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The What, Who, How, and Why of Pilates from a Pelvic Floor Physical Therapist: Part 4.1

Why should you try Pilates?

What value can it add to your life? In my opinion, there are 5 primary reasons to practice Pilates. The first…

1. Rehabilitation

Pilates is an excellent rehabilitation modality to restore function after surgery, injury, illness or other physically-impairing health event. Joseph Pilates initially developed the Pilates repertoire to rehabilitate his own health ailments and improve his quality of life, concerns he felt were not adequately addressed by traditional medical care. He then began to instruct injured performers through his method to restore their physical function and return them to their livelihood on the stage. So Pilates was actually originally intended as a tool in rehabilitation.

Often I will hear from my physical therapy colleagues that Pilates is not a productive form of rehabilitation because of the equipment involved. The thinking is that if patients do not have the equipment at home, then there can be no carryover for home practice. While I understand where this gripe originates from, it is the qualm of someone who perhaps has not completely considered the applications of a Pilates-based program. Although most patients do not have Pilates equipment at home, there is an entire repertoire of mat exercises that is suitable for developing a comprehensive and targeted home exercise program— no equipment necessary. Also, practicing on the equipment in the clinic may actually facilitate enough change so that mat or body weight exercises are possible to assign for home practice. Allow me to explain further…

There are two primary purposes of using Pilates equipment in rehabilitation plan of care. One is to reduce pain and improve efficiency of movement by strategic use of springs that assist or resist the body during a task. A patient who is highly acute and painful may not be able to perform many body weight home exercises initially, but will be able to participate in a movement experience with assistance from springs, like in the Tower exercise 90-90, which suspends the lower extremities in a restful position of 90 degrees flexion in the hips and 90 degrees flexion in the knees, and is typically alleviating for hip and low back pain. The patient can then be passively or actively taken through hip and knee range of motion to their tolerance with less effort required of the therapist and less guarding elicited by the patient. This is no different in principle from using a passive modality like heat/ice or manual therapy to reduce tissue irritability and mitigate fear and threat of movement so that active interventions are possible. It is another tool to elicit positive change in patient symptoms quickly, thus, promoting patient buy-in and participation. And isn’t that the whole point of rehabilitation to begin with: to help patients get better faster?

A second reason to use Pilates equipment for rehabilitation is to promote motor learning. The beauty of Pilates equipment is the control it lends clinicians over task environment. We can place patients in an unfamiliar context (i.e. lying supine on the Reformer carriage) and then simulate functional tasks (i.e. Footwork and Semi-circle on the Reformer require similar mechanics to those of a sit to stand). The motor patterns of many Pilates exercises are similar enough to tasks be perform in our daily lives (i.e. sit to stand, rolling in bed, hip hinging, lifting, etc) that adaptations made on the equipment can later be transferred to functional positions, but the environment is dissimilar enough that the nervous system is able to adopt a new motor plan and movement strategy without immediately snapping back into familiar engrained movement patterns that do not serve the patient. For example, a patient exhibiting a rigid, hip-flexor dominant pattern of stabilizing the spine may benefit from an exercise like Reformer Feet in Straps with spring tension adjusted to provide enough assistance that permits the hip flexors to relax, but still encourages the deep anterior core to activate and allows the hip extensors to work more freely. The final result is achieving true hip extension while maintaining a neutral spine and breathing under load, which has applications to nearly every functional movement in our daily lives, including walking.

Another example may be mastering spinal articulation. Perhaps a patient lacks the spinal mobility and core control to perform a roll up from supine without assistance, but with help from springs on the Reformer, they can be successful with the task, develop the flexibility, and learn the motor plan.

Depending on the patient’s deficits, the strategy of interest (i.e. hip dissociation, trunk organization, axial elongation, breath control, shoulder alignment, etc) can be learned on equipment and then progressed to more functional positions. Ultimately, practicing these strategies on the equipment improves the efficiency of learning a complex motor task like a sit to stand without overburdening the nervous system since many of the mechanics have been mastered in part practice prior.

So Pilates can be used with and without equipment for rehabilitation purposes to achieve excellent clinical outcomes. The equipment is beneficial by providing assistance to reduce pain and to promote better mechanics, but it can also be used to advance a challenge by progressively removing assistance or adding resistance. The mat repertoire can be modified in a nearly infinite number of combinations to address a patient‘s specific deficits and then be easily assigned to a home program for carryover outside the clinic. Often the equipment incorporated into mat work is more affordable and accessible to patients so replication at home is not a concern.

Pilates is a fantastic rehabilitation tool, one that I would like to see more widely incorporated into clinics of all types. But it‘s applications extend beyond the clinic. Check out our next post to explore reason number 2 to practice Pilates.

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