Pilates Power: An Overview
Many clinicians see the intricate twists and turns of Pilates and wonder whether it's appropriate for their patients. After seeing the deluge of magazine articles and television features about this latest exercise craze, you may be wary of your patient's ability to really handle all the maneuvers.
If the latest surge in participation is any indication, more people are willing to give it a try. You can help change physical appearance, posture, even attitude, with Pilates techniques. In the process, these exercise techniques can increase flexibility and muscular strength, without packing on bulk. These techniques use core stabilization and focus on form and function, breathing, posture and balance.
People approaching middle age are ideal candidates. Many of these baby boomers are discovering that too much jogging and weight lifting are taking a toll on joints, and the nonweight bearing aspects of Pilates offer a welcome respite. In addition, Pilates techniques, with 2,000 exercises and maneuvers, can provide an added edge in the fight against the middle-aged bulge.
Some people even use Pilates as their only exercise regime because they can work every body part, including the small muscles of the feet and hands.
Joseph Pilates developed his exercise techniques in 1915, integrating gymnastics and Yoga with theories of movement. His idea revolved around creating a program - using movements and specific equipment - that focused on building lifelong fitness.
Over time, Pilates has branched out into three schools of thought: West Coast, East Coast and Canadian techniques. While the basics are the same, each philosophy is slightly different. The alterations may involve slight differences in breathing patterns, foot placement on Pilates-specific equipment, wearing socks vs. not wearing socks and equipment modification.
Primarily, I adhere to the West Coast Pilates technique, which uses floor and towel work, in addition to the primary Pilates equipment. Floor and towel work encompasses upper extremity movements to build the scapulothoracic and trunk musculature through dynamic movement.
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Some of the motions for upper and lower extremities are similar to those for traditional physical therapy exercises, such as prone pushups or single leg lifts.
Many of these exercises are first done standing, then transferred to floor or mat work. A client also can do the motions in a sitting position on one of the Pilates spine machines. And once clients learn the basics of towel work, they can do these movements anywhere, not just at your clinic.
An essential component of standing floor work is called "imprinting," which focuses on balance and centering the body through the foot centers. Other key elements of this technique are breathing, coordination, body form focus and segmental mobility.
But the most important aspect of Pilates is core stabilization, which provides a foundation of strength and balance that originates from the pelvic and shoulder girdle regions. Core stabilization enables patients to learn to contract pelvic girdle muscles (abdominals, hip abductors, gluteals) and make a tight "girdle or wrap" of muscles to support the spine in neutral.
Scapulothoracic muscles are also pulled back and downward to support the upperbody in an erect posture. It also keeps the pelvic girdle aligned with the center of gravity.
By centering the body, clients learn to align the feet, knees, pelvis, trunk, shoulder girdle and head. This "rule of the bones" addresses postural alignment and sets the tone for the physical work being handled by the muscles. Improper body alignment can lead to poor form and inefficient muscle use.
Instruct clients to hold muscles taught, as in normal standing posture. Overtightening core muscles can lead to muscle fatigue, soreness and failure to achieve postural alignment. By solidifying core stabilization, you can improve muscle tone in the abdominals and buttocks and create a more erect posture.
To address core stabilization, one of the Pilates machines is designed to increase spinal strength and flexibility. Another device uses a gravity-eliminating moving platform table to improve the ability to move body parts on the stabilized spine.
Two additional pieces of equipment focus on strengthening. A device, of spring cables focuses on increasing resistance, moving body parts against the core, which improves strength and flexibility. Another unit combines resistive springs and an upright pole to facilitate better posture and control. It also provides isometric resistance to extremity exercises with core stabilization of the spine. Through these motions, patients can eventually develop the ability to automatically maintain correct posture.
Core stabilization and postural alignment occur continuously throughout Pilates training sessions. Segmental mobility of the spine with movement, and core stabilization occur simultaneously. Instead of a series of separate exercises, segmental mobility is a continuous progression of movement, which makes the technique functional and enables a client to automatically align and support posture, working from the inside out.
Floor, mat and towel work exercises progress through increasing levels of difficulty. The machine and mat work go together. The difference is that the Pilates equipment provide resistance or assistance with springs, and the body provides resistance to movement on the floor.
Diaphragmatic abdominal breathing is another component of stabilization. Full inhaling and exhaling during movement oxygenates red blood cells. Breathing and abdominal contraction techniques anchor the body's center of gravity.The breathing patterns are done continuously to facilitate abdominal contraction during exhalation, which strengthens and flattens the abdominal wall. One technique uses a rhythmic breathing pattern that varies with movement. The added percussive diaphragmatic breathing increases the force of the diaphragmatic contraction during exhalation, making abdominal wall contractions even stronger. The abdominal contractions anchor the center of gravity by holding the pelvis in a neutral position.
In addition, spinal stabilization techniques improve postural alignment. Segmental spinal mobility and centering the body improve spinal mobility. Using Pilates equipment with springs focuses on exercises to reduce the asymmetry of scoliosis by stretching tight muscles, strengthening lengthened muscles and derotating the spine.
But clients with osteoporosis shouldn't participate in exercises that promote excessive flexion, since forward flexion can cause compression of the anterior vertebral bodies. For example, the roll up/roll down motion for standing is contraindicated for someone with osteoporosis and kyphoscoliosis. For clients with osteoporosis or spinal fusions, use the flat back position so the back stays flush to the floor.
In physical therapy, you can integrate Pilates-based exercise in rehab, modifying techniques for specific needs and conditions. In my setting, I use Pilates techniques for back pain patients, people with arthritis, osteoporosis and kyphoscoliosis. But be conservative and don't push clients beyond their abilities.
Developing a Pilates program is similar to putting together a physical therapy plan of care. Select exercises based on a client's capabilities and restrictions. Use basic exercises until the person improves and can safely progress to more advanced levels.
For instance, if a client has extreme back pain, use pain management techniques, manual therapy and basic mobility exercises. Work in movements with the flat back position using Pilates equipment that emphasizes foot work and partial range of motion, then combine modified roll downs with the wooden bar to teach spinal stabilization and mobilization.
A healthy person can progress through a protocol of increasingly difficult tasks and maneuvers to build strength, flexibility and endurance. It can take some people almost two years of practice and concentration to develop enough strength and flexibility for advanced maneuvers.
You can even carve out a niche for a specific patient population. For instance, you can target golfers and implement Pilates techniques to increase power behind the swing. By integrating these techniques into a complete golf fitness program, a client can generate strength and stability from the body's core musculature.
Other golf fitness techniques should include using stability balls, rubber tubing; balance boards, weight machines, manual therapy and soft tissue mobilization techniques to strengthen deficit musculature. But by adding Pilates, you can teach clients how to automatically maintain core stabilization continuously during the golf setup and swing phases. The techniques improve flexibility through active dynamic stretching throughout movement, rather than through static stretches in one position.
Pilates-based exercise is a discipline; it takes time, concentration and dedication. And it's more intricate than sending a person to the gym to work with weights.
Before long; however, your clients will find it easier to put more power into a golf swing, lug a heavy suitcase through the airport and do bicep curls with full gallons of milk. In the process, you'll help them achieve a higher level of physical functioning, better balance and enhanced flexibility.
