Integrating the Reformer into Clinical Pilates sessions can be a bit of a mystery when you first get started. Understanding the full value of the Reformer and it’s usefulness took me a few years to nail down, and that’s why I’m sharing these real world examples. And what better than using Clinical Pilates to treat low back pain? This case beautifully illustrates why the Reformer—and specifically exercises like Mermaid on the Short Box—can be game-changing for multifidus rehab when Mat work alone isn’t cutting it.

These past few months I’ve had the pleasure of working with ‘Annika’, who came to me with complaints of chronic low back pain. What makes Anika’s case more interesting, is that she herself is a Pilates physio. So of course I’m all in my head before her initial assessment and wondering what I could possibly do for someone with a similar skill set as mine. 

We’ve now had four sessions together and it’s been so much fun comparing notes and, in her words, ‘checking for blind spots’. 

Today, I’m walking you through Annika’s treatment session and showing you how targeted side flexion work on the Reformer helped us address her thoracolumbar dysfunction.

To boil it down, Annika has decreased multifidus recruitment along the left thoraco-lumbar region. From a postural standpoint, she has a tendency to stand in anterior tilt and thoracic extension with knees locked. As per her report, her posture has improved quite a bit in the past several years, but her back is still problematic. She realized that she was only thinking about targeting TA and multifidus with Mat exercises.

Annika’s first few sessions focused on TA endurance in upright positions while reducing thoracic extension in static positions as well as thoracic rotation. She was able to follow through, however the weak multifidus segment would get grumpy when asked to hold a more flexed and softened rib cage. 

So this week, we did a deeper dive into side flexion. Not only was she more limited moving to the left vs. right, but there was significant firing of the left lat that was pulling her down and collapsing her waist. There’s so much more to Annika’s case and I would love to dive into more of her assessment findings, but for today, I’m going to simply focus on treatment. 

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Here’s a brief overview of Annika’s 30 min treatment session: 

1) Left Lat release with dry needling and fascial release along axilla in side lying. This was done on the plinth, but could easily have been performed on the Reformer. We did a quick retest afterward and side flexion AROM was restored. (5 min) 

If dry needling is not in your wheelhouse, try this lat release exercise or tag in a massage ball.

2) Side flexion AROM in standing with cues to be more mindful of when her lats were taking over. (2 min)

3) Reformer: Short Box Mermaid with Maple pole held overhead. Taking Annika through side flexion with a longer lever was incredibly helpful in revealing the asymmetry in her trunk movement patterns. When side bending to the left, Anika would shear before side flexing. 

I gave her imagery of being a jack-in-the-box to think of elongating upward before arching over like a rainbow. This lower trunk support and moving ‘up and over’ is important when doing Mermaid in any of it’s variations, be it on the Reformer, Chair, or Mat. 

In my opinion, Clinical Pilates for low back pain really relies on good cueing to correct altered movement patterns.

After we mastered side bending, we added rotation as well, sort of like a Hawk variation. (10 min for both sides). See below for a quick reminder of Mermaid on the Short Box.

Clinical Pilates for Low Back Pain – Using Reformer for Multifidus Rehab

4) Reformer: Short Box Round Back +/- Twist. Returning to TA endurance, I also wanted to add more targeted lengthening and flexion through the extensors. Being an APT body-type, Anika had trouble with lower spinal flexion. She did well with cues of tilting the pubic bone up toward the ceiling and thinking of making a ‘J’ shape with her spine vs. ‘C’ shape. I also threw in a twist on the last few reps here. (5 min)

5) Homework was a review of postural cues to find more optimal alignment while moving through the day and when standing at work. Cues like allowing the rib cage to stay stacked over the pelvis, and shining the rib cage down into the pelvis worked well for her. She was also encouraged to continue with Short box exercises completed today with her home Reformer.

If you have any Reformer success stories of ‘aha’ moments I would love to hear them!

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Looking for more posts about Clinical Pilates for low back pain on the Reformer? Click here.

Interested in learning more about how you can use Reformer Pilates to help your health and fitness clients? Check out my online Clinical Reformer courses here.