SPECIAL PROGRAMS

Pilates continues to receive attention in the field of rehabilitation – with good reason. Recent research supports Pilates as an appropriate intervention for common orthopedic injuries.

 

Pilates-integrated Physical Therapy is traditional Physical Therapy incorporating equipment. Pilates equipment helps physical therapists manipulate gravity and supply assistance to movement that might normally be too fatiguing to execute. It is also combined principles of breathing, core strengthening, alignment, integration, and spine articulation that involve body and mind.

Pilates can be modified to create positive movement experience for special populations that cannot be overheated or fatigued such as Multiple Sclerosis and Parkinson’s. The ability t modify a functional activity- like sit-to-stand, reaching, rotating, and walking within the Pilates environment is key to a successful movement experience. The ability to grade difficulty using springs, levers, and gravity require the education of a Physical Therapist. This provides a continuum that can help patients reach their ultimate rehabilitation goal – the successful restoration of function.

Pilates training for Physical Therapists necessitates skill levels that far exceed the normal memorization of a cookbook Pilates repertoire. It requires critical reasoning to identify objectives, match patients’ goals, design an intervention, and create modifications to facilitate a positive movement experience, as well as adjust the program daily to progress the patient towards function.

Clinically, Physical Therapists have noticed a range of successful outcomes with patients suffering a variety of ailments- from Parkinson’s Disease to chronic low back pain- with the help of Pilates

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Most people all over North America are familiar with Pilates – it is still is one of the fastest growing exercises in the world. And millions more have experienced the physical fitness benefits of added strength, length, and agility that it provides.

But few know that Pilates is rapidly rising in another area – rehabilitation from injury.

The Culprit: Muscle Imbalances
Many injuries are caused by muscular imbalances within our bodies. And many things cause these imbalances – our posture, the way we walk, bend over, sit, lie down, or work out – basically the way we move. Most of us move incorrectly in some way or another, which puts too much pressure on some muscles and weakens others, causing an imbalance.

Take the back, for example: the way we move may put too much pressure on the spine, while weakening the pelvic muscles in the front of the body or vice-versa. Either scenario creates an imbalance, which means the body is much more perceptible to serious strains, pulls, tears or worse.

Pilates exercises promote an even musculature throughout the body by strengthening the core. The core is considered the “center” of the body and consists of the deep abdominal muscles along with the muscles closest to the spine. Pilates also stresses spinal and pelvic alignment, which is critical in getting us to move the way we’re supposed to move to avoid injury.

A Flexible Form of Rehab
These are big reasons why physical therapists all over the globe are now using Pilates as a form of rehabilitation. Kris Bosch, president of Northstar Pilates in Buffalo, NY, says Pilates is tremendously effective for other reasons, too.

“Part of its success is indeed based on the approach to the principles of Pilates – core strength, an even musculature, etc. But another reason is that it provides a greater degree of flexibility than most conventional forms of physical therapy. This is true because Pilates exercises can be modified for each person and still be extremely effective. You can go from basic movements to very advanced, depending on how a patient needs to progress or how badly they are injured.”

Conventional physical therapy, on the other hand, often involves patients being given a set of exercises that may be too hard for them to tolerate, says Bosch. It might be because they cause too much pain, or perhaps they are not aware of how to correctly position their body for maximum results – something that Pilates teaches you to do.

Positive Movement Experiences
In addition, with Pilates, clients become responsible for their own rehabilitation. It is not just coming to a therapist, lying down and having them do all the work. With Pilates a patient learns where their body is in space and to identify the best movement sequence. All these factors contribute to a positive movement experience, which Bosch says greatly facilitates a recovery.

“When you create a positive movement experience, you are able to take a step forward without pain. The more you move without pain, the more confidence you gain. And the more confidence you gain, the more likely you are to try another movement or exercise. That’s a very healthy rehabilitative cycle.”

Most Pilates exercises are performed on a mat or piece of equipment called a Reformer (a sliding carriage inside a long frame connected to springs, ropes and pulleys). One of the nice things about Pilates, Bosch says, is the way you can combine the Reformer and mat together as a solid 1-2 approach:

“It’s nice to get them on the Reformer first, because the springs on the Reformer assist the movements they attempt. This gets them out of bad or incorrect movement patterns they’ve developed which probably led to the injury in the first place. Then, as they progress and are no longer experiencing pain, they can use the mat for home exercises to continue their rehab, strengthen those muscles and prevent further injury”.

Rehab vs. Conventional Exercise
If you have injured yourself and are considering Pilates, it’s important to make sure that your instructor has physical therapy experience. “There’s a big difference between teaching Pilates as a form of exercise and using it as form of therapy,” says Bosch. “The principles of Pilates are awesome for rehabilitation, but if they aren’t used in conjunction with proper therapy techniques it could aggravate the injury. Before you start, make sure you ask your instructor if he or she has physical therapy training.”

by Ken Endelman

fibromialgiapilatesAccording to the National Fibromyalgia Association, Fibromyalgia Syndrome (FMS) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. While the cause of FMS is still unknown, the disease affects between 6-12 million in the U.S. alone. It is most common in women between 25-50 years of age. Symptoms of FMS can include headaches, sensitivity to temperature, restless leg syndrome, irritable bowel syndrome, tingling or numbness sensations, painful menstrual periods, and cognitive memory problems.

Many who suffer from FMS tend to believe that exercise will increase the pain they are already experiencing. However, current research suggests that low impact aerobic exercise, such as Pilates, can be done without increasing pain. For some, it can actually increase their pain threshold. However, gradual progression, ideally supervised by a Physical Therapist, is key. It is suggested to begin with exercising 3-5 minutes 3 times a week then progressing to 30 minutes 4 times a week.

Pilates emphasizes the connection of the mind and body, being a huge benefit to those with FMS. The client’s ability to participate in an exercise program from which there is no exacerbation of symptoms can greatly improve their sense of well being. Pilates also allows for the improvement in articular mobility of the spine in a very gentle and supported environment. Clients with FMS will improve best with personalized programs, which can be accomplished with Pilates. The focus should be on gentle stretching exercises and focus on deep, core stabilization work for both pelvic and scapula stabilization.

Triathletes must achieve optimal biomechanics to perform well in their varying activities and prevent overuse injuries. Imbalances in flexibility, strength, and agility can lead to poor movement patterns, causing loss of efficiency and injury.

Pilates is an excellent method to improve balance by optimizing postural positioning, core strength, stabilization, and flexibility in a low impact environment. The essence of Pilates is control of position and precision of movement. When the core is strong, the extremities can function at their optimum.

The triathlete places a wide range of stresses on their body. Pilates provides the development of improved body awareness, functional strength and flexibility by focusing on the stabilizers in the hips, torso, and shoulders. This ability to differentiate movement can make a significant impact on energy conservation for any athlete.

One of the most important areas for any triathlete to focus on is the hip joint. Triathletes generally train the primary muscles (flexors/extensors) of the hip. Often overlooked is the supporting hip musculature (abductors, adductors, and rotators) that assists the larger primary movers. Imbalances in muscles such as tightness and weakness limit the effectiveness of the larger muscle groups.

Good flexibility of the hip musculature can take minutes off the bike leg for a triathlete and assist in avoiding injury, but poor flexibility can cause minor serious issues. The following are examples of how an inflexible Piriformis can adversely affect cycling position:

  • Excessive loading of the bursae and muscle-tendon junction at the hip can cause bursitis and tendonitis of the Piriformis.
  • Lateral or rotational rocking of the pelvis can cause lumbar fatigue and spasm.
  • Lateral tracking of the knee can cause patellofemoral pain.
  • Piriformis compression over the Sciatic nerve track can cause Sciatica.
  • Poor saddle position due to tight Piriformis decreases power and causes a higher aero-bar position, creating greater aerodynamic drag.

Good strength and coordination in the hip musculature can take minutes off a run and help prevent injury as well. Lack of strength/coordination in the Piriformis muscle can produce:

  • Abnormal loading of the posterior Gluteus Medius and secondary hip rotators, causing bursa and tendon inflammation.
  • Poor stabilization of the sacro-iliac joint, creating hypermobility and pain.
  • Weak Piriformis, which contributes to decreased power of hip extension and reduces running speed and endurance.
  • Excessive internal rotation of the femur during stance phases of gait contributing to instability of the knee, which can cause rotational injuries of the knee.

Working on Piriformis mobility, coordination and strength will improve hip stability and tracking of the femur. This increases the ability to transfer power and improve aerodynamics on the bike and enhance the effectiveness of the stride on the run. Remember the core holds the pelvis, allowing everything else to function.

An accurate assessment of client limitations by a Physical Therapist is the key to great results. Pilates is an excellent exercise method, but it is the instructor’s knowledge, skill, and ability to adapt to the needs of each client that provides the greatest results.

Footwork using jump board, on heels. Used with permission. This figure is available on (www.topicsingeriatricrehabilitation.com)

Osteoporosis and reduction and/or prevention of worsening symptoms are imperative to those practitioners and trainers who assist the elderly in rehabilitation or training in order to improve their quality of life. Physical therapists, health care practitioners, exercise physiologists, kinesiologists, and trainers alike should be familiar with osteoporosis/osteopenia and the indications and contraindications of exercise for this population. Studies looking at Pilates and its effects on osteoporosis have been published, with overwhelmingly favorable results (including but not limited to prevention of continued bone loss and improved quality of life and perceived physical function). Researchers have specifically examined Pilates in comparison with other exercise interventions – and the overall effect and results have also been favorable. These articles indicate the benefits of exercise and the utilization of exercises in the Pilates repertoire for promoting good bone health.

A recent case study has demonstrated that Pilates exercise intervention can help reduce the effects of osteoporosis and reduce the progression of osteopenia in a 52-year-old man, Mr. H. Mr. H was diagnosed with osteoporosis/osteopenia at 34 years old. His medical history includes bilateral total hip replacements because of his poor bone density, a rotator cuff repair, and a torn Achilles tendon. His orthopedic history had been quite extensive. In 1998 after magnetic resonance imaging was performed, it was revealed that he had avascular necrosis in both hips. He was immediately prescribed a series of medications to increase his blood circulation. This intervention was not successful, and his symptoms actually worsened.

Toward the end of 1999, he was limping badly and having to utilize a cane. It was at this time he decided to interview doctors in Louisiana, Dallas, and New York areas and finally settled on a doctor in New York who was both an MD/orthopedic surgeon and a biomechanical engineer. He had invented a new type of hip replacement with a different point of view regarding “weight bearing.” He was also the only doctor who had at the time performed a bilateral replacement at the same time.

Surgery was performed in February 2000. Three years later, his MD noted that his bone density was significantly worse. He was given Fosamax (alendronate) and testosterone. In 2008, he was not very active and was still having back issues and mobility challenges. He came to Core for gait training and overall conditioning. Working with our team, he discovered Pilates! By 2013, he could no longer be prescribed Fosamax because 10 years was the limit. Once he was taken off the Fosamax, his bone density testing got much worse and fell into the osteoporosis range. Mr H. was instructed to start a specific Pilates repertoire focusing on exercises designed and executed for a client with osteoporosis. He was retested in 2014, and his results for bone mineral density improved (0.815 to 0.893) to the point where his diagnoses was reduced to osteopenia. In addition, Mr. H reported a significant reduction in pain and improved strength, flexibility, posture, and overall well-being.

The need for pelvic floor muscle exercise to help bladder control

In Arnold Kegel’s landmark article published in 1948, pelvic floor muscle exercise was an effective treatment and preventative measure for urinary incontinence, mild to moderate pelvic organ prolapse, and loss of sexual desire. Since then, the medical literature has only further established pelvic floor exercise as first-line treatment for the aforementioned disorders; the Cochran Review, for example, has published support for the recommendation of pelvic floor muscle exercise as first-line conservative therapy for women with stress incontinence, urge incontinence, and mixed incontinence. Despite this, these patients are generally not offered, and therefore do not participate in, an organized program of pelvic floor rehabilitation before using medication and/or surgery to address these problems. Barriers to care involve social, economic, and cultural factors, such as the embarrassing nature of such symptoms, accessibility of health insurance, and the surging prevalence of pharmaceutical and surgical interventions to treat bladder control.

With that in mind, patients and physicians need to realize that treatment of bowel or bladder control issues is within the scope of health care services. There is a notion that a nonmedical intervention is an inappropriate or suboptimal means of treatment, and it is important that we reconsider this perspective. As healthcare costs continue to skyrocket, we need to examine the possibility that some conditions may be best addressed outside the scope of medication or surgery.

How can Pilates help?

A recent study by Bruce Crawford, MD, further supports pelvic floor exercise as an effective preventive and first-line therapeutic strategy for pelvic floor disorders. Crawford’s team used electromyographic (EMG) recordings to test the effectiveness of Pilates compared to traditional Kegel exercises. The team found that patients were able to increase pelvic floor EMG activity from 10 mV during the isolated Kegel to 30 mV during the pulse of the Pilates movements. In other words, subjects were able to concentrate his or her fitness efforts more efficiently. And after six to eight weeks of training, subjects increased pelvic floor strength by 33% and improved bladder symptoms by 74%.

These results highlight the importance of considering pelvic floor muscle fitness training for patients with these disorders. Such a fitness training program is offered at AATB Pilates, and we would be more than happy to put you in contact with our exceptional Pilates instructors. Pilates is a proven way to combat pelvic dysfunction and bladder control challenges and may provide a less strenuous solution than surgery and medication.

Scoliosis is a chronic spinal condition in which the spine has an abnormal sideways curvature. Although is often seen as an adolescent issue, scoliosis certainly affects the adult population, particularly in the development of spinal arthritis and adult degenerative scoliosis (ADS). Current advances in the orthopedics sector of medicine, such as sclerosing injections for the spine and extremities, may help lessen the pathologic changes of aging, such as instability of intervertebral segments or extremity joints due to damage or deterioration. These advances, however, come with risks, especially for older adults. Surgical interventions are similarly controversial for adults with scoliosis.

 

Therefore, the relatively low risks of nonconservative procedures make it well worth the adult with minor to sever scoliosis to seek other forms of conservative intervention, such as the Pilates Method. Conservative care for adults with scoliosis emphasizes the minimization of symptoms and the maximization of function in the roles of daily life. The Pilates Method, specifically, is designed to both assist and challenge the patient. This environment traditionally progresses from the establishment of a stable skeletal base to a dynamic, moving base of support that can withstand external forces generated from one’s body weight or the resistance of a spring system.

The Pilates Method has evidence supporting its use for much of the musculoskeletal system along with neurological implications of benefits. Studies citing the benefits of Pilates have included thoracic mobility, lumbar spine stability, upper and lower extremity functional improvement, and the enhancement of brain activity and prevention of cognitive decline and dementia.

For those with ankle mobility issues, it is essential to work on the correct type of footwork to see improvement. Basic footwork can be done on the foot bar of the Pilates reformer machine, or the jump board, an attachment the reformer. In both scenarios, Pilates can help increase the mobility of one’s ankles, hind feet, and fore feet. In addition, this footwork strengthens the muscles in one’s feet and ankles and improves balance and proprioceptive awareness.

 

The foot and ankle contain 33 joints and over 100 muscles, tendons, and ligaments – here’s to the health of your feet! We put a lot of demand on them and they deserve to be treated well. Below are some basic footwork exercises to begin working on your ankle mobility.

 

 

 

 

 

Heels                                                                        Toes/Prehensile

 

 

 

 

 

V feet                                                                          Wide/2nd Position

Starting Position: Knees bent at no more than 90 degrees. The lumbar spine is in a neutral position, and heels are in line with the ischial tuberosities (“sit bones”).

Foot and Leg Positions:

  • Heels: place the center of heels on the footbar with parallel legs.
  • Toes: Place balls of the feet on the footbar with heels slightly raised.
  • Prehensile: The heels are underneath the bar, wrap balls of feet around bar. Heels reach under bar as knees bend.
  • V Feet: Balls of feet on bar with heels partially raised and pressed together, legs turned out and knees bent.
  • Tendon Stretch: Lift/Lower. Push carriage back by straightening knees and rising onto balls of feet. Lower the heels, lift the heels, and bend knees to return.
  • Wide/2nd Position: Heels wide on footbar, legs turned out with knees bent. For a deeper knee bend, heels can be placed on the footbar directly above the reformer frame or at the ends of the footbar.
  • Running in place: Balls of the feet on footbar, push carriage back by straightening knees, dorsiflex and drop one heel under the bar while bending the other knee.

Cueing and Imagery:

  • Engage the abdominals before you push back; draw navel towards spine, draw hip bones together.
  • Maintain a neutral position of the spine and pelvis throughout the exercise.
Pilates is often recommended for clients with low back pain because of its emphasis on core strength and stability. Pilates can be very helpful for many clients with back pain, when principles and exercises are carefully and appropriately applied. Pilate exercises carelessly taught can cause or exacerbate back pain.

 

According to modern biomechanical research, the functional stabilization muscles of the spine work most efficiently when the spine and the pelvis are in neutral position.

Common Diagnoses and Usual Symptoms:

  • Nerve Symptoms: The most important first step is to try and find a position of the back and pelvis that causes the least nerve irritation and to work in a way that does not cause the nerve to flare up during or after the session. Nerve symptoms are most commonly caused by disc injuries, spinal stenosis, or muscle spasms.
  • Disc Injuries and Degenerative Disc Disease (DDD):  Disc injuries most commonly cause pain when they protrude toward back and put pressure on the nerves running through the spinal canal. Spinal flexion increase disc pressure, while a neutral spine or spinal extension decreases disc pressure.
  • Spondylolisthesis and Spondylolysis: This is a condition where one vertebrae slides forward on the vertebrae below it, and becomes unstable. The vertebrae are at risk of sliding and pinching the spinal cord in the process. Work in neutral or with a slight posterior tilt, avoid spinal extension and avoid loading at the front of spine.
  • Spinal Stenosis, Arthritis, and Degenerative Joint Disease: All of these conditions involve deterioration of the joints of the spine, either through development of bone spurs in spinal nerve canals or on body of vertebrae. Work in neutral or with a slight posterior tilt and avoid spinal extension.
Exercise during pregnancy is an important part of maintaining a healthy lifestyle. However, the physical changes that accompany pregnancy may require mothers to modify their exercise routines during their pregnancy and immediately after delivery. With proper supervision, our instructors at AATB Pilates will help keep you safe and active during and after your pregnancy.

First trimester, up to 12 weeks

During the first trimester, there are no specific contraindications as far as body positions or specific exercises. Exercise should be based on the energy level of the mother and geared to minimize fatigue. Some women continue on with all of their normal routines while others may experience fatigue, nausea, and disturbed sleep that limits their ability to perform at their previous level.

The primary exception to this rule is in high risk pregnancies, such as first pregnancies in women over 35, women with a history of miscarriages, or women who are undergoing in vitro fertilization. In these cases, if may be in your best interest to minimize your routine until you are past the 12 week mark.

Exercises to focus on during the first 3 months

Early in pregnancy is a great time to develop a program that will address the key needs of the pregnant woman. These exercises include:

  • Pelvic floor exercises
  • Adductor work (use a small ball between the knees in leg work)
  • Abdominal strengthening
  • Core stabilization
  • Arm and upper back strengthening
  • Lower back and chest flexibility
  • Decrease inversion exercises such as short spine stretch and rolling exercises
Months 3 to 5

Sometime around the end of the third month or during the fourth month, it will become uncomfortable to lie on your stomach. Prone work should be discontinued. Your abdominals may begin to feel a bit out of touch as the abdomen stretches and the pregnancy starts to show. During the fifth month, the uterus will be large enough to start putting pressure on your arteries that run along the inside of the spine, so exercises while lying on your back should be limited.

Months 6 to 9 

At this point in the pregnancy, the size of your abdomen will start to affect your ability to flex your spine and deeply flex your hips. The hormone relaxin is starting to circulate in the body at higher levels, leading to a loosening of the ligaments around the joints. This can lead to a lack of stability around the pelvis, which can cause low back, sacroiliac joint, and hip problems to flare up. To accommodate these changes, think about using a wider leg position on leg and foot work and focusing on increasing stability of the pelvis and hips (with adductor, abductor, and light abdominal exercises).

Post-natal

Once the baby is born, you can start doing simple core activation, pelvic floor, and pelvic stability work as soon as you feel like moving. If the delivery was vaginal, you will be able to return to a beginning level routine as soon as you feel like moving. If you had any episiotomy repairs, you may want to minimize hip adduction and anything uncomfortable for four to six weeks until the area begins to heal. If the baby was delivered by caesarian section, strenous exercise is usually not suggested for six to eight weeks following delivery. Gentle core work is very helpful but it is not recommended to put stress on sutures that are healing.

 

According to the National Fibromyalgia Association, Fibromyalgia Syndrome (FMS) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. While the cause of FMS is still unknown, the disease affects between 6-12 million in the U.S. alone. It is most common in women between 25-50 years of age. Symptoms of FMS can include headaches, sensitivity to temperature, restless leg syndrome, irritable bowel syndrome, tingling or numbness sensations, painful menstrual periods, and cognitive memory problems.

Many who suffer from FMS tend to believe that exercise will increase the pain they are already experiencing. However, current research suggests that low impact aerobic exercise, such as Pilates, can be done without increasing pain. For some, it can actually increase their pain threshold. However, gradual progression, ideally supervised by a Physical Therapist, is key. It is suggested to begin with exercising 3-5 minutes 3 times a week then progressing to 30 minutes 4 times a week.

Pilates emphasizes the connection of the mind and body, being a huge benefit to those with FMS. The client’s ability to participate in an exercise program from which there is no exacerbation of symptoms can greatly improve their sense of well being. Pilates also allows for the improvement in articular mobility of the spine in a very gentle and supported environment. Clients with FMS will improve best with personalized programs, which can be accomplished with Pilates. The focus should be on gentle stretching exercises and focus on deep, core stabilization work for both pelvic and scapula stabilization.

fibromialgiapilates

What is Diastasis Recti?

 

Diastasis Recti is commonly referred to as the separation of Abdominis muscles due to excessive intra-abdominal pressure. It is the widening of the gap between the outermost abdominal muscles; and the split occurs at the Linea Alba, the mid-line collagen structures of connective tissue at the front of the abdomen. This split of the Linea Alba compromises ALL of the abdominal muscles due to the lack of support and tension needed from this connective tissue. Although anyone can develop Diastasis Recti, it is extremely common in pregnant women, especially towards the later stages of pregnancy. 100% of women have some level of diastasis of the rectus abdominis in the third trimester, and for many women this gap remains untreated and unchanged at 1 year postpartum. When pressure is increased inside the abdomen, the muscles begin to separate and weaken the connective tissue in the mid line. This leaves the front of the abdomen unsupported and will cause a bulging of the stomach.

How to test for Diastasis Recti

Lie flat on your back with your knees bent and your feet flat on the floor. Place your fingers, palm down, just above your belly button and lift your head a neck very slightly off of the floor. Press down with your fingertips and feel for the abdominal muscles. Repeat this test in two other places: directly over the belly button and a couple of inches below. The goal when contracting the muscles is to feel slight tension in the midline, as well as have a gap of 1-2 fingers or less. If the gap is much larger than 1-2 fingers, and/or you feel no tension, that is known as Diastasis Recti. Stay posted on a video link on how to test.

 

What exercises help Diastasis Recti?

Treatment for Diastasis Recti should focus on re-aligning, re-connecting, and strengthening the entire core musculature. Weakness of the pelvic floor and core all contribute to developing Diastasis Recti, and should all be treated as a unit. The purpose of the exercises should be to correct alignment and re-engage an entire system of muscles and fascia. You must learn to engage your transverse abdominis and pelvic floor muscles correctly, as well as strengthen the muscles in order to lessen the separation gap and pull the abdominal muscles closer together. This is where Pilates is applicable with a Physical Therapist trained in core and pelvic floor strengthening! Additional bonus is to find a physical therapist who is also certified in Pilates.

Stay posted for a video on Pilates mat exercises and Pilates reformer exercises!

For the older population keeping fit is essential. But so many forms of exercise can be hard on the bodies of older adults. Many have turned to Pilates sessions at their local clubs as a way to stay in shape while reducing the risk of injury that weight-bearing exercises may cause. With its focus on controlled breathing and quality of movement-not quantity of repetitions-many experts agree that Pilates is one of the best ways for older adults to stay healthy.

“Pilates is perfect for older adults because it does not have the impact on the body that other forms of exercise do, and is not nearly as severe on the joints as most workouts are,” says Ellie Herman, owner of several Pilates studios, and a renowned Pilates instructor and author. “It really is a gentle way to exercise. If you’re an older adult and haven’t exercised in a while, Pilates is a safe way to restart a workout program.”

Most conventional workouts tend to build short, bulky muscles more prone to injury–especially in the body of an older adult. Pilates focuses on building a strong “core”–the deep abdominal muscles along with the muscles closest to the spine. Many of the exercises are performed in reclining or sitting positions, and most are low impact and partially weight-bearing. It also can positively affect postural positions.

“Pilates for older adults, particularly on a Reformer (resistance-based equipment with springs and ropes connected to a sliding padded carriage) is wonderful because it is a relatively light resistance as opposed to some gym equipment, where even the lightest weight on the rack might be too much for them,” says Beth Williams, a physical therapist at Dynamic Movement in Reno, Nevada.

Increased Stability and Balance

Pilates centers on movements at the midrange of the body instead of the extremities (arms and legs), where, again, the potential for injury is greater. In contrast with other forms of exercise, Pilates develops the midrange and gradually works toward the endrange, while maintaining complete control around the joints. To the benefit of older adults, Pilates teaches control and stability in a small range of motion, graduating to a larger range of motion as they gain control and confidence.

Increased control and stability is crucial for older adults as it can help them improve much of their functional movement, including balance and posture. “As people get older, they can lose some of their balance and coordination. Pilates increases strength and flexibility in both the core and the legs, which positively affects balance. This, along with basic fitness benefits, can help them reduce the risk of falls,” says Herman. “And Pilates is also a good way for older adults to rehab from surgical procedures like a hip replacement or knee surgery.”

An Antidote for Many Ailments

Pilates also helps with a variety of age-related ailments. Arthritis sufferers benefit because the gentle mid-range movements decrease the chance of joints compressing while maintaining the range of motion around them. For sufferers of osteoporosis or stenosis, Pilates can also help. For osteoporosis the simple and standing Pilates leg exercises may increase bone density in both the spine and the hip. For lumbar stenosis there are exercises that can stretch out tight back muscles and strengthen the extensor muscles of the spine to counteract the forces of gravity that can pull people into a hunched position. Be careful, however. Any type of flexion exercise, for example, is not good for someone with osteoporosis. Conversely, any type of extension may cause injury to someone with stenosis. If you have either of these conditions it is important that you make sure your Pilates instructor knows how to modify the exercises so that you do not hurt yourself.

Pilates has also been documented to slow or reverse the effects of debilitating diseases like Parkinson’s and multiple sclerosis. The mid-range motion of the exercises can help people overcome rigidity and become more limber. It can even help with brain traumas like a stroke.

“The sooner people with brain damage or a stroke can start balance exercises with Pilates and get their bodies moving symmetrically, the better they will fare in their overall permanent outcome,” says Herman.

Most clubs now offer some type of Pilates program. If you are an older adult and are interested in Pilates, talk to the program director about what kind of Pilates class will best benefit you. Many clubs offer classes geared specifically for the older population. It is also a good idea to consult your doctor before you start a Pilates regimen.

The health of today’s children is compromised by a culture of convenience and increasingly sedentary activity. Eating fast food, watching TV and playing video games has become habitual while a nutritious diet and physical activity is on the downslide.

A recent report from the Institute of Medicine of the National Academy of Sciences indicates that approximately 30.3% of children between the ages of 6 to 11 are overweight and that 15.3% are obese. For adolescents between the ages of 12 to 19, 30.4% are overweight and 15.5% are obese. These are startling numbers and much higher than for previous years.

Concerned parents are now looking at exercise programs for their children in an effort to keep them fit and set them up for a lifetime of good health.

A rigorous exercise regimen, however, may not be beneficial for young children and could even be harmful. The concern stems from the fact that a young child’s developing skeletal frame cannot handle the demanding forms of exercise in more aerobic-oriented or cardiovascular programs. For these children, a safer, healthier, low-impact workout is needed such as Pilates.

While the popularity of Pilates among adults is well chronicled, the exercise program also offers a large range of benefits to children. Improved posture and spinal alignment are realized as exercises increase the strength and flexibility of the abdominal and inner muscles of the body (the core or trunk). It promotes toned, sleek bodies and improves athletic performance. Through Pilates, children can gain awareness of their body, and learn how to move efficiently and gracefully. As children grow, their bodies are in a constant state of change and development.

Correctly or incorrectly it is here where they will formulate the physical attributes that they will take through life. Posture, the way they walk, the way they bend over, etc. Pilates can help establish correct principles of movement that children will use for their entire lives. It will also create a balanced musculature that can alleviate pain and reduce the potential for injury now and as they continue to grow into adulthood.

Beyond physical fitness, having a strong core can open up other benefits for children-including improved learning. Advocates believe that when trunk, or torso, stability is absent, sitting and standing for extended periods in school can be difficult. If children are expending their energy throughout the day just to maintain stability, their stamina for homework and other after school activities may be depleted. A strong trunk or core conserves their energy and allows them to be more attentive to schoolwork.

Because Pilates is a mind and body discipline, it can guide kids to a stronger body, and a more relaxed state of mind. Working to strengthen their bodies can increase children’s selfesteem, stamina, abdominal strength and sleep. That, combined with the focused breathing techniques essential to the exercises, can help kids attain a much more serene and less stressful outlook.

Now many clubs and studios are offering classes aimed specifically at children. Generally, Pilates is suitable for children eight years and up under adult supervision. If you’re thinking about enrolling your child in a class, here are a couple of things to think about:

1. Make sure the instructor not only has Pilates experience, but is experienced working with children.

2. Most classes are mat-based, often including stability balls, which are easy for children to use. However, some classes are offered on reformers-moving carriages inside a wooden or metal frame, connected to a network of pulleys, ropes and springs. While effective and fun, equipment-based exercise programs are aimed at adults, so ask the instructor how they’re modifying the movements on the Reformer for children.

According to the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, every 45 seconds, someone has a stroke it the United States. This equates to over 700,000 victims a year and 500,000 of these strokes are first occurrences. In addition to these sobering statistics, the “face of stroke” is changing. According to the Joint Commission, “Strokes are getting younger and younger”, about 30% of strokes occur to those under 65 years of age, in other words, during their productive “wage earning years.” In a study performed six months after a stroke, they found that 30% of stroke survivors continued to need assistance to walk and 50% had some degree of paralysis on one side of their body. Another long-term follow-up study revealed that long-term stroke survivors, especially those with only one episode, had a good chance for full functional recovery.

The impact of a sudden disability can be devastating not just physically but emotionally, financially and socially as well. As a result, the rehabilitation programs for this patient population needs to be reexamined with strong emphasis on effectiveness and efficiency. In over 17 years of experience as a physical therapist working with neurological patients, I have found Pilates to be extremely powerful when incorporated into the rehabilitation program of stroke survivors. At Rehab Hospital of the Pacific, this is what we call Clinical Pilates.

Centering, control, flow, breath, precision, and concentration.

These six principles are the essential components of a Pilates session with emphasis on quality over quantity. Pilates exercises do not include a lot of repetitions for each move. Instead, doing each exercise fully, with precision, yields significant results in a much shorter time. With assistance from Pilates equipment such as the Reformer, these principles in integrated into each exercise resulting in a more effective and efficient exercise program to facilitate maximal recovery.

“Centering” after a stroke.

The most common physical dysfunction as a result of stroke is hemiplegia or the paralysis of one side of the body. During the initial rehab process, it is common to utilize compensatory patterns as quickly as possible in an effort to gain mobility and as a result, the patient’s awareness of their bodies is often altered.

With Clinical Pilates, the focus is continuously on centering and strengthening those deeper core postural muscles with an emphasis on control. With the guidance of the Reformer and a trained practitioner, the treatment becomes “self-correcting” and facilitates rewiring of the nervous system with minimal compensatory patterns through the encouragement of fluid movement patterns that emphasize control, stability and alignment all at the same time. As a result, patients gain a better understanding of their bodies at this critical point in their recovery process. During the initial rehabilitation process, it becomes a powerful combination to integrate Pilates principles such as core strengthening and control into traditional therapeutic techniques such as gait and balance training to maximize functional recovery.

The Breath and Alignment

Most stroke survivors intuitively hold their breath as they make the arduous journey to learn to move their bodies again. It is instinctive and almost universal when your body suddenly feels unfamiliar, weak and unstable. As a result, their physical recovery lacks efficiency as the body globally contracts its muscles and become easily fatigued from the constant contractions.

Pilates’ emphasis on controlled breathing with each movement not only boosts physical efficiency by decreasing unnecessary contractions but also facilitates proper alignment in posture and overall balance. In addition, the emphasis on elongation of each movement helps to open up the trunk and pelvic area allowing more range of motion resulting in more freedom of movement during dynamic activities. With hemiplegia, there is a strong tendency to shift completely to the unaffected side, which only reinforces the weakness and poor motor control of the affected side. As a result, the asymmetry in the physical body becomes reinforced as opposed to moving towards correction. By using Pilates principles to facilitate proper breathing and alignment, comes improved balance and with improved balance, comes increased confidence.

Educating the patient.

As physical therapists, our job is to educate each of our patients on how best to heal their bodies after an injury to maximize their functional potential. This becomes a significant challenge when the nervous system has been damaged and proprioception, sensory input and motor function are all impaired. Additionally, in the stroke population, often there are cognitive impairments, and abnormal reflexive tone that is often not under voluntary control.

The utilization of the Reformer in the rehabilitation program facilitates this education process instinctively. Again, if done properly, Pilates is self-correcting, meaning the patient can see and feel their weakness, their asymmetries, and their abnormal motor patterns themselves. This increases their body awareness significantly and allows them to gain a deep understanding of their body and take a proactive approach in their rehabilitation process.

With the rapidly changing currents in healthcare, there is an emphasis on rehabilitation programs to focus on educating each patient to be responsible for their own recovery process, regardless of their diagnosis. Each patient needs to understand the recovery process can continue long after their formal rehabilitation programs ends and therefore, the better they understand their bodies and it’s strengths and deficits, the better equipped each patient will be to maximizing their own recovery.

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