The Beginnings of Pilates in Rehabilitation
Joseph H. Pilates was born in Germany. As a child, he was a very sickly and weak boy. He decided not to succumb to the weaknesses of his own physicality and spent many years testing various types of activities on himself. He practiced yoga, ballet, martial arts, Zen meditation, Greek and Roman exercises. He dedicated his entire young life to overcoming his own weaknesses and becoming physically stronger. Later on, he also collaborated with specialists in the field of medicine, doctors, therapists, and nurses. One of them, Clara, even became his wife. The experience he gained allowed him to develop a unique method of exercise that was named after him.
In 1923, he moved to the United States of America, where he continued his work. In the 1930s and 1940s, he actively collaborated with dancers and choreographers, whom he included in his proprietary exercise program. Among them were Martha Graham, George Balanchine, and Jerome Robbins. As elite performers, they often suffered from injuries that prevented them from working and perfecting their craft. The long recovery times excluded other methods of exercise. Pilates, on the other hand, encouraged his patients to engage in physical activity as soon as possible, of course, properly adapted. He discovered that natural, unforced, and fluid movement from the very beginning of rehabilitation accelerates its process.
After many years of experience, Joseph Pilates’ method is gaining popularity. In the 1990s, many therapists began to use Pilates in their practice. It proves to be helpful in treating back pain syndromes, after orthopedic injuries, in neurological, geriatric, and sports rehabilitation. During the rehabilitation process, most exercises are performed on just a few special devices designed by Pilates, as well as on the mat. However, the exercise machines are constructed in such a way that springs and gravity work in favor of the patient, utilizing all their capabilities and assisting in case of weaker condition or injury.
Biomechanical and Physiological Postures
Currently, researchers focusing on biomechanics and restoring full movement functionality see an increasing potential of Pilates in neuromuscular re-education. Joseph Pilates’ method assumes that most injuries and improper body alignments can be healed through exercise. Assessing the patient’s needs allows for easily designing a movement pattern tailored to the patient for activities such as sitting, reaching, rotating, or walking, with the appropriate level of load on the spine and limbs. Proper manipulation and stimulation of damaged structures shortly after an injury can accelerate the process of movement re-education. A very important element of the described method is the control of the so-called core, which includes the trunk, abdominal, and pelvic muscles (we use the terms core and trunk interchangeably). Usually, trunk control is a desired outcome of the body’s physiological movement and requires successful integration of all its components to maintain proper orientation to gravity. In studies led by Richardson and Hodges in Australia, the significance of core control was analyzed. They focused on determining the activity of trunk muscles in healthy individuals and those burdened with chronic lower back pain while performing upper limb movements. The research results demonstrate the importance of trunk muscle stability in initiating limb movement. Stabilization of the trunk, abdomen, and pelvis in Pilates is not aimed at limiting spinal mobility but rather facilitates movement control. Joseph Pilates was the creator and advocate of the theory that a stable core of our body determines the proper control of our mobility.
In their experiences, Richardson and Hodges also defined the transverse abdominis muscle as the main element controlling our posture and movements. It is believed that the transverse abdominis is activated as a subconscious and submaximal contraction to achieve trunk stabilization during movement. This approach makes the Pilates method more recommended in movement rehabilitation than other activities. Its goal is to achieve movement efficiency and return to a functional state.
The exercises developed by Pilates are constructed in such a way as to facilitate the patient’s performance by allowing positions that minimize unwanted muscular activities, often responsible for the development of pathological movement patterns and rapid muscle fatigue, resulting in dysfunction or injuries. When the desired movement is achieved by reducing proprioception, patients often overtrain muscles to achieve stability. Although this has not been proven, it is likely that excessive or faulty stabilization hinders performance and often poses an obstacle to efficient movement. For example, a patient can passively extend their leg to 90 degrees, but when asked to lie on their side with a reduced base, their range of motion drastically decreases. When in the therapeutic process the basis of stabilization, support, and balance are disturbed, performance and range of motion are most often limited. Therapists using the Pilates method can achieve a reduction in proprioceptive load by increasing the support surface and providing appropriate support and feedback for learning proper movement. This allows for an increase in the movement sequence while ensuring that the quality of that movement does not suffer.
Another important factor in achieving movement automatism is neurological feedback from the deep trunk muscles or the multifidus muscle of the back. The multifidus muscle consists of several myomeres and is the strongest muscle in the lower spine. As an excellent source of kinetic feedback, it plays a significant role in trunk functionality. Richardson demonstrated that patients with chronic lower back pain load the multifidus muscle differently compared to patients without pain. Healthy subjects showed symmetrical bilateral loading of the multifidus muscle, while individuals experiencing lower back pain exhibited asymmetry.ę muscle on the side burdened with pain. Further studies using ultrasound showed a discrepancy in muscle circumference at different levels, which correlated with the location of the pathological change.
The loss of proprioceptive feedback leads to a decrease in trunk stability. The inhibition of basic proprioception may be responsible for faulty compensatory patterns, which can cause destructive forces to act, slowing down the healing process. Working with the patient to overcome faulty compensatory movement patterns is a fundamental goal in the method developed by Pilates. The ability to trigger proprioception through various phases of movement is infinite in Pilates. Three variables: base of support, lever length, and degree of assistance can be individually tailored to the patient exercising on Pilates equipment, providing greater variety in the precise modification of movements selected by the therapist.
I am a graduate in Managerial Economics as well as Finance and Accounting, with a specialization in Marketing. Since 2018, I have been working as a Copywriter at Balanced Body, where I create marketing content for the fitness and Pilates industries. One of my particular strengths is translating complex topics into accessible language and accurately analyzing the needs of target audiences. Outside of work, I am passionate about fire shows and volleyball, which helps me better understand the needs of physically active people.