Episode 90

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:

  • Buy Raph's book: Strengthen the Person, Not Just the Body Part here
  • 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

Find more resources here.

This podcast uses the following third-party services for analysis:

Chartable - https://chartable.com/privacy
AdBarker - https://adbarker.com/privacy

About the Podcast

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Pilates Elephants
Raph applies critical thinking to the “Elephants in the Room” in the Pilates industry, and share evidence-based strategies for you to become a more effective, happier and more financially successful Pilates instructor.

About your host

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Raphael Bender