Hi First name / friend!
Chronic Nonspecific Low Back Pain (CNLBP) is one of the most common persistent pain syndromes in the world. While up to 30 percent of the world's adults experiences chronic pain at any one time, it is estimated that more than 70 percent of adults will experience CNLBP at some point in their lifetime.
The “Nonspecific” part may make it sound innocuous or like it has no known diagnosis. But in fact, things like disc herniations and facet joint arthritis fall into this category. This is because while imaging may show tissue changes or even damage, it is now widely accepted and understood that the occurrence of pain depends on a wide range of factors, of which tissue damage is only one.
We need only look back to the studies we have shared here of asymptomatic tissue damage (You can check out one in the Research Highlight below). In other words, there are people walking around right now with torn rotator cuffs, damaged hip labrums and degenerative disc disease who don't feel a thing and have no idea. Since pain doesn't necessarily relate directly to tissue damage, the “nonspecific” label is now added to the common syndrome of “low back pain.” We cannot ever know for certain what causes the discomfort because pain is controlled by the brain and its stimuli are many.
This review article is particularly interesting because the researchers narrowed their focus on randomized controlled trials only and on interventions that used resistance training by itself so they could isolate the findings. In their words:
The results of our study indicated that, with moderate evidence, resistance training is an effective intervention for improving pain intensity, quality of life, and disability in patients with CNSLBP compared with aerobic exercise and usual care, with no difference compared to combined therapy. In addition, resistance training has been shown to produce clinically relevant improvements in pain intensity…Moreover, disability improved significantly in all comparisons, which demonstrates the importance of improving muscle strength not only in patients with CNSLBP, but also in those with all musculoskeletal disorders.
What's particularly cool about this as that the majority of interventions were only 12 weeks in length. It is easy to imagine that if pain has been reoccurring for a long time, it will take as long to find relief and agency in our bodies again. But the human body is amazingly good at adapting, which can really work in our favor when it comes to building strength and improving pain symptoms. Pilates is a particularly special exercise modality because most of the pieces of equipment use springs for resistance, which allows for gentle progression of intensity, minimal joint strain and also unique relationships to gravity that can help us relearn movement patterns in pain-free ranges.
Traditional strength training also increases sympathetic nervous system activity, which can be challenging when you have a central sensitization syndrome like fibromyalgia or chronic regional pain syndrome (CRPS). But Pilates uses foundational principles of flow, coordination and breath, which can help bring the parasympathetic nervous system online when we need it most.
What this study proves is that we are on the right track with the shift toward movement as medicine. When I was first diagnosed with an L4-L5 disc herniation in 2006, I was told to never bend over again or lift anything over 5 pounds. That kind of advice is still kicking around in some circles, but thankfully, the majority of clinical guidance is now steering people back to movement as quickly as possible. Since that terrible advice, I have worked with a number of informed trainers who have helped me rebuild my strength, and I have been surprised to find that exercises that cause my hips, legs and even my back to work extra hard are usually the most beneficial (e.g. Romanian deadlifts).
I have said it before and will say it again: there is no perfect movement modality that is the only one you need. Nope, not even Pilates. Our daily lives demand diverse movement patterns from us, so our structured exercise should prepare us for those things. Anyone in this industry worth their salt will tell you that it's important to vary your movements and also to do the things that you ENJOY most of all. But there is no way around it: the evidence just keeps piling up in support of movement as a path out of the downward spiral of pain.
