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Incorporating Pilates into Rehabilitation – A Physio’s Perspective

As physiotherapists, a large part of our role is to help clients keep moving. Our bodies are incredibly resilient and quietly work in the background to control all of our internal systems, including muscle activation and control. This happens 24/7 without conscious thought, in a well-functioning system. Add a little too much load, resume an activity with enthusiasm too quickly, or suffer an injury... and this natural balance can be thrown off track. Suddenly there are creaks and cracks in joints, pain or stiffness when trying to perform day to day activities, and ‘simple’ movements require a lot of concentration or feel too effortful to complete.

How do physiotherapy and Pilates come together? Believe it or not, you can find Pilates principles (6) sprinkled through any physiotherapy session. Your therapist may have you concentrate on a certain area of your body during an exercise. When you initiate a movement, you may be encouraged to activate some stability muscles first – improving your body’s control and establishing a centred ‘start point.’ Depending on the functional task of choice, there may be some precision involved or flow between movements. If anything, just remember to breathe!

Clinical Pilates

Clinical Pilates can be utilized in a physiotherapy setting for injury prevention, postural correction, and performance enhancement. It is based in finding stability in some areas of your body, while moving others, using awareness to maintain control through a sequence of movements.

Where do we start? Classical Pilates emphasized the importance of the core or “powerhouse,” which involved pressing the back as firmly into the ground as possible. There may be benefit for some to utilize this stabilization strategy, but this is not where we, as humans, spend most of our time! Clinically, we will help you find a neutral starting point. Often this neutral or mid-range position can help encourage effective muscle engagement, including your core. Then we develop a sequence of activation and coordinated movements – this is to allow your body to move more efficiently. This may involve components of Pilates including:

  • Dissociation (separation of movement components). For example: Can you tip your pelvis forward and back without having the movement ripple up the length of your spine? Is there an area of your body that feels like cement; it doesn’t like to move? Our bodies will take the path of least resistance – if the cement area is not moving, the areas above and below will be working overtime to successfully complete the task at hand.

  • Integration (stringing together of movement components). For example: When does your shoulder blade start to rotate as you lift your arm up over your head? Can we help your shoulder blade and arm work together to create a smooth movement through the full range?

  • Posture (everyone’s favourite!). For example: How is your head positioned relative to your spine? How are your ribs positioned relative to your pelvis? Contrary to popular belief, it is not about being as rigid as a perfectly stacked Jenga tower; we want you to be able to move and return back to your start position. If you are spending a lot of time in one position, it could be the most textbook-perfect posture, but your body is going to have some complaints. Think: motion is lotion, the best posture is your next posture!

  • Breath Work. Our cells need oxygen, especially our muscle cells when they are under load during exercise! Thinking about the body as a machine, oxygen and nutrients (food) are the body’s fuel. When we hold our breath during an exercise, this can create tension (sometimes required under high load). Typically, a continuous flow of breath in and out is preferred. Pay attention to what happens to your body as you breathe: where do you notice the body expand and contract in response to inhaling and exhaling? Does the position of your head, shoulders, or hips change? How deep are your breaths?

  • Activation. Purposeful, concentrated muscle firing to set the stage for what comes next: a quick turn, lateral (side) step, jump, or run. This is the first step to reclaim foundation movements for return to sport. It is especially important when recovering from injury or surgery, when you are working to recalibrate the body to restore range, strength, and function. Props and equipment can be used to offer proprioceptive feedback (information to the brain of where the body is in space) and create tension in the body to guide movement, particularly if it is a new or foreign way of your body to move (often different than following the path of least resistance). The more we practice conscious activation, the faster this activation will become more automatic.

Pilates is an incredible clinical tool to develop body awareness and encourage movement efficiency. When we move more efficiently, we can develop an improved capacity for movement and load. It can be used in conjunction with injury rehabilitation and return to sport, as well as enhance performance.

Written by Mikaela Barnes from her experiences in putting Clinical Pilates into her practice after training through Calibrate Pilates course with Kobi Jack and On Field Training with Randy Celebrini at Royal City Physio. Book with Mikaela today.


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