Clinical Pilates is fast becoming a very common treatment modality for many musculoskeletal injuries, in particular for those who suffer from chronic low back pain. A study about the application of clinical Pilates, found it is recommended people with chronic lower back pain should undertake supervised, clinical Pilates sessions for 30-60minutes twice per week for 3-6months (Wells, Kolt, Marshall & Bialocerkowski, 2013). The physical therapists who participated in this study also suggested people with chronic low back pain would benefit from an individualised assessment and exercise prescription, supervision and functional integration of exercises, and the use of specialised equipment.
So what is the difference between Pilates at a gym class and clinical Pilates?
There are many forms of Pilates that exist today, and each have a different role in the health and fitness industry. Traditional Pilates is often what we find at our local gym. Traditional Pilates exercises were designed for fit and healthy people, they were originally used largely in the dancing world. These traditional exercises require very good muscle flexibility, encourage end of range joint movements, and have very little focus on the inner core muscles which support the spine.
Clinical Pilates has been designed by Physiotherapists specifically for use in the rehabilitation setting, by breaking down the traditional exercises to make them suitable for the clinical population. Clinical Pilates is based on segmental spinal stabilisation research and lumbo-pelvic stabilisation theory. It focusses on activation of the deep core muscles and is suitable for use in orthopaedic, women’s health, sports, neurological and Paediatric settings.
The 5 key elements
The 5 key elements are the basic underlying principles of clinical Pilates. It is important to learn these key elements before commencing specific exercises. The key elements include:
You may be thinking “I know how to breathe” but Pilates teaches correct and natural way to breathe. Many people use only a fraction of their lung capacity and deny themselves the benefit of breathing correctly. Pilates aims to improve the breathing pattern and depth, which is vital to get sufficient oxygen to working muscles, and to remove waste products that accompany fatigue. Many people use the wrong muscles for breathing which can lead to pain and fatigue. Pilates focusses on lateral breathing; on inhalation the ribcage actively moves upward and outwards, and on exhalation, the ribcage relaxes downward and inward.
Pilates aims to develop a strong centre of abdominals, lower back and pelvic floor muscles. The Transverse Abdominals, multifidus and pelvic floor muscles, form an internal muscular ‘corset’, which supports the spine, pelvis and abdomino-pelvic organs. These are postural muscles of the body, which are designed to work at a low level, all day long, to provide support.
- Ribcage placement:
For ideal posture, the ribcage should be aligned directly above the pelvis. However, it is common for people to ‘flare’ the ribcage forwards, this places stress on the muscles at the back of the ribcage, and prolonged time spent in this posture can lead to tightness, stiffness and pain. To prevent the ribcage flaring forward, think of ‘softening your breastbone’.
- Shoulder blade placement:
Stability around the shoulder joint is critical for efficient arm and neck movement. Many muscle work together to stabilise the shoulders, in Pilates we focus on serratus anterior and lower trapezius muscles. To maintain a neutral shoulder position- gently glide your shoulder blades downwards and together, you should feel a sense of widening of your collarbones.
- Head and neck placement:
Lengthening the back of the neck helps to align the head and neck into the correct posture. With so many people today sitting at computers for extended periods, poor head and neck posture is very common. This can often be the cause of headaches, and upper and mid back stiffness and pain.
References: Wells C, Kolt GS, Marshall P, Bialocerkowski,A. (2013). The definition and application of Pilates exercise to treat people with chronic low back pain: a Delphi survey of Australian physical therapists. Journal of Physical Therapy. 2013 (Oct 31)