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Is there anyone who shouldn't do the core stabilization exercises taught in Pilates courses? Our fitness facility offers these classes to everyone. We're thinking we should post a warning for anyone who shouldn't be doing these exercises. But who would that include?

There may not be a clear cut answer to this question. Most of the studies of lumbar stabilization (core) exercises do not report any harm from doing this program. But these studies also exclude (keep out) patients who have any potential risk factors.

For the most part, anyone with a fracture, severe osteoporosis, malignancy, or spondylolisthesis should get medical approval before participating in a class of this type.

Others who should be precautioned to seek medical counsel include anyone who has had prior back surgery, pregnant women, and anyone with a serious medical condition that could prevent any kind of exercise from being done. Anyone with numbness and tingling, muscular weakness, or other neurologic sign should also have a medical exam before exercising.

The majority of the people who participate in core stabilization exercises have a history of chronic low back pain. Usually this pain is of unknown cause but it could be from disc lesions, osteoporosis, or arthritis.

Another group of people who take these kinds of classes are interested in keeping from developing back pain. A subset of this group would be the worried well. These people engage in all kinds of activities and exercise designed to stay well and keep from any illness or injury. There is nothing wrong with this and unless they have any of the conditions listed, they should be included.

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