How Discovering Reformer Pilates Finally Helped My Back Pain
On a typical summer Friday in 2019, I came home from a long day of work, power walked on the treadmill, ate a bowl of pasta on an outside patio, and came back in to lounge haphazardly on the couch while pressing "next episode" in my Netflix queue. All signs pointed to a normal start to the weekend, until I tried to get up. I felt a shooting pain radiate through my back and was unable to stand. I screamed for my then-fiancé who came running into the room to hoist me up and guide me to the bed. The pain progressed throughout the night, and it became clear I wasn't okay. One thing led to another, and I found myself being carried into the back of an ambulance and onto a hospital bed at 3 a.m.
It took two weeks, lots of pain medication, and a trip to an orthopedic doctor to begin feeling some relief after that night. The findings showed my bones were okay, and my issues were muscular. I'd experienced some level of back pain for most of my adult life, but never a situation that affected me as deeply as this. I couldn't understand how such a dramatic event could be the result of such seemingly innocent activities. Although my lifestyle appeared healthy overall, I had never followed a thorough or consistent workout routine, and lifting weights and stretching were always on my future to-do list. I knew things had to change, but by the time I started to feel better, I had also developed a fear of movement (something I now know is the worst mindset to have when dealing with back issues).
I spent the next few months focusing on my job, going to physical therapy, and planning my upcoming wedding. Like clockwork, the days of feeling good vanished the night before our celebration. I had known from my research that stress and anxiety were key factors in back-related problems, so it came as no surprise that the biggest event of my life would be the perfect time for my pain to creep back into the picture.
I made it through the incredible night with surging adrenaline, but realized I needed a more hands-on approach going forward. My friend suggested I try group reformer Pilates classes in our Brooklyn neighborhood, and I begrudgingly looked into it. I'm much more of a DIY workout person, making up wild excuses every time a friend asks me to join her at a "fun class," but the reformer sparked some interest. After a few classes, I was hooked. I wasn't good at it, but the carriage, springs, ropes, and loops intrigued me like no exercise had before. It felt challenging, but not impossible. The instructors were chill, without being intense. And after a few sessions, I was moving in new ways with less difficulty. Finally, I found something I liked that would also help prevent pain.
Then, the pandemic hit.
I reverted back to my days on the couch, only this time it was also my office, and I was there 24/7. The world locked down and inactivity became the norm. I felt the pain return, and I worried that all the progress I had made had been erased.
After months of the same, we made a location change to my hometown of Indianapolis, and I found a private and duet Pilates studio, Era Pilates, where the focus is on individual and partner training. There, I started my journey to ending this cycle once and for all.
This time around, in order to treat my pain head-on, I conjured up what was going on in my life that led me to this point. Some obvious points I could trace to flare-ups: days of immobility, weight gain, stress like never before, and fear of the unknown relating to an unprecedented global pandemic.
"The traditional risk factors [for back pain] are things like smoking, obesity, age, and strenuous work. And then there are psychological factors like anxiety and depression. With the pandemic, everyone's stress level has increased dramatically," explains Shashank Davé, D.O., physical medicine and rehabilitation physician at Indiana University Health. Given what many people are dealing with right now, "it's almost this perfect storm of things like weight gain and stress that makes back pain inevitable," he adds.
Weight gain causes your center of gravity to change, leading to a "mechanical disadvantage" in the core muscles, says Dr. Davé. FYI, your core muscles aren't just your abs. Rather, these muscles span a large amount of real estate in your body: at the top is the diaphragm (the primary muscle used in breathing); at the bottom are the pelvic floor muscles; along the front and sides are the abdominal muscles; on the back is the long and short extensor muscles. The aforementioned weight gain, paired with workstations like, say, bed or the dining room table, where ergonomics are not prioritized, put my body on a bad path.
The final factor in this "perfect storm" of pain: lack of exercise. Muscles at complete bed rest can lose 15 percent of their strength each week, a number that can be even higher when dealing with "anti-gravity muscles" like those in the lower back, says Dr. Davé. As this happens, people can "lose selective control of core muscles," which is where the problems pop up. As you start to stay away from movement to avoid exacerbating back pain, the normal feedback mechanism between the brain and the core muscles starts to fail and, in turn, other parts of the body absorb the force or work that was meant for the core muscles. (See: How to Maintain Muscle Even When You Can't Work Out)
Reformer Pilates uses a device — the reformer — that "uniformly reforms the body," says Dr. Davé. The reformer is a platform with a padded table, or "carriage," that moves back and forth on wheels. It's connected to springs that allow you to vary the resistance. It also features a footbar and arm straps, allowing you to get a total body workout. Most of the exercises in Pilates force you to engage the core, "the central engine of the musculoskeletal system," he adds.
"What we're trying to do with reformer Pilates is re-activate these dormant muscles in a very structured way," he says. "With the reformer and Pilates, there's a combination of concentration, breathing, and control, which provides exercise challenges, as well as exercise support." Both reformer and mat Pilates focus on strengthening the core and then expand outwards from there. Though it's possible to get the same benefits from both forms of Pilates, the reformer can offer more customizable options, such as providing varying levels of resistance, and can be adjusted to accommodate personalized experiences. (Note: There are reformers you can buy to use at home, and you can even use sliders to recreate reformer-specific moves.)
With each of my private (masked) sessions with Mary K. Herrera, certified Pilates instructor and owner of Era Pilates, I felt my back pain let up little by little and, in turn, could sense how my core was strengthening. I even saw ab muscles appear in areas I never thought possible.
A few major studies have found that "exercise is beneficial at preventing back pain, and the most promising approaches involve back flexibility and strengthening," according to Dr. Davé. When you experience back pain, you're dealing with "decreased strength endurance and muscle atrophy (aka breakdown) and exercise reverses that," he says. By targeting your core, you take the strain off of your lower back muscles, discs, and joints. Pilates helps rebuild the core and more: "We want to have these clients move their spine in every direction (flexion, lateral flexion, rotation, and extension) to build strength in the core, back, shoulders, and hips. This is what typically leads to less back pain as well as better posture," explains Herrera.
I found myself looking forward to my Tuesday and Saturday trips to the studio. My mood lifted, and I felt a new sense of purpose: I actually enjoyed getting stronger and the challenge of pushing myself. "There's a strong association between chronic back pain and depression," says Dr. Davé. As I moved more and my spirits changed for the better, my pain decreased. I also kicked my kinesiophobia — a concept I didn't know had a name until I spoke with Dr. Davé. "Kinesiophobia is a fear of movement. A lot of back pain patients are anxious about movement because they don't want to exacerbate their pain. Exercise, especially when approached gradually, can be a means for patients to confront and control their kinesiophobia," he says. I didn't realize that my fear of exercise and my tendency to lie in bed during periods of pain were actually making my situation worse.
I also learned that my time spent doing cardio on the treadmill might have been one of the causes of my pain in the first place. While Pilates is considered low impact because of its slow, stable movements, running on a treadmill is high impact. Because I hadn't been preparing my body by stretching, working on my posture, or lifting weights, my treadmill moves, a combination of speed-walking and running, were too intense for where I was at the time.
"[Running] can create impact from 1.5 to 3 times the runner's weight. So that means ultimately the core muscles need to be fortified to manage that amount of stress on the body," says Dr. Davé. Low-impact exercise, in general, is considered safer with a minimal risk of injury.
In addition to focusing on low-impact exercise, Dr. Davé recommends thinking about the kinetic chain, a concept that describes how the interrelated groups of body segments, joints, and muscles work together to perform movements. "There are two types of kinetic chain exercises," he says. "One is open kinetic chain; the other is closed. Open kinetic chain exercises are when the arm or leg are open to air and are generally considered unstable because the limb itself is not attached to something fixed. Running is an example of this. With a closed kinetic chain, the limb is fixed. It's safer, because it's more controlled. Reformer Pilates is a closed kinetic chain exercise. The risk level goes way down in terms of injury," he says.
The more comfortable I got on the reformer, the more I found myself breaking down old barriers to balance, flexibility, and range of motion, areas in which I'd always struggled and had written off as too advanced for me to tackle. Now, I know that reformer Pilates will always be part of my ongoing prescription for stopping pain. It's become a non-negotiable in my life. Of course, I've made lifestyle choices as well. Back pain doesn't go away with a one-and-done fix-all. I now work at a desk. I try not to slouch. I eat healthier and drink more water. I also do low-impact free weight workouts at home. I'm determined to keep my back pain at bay — and finding a workout I love in the process is just an added bonus.