The Theoretical Framework of the Clinical Pilates Exercise Method in Managing Non-Specific Chronic Low Back Pain: A Narrative Review

Influence of hip flexion angle on strength and gluteal muscle activities in the clinical pilates clamshell exercise

The study aimed to investigate the presence of directional preference using the Clinical Pilates method of clamshell exercise among relatively healthy young adults, and the influence of hip flexion angles on maximum isometric strength (handheld dynamometer) and muscle activities (electromyography). The clamshell assessment involves testing in varying angles of hip flexion (0°, 30°, 60° and 90°) and 21 participants were tested. Directional preferences in the transverse and anteroposterior axes of movements were present among the participants. Gluteus medius activation was highest in the non-problem side across all hip flexion angles. In contrast, the problem side showed dysfunction of the gluteus medius, especially at the 60° hip flexion angle, 0.89 unit (ratio of maximal voluntary isometric contraction) reduction per 1 N force exerted, 95% CI -1.69 to -0.09, p = 0.031. Comparison against the non-problem side found gluteus medius activity lower on the problem side, mean difference (SD) was 26.2 (56.1), p = 0.045. Therefore, directional preference is not limited to people with injuries and can exist in healthy individuals or people who have recovered from injuries. The gluteus medius was identified to be dysfunctional on the problem side and Clinical Pilates clamshell assessment is potentially useful in assessing for motor coordination impairment.

Relation between Physical Fitness Components and the Occurrence and Subjective Intensity of Back Pain in Secondary School Adolescents

Despite the well documented benefits of physical fitness (PF) on general health, its role in back pain (BP) is still unclear. The objective of this study was to assess the association between different PF profiles and BP in a sample of adolescents. The study assessed PF and BP in a sample of 919 youth (age = 15.5 ± 1.3 years) from North and South Tyrol. A total of 531 participants (57.8%) reported no BP, whereas 4.7% (n = 43) reported severe BP. A two-step cluster analysis detected three main groups: the “less fit”, with significantly lower scores in all PF tests (p < 0.001); the “strong sprinters”, with higher speed and muscular strength than the others (p < 0.001); and the “flexible marathoners”, with higher flexibility and cardiorespiratory fitness (p < 0.001). The “flexible marathoners” showed significantly better BP scores than the “less fit” (p = 0.029). Cardiorespiratory fitness and trunk flexibility are potential preventive components of BP in adolescents. Since the decline in flexibility starts very early in life, it is recommended to put a particular emphasis on this component of PF. The role of other components of PF should be further investigated in the future.