What Makes a Pilates Class Great for Chronic Pain?

When I started taking Pilates in 2007 it was simply because a very dear friend said, “I hear that Pilates is good for backs.” I was so desperate to feel better after my disc herniation diagnosis that this piece of information was enough. I had tried everything else and still felt so broken, it certainly couldn’t hurt to give it a shot.

My expectations were low. But I felt better immediately after that first class. Interestingly, while I often tout the benefits of using the Pilates equipment and spring-based resistance, I in fact only did Pilates in the mat class format for the first 7 or so years. Before long, the moves I learned in those mat classes became part of my daily routine, which was critical when I later moved to Switzerland for graduate school and didn’t have a Pilates studio nearby. 

Podcast hosts often ask me, “What was it about Pilates, specifically, that was so helpful for your back pain.” I have for years looked back and tried to piece together why those early mat classes were so beneficial. Since that first class I have experienced many teachers and studios and each individual teacher has their own approach, typically informed by their own individual experience and physical hurdles. Some have felt amazing; others, not so much.

Combining my own varied experience of other teachers along with client observations, I put together and have continued to refine my Restorative Pilates Mat format, which is the only kind of mat class I teach at Movement Remedies. This format includes what I believe is the winning formula for a Pilates mat class for musculoskeletal pain sufferers:

Balanced muscle activation (front, back, side, rotation)

When it comes to my own low back pain, this is probably the principle I find most impactful. I have been to many Pilates Mat Classes that required exertion of the muscles on the front of my body 90% of the time (in other words, motions that bring the torso and legs closer together). While this might work for others, this kind of format is almost guaranteed to leave my spine feeling worse. 

It makes sense that since our modern world typically requires us to spend a large part of our day in forward flexed positions already, reinforcing this shape with added load and intensity may not feel so great. We also tend to be in a rigid posture for long periods, which leads to unpleasant sensations for many. The antidote to both of these challenges is to explore a full range of motion in our joints (including side-to-side and rotation, which we don’t practice as much in daily life), using all available muscle groups. When I have surveyed my clients, they all agree that they feel the most elongated and the least amount of residual muscle tension when they experience a movement session incorporating all sides of the body.

Focused attention on both the exertion and the release of muscles

This is where we depart from your classic fitness mindset. A movement practice focused on maximizing muscle activation and minimizing rest is what you seek if weight loss is your goal. But since Movement Remedies is interested in overall wellbeing and–in particular–pain self management, balancing tension and release of our muscles is essential. It’s not enough to just move and then take time to rest, though, there is an essential ingredient and that is intention. For chronic pain sufferers, the body often starts to feel like a hostile place to inhabit; many have reported seeing themselves as separate from their own bodies. I know I sure did. As a result, we often miss out on important cues from our bodies that we need to acknowledge in order to heal.

I recently read a passage in The Body Keeps the Score about how increased awareness of sensations associated with both tensing and releasing muscles can be an important part of healing for trauma survivors seeking safety in their bodies. This makes complete sense to me – chronic pain and often the injury that might have preceded it are themselves traumatic. Learning to move even when uncomfortable sensations occur is part of the process of retraining the body to move without fear. 

Transitional movements that soothe and recenter the person moving

The more I have learned about the nervous system, the more evidence I have seen around the value of movements whose sole purpose is to soothe. This typically includes swaying, rocking, bouncing, and breath that uses into a vocal humming sound. We want to work in partnership with the body to instill a sense of safety where fear of pain tends to rule. So we use all the tools at our disposal to keep bringing the mind back to the present, back to the notion of the body as refuge. 

For this reason, I now include transition movements with these soothing components after short bursts of movement intensity or when we reorient the body to a new position, to prevent a bracing or guarding response. Each person will have something that speaks to them more than the others. This is their “signature” soothing action, which they should be encouraged to experiment with and take note of how they respond.

Participant ownership of the movement experience

Inviting the class to explore a soothing motion or breath is just one of the many ways I encourage participants to take the reins on their movement journey. A chronic pain sufferer can only rebuild a sense of connection to and safety within the body when they feel agency in the choices they make about how and when to move. This also helps them acknowledge their achievements, which builds more confidence and courage.

As class participants feel empowered to make decisions about their own movement practice, they are more likely to take the experience with them and continue progressing at home. I try to increase the chances of this by using affirming, supportive language as I teach. The movement studio, the Pilates mat, these are places of openness and connection. The more we each participate in building that connection and sense of safety, the more we get back. 

I believe as teachers that the words we use are critical. They should inspire confidence and optimism. They should redirect away from what feels off-limits towards what is possible. It is a privilege to cultivate such spaces and speak words of encouragement directly to the clients who put themselves in my care for those 50 minutes.