evidence-based Pilates Archives

The influence of words that you hear about your body on your movement. (The nocebo effect)

Movement Notes — Pilates on George — by Olya Kudryavtseva

QUICK ANSWER (TL;DR)

Nocebo is the opposite of placebo. It means – negative outcomes produced by negative expectations. Research (Darlow et al. 2013) shows that the language clinicians use about back pain directly affects beliefs, function, and disability independent of actual pathology. Pain neuroscience education combined with movement is the evidence-based approach. Words shape outcomes.

How we talk about the body

Across every blog post on Movement notes – discs, ligaments, joints, tissues – there’s one thread that keeps coming back.

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Patellofemoral Pain: Can the knee pain be originated in the hip?

Movement moment

Movement Notes — Pilates on George — by Olya Kudryavtseva

Patellofemoral pain (PFP) is pain around or behind the kneecap, typically aggravated by squats, stairs, and prolonged sitting. Imaging usually shows nothing structural. The 2018 international consensus statement confirms hip and knee strengthening combined is more effective than knee-only programs. The knee is downstream but the work is upstream.

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Diastasis Recti: It’s Not About Closing the Gap

Movement moment

Movement Notes — Pilates on George — by Olya Kudryavtseva

QUICK ANSWER (TL;DR)

Diastasis recti is a separation of the rectus abdominis along the linea alba. It’s present in 60% of women at 6 weeks postpartum and around 33% at 12 months, meaning some persistence is normal. Recent research (Lee & Hodges) showed that linea alba function (its ability to generate tension) matters more than gap width. Crunches aren’t categorically forbidden. The entire system coordination is the goal.

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FAI, Labral Tears, and Early Hip OA: Why the Imaging Doesn’t Tell the Whole Story

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Movement Notes — Pilates on George — by Olya Kudryavtseva

QUICK ANSWER (TL;DR)

Femoroacetabular impingement (FAI) is a mechanical conflict between the femoral head and socket. Labral tears are common in pain-free people (69% in one study). The FASHIoN trial showed personalised hip therapy is a valid first-line treatment. Hip strength, particularly abductors and external rotators, is the foundation of conservative care. Pilates is well-suited to this work.

Hip pain in active adults often gets one of three labels: FAI, labral tear, or early osteoarthritis. They overlap clinically. They overlap on imaging. And they often can be present in one client at the same time.

The label matters less than the functional picture in front of you.

Here’s how to make sense of all three.

What Is FAI (Femoroacetabular Impingement)?

FAI describes a mechanical conflict between the femoral head/neck and the acetabular rim (the socket edge) during certain movements typically deep flexion combined with internal rotation.

Two morphological types are described:

• Cam morphology – an aspherical femoral head (the ball isn’t perfectly round). Common in young athletes who developed in sports loading the hip in flexion (football, hockey, dance).

• Pincer morphology – over-coverage of the acetabulum (the socket extends further over the ball than it should), pinching the labrum on flexion.

Mixed (cam + pincer) is the most common. But many people with these morphologies have no symptoms. Morphology + provocative loading + symptoms = FAI syndrome. Morphology alone isn’t enough.

What Is the Hip Labrum?

The acetabular labrum is a fibrocartilaginous ring (similar tissue to the meniscus of the knee) around the rim of the socket. It deepens the socket, contributes to a suction seal, and provides proprioceptive feedback.

Tears are extremely common on imaging Register et al. (2012) found labral abnormalities in 69% of pain-free volunteers. Symptomatic tears typically produce sharp anterior groin pain, clicking or catching with hip flexion and rotation, and sometimes a feeling of giving way.

But again: tear on the MRI doesn’t equal pain in the hip.

Early Hip Osteoarthritis

Hip OA involves loss of articular cartilage, but the picture is broader: subchondral bone changes, capsular thickening, muscle weakness around the joint, and altered pain processing. Early OA may show normal-looking cartilage on plain X-ray but altered MRI signal.

It’s not just “wear and tear” – that’s an outdated framing. It’s a whole-joint condition where the cartilage is one piece of a bigger story.

Do Hip Labral Tears Need Surgery?

Often not. The FASHIoN trial (Griffin et al. 2018, The Lancet) compared hip arthroscopy to personalised hip therapy for FAI syndrome. Surgery was modestly better at 12 months, but conservative care produced meaningful improvement for many patients and crucially, conservative care can be tried first without precluding surgery later.

For hip OA, exercise has strong evidence (Fransen et al. 2014, Cochrane). Strength training, particularly targeting hip abductors and external rotators, reduces pain and improves function.

What Exercises Help Hip Impingement and Labral Tears?

The evidence-based foundations:

• Hip abductor strength (gluteus medius and minimus), side-lying leg work, standing single-leg work, reformer side splits. Critical for offloading the hip joint during gait.

• External rotators (the deep six: piriformis, gemelli, obturators, quadratus femoris), clamshells with progression, reformer footwork variations.

• Avoid forced end-range flexion + IR in symptomatic FAI. Stay where the joint stays quiet.

• Build hip extension capacity. Many hip-pain clients live in flexion. Bridging variations, prone leg lifts, standing extension work all matter.

Frequently Asked Questions

What does FAI feel like?

Symptomatic FAI typically produces sharp groin pain or anterior hip pain with deep flexion movements (squatting, getting in and out of cars, sitting cross-legged). Pain may be reproduced with the FADIR test (flexion, adduction, internal rotation). Stiffness and reduced range of motion are common.

Can a hip labral tear heal on its own?

Labral tears generally don’t heal in the way a muscle does, because of poor blood supply. However, symptoms from a labral tear often improve significantly with appropriate strengthening and load management, meaning many people live well with the tear without surgery.

Is squatting bad for FAI?

Not necessarily, but how you squat matters. Forced end-range flexion combined with knees collapsing inward (which loads the hip in flexion + internal rotation) can provoke symptoms in cam-type FAI. Squat depth and form should be matched to symptoms.

Can Pilates help hip pain?

Yes, Pilates is particularly suited to hip pain because it allows targeted strengthening of the abductors, external rotators, and extensors in supported positions. Our Sydney CBD studio works with many clients managing FAI, labral tears, and early OA.

How long does FAI take to improve with exercise?

Many people see meaningful improvement within 8–12 weeks of consistent strengthening, with continued progress over 6–12 months. The FASHIoN trial showed conservative care produced significant benefits at 12 months.

The Bottom Line

Whether the label is FAI, a labral tear, or early OA the work is largely the same. Build strength around the joint. Avoid the positions that flare. Progress thoughtfully.

References

• Griffin, D. R., Dickenson, E. J., Wall, P. D. H., et al. (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (FASHIoN). The Lancet, 391(10136), 2225–2235.

• Register, B., Pennock, A. T., Ho, C. P., et al. (2012). Prevalence of abnormal hip findings in asymptomatic participants. American Journal of Sports Medicine, 40(12), 2720–2724.

• Fransen, M., McConnell, S., Hernandez-Molina, G., & Reichenbach, S. (2014). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews.

Cervical Disc Pathology: When Neck Pain Is Actually a Disc Issue

Movement moment

Movement Notes — Pilates on George — by Olya Kudryavtseva

QUICK ANSWER (TL;DR)

Most neck pain is non-specific and resolves with movement. Cervical radiculopathy that is a nerve root irritation, usually from a disc herniation – is different: it produces pain, numbness, or weakness that follows a specific arm pattern. Most cases improve with conservative care within 4–6 months. Deep neck flexor work, thoracic mobility, and scapular control are the evidence-based exercise foundations.

Most neck pain in our clients is non-specific – muscular, postural, stress-related, and resolves with movement and load. But some isn’t.

Knowing the difference is one of the most useful clinical skills, whether you’re a movement professional or someone trying to figure out whether to push through or seek help.

Here’s how to tell.

How the Cervical Spine Is Built

The cervical spine has seven vertebrae (C1–C7) and intervertebral discs between C2 and C7. Cervical discs are smaller and more loaded per square millimetre than lumbar discs. Combine that with the head’s mass, the neck’s range of motion, and modern life’s tendency to keep us looking down at screens, so degeneration starts early.

Disc height loss is often visible on imaging by the third decade. That’s normal. It doesn’t mean broken.

What Is Cervical Radiculopathy?

Cervical radiculopathy means a nerve root in the neck is being irritated or compressed. In most cases, this is from a disc herniation or from foraminal narrowing due to facet osteoarthritis or osteophytes (bone spurs).

The classic symptoms:

• Pain that radiates from the neck into the shoulder, arm, forearm, or hand

• Numbness or tingling in the same distribution

• Weakness in muscles supplied by that nerve root

• Symptoms often worsened by neck extension and rotation toward the affected side

If symptoms travel into the arm in a specific pattern that’s the signal to get assessed properly. Not every neck ache is a disc, but pain that follows a clear pattern down the arm warrants attention.

Common Patterns of Cervical Radiculopathy

• C6 radiculopathy: thumb-side forearm and thumb numbness, weak wrist extensors

• C7 radiculopathy: middle finger numbness, weak triceps

• C8 radiculopathy: little finger side numbness, weak finger flexors

How Long Does Cervical Radiculopathy Take to Heal?

Cervical radiculopathy from disc herniation has a generally favourable natural history. A meta-analysis by Wong et al. (2014) found that most cases improve substantially within 4–6 months of conservative care.

Surgery is reserved for progressive neurological deficit or persistent disabling symptoms that don’t respond to conservative management.

What Exercises Help Cervical Disc Issues?

Exercise, particularly programs combining neck-specific endurance work, scapular stabilisation, and thoracic mobility, has consistent evidence for symptom reduction (Salt et al. 2011; Falla et al. 2007 specifically for deep neck flexor work).

The key components:

• Deep neck flexor endurance (longus colli and longus capitis – the deep front-of-neck muscles). Craniocervical flexion (chin nod) work in small ranges, holding for time.

• Thoracic mobility. Stiff upper backs make necks work harder. Foam roller extension work, thread the needle, mermaid.

• Scapular control. Lower trapezius and serratus anterior work – the scapula is the cervical spine’s silent partner.

• Avoiding provocation in the acute phase. End-range cervical extension and rotation toward the affected side can flare symptoms.

Frequently Asked Questions

How do I know if my neck pain is a pinched nerve?

Pinched nerves typically cause pain, numbness, tingling, or weakness that travels down the arm in a specific pattern – not just generalised neck and shoulder soreness. If symptoms follow a clear path into the arm or hand, get assessed properly.

Can a cervical disc herniation heal without surgery?

Most cases improve substantially within 4–6 months of conservative care including exercise, education, and sometimes medication. Surgery is reserved for progressive neurological deficit or persistent disabling symptoms that don’t respond to conservative management.

Is Pilates safe for neck disc issues?

Generally yes, with appropriate programming. Working with an instructor who understands cervical pathology and can avoid provocative positions during acute phases is important. Our Sydney CBD studio specialises in personalised Pilates for clients with these conditions.

What’s the difference between neck pain and cervical radiculopathy?

Neck pain stays in the neck and possibly the upper shoulders. Cervical radiculopathy involves nerve root irritation and produces symptoms that travel down the arm in a specific dermatomal pattern, often with numbness, tingling, or weakness.

Should I avoid neck exercises if I have a disc bulge?

Not typically. Most cervical disc issues respond well to specific exercise — deep neck flexor work, thoracic mobility, scapular control. What matters is matching the exercises to your current symptoms and avoiding positions that provoke radicular signs.

The Bottom Line

Most necks aren’t broken. But the few that are need different programming and the only way to know the difference is to listen carefully to the symptoms.

When the symptoms travel into the arm, when they follow a pattern, when extension makes them worse that’s the conversation that matters. That’s when slowing down and getting assessed makes all the difference.

References

• Wong, J. J., Côté, P., Quesnele, J. J., et al. (2014). The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy. The Spine Journal, 14(8), 1781–1789.

• Falla, D., Jull, G., Russell, T., et al. (2007). Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical Therapy, 87(4), 408–417.

Salt, E., Wright, C., Kelly, S., & Dean, A. (2011). A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Manual Therapy, 16(1), 53–65.

Lumbar Spinal Stenosis: Why Flexion Provides Relief (and What to Do About It)

Movement moment

QUICK ANSWER (TL;DR)

Lumbar spinal stenosis is a narrowing of the spaces around the spinal cord and nerves, most commonly caused by age-related changes. Forward bending (flexion) increases canal volume and relieves symptoms, which is why sufferers lean on shopping trolleys. Flexion-based exercise programs, including clinical Pilates, have moderate-quality evidence for reducing pain and improving walking tolerance.

There’s a reason the older client in your life leans forward on the shopping trolley. There’s a reason they can ride a stationary bike for an hour but barely make it to the corner shop on foot.