An exploration of the relationship between Pilates teachers and clients with persistent low back pain

Abstract

Clinical guidelines identify a clear role for managing back pain with structured exercise. Pilates is a commonly recommended modality; however, Pilates-specific research is limited. Research suggests the patient-practitioner relationship may be important in managing persistent low back pain, although further research is needed to evaluate its impact on outcomes. The purpose of this study was to identify the components of the relationship between Pilates teachers and clients with persistent low back pain, explore key influences on the relationship, and to examine whether the interaction represents a therapeutic relationship.
This qualitative study used a multi-site, ethnographically-informed methodology. Data collection included observation of 24 Pilates sessions at eight sites in the South of England, and 19 semi- structured interviews with Pilates teachers and clients with persistent low back pain. Data were audio-recorded, transcribed verbatim and analysed thematically. From the interviews and observations, ten themes emerged, of which six related to components of the relationship: (1) eing Known’; (2) ‘Encouragement’; (3) ‘Teacher Expertise’; (4) ‘Mastery’ of exercises, facilitated y the teacher; (5) ‘Trust’; and (6) ‘Professional Identity’ of the teacher. Key influences on the relationship were identified in three themes: (7) ‘Health Perceptions’; (8) ‘Social Influences’, such s group
dynamic; and (9) ‘Service Perceptions’. An additional theme described the perceived impact of the relationship: (10) ‘Feeling Good’.

Further contextualisation of the findings using a social constructionist lens provided a tentative proposal that the relationship between Pilates teachers and clients with persistent low back pain may be considered a therapeutic relationship. The teacher-as-expert guided the client through culturally-based ritual-like practices associated with control of postural alignment and movement, facilitating a reduction in clients’ anxieties by providing meaning for their back pain. This
conceptualisation demonstrates a complex, multi-faceted interaction, where the teachers’ authority is valued. This novel perspective offers a potential avenue for further research.

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Identifiers

ORCID for Nicola Godfrey: orcid.org/0000-0002-1949-021X

ORCID for Lisa Roberts: orcid.org/0000-0003-2662-6696

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