Response to articles by Peta Bee in The Times 10th August 2010

Response from Christopher Norris MSCP to Article in The Times by Peta Bee

There have been several articles which pick up on the Lederman article published initially online and then in JBMT, and Stuart McGill's research.  All of these support what Modern Pilates is doing.  If we go back historically spinal rehabilitation was traditionally performed using high intensity exercise as a result of research done by the Saal brothers in the California Institute of Spinal Rehabilitation which showed that patients having weight training recovered better than those having spinal surgery.  This led to further research into what exactly rehabilitation achieved - remembering that this was in the days of the Back School program in Scandinavia and criticism of it by Nachemsen who basically argued that as all chronic low back pain resulted from discal pressure changes, exercise which increased this pressure was pretty pointless.

Australian researches (essentially Gwen Jull and Caroline Richardson) where able to show changes in the TA and Multifidus and their students (Hodges etal) pursued this with vigor.  This was muscle isolation gone mad because it was good research, but demanded close one-on-one supervision, a highly motivated patient and a lot of time.  Pragmatic research (i.e. with real patients) started to come out which showed that this type of core stability training was no better than traditional spinal rehabilitation in its long term benefit (one leading paper used the exercises from my book).  If people would actually take the time to read the papers rather than just the abstracts on Google Scholar, they would see that the research compares muscle isolation only (Multifidus / TA etc) with spinal rehabilitation and found that both were the same - readers then take this up and say that core stability (and now Pilates) is no good.  The papers do NOT say that, simply that it is no better.

Stuart McGill took a different route as he was essentially interested in occupational injury and heavy lifting.  Essentially he concluded that other muscles (Quadratus Lumborum particularly) were equally important as was postural re-education.

In my Back Stability book (and my original articles in Physiotherapy Journal) I argued that muscle isolation was a starting point which should be progressed to more functional activities using balls, bands weight etc, and that a postural approach could be used to guide exercise selection.  At the time many people said this was wrong, but (thankfully) the research is now proving this right.  This is why when Cherry Baker originally contacted me about Modern Pilates I agreed to go ahead with her and the program we created does the same thing - it starts with foundation movements and progresses them using posture as a guide to exercise selection.  The research supports what Modern Pilates is saying and instructors can use this in their marketing - i.e. Modern Pilates does not just use muscle isolation but a progressive program of spinal rehabilitation which is evidence based. This was the subject of my Phd which supports the research and MP philosophy.

Dr. Christopher Norris