What is Clinical Pilates and why has it made such an Impact?

What is Clinical Pilates and why has it made such an Impact?

Clinical Pilates has been shown to reduce the onset, persistence and recurrence of pain by addressing the neuromuscular dysfunction it is associated with.

Clinical Pilates is largely concerned with training local spinal and pelvic stabilising muscles to work efficiently throughout functional activity. It is particularly important in the rehabilitation of spinal pain amongst other motor control problems and is associated to what researcher’s term “specific stabilisation exercises” or “motor control exercise”.

With the latest research emerging, evidence-based Physiotherapists have re-evaluated their management of low back pain with a shift towards this type of exercise rather than focus on strength and endurance, which is perhaps more appropriate in the advanced stages of rehabilitation.

CLINICAL PILATES involves the following components which are particularly helpful to aid in the rehabilitation of low back pain:

1. Teaches co-activation of Transversus Abdominis (TA), Pelvic Floor (PF) and Multifidus (MF) muscles

Research into muscle dysfunction in patients with LBP has identified motor control impairments in the deep muscles of the trunk. These muscles normally contract in anticipation of movement to increase stability of the spine and pelvis. This anticipatory function is lost in patients with LBP and not restored with the resolution of symptoms  therefore requiring specific retraining.

1. Teaches correct muscle activation patterns

A focus on low load high repetition optimizes tonic recruitment of the Type 1 stability muscles. Researchers suggest a prolonged low intensity (submaximal) contraction is effective in retraining the stability function of TA and MF.

Further research proposes that specific exercises to train the deep abdominal muscles address any motor control deficits and this stability can provide the basis for more skilful functional activities.

3. Trains local and global stability systems

Functional spinal stability is dependent on the integration of local and global muscle systems . Clinical Pilates progresses from basic exercises which recruit stability muscles separately to more complicated exercises that involve the larger, more superficial global abdominal muscles.

Researchers  suggest specific exercises which isolate the local muscles independently from contraction of the global muscles has proved to be the most beneficial way of targeting them in rehabilitation programs and ensuring that the correct muscles are being activated.

4. Trains neutral stability before end range stability

Clinical Pilates teaches participants the idea of neutral spine and encourages initial training in neutral and non-provocative postures. Spinal Instability occurring through injury or degeneration can contribute to an increase in the range of the neutral zone which is thought to be a primary source of LBP. This increased zone can be reduced to within physiological limits by re-educating the active system, more specifically the local stabilizers, thus relying less on the passive spinal structures to maintain posture.

5. Progresses static stability to dynamic

This is in line with spinal stabilisation research programs which progress individuals into functional activity and sport specific exercises.

6. Direction specific

Researchers  showed that performing exercises in a direction that does not reproduce symptoms was met with better outcomes than those exercised in provocative directions or with no direction preference. By employing this preference in Clinical Pilates the therapist is able to effectively “treat” the patient whilst they complete their rehab. For example, a patient with discogenic LBP requires extension biased exercises versus a patient with spondylolithesis with flexion biased exercises.

Our Clinical Pilates program focuses on correcting the causative factors which have contributed to acute and recurrent conditions under the supervision of a Physiotherapist. It is a specific and progressive program aimed at Transverse Abdominus, Multifidus, Pelvic floor and Gluteal muscle control to help stabilise the spine, correct posture and improve strength, balance and confidence with movement.

Our small groups, which still provide individual attention, are a great option once pain settles and can lead to enhanced compliance, better improvement and a more successful outcome in the long term versus home programs.