So I just returned from the FAMI workshop at Mt. Sinai School of Medicine in NYC, and all I can say is WOW!! If you're a pilates or yoga instructor, massage therapist, or personal trainer, get thee to FAMI!
I was so privileged to be part of such a fantastic and inspiring group of fellow instructors, and to be taught by such passionate and enthusiastic doctors who are specialists in their fields. If you want to be inspired to learn more about the body, meet people, and spend a week in nyc, check out the FAMI website that I linked below!
Now, onto back pain statistics. I've actually heard these stats before, but now that I heard them straight from a doctor at FAMI (Dr. Adam Bender, a Neurologist who spoke at the workshop), I feel more confident in their validity.
Did you know....
75-85% of people have back pain at some point in their lives
Back pain is the 2nd most common reason for seeing ANY doctor
Back pain is the 3rd most common reason given for surgery
Back pain is the 5th most frequent cause of hospitalization
The age group with the most reported back pain is adults age 45-64
Only 5% of people actually have a difinitative cause of their back pain, AND even less of a percentage actually have a pinched nerve causing their pain.
These stats can mean different things to different people, depending on their situation with back pain. Most importantly, notice that many people seem to be complaining about back pain, and seeking care for their pain, but the true cause of back pain frequently tends to allude doctors.
My Alexander Technique teacher used to tell me to stop trying so hard to figure out "why" my body was in pain with sciatica. She would get quite annoyed with me! Her point was, sometimes we can't focus all of our energy on WHY things are the way they are. When there is no obvious answer, sometimes we have to say, "Ok, let's work with what we have here, the fact is that I'm in pain and what I really need to focus on now is healing".
So what can you do for yourself if you have pain? Seek advice from professionals who you know and trust, and follow whatever seems to make the most sense to you. Of course, I think taking private pilates lessons with an experienced and certified instructor is one of the best things anyone can do for chronic back pain. You'll strengthen your core muscles, learn what correct posture is and how to move your body in proper biomechanical ways. And, MOST importantly, pilates will help you gain a feeling of control over your pain, and hopefully, you'll eventually conquer it.
Here is FAMI, one more time:
FAMI Workshop: http://www.famiworkshop.com/
Monday, June 23, 2008
Back Pain Statistics
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9 comments:
"My Alexander Technique teacher used to tell me to stop trying so hard to figure out "why" my body was in pain with sciatica. She would get quite annoyed with me! Her point was, sometimes we can't focus all of our energy on WHY things are the way they are. When there is no obvious answer, sometimes we have to say, "Ok,let's work with what we have here, the fact is that I'm in pain and what I really need to focus on now is healing"."
I can't help but wonder why your Alexander teacher did not have an interest in knowing what was causing your back pain. Wouldn't it be easier and safer to treat someones back pain if you knew what was causing it? And how was your teacher helping you with back pain if she didn't know 'why' it was occurring? How did she know what was appropriate and what wasn't?
It concerns me a little to think that teachers (of any discipline) could be asking their students to do things without knowledge of the condition they're presenting with. Students (& teachers themselves) could be making the problem worse with the activity their doing and not realize it, simply because they're not looking objectively at all of the possibilities.
As you noted on 'back pain statistics', there isn't always an obvious organic cause, however there are many other indicators as to why someone is experiencing pain.
I hear what you're saying, and I think that I did my teacher some injustice by only giving a small part of the story, so I'll give more details here.
My teacher has been teaching since the early 1980's, so I trust her expertise. When I finally went in to see her, I had been to a zillion different doctors, a chiropractor, massage therapists, acupuncture, etc to find out what was causing my pain. Doctors did all kinds of tests and I did not have any disc problems, no leg length issues, no obvious "poor habits", nothing that was obviously causing my sciatica.
So out of desperation I decided to try Alexander Technique, which ultimately was the one and only thing that "cured" my acute sciatica. In fact, I owe it to my teacher that I can walk around today and function like a normal person!
In regards to this post, I was the one with the problem, constantly trying to figure out "why me?", instead of focusing on the first 15 minutes of every session with her. I think her point was that I was "holding on to the pain" and needed to release some of my control-freakish grip on "why" and focus more on "how to heal".
People with all types of injuries and illnesses need to focus on the positive and focus on recovery, not stay obsessed with the problem itself. That's the best, fastest, and most long lasting way to heal.
It wasn't that she didn't care why my back hurt. It was that she was faced with someone who either had biomechanical problems, emotional problems, who knows, and she needed to get me to focus on what was actually going on in the moment, not focus on what I cannot control.
This is such a valuable tool for life in general, right?!
I hear what you're saying that its concerning that any kind of teacher would ask their students to do things without knowledge of what the problem is. In this case though, and in many, many cases that I have personally seen myself, the student comes in after having been to doctors and through tests, and nothing is proven to be the cause of a problem. So then what do they do? Just lay in bed all day saying, "I can't do anything, something may hurt me more"?
No, people in this type of situation can choose to go to an experienced instructor and work privately in a slow and meaningful way to try to regain strength and proper biomechanics, and to try to understand what their body is trying desperately to tell them.
Now, if someone came in to see me with an unidentified problem or pain, I would give them a very simple, beginner pilates session and eliminate any movements or positions that I think could even remotely irritate them, based on what they've told me about their pain or injury. I don't personally know any teachers who would give someone with a severe, mysterious pain just any old exercises- most teachers I know are very thoughtful, well-studied people.
Thanks for the clarification. I see what you're saying now.
I still feel though that medical imaging is an important first step to eliminating any 'detectable' abnormalities, but those are only a small percentage of the causes of pain. So my question is this; How does a pilates teacher determine what these other potential causes are and how do they know that pilates will be the appropriate 'solution'? From my understanding and experience, pilates teachers only have a small amount of education in anatomy and virtually none in physiology. Are teachers really qualified to take these tasks on?
I was also confused about the comment you made about your Alexander teacher... "
My teacher has been teaching since the early 1980's, so I trust her expertise." But didn't you mention in another post that your Alexander teacher pointed out to you that the first rib sits above the clavicle.. This absolutely is not the case.. the first rib sits & attaches below the clavicle. "Expertise" is a relative term in that maybe she's very adept at movement cues and such but anatomy is not the strong point of most alexander teachers.
"I have personally seen myself, the student comes in after having been to doctors and through tests, and nothing is proven to be the cause of a problem. So then what do they do? Just lay in bed all day saying, "I can't do anything, something may hurt me more"?"
Maybe the next step would be to go to another health care professional other than a Doctor (PT, massage therapist, osteopath, OT, etc.) and get another perspective on the matter. When there's pain, there's usually a problem at hand... moving around or through the problem isn't necessarily the best long-term solution. It usually just complicates matters more, at which point things will resolve for a while and then rear their head again later into the future with more intensity.
I thought Alexander technique was devised and used for breath training and such... when did it become a 'fix' for musculo-skeletal problems?
I'm sorry to be antagonistic, I just can't help but notice that so many pilates teachers and students alike suffer from the same problems (sciatica, SI joint pain, back pain, neck pain, hip flexor issues, etc.) and it makes me wonder why??? Something worth looking at, I think. Are we just prolonging the inevitable?
Hi Anonymous,
This a very interesting conversation. You have every right to question anything I write on this blog and I do see you're points. I'm going to try to respond to all of them.
I'm going to be totally honest and mention that it seems like you are anti-pilates, and some of your comments and judgements seem to be coming from a decision you've already made that pilates is bad. Its not really fair to assume "From my understanding and experience, pilates teachers only have a small amount of education in anatomy and virtually none in physiology."
I need to stick up for the many dedicated, well-educated pilates instructors I know. If you read my bio, you'll see that I've extensively studied anatomy and movement with many different medical professionals and a variety of teachers. In my pilates certification program eight years ago, 200 hours of anatomy of part of the 600 hour process, and we took a separate test on anatomy at the end of the course. And of course I'll always continue learning more for the rest of my life, I'm certainly no expert but I would never say that I have "a small amount of education in anatomy and virtually none in physiology."
In fact, compared to many pilates teachers out there, I'm just a newby. There are teachers who've been studying and teaching pilates and anatomy for over 20 years who have much more knowledge than I do.
I have no idea what your experience with pilates teachers is, but maybe you've come into contact with new, inexperienced teachers. Or, maybe you've simply experienced bad teachers.
To answer one of your first questions, I don't believe I have ever personally said that pilates is a "solution" to any problem. I don't believe that is true at all. No one thing is a "solution" to a physical problem. Pilates can be helpful, and I have seen it help MANY people over the years, to build strength and body awareness. But I would never, ever tell a client that all they need to do for their back problem is pilates, and nothing more. That would be totally irresponsible of me and I don't think any one of my clients would believe it or trust me after I said that. In fact, in the original post I listed ways that pilates could help with back pain, and all of those ways are totally realistic things to expect from pilates.
You mention "When there's pain, there's usually a problem at hand... moving around or through the problem isn't necessarily the best long-term solution." I would never, ever have a client move around pain, and definitely never work through pain. There would be absolutely no point to either. If a client was experiencing pain, I would look at their bodies and the way they're moving and try to help them figure out if its a biomechanical problem. I would encourage them to see a doctor if the pain persists. I'm not sure what else you would expect me to do. I continue to educate myself on anatomy and movement for a reason, to help my clients, so why would I not use my education? I would never make an absolute determination of what a problem is.
Why is a massage therapist more valid than a pilates instructor to help someone with their problems after they've been to a doctor and no one can figure out what's wrong? I'm not talking about taking a mat class with 50 other people, I'm talking about private sessions in a pilates studio with an experienced teacher. It seems like you may have come into contact with teachers that are less than impressive to you, but to judge 1000s of teachers is just not fair and inaccurate.
About Alexander Technique:
You mention an older post I made about one of my Alexander teachers talking about the upper most rib extending above the collar bones. First, the teacher who said this is a different Alexander teacher than the one who I mentioned has been teaching since the 1980s. Second, I did not say that the rib "sits above the collar bones". I know that it does not. I said it "goes up above your collar bones". And, it does. I have not only seen this myself on skeletons but its also clear in the many photos I have in that post.
Personally, for me, Alexander Technique was the only thing that has ever been able to really help me with my problems, and I've been to tons of doctors (and I've had imaging), massage therapists, structural integrationists, pilates teachers, yoga teachers, chiropractors, etc. Why would I not promote what has helped me, and helped countless others? What difference does it make if Alexander Technique was originally devised as a breathing technique?
Its fine if you have so many questions about the technique, but maybe you should go experience a few sessions yourself before you decide that its not valuable?
And you also mention that many pilates teachers complain of the same ailments. This is a good observation. Maybe the reason why you're seeing pilates teachers with ailments (I'm assuming you're some type of therapist?) is because as teachers we are in tune with our bodies and know when its time to see someone for help? Consider the countless number of people out there with the same problems who either don't take the time to see someone, don't have the money to see someone, or aren't even in touch with their bodies and might not even realize they're in pain? And the fact that you're seeing pilates teachers and students with problems is proof that these people don't think that pilates is a "solution". They realize that there are other methods out there that can work with pilates to help their bodies be the best they can be.
There are two other points I'd like to make about this. It sounds crazy, but most pilates teacher I know don't even do pilates on a regular basis. We don't either don't have time or don't feel like being in the studio when we don't have to be (just like anyone else doesn't want to stay in the office after work!). I personally do pilates only once a week, if that,(and my students without problems have been doing pilates three times a week for years), and I sometimes go months without taking a pilates lesson. So, I don't consider pilates to be the cause of my problems.
On the other side of things, too much of ANYTHING is bad thing. If someone is doing too much pilates, they could experience the ailments you mentioned. Again, I wouldn't blame pilates, I would say these people need to find more of a balance in their lives.
I appreciate your comments and points of view, I really do. I definitely do feel that you're being "antagonistic", as you say, but I'm trying to respond professionally and respectfully because I do hear your points and value comments on this blog. Its very obvious that you are against pilates, and that's unfortunate.
Through your apparent angry towards pilates (and possible Alexander Technique?) I hear valuable and thought-provoking questions, so I've tried to respond to those.
Hopefully my response will clear some things up for you and maybe you'll see that not all pilates instructors are what you think they are? Maybe you still think I'm an idiot, I don't know, but I can only do my best to write about my experiences and points of view in a positive way. My only goal is to help people exercise mind-fully and live their best lives, both when I'm teaching in my studio or writing here on this blog. I hope this is obviously true since I just took an hour out of my only day off to respond to the question of a complete stranger!
I welcome your further comments and hope to continue a respectful dialogue.
Hi,
First of all, I'm not suggesting you're an idiot... Please, I mean no disrespect in that regard. Yes, I'm a little antagonistic by nature only because I think everything put before us is worth questioning, ...after all, people can say just about anything and get a following these days. Without objective analysis we're only fooling ourselves.
I'll be as brief as possible... but I just wanted to reply and respond to a few things you mentioned.
First, I'm not "anti-Pilates". I actually used to work at a gyrotonic and Pilates studios in NYC. I've known many teachers, some of whom you've mentioned studying with. And I've done Pilates myself once a week for about 8 months consecutively with a very good and knowledgeable instructor... But I had to stop as it was creating an anterior tilt of my pelvis, shortening of my low back and resulted in low grade low back pain. I'd be happy to chalk it up to my own inability but it's hard to do that when I consider I've done yoga off and on for over 12 years until recently and I've been a very active person in general. I'm into exploring pretty much anything, ...at least give it a try. (From Feldenkrais, Alexander, Tai Chi, Akido, improv movement, various Yoga styles, etc.) They've all offered insight into my body and being in their own unique ways, including Pilates.
My 'antagonism' only stems from this perpetual notion that it is some sort of alternate to PT or something. And that the alignment and movement principles/concepts ('the core') are accurate and soundly justified anatomically or functionally. My education and experience has provoked me to think otherwise about those concepts and principles. Are they really healthy for the body long-term? And what is the consequence of immobilizing ones pelvis and lumbar spine while performing movements with the legs or the rest of the body? Was that how our bodies were designed to move? With such rigidity and isolation???? I simply think those are worthy questions to consider, discuss or at least put on the table within the profession in a more objective fashion than by solely saying, "Thats' what Joseph Pilates taught as the gospel.".
On the comment about massage therapists (I'm assuming you didn't mention other professions due to their more extensive education)... Massage therapists in some states (New York being one of them) are required to have 1000 or more of education and pass a state board exam. 250 - 300 of those hours is in anatomy and physiology alone. So as a starting point, that well exceeds the education of Pilates instructors, so I think it would be reasonable to suggest that someone see a massage therapist prior to, or in combination with, a Pilates instructor. Not to mention they also have an education in pathologies... . Pilates trainings as I've see them (the major ones) spend the bulk of the time learning the exercises and learning to teach them. Many of those hrs out of 600 is spent logged as "teaching hours". And most of the programs have about 30 hours of anatomy training as "required". But I guess that's neither here nor there as each individual is ultimately responsible for the level of their own education and how far they take it. I can appreciate your enthusiasm and initiative to constantly stay informed.
I saw a client recently who had been doing Pilates regularly with a very experienced and reputable instructor, but had to stop for a couple of months for life reasons... Her chronic SI joint pain diminished and subsided over that time. When she resumed the pain returned and she was convinced by the teacher that they were working to provide stability to help it. But to me it, and my client, it seemed clear that although the pilates didn't 'cause' the problem in the first place, it was certainly contributing to further strain and subsequent pain. I'm seeing this often and I'm just taking note... .
I'm glad that Alexander has helped you and I see nothing wrong with it. But if it did in fact address the problem then you probably wouldn't have had to go see all the other specialists/practitioners in addition to. So my feeling is just that if the problem still exists, the approach probably isn't addressing it accurately or effectively. Symptomatic relief is different than treating the actual cause. Treating the cause may not bring immediate relief but it ultimately will help get you out of the mud and the symptoms subsequently resolve or diminish... How long that takes depends on many factors, including how deeply ingrained the pattern is... and movement work will cause people to move around and within their problem rather than removing the obstacle itself to allow for freedom of movement to happen naturally.
"What difference does it make if Alexander Technique was originally devised as a breathing technique?"
That's fine as I said I'm not against it entirely... But treating musculoskeletal problems with movement awareness is useful, but can only go so far by its nature. There are limitations in every approach... . Alexander may teach someone to move with awareness and ease such that they limit the particular movements that cause pain... this isn't freedom in the body from pain but rather setting limits on what's possible... maybe more is possible when you speak more directly to the issue at hand... which could be in a variety of ways depending on the situation presenting. Alexander will never free an entrapped nerve, only teach us to move in such a way as to not irritate it. But that doesn't mean it won't get worse over time, it usually does while we avoid the symptoms.
And I hear what you're saying about the frequency of pilates classes/lessons for many teachers... But it's also the case that when they are training to become a teacher they are usually doing it in excess for many months on end... which is enough to create some potential issues. It may not cause problems by itself (or it may some cases, if we're realistic here) but it can irritate things if biomechanics aren't what they should be. And when you mix in the fixation of the pelvis, sacrum and lumbars during the various leg movements performed, you get a recipe for strain in either the hips or lumbosacral region to start.... .
Despite some of my roughened opinions and observations, I do respect pilates and Alexander and beyond... I was curious, in part, about why you always mention turning to pilates when pain or problems arise. Going from the Dr's office to the pilates studio (barring any serious medically treatable conditions) seems like a leap that overlooks many other valuable and intelligent approaches. Maybe someones pilates class could be enhanced if they improved their functioning and issues a bit first and then follow a movement regimine. Just my opinion...
I respect your trainign and education... I've done a few lab dissections as well in conjunction with my formal and informal education (which is always ongoing). Certain things provoke questions though.. I'm sorry if it upsets you or offends you, that's not my intention. For instance, I just couldn't see how the posterior articular junction of the 1st rib with the vertabrae has much significance in regards to its level in relation the clavicle. That portion that lays "above" the clavicle on the transverse/horizontal plane doesn't elevate when we breath, it just rotates. So height isn't an issue in its function because it can't move up or down during normal biomechanics in that location. The part that really elevates is the front of the first rib which sits under the clavicle. Anyway... probably splitting hairs at this point.
Don't let me take up your free time responding to my comments... I do enjoy a good, thought-provoking conversation, but not if it upsets or offends people.
Hi again,
Thanks for your comments again. And thank you very much for filling me in on some of your movement history, I really appreciate knowing more about where you are coming from since up until this point, I've known nothing about you whatsoever!
Now that you've told me more about your history, and where you're coming from with your questions, I feel more comfortable with this conversation. Up until now, I felt like your questions were less curious than they were judgemental.
I love questioning things, questions are one thing that make life interesting! And I really understand your points in the last post, and your experiences. I have also seen the same types of things occurring, I'm not going to deny it. But you know what, every single type of exercise, habit, or even types of bodywork, has both benefits and negatives. Running, for example, is great cardio activity but can be very jarring on the joints. Yoga is great for increasing flexibility but I've seen countless neck and shoulder injuries. The list goes on and on. Maybe you've seen people who've had somewhat negative experiences with pilates because those people come to you for help, but you haven't seen people who have no problems from pilates because they have no reason to come to you? These are just some thoughts.
Of course I promote pilates on my blog, that's one of the reasons why I have this blog. I'm not making any money from writing here, its just a way for me to communicate my thoughts on pilates and fitness, to communicate with people like you, and to promote my business. In every applicable post, I try to mention that people should see a doctor for their problems, and if I forgot to put that in any particular posts that is really just a mistake and not my intention.
I agree with you that pilates instructors shouldn't try to be PTs or massage therapists if they're not adequately trained. I actually made a comment about this very topic on Alycea Ungaro's blog under her post "Functional Pilates".
I really hear what you're saying when you question the value of moving the legs while maintaining a rigid pelvis and low back. That is a brilliant question, and you are right, the body is built to move fluidly. But there are values to the neutral pelvis from my perspective.
For a person with no abdominal strength, keeping a neutral pelvis is a way for them to work their abdominals in an effort to support the low back. For a person with poor posture or who sits at a desk all day, learning neutral pelvis while sitting or standing (along with learning other things) is a way to "re-teach" the body how to hold itself up properly. For a person with chronic low back pain due to poor biomechanics, neutral pelvis gives them a reference point to come back to when their day gets busy and they start to let things go and start "slumping" into old habits.
I should also point out that a well-rounded pilates session also incorporates rolling, spinal extension, and side bending, so the neutral pelvis is just a part of it all. I personally try to have the whole body move around as much as possible (unless there are any injuries that would not benefit from any particular movements!)
And just to clarify, I tried all the other things besides Alexander Technique before I met my original AT teacher. After I began AT, my sciatica went away and ever since then (2003), I've been back to my old self and in great shape.
Anyway, like I said, your last post cleared a lot of things up for me as to where you are coming from, and I definitely welcome any further comments. It doesn't upset me to hear questions, but it does upset me when I feel attacked (which I really don't feel after your last post, but I did kind of feel previously and in my Pilates-Pro post that you also commented on because I felt that you were putting words in mouth).
I think my feelings were in part because I've poured my heart out in this blog and I've given my name, phone number, business info, etc, but anyone can make comments anonymously and say anything they want to me. So that kind of automatically puts me on the defensive, you know what I mean?
Well, I really enjoy this conversation and in fact think that it would be cool to continue to discuss this through email where we can get into more (friendly, of course) detail on these interesting topics. Feel free to email me privately if you have any desire to. Or we can keep the comments here, whatever you prefer. But my point is, thank you for keeping me on my toes and I welcome any future comments, whether they are in agreement with my words and thoughts, or not.
Thanks for considering my viewpoint and again, my apologies for making you feel defensive... not at all my intention.
I can certainly appreciate the efforts you've put into this blog, and I don't mean to thwart them.
The questions or inquiries I have were meant for discussion, certainly not an offensive. These are questions I simply have and can't explore them myself because they regard a profession that I don't have an education in. I see these environments as potentially fertile grounds for furthering perspectives and stimulating new questions. Ultimately leading to personal and professional growth alike... I find it's usually the tough questions that help us break through perceptual barriers into a more evolved place... with yet more obstacles/inquiries/questions/etc..
I tend to thrive on those situations and constantly try to challenge my own perception and belief systems... But I do apologize for bringing that mentality into this forum. Who am I to expect others would be welcoming of the same? Some of those ideas/comments/questions would probably be better suited for private discussion.
I clearly see your points and don't want to diminish or cloud the intentions of your blog (which I have enjoyed reading).
Best to you
p.s. - I see your points on the "neutral" pelvis... well said.
Hi again,
I totally agree that asking tough questions and challenging belief systems is healthy and can foster personal and professional break-throughs. And I don't mind anyone questioning anything I write, or just pilates in general, here on my blog. Interactions are part of what blogging is all about.
It clear that I don't mind thought-provoking questions because I have to approve all comments before they are posted, so if I really didn't like the things you are saying, I could just never post them or delete them!
So I don't mind if you want to continue commenting and discussing things here, I just suggested we chat through email as another option (and we would have a larger space to type in!). But either way is fine with me.
Our discussion is still unbalanced though, because in order for both of us to really grow and learn about other professions that we don't have an education in, it would be helpful if I knew more about you and what your profession is. You've given me some insight as to where you've studied, which was very helpful for me to feel less defensive and understand where you're coming from, but I still don't know anything more. I think if you did a quick role reversal in your mind you would understand my point.
However, if you wish to remain anonymous that is certainly your right.
But anyway, I'm glad you've enjoyed reading the blog and hope you continue to do so, and continue to comment anytime you like.
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