Pilates

Does it work? It depends what sort of pain you have. If you have lower back pain or if your pain has anything to do with poor posture and/or weak muscles, then, yes, Pilates is likely to work for you. If your pain is completely unrelated to muscle or posture problems (including tense muscles), then other than generally improving your health it's not likely to do much for you. Also, a warning from my personal experience of Pilates: depending on the cause of your pain, you may have to significantly modify it so as not to cause yourself even worse pain problems (this particularly applies to anyone with a hypermobility syndrome, as all that stretching can be a problem for us - see the top of page 7 of this PDF.). If you find yourself in more pain after Pilates, talk to your teacher about how you can modify it to suit you. I'm not sure how well Pilates works for my chronic pain, but I've done it on a regular basis for several years, as if I don't I tend to end up in physio with the physiotherapist prescribing Pilates-style exercises for the various acute pains I end up developing without it.

What is it? Pilates is a physical fitness system that uses low impact exercises and has a particular focus on the core muscles - the ones you need to sit and stand and do every day activities - and stretching. The aim is to build strength in your core muscles and attain better posture, balance and flexibility. Pilates can be done just on a mat or can involve a wide range of equipment. It can be done by people of all ages and levels of ability. I've been in classes with everyone from fit young men and women to old people who need help getting up and down from the floor (although a word of warning to shy men: group classes usually only contain between zero and two men in them, not because it's unsuitable for men, just because it typically attracts women). Many Pilates exercises can be done at different levels, and in a mixed ability class I find the teacher will often explain how you can make the exercise harder or easier, depending on your own level of fitness and strength. As my Pilates teacher frequently says, we're all different, so we all come to the class with different needs. Pilates classes typically have a focus on doing the exercises in the proper form to get the maximum out of each exercise and concentration on what you are doing, which is also a handy approach to bring to any other exercises you do.

Who does it work for? It is often recommended for people with lower back pain. People whose pain is due to weak muscles (particularly in relation to posture) may also be helped because it strengthens your muscles, particularly the ones you need to sit and stand up properly. Also, if you have a lack of flexibility for any reason, Pilates may be able to help because of its focus on flexibility and stretching. Its flexibility exercises and core strength exercises have the potential to improve your posture, which may in turn improve your pain levels if any of your pain is caused by poor posture, muscle weakness or areas of your body taking the strain because other areas are out of shape or not flexible enough.

Who doesn't it work for? Anyone whose pain is not caused by musculoskeletal or postural problems. In particular, anyone with neuropathic pain. (That doesn't mean people with other sorts of pain should avoid Pilates, it just means it's only likely to work for you as exercise and postural help and not as a pain reliever).

Where can I get it? Pilates is taught in group classes in gyms and other places, such as church halls. Try googling the name of your local area and "Pilates" to find classes. Also check out local gyms, which tend not to advertise their classes in a way that comes up in online searches. Pilates is also taught one to one or you can get Pilates DVDs and practice at home. I have tried all three and my preference is the group classes, as often I turn out not to be doing the exercises quite right and a teacher can correct me, whereas an exercise DVD can't; plus Pilates teachers vary the exercises in classes, which is both more interesting and better for you than repeating the same workout over and over. I have also had individual Pilates classes because my severe pain problems and the unusual way my body works mean I need to modify the exercises a lot, and so I've taken one or two additional individual classes from my group class teacher so we can work out solutions for me. But if your body and pain fall more within the range of normal than mine, then you may well not need additional individual lessons. If you are new to Pilates, look for a beginners' class or a mixed ability class and don't forget to tell the Pilates teacher about any injuries before you start.

How much does it cost? It depends where you live, but expect to pay around £8-£15 per group class on a mat and £40-£70 for individual classes. Alternatively, some gyms offer Pilates classes as part of their membership package (and it may be cheaper to join than just attend classes elsewhere). If you go to classes, the provider will usually provide all the equipment you need, unless like me you need extra equipment to modify the exercises. (I use this ball, partially inflated, to avoid lying on my back, and a pillow to cushion my back when I do lie on it).

Is there a cheap or free version? Yes, a cheap one: you can use Pilates DVDs, such as this boxset for £18.99. I like the look of this particular boxset because it includes several lessons and is suitable for beginners. If you use a DVD, I suspect you may also end up buying a mat to do it on, such as this one for £12.99. (Words of advice from my Pilates teacher: Pilates is best done on a thick, soft mat.) Unless you're a natural when it comes to exercise or have plenty of existing experience, I recommend taking at least a few group classes if you can afford it to make sure you're doing the right thing.

Is there any evidence for it? Yes, for low back pain. Specifically, a review of 2 randomised controlled trials and a clinical controlled trial found positive effects, such as improved general function and reduction in pain compared to minimal intervention when applying the Pilates method in treating non-specific chronic low back pain in adults, and a review of 7 randomised controlled trials found Pilates produced better pain relief for non-specific lower back pain than minimal intervention, but no significant reduction in disability. The same review found Pilates to be no better than other exercises for pain. In general though, researchers think more high-quality randomised controlled trials are needed and I had difficulty finding trials that looked at any form of pain other than lower back pain.

Does the individual teacher matter? Yes. I've mainly had good teachers, but some are no good at all. After a good teacher has taken a class, I'll often feel that my muscles have been working hard (in particular I'm likely to work muscles in my abdomen so much that they protest either during the class or the next day). Also, good teachers often remind you to use your core muscles when you do the exercises (they might not call them that, but they're likely to mention things like using the muscles you use to stop yourself peeing or holding your tummy in). After a bad teacher has taken a class, I don't feel like my core muscles have any sort of a workout. If you're not sure if your teacher is a good one, try another teacher for comparison.

Are there any downsides? Yes. Obviously there's the cost. Also, especially when you're a beginner, you're likely to have a sore abdomen the next day from all the core strengthening work (this is perfectly normal pain after exercise). But there's also the risk of doing yourself further damage. Pilates exercises are low-impact, controlled exercises, but if your body is very vulnerable for any reason, you should approach even Pilates with caution, and in particular you should be wary of pain in your lower back either during or after the lesson and talk to your teacher about it. My experience is that Pilates teachers tend to be used to dealing people with pain and injury issues, but Pilates teachers are not medically qualified, so if you are particularly vulnerable to injury, then you do run a risk of further injury (mind you, in my case, the same can be said of doing exercises given to me by medically qualified people or just doing things around the house, some of us are just highly prone to injury). In my case, I learnt that exercises lying on my back, exercises and stretches involving my hips and stretching my lower back at all cause me a problem, so I now modify or leave out all the exercises that do this. Please bear in mind though, my HMS means that I am particularly vulnerable and most people who go to Pilates classes are unlikely to have major problems like mine.

Are there any other upsides? Yes, expect to improve your fitness and your posture, and you may also improve your flexibility and your balance.

Was it worth the money? For me, yes. I can't be completely sure that it's improved my pain, but I feel a lot more vulnerable and tend to be a lot more prone to injury in the periods when I don't take regular Pilates classes.

Have you tried Pilates? Does it help with your pain?