Pilates Elephants 90. Pathologizing Normal, with Natalie Wilson and Raphael Bender
Jun 5, 2022
01:48:26
Many, possibly most of the things we think of as “dysfunctions” in Pilates are in fact just normal variations. Things like:
- Anterior pelvic tilt
- Rounded shoulders
- Asymmetrical range of motion
are highly prevalent in pain-free people and do not predict injury. In fact, 80% of pain-free people have anterior pelvic tilt; so is it really a “tilt” or is it just the shape of the human pelvis?
Even hypermobility & scoliosis are arguably not the cause of pain, or increased pain, and don’t need to be (nor can they be) “corrected” or “protected” by exercise.
Raph and Natalie talk through:
- What is the evidence that these things are not pathologies?
- Why do we pathologize normal?
- What should we do instead?
Resources mentioned in the episode:
- 80% of pain-free people have anterior pelvic tilt here
- Anterior pelvic tilt is not related to hip muscle tightness or strength here
- Surgery is not more effective than exercise for hip impingement and labral tears here
- Subacromial decompression for shoulder impingement is 100% placebo here
- In fact ALL surgeries for musculoskeletal pain are not better than placebo here
- Early MRI causes harm here and the value of MRI for musculoskeletal pain results in more harm than benefit here
- Stabilization exercise works better if you THINK your back is unstable here
- There is very weak correlation between scoliosis curve magnitude and back pain here and here
- Pain in hypermobile people is not related to joint angle here but is more likely a result of higher pain sensitivity of the central nervous system here
- Current ACSM guidelines here
Connect with me on Instagram: @the_raphaelbender
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