I am a lover of Pilates as you maybe aware from my previous posts, but I certainly do not suggest it’s the solution to all problems.
So, when is Pilates not suitable?
These are a few injuries that I will often recommend that patients stop or do not do Pilates.
Hamstring Tendinopathy (sit bone pain)
This is an underdiagnosed injury that I often see in women post 40s. The pain often starts as an ache around the sit bone and will gradually get worse. It is worse with sitting on hard chairs and bending. Often its triggered by running. The pain comes from the origin of the hamstring muscle which is right on your sit bone. The tendon gets aggravated by either an increase in its work (say an increase in running or running faster) or by lots of stretching. The type of stretching you will see in Pilates. Positions such as long sitting or down-dog or lots of forward bends will cause the tendon to stretch and become unhappy. Strangely when women get this problem they feel that they need to stretch and start stretching more.
The hamstring needs to avoid any stretch for a while as seeing as Pilates has considerable hamstring work its hard to manage this injury and keep you doing your Pilates.
I’ve seen several patients with this problem recently. Coccydynia can either be triggered by a fall or by sitting on hard chairs. The main problem with this injury and Pilates is all the lying and sitting on the matts, this can result in prolonging the problem, so its worth avoiding until it settles down.
Irritable Gluteus Medius Tendinopathy
In my blog ‘Pain in my hip’ I discussed the case of the gluteus Medius tendon. In the blog I brought up one of the causes of gluteus Medius tendinopathy is also compression so lying on hard mats. Often this complaint is minor, and we can get away with simply not lying on that side when performing the clam or side lying section of your workout. But if you are suffering with constant pain with walking then other aspects of the class may not agree with you. These could be single leg work or crossing legs and therefore if your Gluteus Medius Pain is stopping you in your daily functions then you probably need to stop the Pilates. It is also worth while considering that the Pilates may have triggered it.
I recently saw a lady who had decided to do more Pilates Classes at her gym and was doing 4 a week. As a result, she then started to notice lateral hip pain when she was walking. This may have coincided with either more lying on that side or perhaps another cause is that too much Gluteus Medius work may not be good either. Make sure you trigger ball it if you feel it’s getting tight.
Unmanaged low back pain or sciatica
This may sound obvious, if your back was painful most people would not consider exercising but when I say unmanaged what I mean is that you are not aware of what makes your back better or worse. This is a tricky situation when you are starting a class that aims to get your back moving. If you imagine that you spend your day slumped over a computer and then come along to a Pilates Class and then spend another hour doing back bends, it may not be happy. But if you manage your day time sitting and control how much back bending you do to start with (always speak with your teacher) then you may get the benefits of the class.
Don’t always assume all classes are suitable for you. If your back feels worse after a Pilates Class its worth discussing with your teacher and see if you can work out why. Don’t keep on until it flares your back up.
Shoulder pain is mainly mentioned as I tend to work on the shoulder area, not only to strengthen the shoulder but to get the upper back and back muscles working. If your shoulder is sore it may not cope with all the upper body work, but you can discuss this with your instructor. My general rule about classes is; ‘if you spend most of the class avoiding exercises then its probably not worth you doing it right now’.
If you feel worse after
I think this is self-explanatory… only other comment is if it feels worse for half an hour or so but then feels better after, then maybe it’s a sign things are getting moving. If it triggers your problem, then it’s worth talking to your Pilates teacher to make sure you have the right technique and see if you can isolate which exercise is the problem one.
Osteoporosis (thinning of the bones)
Resistance training for osteoporosis is advocated but what you must be aware of is the risk of rib injuries if you do rotation exercises in Pilates. These are exercises like arm openings or spinal twists. You would benefit from finding a better bones class that is tailored specifically for osteoporosis.
If you can’t get on the floor
If you are struggling to get on and off the floor then mat work may not be suitable, instead you may want to try equipment work.
If you have any knee problems the main exercises you need to be aware of are squats or lunges. Any kneeling positions as this puts a big compression through the knees but if it feels comfortable you should be ok and just be aware of the crossed leg position it is also very compressive on the joint.
Most of the time if you speak to your Pilates teacher you should be able to find modifications and the benefits of exercising out weigh the risks.
Finally, remember most Pilates sessions are not aerobic so you should always consider a rounded programme including some aerobic work. Have a look at our classes or book in a free Pilates assessment