Physiotherapy and clinical Pilates

Physiotherapy and clinical Pilates

The last decade has seen a growing body of research supporting proximal stabilisation for management of spinal injuries. Poor control and lack of endurance of trunk musculature are associated with low back pain. Researchers have developed a range of criteria for training "core control".

With the focus now on control of muscle rather than strength a "new" approach had to be taken to meet the criteria.

The Pilates (Pi-lart-ees) system of exercise been popular amongst performers for many years. With a basis of submaximal /variable resistance work in potentially unstable positions it had many of the right ingredients to satisfy stability training criteria. The exercises can encourage efficiency and submaximal muscle control by using variable (i.e. spring loaded) resistance and movement. To execute the exercises properly a stable, controlled pelvic and shoulder girdle is established with load facilitating both deep and global stability musculature.

Clinical Pilates description



The Clinical Pilates program has been developed by Australian physiotherapist Craig Phillips since 1990 to develop training of functional stability by progressing static stability into dynamic. Drawing on the original work of Joseph Pilates the program needed refinement to improve safety and highlight the components valid in stability training and injury diagnosis and management.

Developed specifically as a treatment tool for physiotherapists, Clinical Pilates is unique as a tool for establishing differential diagnoses, identification of radiological false positives / false negatives, establishment of outcome predictors  and  application of pathology specific exercise programs. 

DMA Clinical Pilates is the first to use real time ultrasound to determine if muscle activation patterns are being achieved. As a result changes had to be made to the traditional Pilates approach as a predominance of "bracing" activity was being consistently noted instead of appropriately sequenced, controlled tonic activity of the deep stabilisers.

Movement dysfunction often leads to pathology and vice versa. Low level Type 1 endurance musculature is the primary focus of stability training, and the aim is for early onset, at low loads, of both the local / deep stabilisers such as transversus abdominus and the deep multifidus and the more superficial global stabilisers such as the oblique / superficial multifidus, latdorsi etc. The difficulty in getting patients to activate stability musculature is because low % maximum voluntary contraction (MVC) required for stability and postural control is not as easy to "feel" as higher % MVC.

Therefore the exercises must facilitate and challenge those muscles irrespective of whether the patient is consciously aware of the muscle activity or not. If the muscle is to act as a background to movement it stands to reason that it should then be trained in the background and a "movement pattern" developed .Stability training must progress from the static to the dynamic and incorporate the connection between the shoulder and pelvic girdles. Static isolated muscle activity does not guarantee carry over into the dynamic situation. Load and movement are key factors in muscle activity so "if you want a muscle to do a job it must have a job to do" and it must be appropriate.

Injury management with clinical Pilates

An important issue in stability training is the effect of pathology. Pathologies are generally load sensitive as well as direction sensitive. Therefore if a pain producing pathology exists it must be determined if it has a direction preference. The neutral position required for ideal posture may in fact be provocative in the initial stages leading to pain, hence, muscle inhibition. Unloading the pathology in either flexion, extension or off center may well protect the pathology and allow muscle activity to occur. With progression, neutral is incorporated and eventually the provocative position used to determine the "threshold of function" of the injury.

As the research and knowledge develops in this area it is encouraging to know that the CLINICAL PILATES program can be "tuned" to both satisfy the guidelines of the researchers and meet the needs of the clinician.

Exercise and Physiotherapy

Exercise and Physiotherapy

Most people with MS, regardless of their degree of disability, can benefit from some exercise. Many have some degree of ability. The right kind of exercise can bring positive physical and psychological health benefits.

Exercise helps you do the things you want to do and helps to prevent complications that can result from inactivity. It can improve flexibility, fitness, strength and stamina, circulation, muscle tone and mood. It can also help with the stimulation of fluids and excretion of waste products.

Many people with MS think they cannot do any exercise because they will become too fatigued but the strange fact is that it can actually give you energy rather than take it away from you – as long as you exercise sensibly and know your levels of ability. It is important to balance the exercise with rest.

You may wish to only undertake short sessions so you can avoid overheating. Remember, over-exercise can lead to weakness, fatigue, pain and spasticity. Therefore it is sometimes better to build up your exercises slowly.

Even if you are quite inactive, simple exercises like calf muscle lifts and stretches can be done at home on a daily basis. Passive exercisers are useful and there are many good products on the market, which can be used sitting down. If you suffer with spasticity a Physiotherapist can do assisted movements with you.

Good Forms of Exercise:

Physiotherapy

It is quite important to see a neurologically trained Physiotherapist as early on as possible. MS patients are often referred too late. Your G.P. or Neurologist should supply a referral. You can also receive Physio at one of the many MS Therapy Centers around the country, where the number of sessions are not rationed.

If you suffer with spasticity a Physiotherapist can do assisted movements with you and also help you to stand and balance properly, stand up from sitting and lying, walk better, position yourself to sleep, co-ordinate your movements better and help with posture etc.

It is a good idea to speak with your Physio if you are thinking of undertaking any of the under mentioned therapies and also ask their advice on any exercise machines available.

Swimming

Swimming is especially helpful because the water supports your bodyweight – the water will help to stabilize someone with balance problems. Weakened muscles can operate in this environment and will strengthen from the resistance. As swimming involves many muscles in your body, it can help to increase co-ordination.

There are now many more swimming pools and leisure centers having special sessions for people with disabilities or those who require special help and it may be worth trying one of these sessions first.

As a precaution it is best to ascertain the temperature of the water beforehand as many people with MS find water that is too hot or too cold a problem. The most comfortable temperature is about 30°C (86°F).

Pilates

Pilates is a type of exercise program based on correct body alignment. The focus is on co-ordination, moving properly and “core strength”. Good breathing patterns are important also.

As a holistic method of body maintenance, it prioritizes general fitness and body awareness, which contributes positively to rehabilitation.

In MS, Pilates can improve posture, boost the immune system, reduce stress, increase energy and bone density, improve circulation and respiration, improve muscle tone and balance.

T’ai Chi

T’ai Chi is meditation with movement. It concentrates on relaxation and correct breathing while performing graceful, circular, flowing exercises, sometimes to music. It is especially helpful for people with MS who no longer have the stamina to exercise at a high speed and another advantage is that you can exercise without overheating.

Really you need to be able to stand to be able to cope with all the range of moves. However, it is possible, according to the teacher, to do some of the moves sitting down, e.g. the arm movements and breathing exercises.

T’ai Chi can help in MS by improving balance, combating fatigue and giving you more energy. It can also help with spasms, exercises muscles and is very relaxing. Regular practice can also help with depression and maintain a calm and more serene inner state. T’ai Chi is a good method of self-development, focusing the mind and giving people with MS a sense of well being.

Yoga

Yoga is widely used by many people with MS and there are now specialist centers and teachers. It is a unity of mind and body and is as much about your breathing and your outlook on life as it is about postures. It can calm the mind and energies the body as well as helping to counteract stress, fatigue and depression.

It has a good effect on the endocrine glands, circulatory and respiratory systems and improves wellbeing. Yoga also tones the digestive organs and other glands in the body such as the thyroid and adrenals.The main concern with yoga and MS is that you should work well within your limitations in a relaxed way and be careful not to push yourself too far or raise your body temperature, as this may increase fatigue.

Vibration training

Vibration training is becoming more widely used amongst people with MS. You stand on a platform that sends vibrations through the body to tone up muscles, increase blood flow and bone density. This can also be done from a seated position by just placing the feet onto the platform. It helps to make leg muscles stronger, improves flexibility, aids circulation and helps balance by increasing the core stability.

Many People with MS have used these machines and found a reduction in some of their symptoms. Mainly with a reduction of muscle spasms and spasticity. An increase in blood circulation helps provide warmth to the legs and feet as well as reducing swollen ankles. Sessions should ideally be overseen by a trained professional and started with only short sessions so to not overload the body.

More physiotherapy and rehabilitation centers are using the vibration trainers as part of their treatment.