Beyond the core: can Pilates be the panacea for pain?

That’s what one writer hoped for when she embarked on a course to address chronic neuromuscular issues

Emilie Goldstein Mikulla teaches therapeutic muscle release with therapy balls at Naya and elsewhere. Courtesy Emilie Goldstein Mikulla

What if I were to tell you that the nagging pain in your knee is the result of a dormant muscle at the base of your glutes being let down by your brain? No, I don't mean that fixating on the pain makes it hurt more, as doctors and psychologists might suggest, but that signals in the body's circuits are faltering, causing the organs they're tasked with feeding to become lazy.

Unfortunately, in my experience, many medical professionals often overlook the simplest of symptoms. Suffer from shoulder pain? You will probably be advised to just take some muscle relaxants, go swimming or not spend too long in front of the computer.

As it turns out, that segment in your workout that targets the back (which you might have thought inconsequential to attaining that beach body) is the crux of the matter.

Paste these declarative sentences on your fridge for starters, and then we can take it from there: knee pain is generally the result of weak thigh and glute muscles; lower back pain is largely thanks to weak abdominal muscles; and dormant back muscles are often the culprit when it comes to discomfort in the neck and shoulders.

Those are some basic tenets of crisis management when it comes to modern-day ailments that continue to be overlooked. But there is also much more to it than mere biomechanics.

For the most part, trainers who teach Pilates, the movement method that advocates using the core (versus vanity) muscles of each body part at the ratio intended by nature, focus on biomechanics. But what if you were working the thighs and glutes week after week, and finding that one side of the body was responsive, while the other still remained dormant, as was the case with me?

For years, I lived with ­chronic pain, both neuromuscular (a consistent dull ache in the ­muscles) and biomechanical (joints and tendons). While I got rid of the latter pretty quickly, the former lingered, at times getting worse. I had done mat Pilates for years, in addition to yoga and swimming, but nothing worked. The latter two actually made matters worse.

When I finally cracked the code of my neck pain (overused traps and underused lats), I thought I had discovered the holy grail. As it turns out, I had barely scratched the surface. And had I not been forced to venture out in search of specialised rehabilitative Pilates teachers, I would never have resolved my chronic right shoulder pain. For months, I wasted time and energy strengthening my right shoulder, falsely believing it was chronically and innately weak, and that the only way to keep the nagging pain at bay was by continually bolstering it ­biomechanically. I was wrong.

Step one of my big discovery involved simply lying down on a pair of therapy balls. The therapy balls were placed on the inside of the shoulder blades – that sweet spot where the muscles often bear the brunt of our addictions to iPads and computer screens.

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The therapy balls told the story of why my right shoulder felt weak – and resolved it. Although it was my right shoulder that perpetually hurt, I was surprised to find that it was the left that was unresponsive to the balls, and hence the left that was the problem all along.

The ball on the right side moulded into the sweet spot, but the left was impermeable. It was as if the ball was pressed up against an excruciatingly painful wooden slab. 

It turned out that my right side was symptomatic all along only because it was bearing the brunt of my dysfunctional left.

"Self-massage on therapy balls causes responsive commotion in the tissues and stimulates nerve endings responsible for proprioception and relaxation," explains Emilie Goldstein Mikulla, owner of wellness company The Mindful Body and a teacher at Naya studio in Dubai. "They are also a natural booster of endorphins, serotonin, oxytocin and dopamine, the winning quartet responsible for your happiness. The roll model therapy balls have a therapeutic effect on both mind and body."

This experience was followed by an extensive assessment with Heba Abdel Gawad, a former Olympic synchronised swimmer and co-creator of the BodyHack brain-based fitness method, who teaches Pilates with a neurological approach.

Abdel Gawad combines traditional Pilates movements with functional neurological exercises, to stimulate the nervous system to alleviate pain and support injury rehabilitation.

"Whereas traditional Pilates instructors would typically train the body using biomechanical principles, those with a neurological background would focus on targeting the nervous system directly," she says.

While traditional Pilates tends to focus more on the trunk, brain-based fitness methods focus on areas of the body with a high number of sensitive nerve endings, such as the feet, hands, spine and jaw. The underlying message is that by improving the function of the brain, every other bodily function will improve by default. The most typical complaints are neck and shoulder tension, while many clients are also keen improve their posture.

"I realised there were many overly simplified answers about why certain body parts are dysfunctional," Abdel Gawad says. "When I started learning how the brain works in relation to movement and pain, it immediately made sense why some Pilates corrective exercises succeeded in certain areas but failed in others," she explains.

"The movements will be similar to a regular mat Pilates class, but will include specific eye positions – for example, inner-ear balance drills or direct brain-activation drills that can be combined with the movements."

My extensive, two-hour assessment was a mode of enlightenment in itself. Holding my rib cage as I inhaled, we discovered my left-sided "wooden" rib cage. By gliding a tissue over my leg, we discovered how desensitised my left thigh was, finally discovering the origin of my constant left knee pain and meniscal tear. Through simple eye movements, we gauged which part of my brain was overactive and which side had to be energised to send signals to the dormant muscles.

"We conduct neurological assessments to identify which parts of the brain are underperforming, followed by a series of other assessments to include things like posture, vision, vestibular balance and muscle testing," Abdel Gawad explains. "A client's history can often be the key and can give us a great deal of information on previous unrelated incidents."

Abdel Gawad gives her clients a number of exercises or drills to do at home, such as wearing an eyepatch on one eye when training or wearing music earphones in one ear to stimulate the non-dominant eye or ear.

There can be psychological reasons for compensation patterns, says Jocelyn Kope, a physiotherapist at the Breath and Health ­Alternative Medical Centre in Dubai.

"Someone who was hit by a car on the left, for example, may unconsciously keep their left side and left shoulder tensed protectively," she says. "Sometimes, all that's needed is for them to be made aware of their holding pattern, but they may also require a deeper intervention to help release past trauma. Forcing change will just cause other compensation patterns. The body holds onto memories of all our experiences on every physical level – in the fascia, in scar tissue and in movement."

"There is no such thing as good posture or bad posture", Kope maintains. "The important thing is to avoid one sustained position."

Pierdanilo Sanna, who is an ­orthopaedic surgeon with Zia Medical Centre Dubai and Awazen Medical Centre Abu Dhabi, is one of few ­surgeons who looks beyond the biomechanical. "We usually consider prolonged postural or muscular imbalances on a functional basis, but looking at neuroanatomy, would discover something completely different," he says.

"Our body is a single unit linked by circuits and governed by reflexes. Thus, to resolve biomechanical pain and dysfunction, we have no choice but to look to the neurological origins. The origins of any form of compensatory behaviour can be found within the neuromuscular system. For example, we have found links between foot misalignment and the teeth."

Caroline Leon is a Pilates master trainer for Pilates Moves Australia who teaches alongside Abdel Gawad, and is also the owner of online fitness education company A Life of Education and Pilates teacher-­training company A Life of Energy. She shattered her feet, pelvis and part of her spine after falling off a rock-climbing wall, and says the difference between acute and chronic pain is easy to decipher.

"Biomechanically, when you hurt, say, your elbow, this is acute pain. But when the pain is recurrent, it becomes chronic pain, which originates in the nervous system. The problem is that acute pain recurs indefinitely if not addressed."

Or, as Goldstein Mikulla puts it: "Embarking on any fitness regimen without addressing the source of any physiological issue will just build dysfunction upon dysfunction."