Pilates is being hailed as "the fastest growing exercise technique worldwide". Once a well kept secret by celebrities such as Madonna and Courtney Cox, people worldwide are committing to what is being termed a more "mindful" and "intelligent" exercise approach. The American Council on Exercise recently predicted that "mindful" exercise programmes will further increase in popularity, particularly pilates, for its ability to develop strength and balance for a large spectrum of health and fitness levels.

Pilates is a mind body conditioning exercise programme that targets the deep postural muscles of the abdomen and spine to improve overall central core stability and posture. The mind and body are brought together to achieve these aims through the following eight sound principles: concentration, centering, breathing, isolation, routine, precision, control and flowing movement.

The medical world is now realising the benefits of the pilates method for the prevention and rehabilitation of back injuries. In order to prevent a recurrence of back pain, it is essential to retrain the deep abdominal and spinal muscles. Hodges (1999) developed a model of spinal stability by drawing on all the research presented previously. Hodges proposes that TrA, multifidus, the diaphragm and the pelvic floor muscles are co-activated to form an enclosed abdominal ring, termed a 'cylinder of stability'. This closed cylinder of stability allows the contraction of TrA to generate an increased IAP to increase lumbar stability (1999). Activation of TrA, multifidus, the diaphragm and pelvic floor is required to increase the pressure in the abdominal cavity and increase tension in TLF to increase spinal stability.

This cylinder of stability hypothesized in the literature is what is termed as the 'central core' in pilates. As stated previously, pilates focuses on building an efficient 'central core'. In pilates, 'central core' refers to the TrA, multifidus, pelvic floor and diaphragm. In pilates, abdominal hollowing techniques are utilized to activate this central core. The 'Modified pilates rehabilitation program'©' also focuses on contraction of the pelvic floor to facilitate the TrA and multifidus muscles to contract, thus activating this central core.  Pilates then challenges this central core by introducing graduated arm and leg movements and stretches.

In conclusion, medical experts have provided substantial evidence on the importance of TrA and multifidus in the role of lumbar instability. Abdominal hollowing techniques have been advocated to reduce the recurrence of low back pain and lumbar instability. The pelvic floor has been shown to activate in close association with TrA and the diaphragm in a feed forward mechanism to increase spinal stability.  Therefore, Pilates offers an excellent adjunctive tool.  Pilates provides patients with a method of exercise unique amongst other forms of exercise that focuses on correct movement quality not quantity, core stabilisation and postural correction.

• back pain,
• poor postures,
• neurological conditions,
• mental health conditions,
• sports injuries,
• arthritis,
• stress related illness and
• before and after pregnancy.

Modified Pilates' is the culmination of years of both physiotherapy and pilates training. The first compulsory module in this program is 'Modified Pilates matwork - level one'. This course is composed of the beginner level traditional 34 pilates matwork exercises that have been modified to compliment current research on lumbo-pelvic instability. We enforce a minimum time of six months in between completing this course and commencing the matwork two course in order to consolidate your new pilates skills in the clinical setting. The matwork instructor course completes your training requirements in order to receive full certification as a matwork instructor. Hence, your pilates training is logically spaced over a period of 12 - 16 months to allow for practice. The reformer course is only offered to those who have completed the full matwork certification program as a strong theory and practical base is required for this intensive course.

Diane Kheir is a member of the Australian Physiotherapy & Pilates Institute, and teaches one to one lessons to people with back pain.  Modified Pilates is a particularly suitable form of Pilates for people suffering from back conditions, and patients attending a course of sessions will go away with a tailor made routine suitable for their condition, which they can then use to prevent further occurrences or a worsening of the condition.