Are you practicing safe Pilates?

This past weekend I attended a two-day course in San Diego learning how to incorporate Pilates into my pelvic floor physical therapy practice. It was amazing to be surrounded by 30 other female PT’s who are just as excited about pelvic floor PT as I am! (#nerds). The course instructor was a Certified Pilates Instructor as well as a Physical Therapist and led us through safe Pilates exercises appropriate for pregnancy, postpartum, and patients with osteoporosis. I left the course with several awesome topics that I cannot wait to share with everyone! Today, I want to discuss the improper spinal mechanics that may or may not be taught at your Pilates classes. In order to safely practice Pilates, spinal alignment is key.

Neutral Spine Versus Flat Back

Neutral Spine (Circle 2) refers to the natural curvature of your spine without any excessive lordosis or kyphosis. Our spine has three natural curvatures including a slight cervical lordosis, thoracic kyphosis and lumbar lordosis. Neutral spine is the safest position for our intervertebral discs and joint spaces, promotes blood flow and fluid exchange and allows our muscles to function properly. There are a variety of ways that we lose our ability to “find neutral spine” meaning that our bodies cannot maintain proper alignment. When our muscles become either tight or stretched out, weak or hypertrophy, we can lose that proper spinal alignment. Excessive lumbar lordosis is more common in women and indicates weak deep abdominal muscles, tight hip flexors and tight lumbar extensor muscles. Decreased lumbar lordosis or “flat back” is more common in men or older people and indicates weak gluteal and hip muscles. If you have ever taken a Pilates class and the instructor told you to “tuck your tummy, pull your belly towards your spine, flatten your back,” I am here to tell you that you were practicing unsafe Pilates.

How Do I Find Neutral Spine?

When laying down on a mat, observe the range of motion in your pelvis and lumbar spine by performing “pelvis rocks.”

  1. Tilt your pelvis forward and arch your back.
  2. Tilt your pelvis back into the mat, allowing your spine to collapse into the mat.
  3. Continue rocking back and forth into smaller ranges of motion until you find the position that feels comfortable without any excessive arching or flattening of your spine.
  4. This final position is the natural curvature of your low back. You should maintain that spinal position throughout your exercise or Pilates routine.

I challenge you to take charge of your own health and be smart about your body mechanics during all fitness courses! If your instructor cannot help you find neutral spine or argues that “flat back” is proper form, I would find a new class!

Lastly, when finding a Pilates studio or instructor, do not be afraid to ask if they are classically or contemporary-trained. Contemporary Pilates instructors will be familiar with the neutral spine position and will be able to help you find the correct lumbar spine positioning throughout the class.

-Dr. Betsey Stec PT, DPT

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  1. Wallden, M. (2009). The neutral spine principle. Journal of bodywork and movement therapies, 13(4), 350-361.

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