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Recovery and Pilates
Joseph Pilates developed the physical and mental fitness system that bears his name in the early 20th century. His practice operates under the belief that this method utilizes the power of the mind to control muscles. Pilates strongly believed that the human mind and body are inextricably linked, and his system grew out of that belief. A 1980 book on Pilates, The Pilates Method of Physical and Mental Conditioning, outlined six principles of the system. These principles are concentration, control, center, flow, precision and breathing.
Originally envisioned as a mat exercise, Pilates later incorporated the use of several pieces of apparatus to help practitioners further this practice. Most of the exercises done in conjunction with one of these apparatuses increased the resistance felt. Today, contemporary Pilates practitioners might incorporate even more props. The modern practice of Pilates is generally divided between two schools of practice: that which adheres to the physical and equipment standards originally laid out by Pilate, known as Classical/Authentic Pilates, and the style that diverged from the lesson structure and original set of exercises, known as Contemporary/Modern Pilates.
Pilates and Cancer Treatment
Besides encouraging the development of strength, flexibility and body control, Pilates also has been identified as a treatment for several health conditions. Most recently, cancer patients have recognized the benefits of this exercise which can both increase one’s level of energy and calms the anxiety that frequently accompanies a difficult diagnosis. Furthermore, patients typically feel better about themselves and their bodies after partaking in physically beneficial exercises like Pilates.
Pilates and Mesothelioma
As a complementary therapy to traditional mesothelioma treatments, Pilates might actually improve the effectiveness of these treatments and help extend patient survival rates. Especially because many mesothelioma patients undergo chemotherapy and radiation, Pilates can be essential in helping fight the fatigue that often follows. Furthermore, exercise programs, like Pilates, can help boost a weakened immune system, lessening the dangers of contracting additional illnesses because of diminished resistance.
Just as heart attack patients are now often put on exercise routines, cancer patients will also likely be prescribed exercise programs that aid in their recovery. Few exercise systems can offer the physical, emotional and mental benefits of Pilates, making it a natural choice for those recovering from illness. However, patients are cautioned to find a qualified Pilates instructor, as this practice has recently become quite popular, spawning a host of amateur instructors that might not be qualified to offer public training in this physical fitness system.
|In an adult population, a torn rotator cuff is the most common cause of debilitating shoulder pain and disability.|
Torn Rotator Cuff In an adult population, a torn rotator cuffis the most common cause of debilitating shoulder pain and disability, with approximately 300,000 rotator cuff surgeries performed annually in the United States.
Asheesh Bedi, MD
September 21, 2010
The diagnosis and management of rotator cuff disease places a significant financial burden on the U.S. economy, amounting to an annual cost of $3 billion.
What is the anatomy and function of the rotator cuff?
The rotator cuff consists of four muscles (namely the supraspinatus, infraspinatus, teres minor, and subscapularis) that act in concert to both stabilize and move the shoulder joint. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, serving in tennis, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.
These muscles arise from the shoulder blade and insert on the humeral head to create a continuous cuff around the shoulder joint, and provide a link from the trunk to the arm. The ball (humeral head) and its socket (glenoid) have relatively little inherent stability, and have often been compared to a golf ball resting on a golf tee. In this capacity, an intact rotator cuff is essential to provide stability to the joint by a compressing the humeral head into the concave glenoid. A large torn rotator cuff , particularly of the subscapularis, can render the joint at risk for instability and dislocation.
The deltoid and rotator cuff muscles work synergistically to maintain a balance of forces around the shoulder joint in every direction. The deltoid and infraspinatus/teres minor maintain a balance in the vertical plane, while the subscapularis and infraspinatus balance each other in the horizontal plane. With lifting of the arm, the deltoid generates an upward force that is resisted by the downward force produced by the rotator cuff muscles, preventing a loss of reduction of the humeral head on the glenoid. A torn rotator cuff can disrupt this balance of forces and compromise normal shoulder joint motion. In fact, a high riding humeral head that shifts superiorly off the glenoid with raising of the arm can be seen in the setting of a massive torn rotator cuff.
What is a torn rotator cuff?
A torn rotator cuff is a disruption in the integrity of the tendon at the insertion into the humeral head. Tendons connect the rotator cuff muscle belly to bone. Most commonly, tears involve the supraspinatus tendon but can involve any combination or all four of the rotator cuff tendons. The mechanism of injury can be highly variable. A torn rotator cuff can result from trauma such as a fall on the shoulder or after a shoulder dislocation. More commonly, however, athletes suffer a torn rotator cuff from repetitive wear and tear activities that strain and chronically fail the tendon. Such tears are particularly prevalent in overhead athletes and are often seen in tennis players, baseball pitches, javelin throwers, swimmers, and football quarterbacks. Sometimes, a narrow space for passage of tendon underneath the acromion can result in direct mechanical abrasion of the tendon. This has been termed outlet impingement and is commonly referred to as impingement syndrome. A prominent acromial spur and thickened bursal tissue in the subacromial space can abrade the tendon running underneath.
How does a torn rotator cuff occur in athletes?
Damage and ultimately tearing of the rotator cuff tendons has been attributed to either static or dynamic causes. Static changes refer to impingement and mechanical abrasion of the tendons from narrowing of the subacromial space, most commonly due to roughness or “spurring” on the underside of the acromion or thickening of the coracoacromial ligament. On the other hand, a torn rotator cuff can result from abnormal dynamic motion of the humeral head and cuff relative to scapula, leading to abnormal strain on the tendon and tearing on either the joint or bursal side. For example, muscle weakness can allow the humeral head to rise higher towards the acromion and is considered to be one of the most common dynamic causes of a torn rotator cuff in athletes.
A torn rotator cuff result when the muscles and tendons of the rotator cuff become frayed under the acromion bone of the shoulder. This occurs both with aging as well as in younger people who perform repetitive overhead activities. Baseball pitchers as well as occupations that require overhead work are two examples of people at risk of sustaining rotator cuff tears. Pedro Martinez and Randy Johnson are both examples of professional, hall-of-fame bound pitchers who developed a torn rotator cuff.
How is a torn rotator cuff classified?
Unfortunately, there is no universal classification system for a torn rotator cuff. They can be classified based on various characteristics, including thickness, size, pattern or degree of retraction. Commonly used terms to descriptively categorize rotator cuff tears include:
Partial vs. Full thickness Tears
L-shaped vs. U-shaped Tears
Small, Large, or Massive Tears (retracted <3cm, 3-5cm, or >5cm respectively
What is the natural history of rotator cuff tears in athletes?
Many patients with rotator cuff tears are asymptomatic. As many as 50% of people over the age of 60 years may have rotator cuff tears. Correspondingly, however, many patients with shoulder pain may not have a cuff tear. In addition, the presence of a rotator cuff tear in a patient with shoulder pain does not necessarily mean that the tear is the primary cause of pain. It is clear, however, that patients with asymptomatic tears are at a high risk for symptom progression over time.
Unfortunately, rotator cuff tears do not heal spontaneously. In addition, tear size progresses over time and can unfortunately lead to irreversible changes in the tendon and muscle. Retraction of the tendon, scar formation, and atrophy of the muscle with infiltration of fat are all predictable changes that occur with greater chronicity of tears. These changes not only produce a weak shoulder with abnormal mechanics, but also compromise the ability to perform a surgical repair of the tendon to bone. The condition can progress to the point where the relationship between the humeral head and glenoid is permanently altered, with significant upward migration of the head. Arthritis secondary to a massive rotator cuff tear can develop as the humeral head erodes the superior glenoid and undersurface of the acromion. For throwing athletes, fixing a rotator cuff tear is important for them to retain their velocity and control of the ball. Pedro Martinez was able to return to the major league level of baseball competition after a repair of his full-thickness tear.
Symptoms of Rotator cuff tears.
What Does a Torn Rotator Cuff Feel Like?
While rotator cuff tears may be asymptomatic, they will frequently manifest as shoulder pain, particularly at night and during activities of daily living. Patients may complain of varying degrees of shoulder weakness and variable losses of range of motion. Crepitus and swelling can occur as well. On physical exam, patients with longstanding tears may have visible atrophy of muscles around the scapula. Functional deficits often correlate with the location of the tear. Overhead activities are often the most difficult and painful.
Overhead athletes with rotator cuff tears may complain of stiffness and pain during warm-up exercises. Pain is often most prominent during the acceleration phase of throwing or serving. Pitchers will often complain of a loss of velocity or ability to “control their pitch” at the mound.
Rotator cuff tears and MRI. Are imaging studies useful?
Plain x-rays can be useful to examine the relationship between the humeral head and glenoid. Also, they can demonstrate a narrow outlet or downsloping acromion that may put the rotator cuff at increased risk for mechanical abrasion. Magnetic resonance imaging (MRI) and ultrasound are the most common imaging modalities used to diagnose rotator cuff pathology. Ultrasound (US) certainly has a role in the diagnostic evaluation of cuff pathology. While the specificity and sensitivity of US is highly operator dependent, the test is dynamic and permits evaluation of the shoulder with during provocative maneuvers that reproduce symptoms. MRI is more than 95% sensitive in diagnosing rotator cuff tears and can accurately be used to estimate tear size, retraction, and fatty infiltration. This has important clinical implications, as the amount of fatty infiltration can help to prognosticate the success of a surgical repair.
What are my treatment options?
Treatment options for rotator cuff tears can be broadly categorized as nonsurgical or surgical interventions.
Nonsurgical options offer the advantage of avoiding the complications of surgery, and focus on pain relief and improving function by increasing the compensatory role of surrounding muscles. On the other hand, nonsurgical treatment will not result in healing of the torn tendon. Correspondingly, the risk of recurrent symptoms as well as tear progression with irreversible, chronic changes is substantial.
Surgical repair offers the potential benefit of expeditious pain relief and cessates tear progression and secondary chronic changes. Improvements in surgical techniques allow the vast majority of rotator cuff tears to be addressed arthroscopically through minimally invasive techniques. Nonetheless, small risk of infection and stiffness after surgery exist.
What are the nonsurgical modalities available for a torn rotator cuff?
Initially, sports injury treatment using the P.R.I.C.E. principle - Protection, Rest, Icing, Compression, Elevation can be applied to a torn rotator cuff.
Rotator cuff exercises for rehabilitation:
Exercise is the most important and useful intervention in the nonoperative management of a torn rotator cuff. Initially, athletes should rest and avoid any provocative maneuvers that elicit discomfort. When the pain has resolved, stretching can begin. The initial focus is on obtaining full and painless range-of-motion.
When full and painless range-of-motion have been gradually achieved, strengthening of the intact rotator cuff muscles and associated peri-scapular musculature can ensue. Strengthening of the rhomboids, levator scapulae, trapezius, and deltoid is of tantamount importance to provide a stable platform to maximize the efficiency and function of the remaining, intact cuff tissue. Some useful rotator cuff exercises to focus on these muscles include:
Latissimus pull downs
Local steroid injections in the subacromial space can function as potent anti-inflammatory agents in the subacromial bursa. They are very effective in relieving night pain and can also be used as an augment to rehabilitation exercises in patients that otherwise cannot comply secondary to discomfort. Steroids can have adverse effects on the quality of tendon tissue and healing, however, and for this reason should not be performed more than 3 times in the same shoulder and no more frequently than at least 3 months apart.
Nonsteroidal Anti-inflammatory Drugs (NSAIDS):
NSAIDs help to both control inflammation and relieve pain, and can be very useful as an adjunct to rehabilitation exercises in the management of a torn rotator cuff. These medications can have significant gastrointestinal and renal side effects, however, and should be carefully monitored by a medical physician.
Iontophoresis and Phonophoresis:
These are both techniques used to delivery medications locally through the skin, and can be useful to provide shoulder analgesia as an augment to rehabilitation exercises. Iontophoresis uses electrical current delivery, while phonophoresis uses ultrasound.
What does surgery involve for a torn rotator cuff?
Several factors influence the decision to pursue surgical treatment, including tear size and pattern, patient expectations, medical comorbidities, and occupational demands. Surgery for rotator cuff tears may be performed as an open, mini-open, or entirely arthroscopic procedure.
Partial-thickness tears usually involve the supraspinatus and/or infraspinatus and can be located on the articular or bursal surfaces of the tendon. Articular-sided tears on the side of the joint are about twice as common as bursal-sided tears. There is increasing evidence to suggest that partial-thickness tears, particularly those that are ignored or left untreated, progress to larger, full-thickness tears.
Partial-thickness tears are common in overhead athletes who perform repetitive activities, such as tennis, baseball, swilling, or cricket. Athletes will have pain and stiffness with warm-up exercises, and are often uncomfortable during the acceleration phase of throwing. They may demonstrate mild weakness with resisted elevation and/or external rotation of the arm, and will complain of a loss of velocity and control with pitching.
Currently, most surgeons decide of the treatment strategy for partial-thickness tears based on the depth of the lesions. If the tendon tear is less than 50% its thickness, the tear is typically debrided. If the tear is high-grade and involves greater than 50% of the tendon thickness, the tear is often completed and repaired down to bone. If the tear is on the bursal-side, a subacromial decompression and acromioplasty (shaving of the acromion) is also important to increase space for the tendon and avoid future injury.
Symptomatic full-thickness tears can be approached with arthroscopic or open surgical techniques to repair the tendon back to bone.
Regardless of which technique is performed, the first step of the procedure involves carefully exposing and visualizing the tear to determine its pattern and configuration. This involves performing a thorough resection of the overlying subacromial bursa until the bursal side of the cuff tissue is clearly visualized. The bursa can often be thick and inflamed, and may provide indication of mechanical impingement. An acromial spur or downsloping anterolateral acromion can certainly compromise visualization and contribute to mechanical injury of the tendon. In this setting, an acromioplasty (shaving of the acromion) to increase the clearance for the cuff and improve visualization should be performed. Bony prominences (or osteophytes) related to osteoarthritis of the acromioclavicular joint may also be encountered, and these should be resected as well to improve clearance for the rotator cuff tendons.
After careful inspection of the tear, a repair strategy should be developed to approximate the tendon to bone. If the tear is chronic, mobilization of the tendons may be necessary by releasing adhesions and scar tissue. Without this step, the retracted tendon may not be repairable to bone.
The tendons are typically repaired to bone using suture anchors that are placed in the humeral head at the site of detachment. These are metallic or biocompatible composite screws loaded with on or two sutures. The sutures are passed through the tendon, pulled down, and tied to the bone. The number and position of anchors required depends on the size and configuration of the tear. Sometimes side-to-side sutures can be placed between tendon edges if a tear within the tendon is present as well.
After the tear is anatomically repaired to bone, the surgeon must also evaluate all other lesions within and around the shoulder that may be a source of pain as well. This will include an inspection of structures within the joint such as the glenoid labrum and long head of the biceps tendon. In addition, the acromioclavicular joint and distal clavicle can be a source of pain and may require a resection as well.
What are the advantages of arthroscopic surgery over a conventional open procedure?
Arthroscopic surgery has become the technique of choice for rotator cuff surgery. It offers several advantages, including:
1- Small skin incisions
2- The ability to visualize and inspect the inside of the shoulder (glenohumeral joint) at the time of surgery, and treat other potential pain-generating lesions. This is not possible with conventional open procedures.
3- Avoid splitting and potential detachment of the deltoid muscle.
4- Ability to visualize and treat partial-thickness tears on the articular (joint) side.
5- Less soft tissue dissection.
6- Less postoperative pain.
7- Expeditious rehabilitation program.
Subacromial decompression, acromioplasty, debridement of partial-thickness tears, and repair of full-thickness tears can all be performed using arthroscopic techniques. Tears of the subscapularis tendon, however, can be challenging using the arthroscopic technique and may require an open procedure to fully visualize and repair.
What is involved in postoperative rehabilitation?
In the postoperative period, the arm must be protected. The forces related to daily activities with the shoulder exceed the strength of the repair and can disrupt it until some healing has occurred. A postoperative brace maintains the arm in approximately 15 degrees of abduction and prevents any overhead activity. Ice packs or custom devices that circulate cooled fluid are very useful to control pain and swelling in the immediate postoperative period.
As pain resolves, early passive range-of-motion is initiated within the first week of surgery. A physical therapist can be a very useful adjunct to this process in order to maintain a safe, supervised program. Gentle pendulum exercises in the sling, as well as passive motions in forward flexion and external rotation are continued for the first six weeks.
Rotator Cuff Exercises: Stretching & Strengthening Strengthening exercises are typically delayed until 8 to 12 weeks when healing has progressed and full range-of-motion has been achieved. Start strengthening exercises only after you have your health professional's approval. Muscle strengthening with rubber tubing can be very effective and often safer than weight machines. Strengthening of the scapular stabilizers (deltoid, trapezius, rhomboids, levator scapulae, etc) is paramount to the strengthening of the rotator cuff to maintain a stable platform and favorable posture for cuff mechanics. Patients continue strengthening for up to a year or longer until satisfactory strength and function are achieved. The degree of strength achieved often relates with the severity and chronicity of the initial tear.
Rehab after rotator cuff surgery can vary widely, but there are some general principles that are true for most patient having surgery for treatment of a torn rotator cuff. Usually these rotator cuff exercises are started gradually as soon as you can do the exercise routine without pain.
The list below provides links to specific rehab video exercises:
● 2 - 4 weeks: Torn Rotator Cuff, Beginning Exercises
● 2 - 4 weeks: Torn Rotator Cuff Recovery Exercise, The Pendulum
● 4 - 6 weeks: Torn Rotator Cuff Stretch - Internal Rotator
● 4 - 6 weeks: Torn Rotator Cuff Stretch - External Rotator
● 6 - 8 weeks: Torn Rotator Cuff, Pulley Exercises
● 8 weeks: Torn Rotator Cuff Recovery Exercise, Bench & Reach
● 8 weeks: Torn Rotator Cuff Recovery Exercise, External Rotation
● 8 - 10 weeks: Torn Rotator Cuff Recovery Exercise, Lat Pull-Downs
How long will it take for me to get back to my sport?
Just like all tears are not created equal, neither is the rehabilitation and recovery. Unfortunately, these timelines need to be individualized based on the severity of the tear and demands of your sport. Tennis, baseball, and other overhand sports can be very demanding, particularly at high-levels of competition. With these sports, a gradual return to activity is planned with your doctor. After healing has occurred, this is usually initiated through a graduated and supervised throwing program in which distance and velocity is slowly increased as tolerated over 2 to 3 months. Small or partial thickness tears will generally permit an accelerated recovery compared to large tears, but the ultimate plan to get you back on the field or court must be determined by your doctor and should reflect a balance of moving forward expeditiously without placing the repair at undue risk.
Can I prevent a torn rotator cuff? Rotator cuff Exercises.
The etiology of rotator cuff tears is multifactorial, and it is unclear with current evidence if tears can be completely prevented. Maintaining the health of the rotator cuff muscles and peri-scapular musculature, however, can certainly help to prevent injury and optimize the kinematics of the shoulder joint. These strategies are employed by elite pitchers and overhead athletes who place remarkable demands on their shoulder and rotator cuff daily. The internal rotators are inherently stronger than the external rotator cuff muscles, and maintain a balance of these forces is important. Rotator cuff exercises to consider include:
Latissimus pull downs
Resisted tubing exercises
Side-lying external rotator
Propped external rotator
Shoulder blade squeeze
If you suspect that you have a torn rotator cuff, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care.
Pilates and Back Pain: How can pilates help people with back pain? Issues like lack of core support, pelvic instability, muscular imbalances, poor posture, and lack of body awareness all effect your back health. The Pilates method specializes in helping people improve these issues. The second article below explains, "Individuals with significant back problems may benefit from several one-on-one Pilates sessions with a qualified Pilates instructor. While more expensive than a group class or mat class, the time, money and effort devoted to learning the exercises correctly can be well worth the investment, as exercises performed incorrectly can make a back problem worse."
Pilates and Back Pain
Why Pilates Helps People with Back Pain
By Marguerite Ogle, About.com Guide
Updated June 13, 2010
About.com Health's Disease and Condition content is reviewed by our Medical Review Board
Pilates Supports the Spine
Pilates exercises are commonplace at physical therapy centers, chiropractors are recommending Pilates, and "My back used to hurt all the time and now I don't feel it anymore" is a phrase we hear a lot from people who do Pilates consistently. So what is it about Pilates that works so well for back pain relief?
What makes Pilates so effective is that it addresses the underlying structural imbalances in the body that lead to back pain. Issues like lack of core support, pelvic instability, muscular imbalances, poor posture, and lack of body awareness all effect back health. They are also issues that the Pilates method specializes in helping people improve.
Pilates Helps Correct Posture
In Pilates, we pay a lot of attention to how our body parts are lined up in relation to each other, which is our alignment. We usually think of our alignment as our posture, but good posture is a dynamic process, dependent on the body's ability to align its parts to respond to varying demands effectively. When alignment is off, uneven stresses on the skeleton, especially the spine are the result. Pilates exercises done with attention to alignment, create uniform muscle use and development, allowing movement to flow through the body in a natural way.
For example, one of the most common postural imbalances that people have is the tendency to either tuck or tilt the pelvis. Both positions create weaknesses on one side of the body and overly tight areas on the other. They deny the spine the support of its natural curves and create a domino effect of aches and pains all the way up the spine and into the neck. Doing Pilates increases the awareness of the proper placement of the spine and pelvis, and creates the inner strength to support the natural curves of the spine. This is called having a neutral spine and it has been the key to better backs for many people.
Pilates Develops Core Strength
Good posture that goes beyond the "look" of being aligned requires core strength. Having core strength means that all of the muscles of the trunk of your body are strong, flexible, and working together to support and stabilize the spine.
Core strength is deeper than the big surface muscles that we are used to thinking of as those of the trunk of the body, like the rectus abdominis, the infamous 6-pack abs muscle or the beautiful big muscles of the back, like the lattisimus dorsi, popularly called "the lats." The core muscles include the muscles that are below the surface musculature.
So while many forms of exercise focus on strengthening the big surface muscles, Pilates trains the body so that all of the core muscles work together to support and stabilize the back. Part of developing effective core strength is to train the body to know when to release, as well as activate, its core muscles. So while core strength is the catch-all term, we might say that the core coherence that Pilates teaches is essential for back health.
Some of these less obvious but very important core muscles are the muscles of the pelvic floor; the psoas, which play a huge role in keeping us upright and in hip bending; the transversospinalis, which are small muscles that weave along the spine; and the transverse and oblique abdominal muscles. The diaphragm, our prime breathing muscle, is right in the middle of the core. All of these muscles play crucial roles in the support and stability of the spine.
...the only real guide to your true age lies not in years or how you THINK you feel but as you ACTUALLY are as infallibly indicated by the natural and normal flexibility enjoyed by your spine...
Joseph Pilates, Return to Life Through Contrology
Pilates Promotes Flexibility
A healthy spine can curve forward and backward, twist, and move side to side, and do so in a way that reveals all the subtle articulations that our many vertebrae allow us to have. As core strength develops, the back muscles learn to work in harmony with the abdominal muscles, forming protective support for the spine that increase the potential range of motion of the spine. Pilates exercises are easy to modify so that we can develop spinal flexibility at our own pace. This is one of the things about Pilates that makes it easy for people with back pain to work with.
Pilates Increases Body Awareness
Whether the cause of pain is from an injury or as is often the case, a culmination of the effects of poor posture and inefficient movement habits, back pain is a messenger letting us know that we have to pay more attention to how we live in our bodies. The Pilates method is full attention exercise. You can't do Pilates without becoming extremely aware of your alignment and the energy you bring to movement.
This kind of awareness practice is extremely powerful for people with back pain because we not only improve physical functioning, but as awareness increases, we move beyond the physical and mental holding patterns that back pain can create. Then, there is more room in one's whole being for positive change.
Learn Pilates Exercises for Back Pain:
Pilates Fundamental Exercises
Pilates for Back Pain Exercise Series
5 Back Strengthening Extension Exercises
Back pain has many causes and Pilates may not be right for all of them. If you have back pain, especially serious or chronic back pain, please check with your health care practitioner before you begin a Pilates program. If you do choose to begin Pilates, it is important to work with a fully certified instructor who is aware of exactly what challenges you are working with.
Pilates Exercise and Back Pain
The important principles of Pilates are consistent with an exercise program that promotes back health. In particular, learning awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment are important skills for the back pain patient.
Patients with pain stemming from excessive movement and degeneration of the intervertebral discs and joints are particularly likely to benefit from a Pilates exercise program. In addition, postural asymmetries can be improved, thus decreasing wear and tear resulting from uneven stresses on the intervertebral joints and discs.
Pilates improves strength, flexibility and suppleness of the muscles of the hip and shoulder girdle. Fluid and supported movement through these joints helps prevent unnecessary torque on the vertebral column.
The Pilates program also teaches awareness of movement habits that may stress the spine, and helps the patient change these habits to those that preserve neutral alignment. Awareness of excessive tension and the use of proper focus helps the patient use the body efficiently.
Before starting any new exercise system, it is always advisable to check with a physician or other healthcare provider. Before starting a Pilates exercise program, it is important to check that the potential instructor has received training in the Pilates exercise system, and that he or she understands any specific back problems. If a patient starts Pilates after physical therapy, the physical therapist should outline the exercise principles identified as particularly important for his or her rehabilitation.
Individuals with significant back problems may benefit from several one-on-one Pilates sessions with a qualified Pilates instructor. While more expensive than a group class or mat class, the time, money and effort devoted to learning the exercises correctly can be well worth the investment, as exercises performed incorrectly can make a back problem worse. Initially, twice-a-week sessions tend to be helpful to learn the program more quickly. After that, weekly Pilates exercise sessions may be enough if the individual practices between sessions.
The principles of movement important for back health are taught in some of the simplest exercises of the Pilates system. One cannot underestimate the benefit of simple exercises that support the deep postural muscles of the trunk, awareness of neutral alignment, and supple use of the shoulders and hips. It is best to learn exercises that can be practiced at home between scheduled Pilates sessions.
Given its roots in ballet and dance, some of the movements in the Pilates system are very difficult and challenging. Many of the exercises should be avoided for individuals with significant back pain or degenerative disc disease. Remember, it is always advisable to first see a physician prior to starting any exercise program.
As a general rule, back patients should avoid exercises that push the spine into extremes of flexion or extension, or combine flexion with side bending or twisting the spine. These motions place excessive stress on the intervertebral discs. Also, it is important to avoid fatigue - either mental or physical - which is when proper form is lost and injuries more likely to occur.
The exercises in the Pilates system should be challenging (both mentally and physically) but not so difficult that they cause anyone to struggle. If an exercise causes pain—it is best to stop and tell the instructor. The exercise may be too difficult, or the person may need additional help to do it correctly.
Finally, it may take awhile for the full benefits of a Pilates exercise program to be realized. Just as problems that create most back pain problems happen gradually over time, learning to use one’s muscles in a way that support - rather than stress - the spine takes time and commitment.
|Joseph Pilates designed his first equipment using bedsprings to rehabilitate injured World War I soldiers who needed to regain strength and mobility. about.com published the following article written by Marguerite Ogle|
Joseph Pilates: Founder of the Pilates Method of Exercise
A Brief Biography of Joseph Pilates
By Marguerite Ogle, About.com Guide Updated February 01, 2011
Today The Pilates Method continues to be used for rehabilitation. The following article was published by Balanced Body and written by Ken Endelman
Pilates' Book, Return to Life Through Contrology book photo (c) Marguerite Ogle
German born Joseph Pilates was living in England, working as a circus performer and boxer, when he was placed in forced internment in England at the outbreak of WWI. While in the internment camp, he began to develop the floor exercises that evolved into what we now know as the Pilates mat work.
As time went by, Joseph Pilates began to work with rehabilitating detainees who were suffering from diseases and injuries. It was invention born of necessity that inspired him to utilize items that were available to him, like bed springs and beer keg rings, to create resistance exercise equipment for his patients. These were the unlikely beginnings of the equipment we use today, like the reformer and the magic circle.
Joseph Pilates developed his work from a strong personal experience in fitness. Unhealthy as a child, Joseph Pilates studied many kinds of self-improvement systems. He drew from Eastern practices and Zen Buddhism, and was inspired by the ancient Greek ideal of man perfected in development of body, mind and spirit. On his way to developing the Pilates Method, Joseph Pilates studied anatomy and developed himself as a body builder, a wrestler, gymnast, boxer, skier and diver.
After WWI, Joseph Pilates briefly returned to Germany where his reputation as a physical trainer/healer preceded him. In Germany, he worked briefly for the Hamburg Military Police in self-defense and physical training. In 1925, he was asked to train the German army. Instead, he packed his bags and took a boat to New York City. On the boat to America, Joseph met Clara, a nurse, who would become his wife. He went on to establish his studio in New York and Clara worked with him as he evolved the Pilates method of exercise, invented the Pilates exercise equipment, and of course, trained students.
Joseph Pilates taught in New York from 1926 to 1966. During that time, he trained a number of students who not only applied his work to their own lives but became teachers of the Pilates method themselves. This first generation of teachers who trained directly with Joseph Pilates is often referred to as the Pilates Elders. Some committed themselves to passing along Joseph Pilates work exactly as he taught it. This approach is called “classical style” Pilates. Other students went on to integrate what they learned with their own research in anatomy and exercise sciences.
Joseph Pilates' New York studio put him in close proximity to a number of dance studios, which led to his “discovery” by the dance community. Many dancers and well-known persons of New York depended on Pilates method training for the strength and grace it developed in the practitioner, as well as for its rehabilitative effects. Until exercise science caught up with the Pilates exercise principles in the 1980s, and the surge of interest in Pilates that we have today got underway, it was chiefly dancers and elite athletes who kept Joseph Pilates' work alive.
Joseph Pilates passed away in 1967. He had maintained a fit physique throughout his life, and many photos show that he was in remarkable physical condition in his older years. He is also said to have had a flamboyant personality. He smoked cigars, liked to party, and wore his exercise briefs wherever he wanted (even on the streets of New York). It is said that he was an intimidating, though deeply committed, instructor. Clara Pilates continued to teach and run the studio for another 10 years after Joseph Pilates death. Today, Joseph Pilates teachings are carried on by the Pilates Elders, and by a large group of contemporary teachers.
Joseph Pilates called his work, contrology. He defined Contrology as “the comprehensive integration of body mind and spirit.” This philosophy is beautifully elucidated in his book, Return to Life Through Contrology.
Joseph Pilates authored two books:
- Return to Life through Contrology (1945) with William J. Miller.
- Your Health: A Corrective System of Exercising That Revolutionizes the Entire Field of Physical Education (1934)
Pilates: Effective For Injury Rehabilitation
by Ken Endelman
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."
Ken Endelman is Founder and CEO of Balanced Body Inc. Ken began his career as a designer and craftsman of fine custom furniture - a background apparent in every piece of hand-finished equipment the company makes. Since the early 1970s, Ken Endelman has updated Joseph Pilates' equipment with state-of-the-art engineering, materials and technology, many of which have become industry standards. The company has been awarded twenty-four U.S. patents, with more pending. Balanced Body Inc. continues to actively promote Pilates to the fitness industry, the medical profession and the media. This article was originally seen in Beyond Fitness Magazine.