The Etiology of Rehabilitation Based on Pilates Exercises PART II
The possibilities for reducing proprioception during the movement phase in exercises derived from Pilates are immense. Three variables: base of support, lever length, and degree of assistance can be shaped independently, providing greater variety in the precise modifications a therapist can make to selected movements.
Another example of an optimal environment for shaping correct movement motor skills is a process discovered by specialists from Polestar Education, an institution teaching rehabilitation techniques based on Pilates. Polestar Education has defined the process of restoring correct movement motor skills by dividing it into three phases.
Phase I: Assisted Movement. Assisted movement using springs allows for the reduction of undesirable muscle actions that often lead to pain or weakness. Phase I can be divided into 3 stages. These three stages can occur simultaneously.
Dissociation. Dissociation means isolating movement at the level of the hip or shoulder girdle from the movement of the pelvis or spine. Such isolation can be initiated by creating an environment with a large base of support (i.e., lying on the back with assistance aimed at the desired limb movement). Dissociation combined with stabilization provides the desired environment for protection against further spinal injuries. Large muscles, which are often responsible for injuries requiring the use of a brace (e.g., quadratus lumborum, gluteus maximus, and superficial erector spinae) can be “retrained” for atypical extension, allowing the hip to absorb and effectively distribute potentially harmful contractile tensions to the spine.
Stabilization. In the early phase, focus should be on mobilizing deep stabilizers (e.g., transverse abdominis, internal and external oblique muscles, and multifidus). These stabilizers mainly consist of type I fibers and are believed to contract at a submaximal level, meaning less than 30 to 40% of maximum voluntary contraction. Such submaximal contraction occurs simultaneously during the dissociation of limbs or segments above or below the injury. When a limb dissociates from the torso while the pelvis remains in a neutral position, the deep stabilizers effectively maintain control. Effective use of deep stabilizers and reduced muscular protection is consistent with Phase I of rehabilitation as described by Porterfield and DeRosa, aimed at controlling pain and initiating biomechanical therapy.
Mobilization. Mobilization is the recovery of mobility in injured joints and muscles. A therapist can contribute to increasing changes if the mobilization they introduce is too aggressive or premature. However, if mobility is not restored, the injury may continue to worsen. Therefore, appropriate assistance is important for properly restoring correct movement. Exercises derived from Pilates allow the therapist to obtain appropriate feedback and apply assistance to properly restore correct movement in the patient. While the physiotherapist restores mobility to specific joints and surrounding joints, the tension force can be evenly distributed, minimizing destructive forces.
Phase II: Dynamic Stabilization. Dynamic stabilization involves converting newly acquired mobility or stability into a more functional and gravity-dependent environment. This phase continues the processes of dissociation, stabilization, and mobilization from Phase I. By reducing assistance and the base of support or lengthening lever length, the difficulty level of the movement or exercises increases. Once the desired movement is restored, the new movement can be practiced at a level appropriate to rehabilitation goals and expected outcomes. More mobile individuals require slightly greater loads than sedentary patients. The goal is movement efficiency. By implementing principles of breathing and movement early in Phase I exercises, the patient’s ability to mobilize secondary stabilizers (i.e., erector spinae, external and internal oblique muscles, latissimus dorsi, and deep pelvic muscles) improves. The anal muscles should be exercised for more ballistic movements, as they are primarily composed of type II fibers (fast-twitch). In this phase of therapy, we continue to focus on control.
Phase III: Functional Reeducation Specificity and functional mobility restoration (reeducation) are currently very popular procedures in rehabilitation. The Polestar clinic divides functional reeducation into two stages: exercises in a foreign environment and exercises in a close environment.
Exercises in a foreign environment are at the center of researchers’ attention in shaping correct movement motor skills. Most studies indicate that neuromuscular reeducation occurs only through movements focused on specific tasks. To teach a patient to jump on one leg, the exercises must consist of jumping on one leg. It has been proven through experience that transitioning a patient too early to exercises in a close environment can lead the patient to seek the path of least resistance and revert to old movement habits. For example, if a patient cannot tolerate jumping on one leg under the influence of gravity, they should be asked to lie on their back and perform jumping movements with gravity factors eliminated. In a foreign environment, the desired movement can be replicated with less proprioceptive load and lower destructive forces, and with appropriate verbal and movement cues, the process of shaping correct movement motor skills can be facilitated by allowing the patient to perform the given movement correctly.
Close environment. At the stage of close environment exercises, the patient is restored to a specific movement task in their daily living environment. The movement task mastered in the foreign environment is transferred to the close environment with normal gravitational orientation. The patient then practices to develop appropriate endurance and movement efficiency in the close environment. Movement and verbal cues in the foreign environment are repeated to facilitate the association of each correct movement with the desired task. The goal is to develop autonomous movement. In summary, shaping correct movement motor skills depends on trunk control. Recent studies show that exercises derived from Pilates are an excellent tool for rehabilitation.
Principles of Biology and Physiology Related to a Pilates-Based Approach
Exercises derived from Pilates have many biomechanical and physiological properties necessary for rehabilitation. Below, we will discuss the latest research related to connective and nervous tissues as well as the musculoskeletal system. We will also discuss anthropometry as a contributing factor to creating effective therapy.
Connective Tissue. Connective tissue provides support to organs and distributes internal tensions within the body, allowing for the maintenance of structural integrity. Connective tissue consists of cells and extracellular matrix made up of fibers and intercellular substances. The elasticity of connective tissue largely depends on the ratio of collagen fibers to elastic fibers present in the tissue. A significant portion of connective tissue is avascular or hypovascular. Lack of vascularization would mean that nutrients are absorbed through changes in pressure gradients, osmosis, and chemical and electrical concentration. Pilates-based exercises provide a closed-chain environment that regulates the compressive and decompressive tensions acting on connective tissue. It can be hypothesized, based on animal studies, that degeneration often experienced due to immobilization or lack of compressive and decompressive sources can be as destructive to cartilage as cartilage overuse. Many changes in connective tissue, such as osteoarthritis, osteoporosis, disc degeneration, chronic arthritis, myofascial pain syndromes, and damage to cartilage and ligaments, can develop due to closed-chain movement with changing loads.
Nervous Tissue. Dysfunction of the peripheral and central nervous systems is still perceived in research as a source of orthopedic pathologies. The nervous system can be temporarily altered; become ischemic; and provoke symptoms such as pain, paresthesia, weakness, and reduced motor control. Often these signs and symptoms are observed in traditional orthopedic diagnosis, but the symptoms do not respond to traditional treatment methods such as injections, cross-friction massage, ice, or muscle stretching. Therapists often achieve good results in reducing the above symptoms through mobilization of the nervous system and its connective tissue. It can be hypothesized, as described by Butler, that in cases that have not been successful, more traditional activation methods (i.e., joint and soft tissue mobilization, static rest, bracing, or stabilization exercises) will work well for movement, and more specifically – mobilization of the nervous system and its connective tissues. Pilates-based exercises can serve as a technique for mobilizing the nervous system and the surrounding connective tissues.
Skeletal Muscles. Skeletal muscles can greatly benefit from exercises derived from Pilates. Unlike traditional methods of working with muscles that focus on maximal voluntary contractions, Pilates-derived exercises mobilize the most efficient motor units. This form of mobilization allows for a focus on energy efficiency and movement quality. Physiologically, most muscle mobilization during daily activities occurs in postural muscles, which mainly contain type I fibers. By exercising postural muscles in the appropriate sequence, the therapist can help the patient achieve more effective static and dynamic postures and significantly reduce the likelihood…podobieństwa wystąpienia sił niszczących powodowanych przez pacjenta. Richardson i inni odkryli, że tradycyjna metoda wywoływania odizolowanego wolicjonalnego kurczu nie jest najlepsza do ukształtowania odpowiedniego ruchu lub doprowadzenia do zmian w postawie ciała. Fizjoterapeuci, którzy stosują ćwiczenia wywodzące się z pilatesu potwierdzają na podstawie swojego doświadczenia, że najlepsze efekty dają mechanizmy wyobrażeniowe oraz mechanizmy sprzężenia zwrotnego zamiast wywoływania maksymalnych woluntarnych kurczy lub wyizolowanych kurczy mięśni, w celu zwiększenia ich siły.
Sekwencje ruchów na różnych urządzeniach do ćwiczeń pilatesu pozwalają terapeucie na modyfikacje obciążenia, w celu osiągnięcia precyzyjnych i skutecznych ruchów u pacjenta. To podejście jest poparte podstawowymi zasadami biomechaniki oraz fizjologii mięśni, takimi jak krzywa mięsień-długość-napięcie lub trening szybkościowy. Zróżnicowanie siły i mechaniki łączeń i dźwigni poprzez łuk ruchu może być zgodne z zasadami krzywej mięsień-długość-napięcie lub prędkości ruchu. Na przykład, największe wspomaganie może być zastosowane na początku oraz na końcu łuku, gdzie siła jest najmniejsza, natomiast mniejsze wspomaganie jest potrzebne na środku łuku, gdzie siła jest największa. W razie dynamicznej stabilizacji, największy opór jest stosowany na środku łuku ruchu, gdzie dostępny moment siły jest największy. To jest również zakres, w którym pacjent jest najmniej podatny na uszkodzenia. Zmiana prędkości ćwiczeń również może zmienić fizjologiczne reakcje mięśni, pozwalając na odpowiednie zaprojektowanie sekwencji ruchów, w celu odzwierciedlenia pożądanego zadania funkcjonalnego pacjenta.
Anthropometry. Anthropometry deals with the measurements of the human body in relation to size, weight, shape, and internal properties of the organism. In the context of Pilates-based exercises, the exercise equipment adapts to the needs of specific individuals. For example, the springs, ropes, and footbar of the clinical reformer can be adjusted to accommodate the movement properties of a given patient. The extensive adjustability of the reformer allows for working with patients of varying weights and heights. A good example is the hamstring exercise on the clinical reformer. The goal of the movement sequence is to teach the patient dissociation of movement at the hip while simultaneously neutralizing the movement of the pelvis and lumbar spine. The foot straps, as extensions of the ropes, are secured to the feet. The springs are set to keep the legs elevated effortlessly at an angle of approximately 45 degrees. If the patient has long legs, the ropes can be lengthened to provide the same level of support as for someone with shorter limbs. If a limb is heavy due to muscle or fat mass, the springs can be more tensioned to balance the weight of the lower limbs, allowing them to move with control while maintaining control over the pelvis and spine. The flexibility of the environment can take into account many anthropometric configurations.
Conclusions. Analyzing the latest theories on shaping correct motor movement, principles of biomechanics, neuro-musculoskeletal physiology, and anthropometry, it is clear that Pilates-based exercises are a very effective method for movement re-education. This method should be further researched as an important, cost-effective, and efficient approach in rehabilitation, post-rehabilitation, and recreation. The application of Pilates-based therapy in various types of rehabilitation, from neurological rehabilitation combating chronic pain, orthopedic, to pediatric, deserves the best possible examination.
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.