Is Pilates Class Hurting Your Back? Confessions from a Pilates Instructor

Does Pilates cause back pain? I can only speak from my own experience, and the answer is... kind of. For perspective, I was a gymnast in my childhood and early teenage years. I sustained a few falls that stayed with me into my adulthood (now mid-40s). I have disc bulges in my neck, osteoarthritis, a compression fracture, and a pars fracture. Although I look very athletic, I have struggled with neck and back pain for as long as I can remember.

I originally became a pilates instructor because I loved the gymnastics quality of some of the more advanced movements, and I loved the feeling of a strong core. Now, two decades into teaching, I'm disenchanted with doing the work myself.

Here's my dirty secret

I don't take pilates classes. Ever. It's not because I don't enjoy pilates—it's because my body pays dearly for it. Anytime I have my arms in straps (mid back series, coordination) or engage in flexion (teaser, backstroke), I end up with an aching low back and a stiff neck. The next day brings migraines, pain, and regret. The irony isn't lost. I teach pilates to help people with back pain—but I don't do it myself.

Over time I've accepted that there are plenty of moves I shouldn't do, even if technically I CAN do them. And that makes me feel more or less unsuccessful in pilates. When I do yoga, in comparison, I can pop into a handstand and achieve advanced poses. But to achieve those awesome pilates moves—teaser, snake—I hurt the next day.

The weight of being a fraud

Maybe it's shame—shame for not being able to fix myself, for getting old, for being a fraud teacher. When I hurt, I feel like I'm the only one. Everyone talks about how much pilates cured their spine, but my experience is to the contrary. At some point, after eliminating the majority of movements to protect my body, I started asking myself: are we really doing Pilates? Or are we just doing exercises on a machine? Does all of this make me NOT a pilates teacher?

I grapple with this question often.

Finding my people

The truth is, the vast majority of my students are serious rehabbers. My soulmate student, the kind I attract like a magnet, has more in common with me. They come to me with a problem to solve—a severe back injury, hip replacement, osteoporosis, scoliosis. For them, I create a blended workout in non-traditional pilates fashion. I give Pilates exercises in ANY order that makes sense in terms of their goals. I use functional exercises unrelated to Pilates, The ELDOA Method, and myofascial stretching.

For some of these people the solution is ZERO flexion, like for my client with osteoporosis-related collapse of 6 spinal bones. This "no flexion" modification eliminates the possibility of ever doing a traditional class in which the vast majority of exercises involve deep forward bending.

This doing-stuff-on-a-machine approach is legitimate and should be respected as such. This is how I serve my own clients with back pain. But I can't be wholeheartedly enthusiastic about the classical Pilates work when I can't get excited about doing the majority of the exercises myself.

I connect best with people facing a health crisis who need to get moving NOW to continue living life on their terms. It's rewarding to teach people motivated by something more real than needing to wear a bikini on vacation. Of course Pilates is amazing for healthy, fit bodies. But my superpower is crafting workouts for people who need to deal with a "situation." I am a decidedly contemporary and rehabilitative type instructor in spite of my respect and admiration of the classical work.

The uncomfortable truth

So, does pilates cause back pain? I would argue, in many cases, the answer is yes.

When I owned a pilates studio, I saw more class attendees drop off due to chronic back and neck injury than anything else. Sorry, that's the god's honest truth. Many aging people start pilates in hopes of correcting their backaches or disc bulges, only to end up disappointed. This is one of the reasons I sold my studio to focus on rehab modalities. My new students typically did well in privates, but when I released them into general pilates classes they inevitably experienced pain and/or exacerbation of injuries. Not because the instructor was bad, but because the general premise of pilates was not for them.

Pilates involves loading the abs and back with spring loaded tension, mostly in the frontal/sagittal plane. Repetitive spinal flexion often isn't the best solution for compromised necks and backs. In fact, if you have spinal stenosis, acute disc bulges, scoliosis, or osteoporosis, there are simply so many things in the classical pilates order that should be modified or avoided altogether. By accepting these individuals into group classes, we pilates instructors are collectively serving up a heap of pain.

For example, if someone has back pain when their knees are in "table top", as is the case for lumbar stenosis, they will not enjoy pilates no matter how carefully it is taught. In contrast, the student who has weak abs and a big swayback (excessive lumbar curve) will likely have a very positive, life-changing experience with pilates.

We are all so different, aren't we?

A call to fellow teachers

Teachers, I'll bet you know the moment a new person steps through your door if Pilates will work for them. Whenever it truly benefits the person to suggest that they do something else, I don't hesitate to tell them so. Most of us are in it for the healing. For me, part of healing is thinking outside the lines of my chosen profession to help my students to the very best of my ability. It means admitting that Pilates is not good for every single body.

What do you think?