I love Pilates. I mean, I must, I teach it everyday. Pilates is known for its many benefits. It's commonly recommended by Doctors and Physical Therapists for pain and physical rehabilitation. Pilates enthusiasts attribute increased energy, strength, flexibility, and overall health to their practice. They each have their own Pilates story about how it has improved their lives. For those of you interested, here is mine.
I started practicing Pilates as a part of a many-pronged approach to reduce persistent back pain. Mindful movements, nutrition, sleep training, mindfulness meditation, & pacing were all tools that I was taught in order to take control of my body and pain experience. And although some medical interventions were also used, these are the only tools I use every day to continue to maintain a reduced experience of pain.
When I was 19, a semi-truck sent my car airborne on a busy city street in the morning rush hour. One man's fatigue and mistake changed the trajectory of my life. But I stepped out of the car in one piece. I had no broken bones and no significant cuts. I seemed fine. So I went on with my life. I went to physical therapy for some stiffness from whiplash and saw some doctors for post-concussion care. But a couple of months past and I seemed to be back to normal.
Six months later was when the pain set in. It started as an ache in my upper back at the end of the day and then slowly made itself a permanent home. The pain was there all day, and it gradually got worse as it simultaneously wore me down. It's a familiar story in persistent pain.
The NOI Group describes two common responses to pain. Avoiding Pain and Trying to Beat the Pain. At different points during the next eight years, I did both.
At some points, when something triggered the pain, I would then avoid that activity or modify that activity to prevent the pain. But by doing so, I slowly lowered the threshold of activity, which triggered the pain. This strategy slowly created more disability.
So then, at some points, I would try to beat the pain. I would ignore the pain, keep going with my activity and distract myself until finally, the pain was so great, it would be unbearable. Then, I would be out for days or weeks.
I flip-flopped between these two useless strategies for 9 years. Neither worked. And throughout these years, I searched and searched for a 'cure.' I saw all sorts of Doctors, Specialists, Massage Therapists, Acupuncture, and Physical Therapists who gave me the diagnosis of Myo-Fascial Pain Disorder and Central Nervous System Sensitization. Exercise and medication were prescribed, and so I tried every type of low impact exercise system that was readily available: Yoga, Pilates, swimming, walking.
Some manual therapies gave short term relief, some did nothing, and some aggravated it. But none offered a long term solution. Some exercise felt safe at first, but when I tried to step it up, my pain increased.
So what did I do? I eventually came across a Medical Clinic in Vancouver, where I was living at the time, that specializes in treating persistent pain. They had an unusual approach that integrated many different disciplines, all working together to create a multi-pronged holistic approach. The clinic is run by General Practitioners and Anesthesiologists, and they work in close conversation with Nutritionists, Movement practitioners, Physical Therapists, Chiropractors, and Psychologists to approach pain management from every angle.
Their goal was to, through collaboration, empower me to use all of the non-medical self-care techniques available before medical interventions were employed. Diet, Sleep Hygiene, Mindfulness, Pacing, and Movement were all advocated. And in this environment, I found helpful self-care techniques. For me, it was movement generally, and Pilates specifically, that provided the most relief.
What was Different?
So why did Pilates help then, but not earlier. I can come up with 2 reasons. First, it was guided by someone who was academically immersed in the field of pain science and experienced persistent pain for much of her own life. Pain science is a relatively young discipline, and the newest knowledge hasn't permeated through to everyone working in rehab yet. Rehabbing from an acute injury with a physical explanation for the pain (i.e. a broken bone, strained muscle, etc.) is a much different thing than rehabbing from pain with no visible explanation.
This leads us to the second reason, Pacing. Understanding pacing was crucial to healing for me. I wanted an instant solution, and if it was movement, I wanted to feel like I was working hard for it like I was doing something. But I had to learn to be patient. For me, small movements healed. And tiny, tiny, barely noticeable increases in activity made massive positive changes to my nervous system and pain experience over time. And with the right instructor, who understood pain, Pilates healed.