Ask Rael Q & A : 5th Issue

by Rael Isacowitz




How long should you wait to do Pilates after major surgery?

It all depends on the type of surgery. For most orthopedic surgeries, for instance knee, hip and shoulder, the goal is to get the joint moving as soon as possible. That is also true of abdominal surgeries, such as C-sections, where the goal is to start walking upright as soon as possible. Of course, there may be exceptions, such as spinal surgeries, and it is vital to follow the guidelines of the medical team. But the bottom line is that movement is good.

Movement does not necessarily mean doing Pilates, or more specifically the type of Pilates you may have been accustomed to. In general, the process should involve gaining passive range of motion followed by active range of motion. These phases should be accompanied by focus on body awareness and recruiting the correct muscles in the correct pattern. Gradual strengthening and functional training then follow.

This can all be accomplished in Pilates sessions, particularly once you have achieved passive and active range of motion. However, your Pilates routine, and each exercise, will need to be modified greatly. That is the importance of working with an experienced Pilates teacher; one who is familiar with working with injuries and pathologies, has excellent grasp of the Pilates repertoire and possesses the creativity to create modified workouts by breaking movements down. [BASI Pilates offers an exceptional Injuries and Pathologies course for Pilates professionals, compiled and taught by BASI Director of Advanced Education Samantha Wood].

It is critical to remember that the body’s tissue needs time to heal. Good nutrition, exercise, sleep and a positive outlook will all help, but the fact is that the tissue still needs time and the process can be aided but not rushed. I made the mistake of rushing my rehabilitation following open shoulder surgery because I was unable to accept that, with a strong will and drive, I could not speed up the healing process. I injured myself several times by pushing too hard and actually set back the rehabilitation process. When the time came to do the other shoulder, I was far more cautious and level-headed.

Undoubtedly, Pilates can play a pivotal role in returning to day-to-day life and athletic pursuits. It certainly did with my surgeries. I would not have been able to bring my shoulders back to 100% master-level function (High Bridge, Star, Single Arm Twist etc.) without the diligent practice of Pilates. After post-surgery physical therapy and returning to their daily tasks, people are seldom instructed in how to build an ongoing exercise program. Even if they do receive a program on paper, lets face it, without instruction, most people will not do it and, even with the best of intentions. there will inevitably be compensations. There is a vast gap between performing daily tasks, like showering and combing hair, and doing Pilates, running, cycling, swimming, playing golf, etc. It is in bridging the gap that Pilates comes into its own, and few if any methods of training will be as good.



 What are the best ways to work your abs if you have back pain?

First, assuming that you must develop the abs if you have back pain is far too simplistic. No doubt the abdominals can play a key role in overcoming back pain, but it is important to view the picture as a whole and not only one small part of it. The way you work the abdominals will depend entirely on the cause of the back pain and the imbalances present in your body.

If you have non-specific back pain with no pathology present, there are myriad options in Pilates. You will need to be guided by what movements make your body feel good and what movements have an adverse affect. You become a “movement detective,” putting together the pieces as you discover more about your body and your condition. If there is pathology present, a therapist or medical practitioner should offer you guidelines for exercise, particularly what to avoid; such as flexion, extension or rotation of the spine.

In most cases, the goal will be to establish spinal stability and controlled mobility. As it happens, this involves developing the muscles of the core (including, but not restricted to, the abdominals) which support the spine, control its movement and are so fundamental to Pilates. In this context, I will regard the core and the Pilates powerhouse as synonymous and, based on this premise. I am going to offer some general guidelines, which you may find helpful:

  1. Remember strength is relative to the other muscles in your body. There is no absolute strength; there is relative strength, with a particular view on the ratio between agonist and antagonist muscle groups. For instance, it means nothing to say someone’s abdominals are strong or weak. It only has meaning when the strength is measured relative to the person’s back extensors and hip flexors.


  1. Following on from the previous point, exercise programs should be tailored to overcoming imbalances in the muscles of your body, with an emphasis on the muscles of the core. Not only should strength be addressed, but also flexibility. Limitations in either can place undue stresses on the body’s structure, particularly the pelvis and spine. For instance, if the muscles of the back are very tight (which is often the case when back pain is present), not only will it limit spinal flexion but it will also inhibit the recruitment of the spinal flexors (abdominals).


  1. Pilates is all about the quality of the movement and not the quantity. Often people are given a prescription to do abdominal exercises and strengthen the abdominals. They go home and perform exercises in a fashion that, at best, is doing them little good and, at worst is actually exacerbating the problem. Not all abdominal exercises are created (or executed) equal! In addition, I am a firm believer that it does not come down to one muscle group but rather a symphony of muscles working together harmoniously to create the desired stability and healthy movement patterns.


  1. Find a good teacher. Even if you are a seasoned teacher it is beneficial to let someone else assess your movement and your body. A friend who is suffering from back problems told me recently that his chiropractor had cautioned him against doing Pilates. I said I both agreed and disagreed. Clearly, his chiropractor had encountered the results of sub-par Pilates teaching, which may not only be ineffective, but could actually be detrimental. So, the chiropractor may well have been doing the right thing by steering him clear of Pilates. However, in the hands of a good teacher, few disciplines will be as effective as Pilates in overcoming back problems.


  1. Practice Pilates consistently. Consistency is key in developing not only strength and flexibility, but also in reinforcing positive movement patterns and overcoming “bad” habits.


  1. Finally, your program should include working the abdominals in different modes; as stabilizers, as movers, with the legs on the ground initially and later with the legs lifted off the ground. Specific attention should be given to recruiting the transverse abdominus and, importantly, working the abdominals in different ranges of motion: flexion, lateral flexion and rotation. Remember, muscles need to be stretched, including the abdominal muscles.


This article first appeared in the March/2013 issue of Pilates Style Magazine. For more great stories about Pilates, check out the latest issue of Pilates Style, on newsstands nationwide, in the app store or at



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