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Pilates for Fragile Backs

Stanton AF, Hiatt-Coblentz R. Oakland, CA, 94609, New Harbinger Publications, Inc, 2006, paperback, 155 pp, illus, ISBN: 978- 1-57224-466-5, $18.95.

Pilates exercises are certainly not a new exercise form. Joseph Pilates introduced these exercises in the United States in the 1920s, and they have been a mainstay in the training of dancers and athletes alike. The principles and exercises have begun to appear by name in some physical therapy research. Research, however, is far from the focus of this text. The authors make no effort to examine either literature specifically about Pilates or literature on exercises that strengthen trunk musculature. They do provide a reference list, but it is short, includes interventions other than Pilates exercises, and is extremely selective.

In the book's introduction, the authors introduce the Pilates concepts and provide an overview of spinal anatomy and spine surgery. The first chapter is devoted to the authors’ stories of back pain, surgery, and the discovery of Pilates. Chapter 2 is the "pinnacle" of self-help. The authors give an overview of body mechanics and intervention options for low back pain, which range from hot packs and transcutaneous electrical nerve stimulation to pharmaceutical interventions. The authors have no expertise in these extraneous topics and the appropriateness of their inclusion in this book is doubtful.

The remaining chapters cover the authors’ Pilates recommendations for a mat program and for exercises that are done using 2 pieces of Pilates equipment: the "Reformer" and the "Cadillac." The Reformer is a gliding platform that uses springs for resistance; the Cadillac is a mat table surrounded by a frame that holds bars, straps, and springs. A careful examination of these exercises through the lens of the trunk stabilization literature by McGill and other biomechanists raises doubt about their appropriateness for people with chronic low back pain. For instance, Mc- Gill emphasizes the importance of not flattening the back because it increases stresses to passive tissues, whereas the recommended Pilates mat exercises emphasize a starting position in which the back is flattened to the mat.

The authors seem confused about the field of physical therapy. Both of them extol the benefits of exercise and yet consider physical therapy to be a passive approach and inferior to their choice of Pilates. This image of physical therapy was jarring and maddening.

This book is written for a general audience. In the spirit of the self-help movement, this book will attract believers but ultimately is written by authors who lack the qualifications to write it. Those who seek care based on an empirical approach are advised not to use this book.

Julia Chevan

J Chevan, PT, PhD, OCS, is Associate Professor of Physical Therapy, Springfield College, Springfield, Mass

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