Much has been written about the power of yoga to heal trauma: David Emerson and Elizabeth Hopper, in their book Overcoming Trauma through Yoga: Reclaiming Your Body, identify four themes through which yoga can help the trauma survivor: experiencing the present moment, making choices, taking effective action and creating rhythms. Their programme "...allows trauma survivors to cultivate a more positive relationship with their bodies through mindfulness, breathing and gentle yoga exercises."

Less has been written about the potential of Pilates as a treatment for trauma.

I am a psychotherapist, personal trainer and Pilates teacher and work with mind and body to help people recover from trauma and chronic lower back pain. Pilates is one of the best forms of exercise for keeping your back healthy but recently I have begun to explore the potential for Pilates to be used by trauma survivors to relieve their symptoms.

Pilates can look very like yoga from the outside: both are relatively slow-paced, emphasise breathing and slow, controlled movements and happen mostly on a mat. Yoga though is an ancient, spiritual practice while Pilates was developed in the early twentieth century by Joseph Pilates as an exercise system to help wounded soldiers and injured dancers rehabilitate and has more of an emphasis on core strength and control, as well as spinal mobility, making it an excellent choice to treat and prevent chronic lower back pain. But how can Pilates help resolve trauma?

Fight and flight

It's partly about the hip flexors. Elizabeth Koch, in her work The Psoas Book, shows us how the psoas muscle one of the main "hip flexor" muscles, along with the Iliacus contracts tightens when the fight / flight mechanism is triggered, in response to danger or a traumatic memory.

The psoas runs from the top of the femur thigh bone , in front of the hip bones and hooks on to each of the five lumbar vertebrae and the lowest of the thoracic vertebrae L12 . If it is too tight, it pulls the lumbar vertebrae down, squashing them together and squeezing the intervertebral discs. These push out at the back, pressing onto the spinal nerves and are a major cause of lower back pain.

The psoas connects with the Iliacus muscle where they both join the top of the femur. The Iliacus starts on the top part of the hip bone, so when that muscle tightens, it can pull the pelvis into an anterior forward tilt, pushing the lumbar spine into an exaggerated curve, another cause of lower back pain.

The psoas also connects to the diaphragm, the umbrella-shaped muscle lying at the bottom of the ribs, which we use to control our breath. Again, when the psoas is tight, the diaphragm tightens, restricting breathing.

The psoas tightens or contracts in fight/flight because of its role in flexing the hip so that the leg lifts, enabling you to run or fight. In chronic trauma, where you live in a constant state of hyper-vigilance, always expecting to be attacked again, the psoas will be permanently tight, causing the back pain and breathing issues mentioned.

Further tension in the body comes from a tightening of the fascia in fight/flight. Fascia is a glutinous, string-like material which covers the body like a net, beneath the skin, holding bones, muscles and organs in place. It is usually slippery and flexible, allowing muscles and joints to move under the skin but can become sticky and stiff, impeding movement in response to trauma: the release of cortisol into the bloodstream, during a traumatic incident or when it is re-experienced, increases the level of glucose in the body which causes the fascia strings to stick together see David Lesondak's book: Fascia: What it is and Why it Matters for more background .

Freeze and dissociation: Losing contact with the body

Trauma survivors, especially survivors of sexual violence, often mention they don't feel they are in their body. It feels numb, unconnected, as if it doesn't belong to them. People describe not being able to identify the feel of particular muscles in the body. This is not the same as being paralysed - you can move - it is more that your body doesn't feel your own.

This happens as the body goes into freeze at the time of the original traumatic incident and again when reminded of it later. The brain's survival system will opt for freeze if fight / flight have been tried or it thinks freeze is a better option. The body goes numb to reduce the impact of the attack. The mind can split off or absent itself from the body for the same reason. And this can keep happening every time you are reminded of the trauma.

How Pilates can help: The principles

In designing and delivering a session or programme, a Pilates teacher is informed by six key principles:

• Concentration
• Breath
• Centring
• Precision
• Flowing Movement
• Control