PilatesJessica Miller

Objectives

• List the benefits of Pilates

• List the 6 principles of Pilates

• List 3 Pilates exercises that can be performed when rehabilitating a TKA

• List 3 Pilates exercises that can be performed when rehabilitating a THA

• List 3 Pilates exercises that can be performed when rehabilitating LBP

What is Pilates?

• Low-impact, complete body workout

• Develops body awareness

• Strengthens core muscles

• Improves stability and support in the body.

History

• Joseph Pilates

• Germany 1880

• Sickly child

• Skilled gymnast, skier, boxer and wrestler

• WWI he taught Mind and Body = Contrology

• U.S. in 1926, New York Ballet

• Pilates (1967)

• Became popular with Hollywood

6 Pilates Principles

Breathing

Concentration

Centering

Control

Precision

Fluidity of Movement

Breathing

• Diaphragmatic

• Improve efficiency of lung function and blood oxygenation

• Increase mental focus

• Improve ability to relax

• Increase overall ribcage mobility

• Encourage efficient exhalation

• Assist posture, musculoskeletal function and movement

patterns

Concentration

• All moves should be done as conscious acts

• Conducive environment

• Calming mood

• Soothing background music

• Don’t let the mind wander, keep focused on the

movement

Centering

• Abdominals should contract before initiating any movement

• Exercises centered on “Powerhouse”

• Use proper alignment and form

Control

• Mind and body control

• Slow and controlled movements

• Constant speed

• No jerky or meaningless movements

• Several muscle groups engaged

Precision

• Body Awareness

• Appropriate placement of limbs

• Correct alignment

• Execute each exercise as best you can

• “Honor every movement”

Fluidity of Movement

• Continuous motion

• Smooth and slow movement

• No jarring repetitions

• Energy flows through body evenly

• No beginning or end

• Body constantly in motion during each

exercise/transition

Pilates and Rehabilitation• Start integrating this principles into your

interventions

• Encourage patients to implement these with their HEP

• "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.”

• Benefits of Pilates

Benefits of Pilates

• Core strength and good posture

• Balance and Coordination

• Mobility and learning to move efficiently

• Joint flexibility and long lean muscles

• Create an evenly conditioned body

• Gentle but challenging as well as adaptable

• Refreshing mind and body workout

Pilates Rehab for TKA and THA• More THA and TKAs are being performed

• Shorter hospital stay and quicker recovery

• Less invasive surgical techniques allow rapid rehabilitation

• Pre-op and rapid post-op rehab may improve patient’s balance and coordination as well as gait adaptations

• Proposed advantages of utilizing Pilates:• Maximizing pre-op function• Develop a pathway for return to outpatient exercise• Promote whole body approach to post-op rehab

Pilates for Rehab Purpose

• 1. Introduce Pilates into orthopedic community as a safe way to restore function

• 2. Describe an improved program suited to all levels of skill that can be continued as a long term maintenance program

• 3. Review a series of patients having completed the rehab programs at 1 year follow-up

• 4. Pilates can be a viable option for rehabilitation

Pilates Field Observation Facts38 Patients (30 Women, 8 Men)

THA• 22 Patients, average

age 46 years• Pre-Operative

Diagnoses:• 16 Osteoarthritis• 4 Osteonecrosis of

femoral head• 1 Hip Dysplasia• 1 Lupus Erythematous

TKA• 17 Patients, average

age 55 years• Preoperative

Diagnoses• 14 Osteoarthritis• 3 Inflammatory Arthritis

Exercise RegimenPre-Operative

Regimen

• Adapted to meet pt needs

• Pre-op exercise 3-4x/week for 1-2 hours

• Exercises recommended: Week 2-6 in Tables

Post-Operative Regimen

• Early post-op exercises should be modified and begin 2 weeks after hospital D/C

• 3-4x/week for a minimum of 1 hour

• Progression can occur according to pain levels, quality of movement and as the MD permits

• Pilates can be an enjoyable approach that can be molded into a maintenance program

Pilates Rehab Protocol for TKA

Pilates Rehab Protocol for THA

Pilates Field Observation Results

• 1 year follow-up by charts and phone calls

• 25 Extremely Satisfied w/ outcome

• 13 Satisfied w/ outcome

• 73% of women continued after rehab• Advantages:• Pre-op exercises to improve function• Implement exercises into HEP• Adaptability of exercises for joint precautions and

restrictions

Chronic Low Back Pain

• 70% of adults suffer from LBP at some point

• 90% of LBP cases seem to be non-specific

• 15% of people develop LBP and have persistent pain one year after initial episode

• Exercise therapy is one of the most common recommended treatments for chronic LBP

Clinical Pilates

• Theory based exercise regimen founded on rationale of improving segmental stability and functional movement

• Adapted from traditional Pilates by physiotherapists

• Described as an exercise based on the Pilates Method adapted for rehabilitation purposes

• Treatment for chronic LBP using Clinical Pilates have shown a reduction in pain and improvement in function compared to no tx, but no significant difference compared to other forms

Pilates and LBP Pilot Study• 15 Participants

• Skilled Clinical Pilates Exercise Program • Spring resistance used with Reformer• Strength, Endurance and Stability Exercises• 1 hour 2x/week for 6 weeks

• Home Exercise Program• Floor Exercises• 30 minutes 3x/week for 6 weeks• New HEP for 26 weeks after skilled intervention

LBP Exercises

• Pelvic Tilt

• Bridge with Pelvic Tilt

• Chest Lift

• Swan Prep

• Child’s Pose

• Kneeling Arm and Leg Reach

• Cat/Cow

• Spine Stretch

• The Saw

LBP Pilot Study Outcome• Statistically significant improvement in all measures

from the start of the intervention to the 6 weeks

• No significant differences from 6 weeks to 26 week F/U, note pt adherence had gone down

• Findings indicate improved function and decreased pain levels maintained for 26 weeks

• Clinical Pilates can be equally effective as other stabilization exercises

References:• Levine B, Kaplanek B, Jaffe W. Pilates training for use in rehabilitation after

total hip and knee arthroplasty: a preliminary report. Clinical Orthopaedics & Related Research [serial online]. June 2009;467(6):1468-1475. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 8, 2012.

• Swann J. The power of Pilates. Nursing & Residential Care [serial online]. October 2009;11(10):520-523. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 8, 2012.

• Taylor L, C., Dean S. Can clinical pilates decrease pain and improve function in people complaining of non-specific chronic low back pain? A pilot study. New Zealand Journal Of Physiotherapy [serial online]. March 2011;39(1):30-38. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 8, 2012.

• Bodylines Pilates, Orchard Hills Athletic Club. The Six Principles of Pilates. Bodylines Pilates. Available at http://www.bodylinespilates.com/principles.html. Accessed 14 Nov 2012

• Pilates Reformer Overview. Pilates Overview. Pilates Reformer. Oct 24 2012. Available at http://pilatesreformer.com/overview/. Accessed 15 Nov 2012

• http://www.youtube.com/watch?v=Fi72rEFT0zc