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

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