September 2011 Newsletter

Archived Newsletters

Pilates
By Dr. Stephen A. Hunt

Joseph Pilates is the father of one of the fastest growing exercise routines. A self-educated nurse-physiotherapist during WWI, he is credited with labeling the center of the human body as the "core" and the "powerhouse."

From 2000-2006, the rate of growth of this exercise routine has risen by 613%. It was the seventh most popular fitness activity in 2009, according to a survey by the American College of Sports Medicine. In spite of this popularity, it is unclear as to the efficacy of Pilates programs for preventing injury or as a means of rehabilitation for musculoskeletal injuries.

What is Pilates?
Pilates defined the “core” as a box delineated by the parallel lines running from shoulder to shoulder and hip to hip, with the sides being the torso. However, extremity strengthening is an important component of the regimen, and the true essence of Pilates includes total core strengthening plus total arm strengthening and total leg strengthening. Pilates also incorporates a mental component through the following principles: centering, concentration, control, breathing, precision and fluidity. Protecting the spinal column is an important aspect of the program, and abdominal hallowing or drawing the belly button towards the spine is a central exercise.

Pilates emphasizes motor learning, alignment and muscular development through a progression of more complex exercises. These progressions occur by using gravity, shifting support and changing the length/tension of levers on Pilates apparatuses. The Reformer and the Trapeze table (“The Cadillac”) are two examples of Pilates apparatuses and are the end results of Pilates’ work during WWI to help rehabilitate injured captives at their bedside by using the bed and a variety of resistive devices (usually bedsprings). While there now are a multitude of other devices, the core principles have remained the same.

Does it work?
Pilates exercise programs are a sure thing for an excellent workout. However, it is less clear if there is truly a benefit for rehabilitating an injury. Several studies have demonstrated a reduction in body mass index in participants in Pilates program versus other programs. They have also shown improved muscle-firing patterns of the lower abdominal muscles. Whiles studies have shown Pilates to be effective for people suffering from low back pain, they have not proven it to be superior to other rehabilitation techniques. It is difficult to analyze many of these studies, as there are often a variety of techniques utilized instead of the classic Pilates program laid out in Pilates’ books from the 1930s and 1940s.

Conclusion
Pilates is an excellent workout program focusing on core strengthening and stability. While it is unclear whether this exercise program is appropriate for all types of musculoskeletal injuries, it is certainly useful in our armamentarium of rehabilitation programs.

REFERENCES:

1. DiLorenzo, CE. Pilates: What is it? Should it be used in rehabilitation? Sports Health. 2011; 3 (4): 352-61.