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90. Pathologizing Normal, with Natalie Wilson and Raphael Bender
Episode 905th June 2022 • Pilates Elephants • Raphael Bender
00:00:00 01:50:24

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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.



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