Functional Re-education: Rehabilitation in Pilates Part 3
Phase III Functional Re-education
According to Polestar, this re-education is divided into two stages: re-education in an unfamiliar (foreign) environment and re-education in a familiar environment.
-
Unfamiliar Environment (Foreign)
Most studies show that neuromuscular re-education is reflected only in movements specific to a given task. For example, to teach a patient how to jump on one leg, practical exercises should consist of jumping on one leg. It has been clinically confirmed that too quick a reintegration of the patient into a familiar environment can lead them to seek the path of least resistance, resulting in a return to old habits, often pathological.
In the unfamiliar environment, the desired movement can be performed with less proprioceptive load and less destructive force load, while providing the patient with the necessary verbal and tactile cues that facilitate the motor learning process and allow for the correct execution of the movement. For example: if the patient does not tolerate jumps against gravity, they may assume a lying position on their back and be asked to jump with gravity eliminated.
-
Familiar Environment
At this stage, the patient returns to performing movements in their daily environment. The motor task learned in the unfamiliar (foreign) environment is transferred to the known, everyday environment, with normal orientation and gravity. The patient is then motivated and encouraged to build appropriate endurance and movement efficiency in the familiar environment. Tactile and verbal cues used in the foreign environment are repeated to link each correct movement with the desired task. The ultimate goal is for the movement to become autonomous.
Biological and Physiological Foundations of Rehabilitation Based on Pilates
The method developed by Pilates has various biomechanical and physiological properties that can support rehabilitation. This is confirmed by current research on connective tissue and the musculoskeletal-neurological system. Additionally, anthropometric methods can indicate Pilates as a factor conducive to effective rehabilitation and injury treatment.
Connective Tissue
Connective tissues provide support, compensate for forces, and maintain the structural integrity of the body. All connective tissue consists of cells and extracellular matrix. They are made up of fibers and intercellular substances. The elasticity of connective tissue largely depends on the ratio of collagen fibers to elastic fibers, while a large part of it is devoid of blood vessels or has very few. These vascular deficiencies cause nutrients in the tissue to be transferred through changes in pressure, osmosis, chemical and electrical reactions. There is a hypothesis based on research conducted on animals that degeneration,
often occurring with immobilization or lack of compression and decompression, can be just as destructive to connective tissue as excessive loading.
Pilates-based exercises provide an appropriate closed-chain environment that enhances the action of compressive and decompressive forces on connective tissues, and consequently – the exchange of nutrients in the tissues. Many pathological changes in connective tissue, such as: osteoarthritis, osteoporosis, degenerative disc disease, chronic arthritis, or myofascial pain syndromes, can be rehabilitated through movement in a closed chain, when the load is modified.
Nervous Tissue
Damage to the central and peripheral nervous systems is still considered one of the more significant sources of orthopedic pathologies. Even temporary dysfunction of the nervous system can lead to ischemia, and thus to pain syndromes, paresthesia, muscle weakness, and impaired body motor function. Often these symptoms resemble traditional orthopedic conditions, and such diagnoses are frequently made initially; however, the symptoms do not respond to traditional treatments such as injections, massage, cryotherapy, or muscle stretching. Doctors and therapists often experience success in reducing disease symptoms through the mobilization of the nervous system and the surrounding connective tissue structures. One can hypothesize, as described by Butler, that cases where more traditional methods fail (i.e., soft tissue and joint mobilization, static rest, strengthening or stabilizing exercises) yield better results through actions related to movement or mobilization of the nervous system and connective tissue, such as during Pilates exercises.
Skeleton Muscles
Thanks to the use of exercises developed by Pilates, one can effectively influence the skeletal muscles. Unlike traditional modes of working on muscles that aim for maximum voluntary contractions, Pilates focuses on engaging the most efficient force units. This form of muscle engagement allows for an appropriate emphasis on energy efficiency and the quality of the performed activity. Physiologically, the greatest muscle activity in daily functioning involves postural muscles, which mainly contain type I fibers. By setting the movement of postural muscles in the correct order, the therapist can help the patient improve their effective static and dynamic posture and significantly reduce the likelihood of destructive forces acting. Literature has described that the traditional method of obtaining isolated voluntary contraction is not the most effective way to teach patient movement or facilitate postural changes. According to the philosophy of the Pilates method, movement efficiency is best facilitated through imagery and the use of feedback mechanisms rather than eliciting maximum voluntary contractions or single muscle contractions to develop strength. Movement sequences on various Pilates machines provide the therapist with great opportunities to modify the load to facilitate the efficiency of a given movement. This is confirmed by the fundamental principles of biomechanics and muscle physiology, such as the muscle tension curve and speed training.
Anthropometry
This is a method of research used in physical anthropology, involving comparative measurements of parts of the human body, e.g., bone lengths (osteometry), volume and proportions of the skull (craniometry), head (cephalometry), body proportions (carpometry), body mass, eye spacing, pigmentation of eyes, hair, and skin, etc.
In Pilates training, the equipment is adapted to many different conditions of the human body. For example, the springs, ropes, and footbar on the reformer can be adjusted so that similar movement sequences can be applied to different body types. The ability to adjust the reformer allows the therapist to take into account various individual body characteristics, such as weight or height. For example – the goal of the sequence is to isolate the movement at the hip while keeping the pelvis and lumbar spine in a neutral position, the straps on the feet are attached to the feet, and the springs are set to keep the legs effortlessly in flexion (about 45 degrees). If the legs are long, the ropes can be lengthened to provide the same level of assistance that can be provided for a person with significantly shorter lower limbs. If a limb is heavy due to muscle mass or fat tissue, the springs can be lengthened to balance the weight of the limbs and control the position of the pelvis and spine. Thanks to the flexibility of Pilates machines, many anthropometric configurations of the human body can be taken into account.
Conclusions
In understanding current theories of motor learning, biomechanical principles, physiology, and anthropometry, the method developed by Pilates can be assessed as a realistic and effective form of movement re-education. The application of Pilates exercise principles in various fields of rehabilitation, including neurological, pain management, orthopedic, and pediatric rehabilitation, proves to be very helpful and effective.
Part II “Dynamic Stabilization”
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.