Pilates Elephants5 Jun 2022

90. Pathologizing Normal, with Natalie Wilson and Raphael Bender

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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