movement again. Unfortunately this is not beneficial in the short term or long term. Movement is what aids the recovery of low back pain. Injuring the lower back is just like injuring any other joint – we may need to avoid aggravating activities for a few days after injury (like you would if you hurt your knee) however we need to gradually return to these activities.

Take home message: keep moving! 

2. Scans (x-ray, MRI etc)

Another common myth, probably the most common one that I hear, is that all back pain needs to be scanned. This is not the case at all at all! Scans are only indicated when serious pathology is suspected like infection, cancer or a bone break, which thankfully only accounts for 1-4% of all cases of low back pain! Scans will almost always show “something”, even in those who don’t have pain, for example:

• 30% of 20 year olds;
• 40% of 30 year olds;
• 50% of 40 year olds; and
• Up to 84% of 80 year olds have disc bulges

In addition:

• 37% of 20 year olds;
• 52% of 30 year olds;
• 68% of 40 year olds; and
• 96% of 80 year olds have disc degeneration

3. Medication

It is a common assumption that strong medication is needed for low back pain. Research done to date shows that taking strong prescription pain medication has no further effects than over the counter pain medication and can in fact have more side effects. It is important to liaise with your pharmacist and/or doctor regarding which medication to take, how to take it, how long to take it for and how to stop taking it.

4. Surgery

There are a few cases of low back pain where surgery is indicated, however for the most part conservative management is adequate. In fact research to date shows that the outcome from surgery has no greater effect than non-surgical or conservative treatment in the medium to long term. 

5. “Don’t bend”

Our spines are robust structures designed to move in different ways just like other joints in the body. If we perform an unaccustomed activity like lifting a heavy object or lifting in an awkward way we can be sore after. This would be the case with any joint after doing something we aren’t used to doing. If we completely avoid doing a certain movement like bending our bodies will never become accustomed to it.

6. Pain

There are lots of factors which influence our experience of pain. We now know that pain is not always a warning sign for damage. Our central nervous system, including the brain and spinal cord, have a strong influence over the pain we feel. For some the pain may start after an injury however our nervous system may then become overly sensitive and can increase the pain we feel, from activities which we may not previously have found painful.

Factors that can affect how sensitive our nervous system is include:

• Social factors – home life & work life
• Psychological factors – mental state, mood & emotion
• Physical factors – how we view movement, are we fearful or exercise? Are we avoiding certain movements because we believe them to be “bad”?
• Lifestyle factors – sleep, diet etc

7. Posture

One of the most common questions I get asked is “what’s the best posture for sleeping / sitting / standing?”. The answer to this question is: your best posture is your next posture.

There is no evidence to support low back pain being caused by particular postures. We do however know that movement is key. The best thing you can do is avoid being in one position for too long.

What is it?

Whiplash results from the head being suddenly jerked backwards and forwards. It can result in injury to bones or soft tissues in the upper body which are collectively referred to as Whiplash-Associated Disorders.

How does this happen?

Whiplash-Associated Disorders most commonly occur after a road traffic accident where the car you are travelling in is rear-ended. They can also occur from sports, diving and other activities.

What are the symptoms?

Other symptoms which can also occur include:

• Restricted movement of the neck
• Stiffness in the upper body
• Pain around your jaw
• Fatigue
• Tingling, pins and needles or numbness in the arm
• Muscle spasms

 

How is it diagnosed?

Whiplash-Associated Disorders are diagnosed by an assessment from a healthcare provider (e.g. Doctor, Registered Physiotherapist etc). This assessment typically starts with some questions about how this injury occurred, your symptoms and your past medical history. You may be asked to fill out a questionnaire to give your healthcare provider further insight into how this injury is affecting different areas of your life. 

 

A physical exam will then be carried out during which you will be asked to perform simple movements like looking to the left/right. Your healthcare provider will carry out certain tests to check what structures are involved. You may be sent for an x-ray to rule out bony injury. It is rare that a MRI or CT scan will be required. 

 

After all of this your injury will be classified depending on the severity of it and the structures involved. Whiplash-Associated Disorders are graded from 0 - IV, with 0 being the least severe and IV being the most severe. Typically in clinical practice we mostly see grade I - II. 

 

What treatment will I need & how long will it take to recover?

Research shows that the earlier you attend a healthcare provider after your injury and the earlier you start a treatment programme the better your recovery will be.

Initial treatment may involve medication to help reduce pain levels.

Evidence-based guidelines recommend starting gentle movement exercises as soon as possible which will help reduce pain and improve your function.

The video "Neck Pain" in the Masterclass Section will take you through tips and strategies on managing neck discomfort, while keeping yourself moving. The "Neck Stretching" video goes through some gentle movement exercises.

 

 

Treatment for the majority of people will consist of exercise. Studies have shown that Whiplash-Associated Disorders respond best to:

• Movement or mobility exercises for the neck, upper back and shoulders.
• Strengthening of the upper back, mid-back and neck.

The Niggly Neck Rehab Series is a progressive series of classes which includes all of these exercises. It is suitable for Whiplash-Associated Disorders (> 6 months previous).

 

 

The most important piece of advice for a quick recovery is to keep moving!!! Research shows that if we move as normal and go about our daily lives as normal (within pain limits) that it aids a speedy recovery. 

 

Recovery time frames vary as there are many factors involved. Approximately 50% of people recover within one year. For a more severe injury it can take up to three years to see full resolution.

 

TAKE HOME MESSAGE:

Keep moving, stay active and return to work as soon as possible to promote a smooth and swift recovery!

 

Information sourced from:

Pastakia, K., & Kumar, S. (2011). Acute whiplash associated disorders (WAD). Open access emergency medicine : OAEM, 3, 29–32. 

National Institute for Health and Care Excellence (NICE) (2018). Neck Pain - Whiplash Injury.

 

Physiotherapist-led Pilates, also known as Clinical or Rehabilitative Pilates, is an amended form of traditional Pilates, taught by a Physiotherapist. It consists of numerous rehabilitation principles and can assist in the management of chronic conditions, spinal pain, rehabilitation from injury and prevention of further injury. It is a low impact form of exercise which means it does not stress any joints, making it suitable for all ages and capabilities.

A commonly held belief is that Physiotherapist-led Pilates is just core strengthening - it is so much more than that!! It is a mixture of strengthening exercises, balancing exercises, stretching and mobility exercises. Physiotherapist-led Pilates combines the principles of more traditional Pilates with the Physiotherapist’s knowledge and expertise to adapt exercises, ensuring they are suitable for those with injuries or painful conditions. Often this will comprise of different options or variations of an exercise to make sure you are doing the most appropriate exercise for your body. Typically Physiotherapist-led Pilates is at a slower pace than traditional Pilates to ensure you can keep up and perform the exercise in a safe yet effective manner. 

Recovering from injuries:

Previous recommendations for injuries used to be an initial rest period. We now know that “rest is rust” and so this recommendation has been changed to relative rest. This may mean temporarily stopping a higher impact form of exercise (e.g. running, walking or gym classes) however you still need to keep your joints mobile and your muscles strong to rehab effectively. Physiotherapist-led Pilates can be a great rehabilitation tool, achieving the relative rest your body needs to heal, while also keeping you mobile and strong without aggravation of your injury.

Low back pain:

For those experiencing lower back pain exercise is a key recommendation in the management of this. In recent systematic reviews exercise has been shown to be beneficial in the management of low back pain and in particular exercise involving strengthening and flexibility, both of which Physiotherapist-led Pilates involves.

Persistent pain:

Persistent or chronic pain is a condition in its own right that for many years has gone underdiagnosed, under-reported and poorly managed. Recent guidelines for the management of chronic pain include exercise as a key component. Commonly when you suffer with pain there is fear associated with exercising. For many this fear stems from an anticipation that exercise will make the pain worse. Studies in this area show that endorphins released when exercising can help improve pain. If we do not exercise we lose mobility, bone and muscle strength, reduce our balance and overall increase our risk of falls/injury. This disuse or deconditioning further negatively affects the quality of life and increases the disability associated with chronic pain. There are many forms of exercise available, finding one that suits you and most importantly that you enjoy is key! If you are looking to start exercising again and apprehensive to do so, Physiotherapist-led Pilates can be a good place to begin as it is slow-paced, low impact and run by a healthcare professional.

So whether you have a short-term injury, long term back pain or chronic pain condition or just want to exercise at a slow safe pace Physiotherapist-led Pilates is suitable for all!