Pilates: The Exercise Method for Rehab

Though Pilates is the fastest growing fitness trend in the nation, it was rehabilitation that Joseph Pilates had in mind when he developed this exercise method. In fact, some physical therapists believe Pilates was one of the first physical therapists in history.

Joseph Pilates was born in Germany in 1880. After a childhood plagued by sickness and muscular weakness, Pilates overcame his physical limitations with exercise and body building throughout his teenage years. At the outbreak of World War I, while Pilates was interned with other German nationals, he developed and refined his exercise ideas and trained others with his innovative exercise method. Pilates would attach springs to hospital beds, enabling bedridden patients to exercise using resistance, an innovation that would later emerge in his equipment designs. When thousands of people were killed by an influenza epidemic in 1918, not one of Pilates’ trainees died. This, he claimed, proved the effectiveness of his exercise system. In 1926, Joseph and his wife Clara moved to New York, where they opened the first studio. There, Pilates’ exercise and rehabilitation method quickly gained acclaim in the dance community.

Today, more and more physical therapists are using this powerful tool to strengthen their rehabilitation programs and the profitability of their practices. The Pilates method of exercise gives them an effective way to integrate core stability, breathing and proper posture with the concepts of flexibility and strengthening. Therapists also use it as a stand-alone regime for patients to maintain and improve their rehabilitated conditions. Personal trainers and group exercise instructors are also integrating Pilates techniques into their programs and group classes to improve and diversify their offerings, which results in improved retention and profitability.

Pilates focuses on the mind-body connection and the body’s “powerhouse” – the deep abdominal and back muscles, and the muscles of the pelvic and shoulder girdles that work together to form the core strength of the body. As fitness professionals look closely at Pilates, many find familiar physical therapy and exercise techniques packaged in a well-refined, dynamic repertoire that can gently and effectively change movement patterns and posture. With its attention to building core strength, fine-tuning body alignment, and re-training the body for correct movement patterns, Pilates can be the primary element of many exercise and physical therapy programs. And, from a business perspective, facilities offering these programs are finding that Pilates is as beneficial to their company’s bottom line as it is to the wellness of their patients, clients and members.

Pilates: A Multi-Faceted Tool

Many fitness professionals find that these highly adaptable and versatile exercises give them a complete toolbox of movements to develop muscle balance and retrain the body for proper motion. Whether using a mat or advanced Pilates apparatus, fitness professionals (physical therapists, personal trainers, and group exercise instructors) can employ hundreds of exercises to create effective, successful programs for their patients, clients, and members. Fitness professionals can incorporate a variety of equipment, including, straps, platforms, balls and other accessories into their programs to encourage proper movement patterns and muscle recruitment. They can use Pilates to effectively work with anyone regardless of age, ability, fitness level, injury or limitation and can be incorporated into almost any therapeutic exercise or neuro re-education program.

Pilates is most effective in treating postural dysfunctions that involve muscle imbalance. The techniques have also been successful in rehabilitating patients with TMJ, scoliosis, balance disorders, fibromyalgia, scapular and humeral misalignment problems, abdominal surgeries, incontinence and pelvic floor dysfunction, lumbosacral sprain and strain, herniated cervical and lumbar disc, spondylolithesis, patellar tracking problems and thoracic outlet syndrome, among others. Pilates exercises can be very basic or progress to challenge even the most advanced, physically fit individual.

In addition to the benefits brought on by its versatility, there are even more reasons why Pilates is a natural component of successful rehab and fitness programs. Pilates, physical therapy, and fitness programs share many similarities that make it a natural partnership, including:

• Principles of effective stretching

  Both physical therapy and Pilates incorporate the techniques of manual stretching, which is achieved by stabilizing the proximal attachment as the distal segment moves. This is best demonstrated by using traditional equipment such as the Reformer, but can also be achieved on the mat when performed correctly.

• Cyclic stretching

  When a short duration force is gradually and repeatedly applied, released, then re-applied, a patient has achieved cyclic stretching. Some therapists believe that when appropriately applied, cyclic stretching is as effective and more comfortable for a patient than a static stretch of similar intensity. Many Pilates exercises incorporate cyclic stretching for target areas such as the hamstrings, calves, hip flexors and back extensors.

• Neuromuscular inhibition (adapted from PNF techniques)

  Fitness professionals have used neuromuscular inhibition techniques for many years to supplement manual stretching or self stretching because these techniques are effective in keeping the muscle relaxed as it is being stretched. The PNF stretching techniques prominent in Pilates exercises include agonist contraction and hold-relax.

• Function into a stretching program

  It is critical to begin low-load resistance exercises to increase muscle strength and endurance. Physical therapists will do this by adding functional activities using the new range of motion in the treatment program as soon as possible. In Pilates exercises, the new range of motion is immediately used and resisted by the pull of the springs on most equipment.

Physical therapists find that all Pilates exercises maximize rehabilitative results by using simple movements and applying great attention to proper form, and personal trainers and group exercise instructors can build on those results in their individual and group sessions.

Back to Basics

In the book Return to Life Through Contrology, Joseph Pilates described the six principles of his work. These six principles are particularly relevant to what a physical therapist or fitness professionals does in therapeutic exercise or neuro re-education.

The first principle is concentration. Pilates encouraged people to visualize and engage the mind with every movement. In physical therapy and exercise, this would be classified as awareness. Pilates assists with kinesthetic, proprioceptive and postural awareness. It also provides a method of self-evaluation for patients.

Pilates’ second principle is control. He believed that all physical motion must be controlled by the mind.¹ Motion and activity without control leads to a haphazard, unsafe and counterproductive exercise regimen. Fitness professionals encompass control in motor learning. It can be as simple as an athlete learning to avoid using momentum or as difficult as re-training a hemiplegic to ambulate.

The third principle is centering. Pilates based his method on the notion that all movement comes from a stable center he called the “powerhouse” – the rectangular area from the shoulder girdle to the pelvis.Fitness professionals often refer to the “powerhouse” as the origin of core stability.

The fourth principle of Pilates’ method is flow. One should move smoothly and evenly outward from a strong center, avoiding stiff jerky movements that may cause strain and damage. In physical therapy, this is known as synchronization – the rhythm we see in the glenohumeral movement or the grace we see in normal ambulation.

Pilates’ fifth principle is precision. Pilates encouraged concentration on proper movements to maximize their value and effectiveness.¹ For fitness professionals this translates into the meticulous exercise we incorporate to isolate just one muscle for testing, strengthening or retraining. This idea of performing and finishing with a proper movement pattern is encouraged so that patients remember the correct form.

The sixth principle of the Pilates method is breathing. Pilates taught that to breathe correctly, one needed to coordinate breath patterns with the exercise using a complete inflation of the lungs with a full-forced exhalation. He wrote, “Squeeze every last atom of air from your lungs until they are almost as free of air as is a vacuum.” Fitness professionals prescribe this type of diaphragmatic breathing during exercise.

There are two additional concepts Pilates incorporated into his method that are important in the physical therapy and fitness realm – relaxation and stamina. To promote relaxation, Pilates instructed people to “learn to move without tenseness.” Fitness professionals often use exercise to reduce client or members' stress and teach the use of the correct muscle movement to decrease strain of other soft tissues. Secondly, stamina or endurance is extremely important for patients in rehabilitation. Patients must gain enough endurance to perform their daily activities without fatigue. These concepts, originating with Joseph Pilates, parallel much of what we do in therapeutic exercise, and the techniques conveniently combine them for efficient use.

Using Pilates to Improve Your Practice

The simplicity of the Pilates method helps fitness professionals become more efficient in member/client education and treatment. Members/clients can easily understand the principles and the steps they must take throughout the day, not just in Pilates sessions, to fully rehabilitate themselves.

"Pilates helps me to put more emphasis into the analysis of posture and movement as part of the evaluation,” said Shellie Sakash PT, MS, an orthopedic physical therapist at Healthworks Rehab and Fitness in Morgantown, West Virginia. “I use Pilates to focus on the source of the problem rather than the symptoms. When the problem is associated with poor posture or movement, I can now give individuals a method to correct themselves.”

While Pilates encourages patients to take a more active role in their physical therapy programs, it also helps fitness professionals conduct more consistent, successful exercise programs. The high level of specificity in the execution of each exercise allows fitness professionals to record the client’s program and progress with each movement. This provides for more consistent communication among physical therapists, preventing loss of momentum in treatment when sharing a patient/client.

Improving program quality and efficiency is obviously beneficial to any practice, but how will the cost of incorporating a full Pilates program affect the practice’s bottom line? Almost one year ago, Sakash approached the owner of Healthworks with the idea of incorporating Pilates training and equipment into the facility. An initial investment of $20,000 was required for Pilates equipment, accessories, training and certification. Within only six months, Healthworks had regained its initial investment and was quickly operating a successful and profitable Pilates program. The program grew quickly, with most clients receiving treatment up to three times a week, requiring the addition of even more equipment and a Pilates-trained assistant for Sakash.

Healthworks, originally specializing in work conditioning, hand therapy, women’s health, chronic pain, and sports physical therapy, has now added Pilates to its areas of specialization. The practice is gaining revenue by billing higher paying codes for physical therapy, including therapeutic exercise, therapeutic activity and neuromuscular re-education.

Heathworks is just one example of how those in the health and fitness industry are integrating Pilates into their existing practices to improve both results and profitability. As more physical therapists and fitness professionals work with the Pilates exercise, they will contribute to its evolution as well as the growing number of healthy, happy bodies.

References

1. Pilates, Joseph; Miller, William and Robbins, Judd: Pilates’ Return to Life Through Contrology. Bodymind Books, 1998.
2. Clark, Marci and Romani-Ruby, Christine: The Pilates Reformer. Word Association Publishers, Pittsburgh, 2000.
3. Kisner, Carolyn and Colby, Lynn Allen: Therapeutic Exercise Foundations and Techniques. F. A. Davis, Philadelphia, 2002.
4. Sullivan PE and Markos PD: Clinical Decision Making in Therapeutic Exercise. Appleton and Lange, Norwalk, CT, 1995.
5. Voss DE, Ionla MK, and Myers BJ: Proprioceptive Neuromuscular Facilitation, ed 3. Harper and Row, Philadelphia, 1985.
6. Starring DT, et al: Comparison of cyclic and sustained passive stretching using a mechanical device to increase resting length of hamstring muscles. Physical Therapy 68:314, 1988.