90. Pathologizing Normal, with Natalie Wilson and Raphael Bender Pilates Elephants

Many, possibly most of the things we think of as “dysfunctions” in Pilates are in fact just normal variations. Things like:
Anterior pelvic tiltRounded shouldersAsymmetrical 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:
Find out about the Clinical Certification here80% of pain-free people have anterior pelvic tilt hereAnterior pelvic tilt is not related to hip muscle tightness or strength hereSurgery is not more effective than exercise for hip impingement and labral tears hereSubacromial decompression for shoulder impingement is 100% placebo hereIn fact ALL surgeries for musculoskeletal pain are not better than placebo hereEarly MRI causes harm here and the value of MRI for musculoskeletal pain results in more harm than benefit hereStabilization exercise works better if you THINK your back is unstable hereThere is very weak correlation between scoliosis curve magnitude and back pain here and herePain 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 hereCurrent ACSM guidelines here
Find more resources here.


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