Pilates is a unique body conditioning exercise designed to rebalance the body, bringing it, into its correct neutral alignment whilst targeting the deep postural muscles (Transverse abdominals and muscles of the pelvic diaphragm). In essence pilates challenges the core muscles and builds strength from the inside out, helping a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension. The phenomena of pilates is a popular and growing trend in western countries amongst athletes and celebrities, as well as in the treatment of peripheral and spinal musculoskeletal dysfunction. Today pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.

Background

Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever and this fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York and soon went on to open the first pilates studio attracting elite actors, dancers and athletes.

Image from Pilates Suffolk click for larger view

Clinical Pilates vs Pilates

Clinical pilates is used to treat people with musculoskeletal injuries and is conducted by a physiotherapist certified with Clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a cause or a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.

In addition certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class, which does a combination of both flexion and extension exercises.

Not only is it important to select the right type of pilates exercise, it is also necessary to ensure that the correct and appropriate level is prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist having tested your muscle strength and range of movement, will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery. 

The added benefit of clinical pilates to routine pilates is not only is it more individualised to the person and their problem, it can also be more functional. If the person for example is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football and not just in static postures.

Peripheral injuries

When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating Pilates based exercises to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries. 

Spinal Injuries

Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.
Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. In the long term these muscles without exercise will continue to waste further and subsequent muscle spasm in the global and more superficial muscles is experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.

In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.

Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.

In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.

If a person is new to pilates one- to one sessions with a physiotherapist or very small classes is initially strongly recommended, this is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be a little tricky and can easily be done incorrectly and therefore close supervision is required to prevent faulty patterns learnt. 

The benefits of Pilates
 
•    General fitness and body awareness greater strength and muscle tone
•    Improved flexibility
•    A flatter stomach
•    Improved efficiency of the respiratory, lymphatic and circulatory systems
•    Better posture and awareness
•    Less incidence of back pain
•    Increased joint mobility
•    Lower stress level

Which clients would benefit from Pilates?

•    Males and females
•    Pregnant: Pre and post natal
•    Athletes and dancers
•    Amputee and stroke rehabilitation clients
•    Elderly
•    Children 12 years-old +

Clinical pilates therefore  targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates therefore looks at treating the cause as well as selecting the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.

If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!

Pilates and Physiotherapy is a post from: Musculoskeletal Consumer Review

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First 48hrs
Immediate post-injury 

Remember RICER. The ice and compression will prevent severe bruising and swelling. Resting your leg will minimise the strain and prevent further aggravation.

After 48hrs – 4days
Using a compressive bandage would be advised to continue for this period.

1. Ice massage over the area of strain might improve the rate of healing. You may also want to try using contrast treatment (i.e. alternate hot and cold compress).

2. Gentle static stretches for your hamstring should be done. Never stretch into the pain. Stretching at this stage helps to mobilise the scar tissue and prevent it from stiffening.

4. Non-resisted hamstring curl should also be done during this period to speed up rate of recovery.

4 – 8 days
 Start to strengthen your hamstring by doing a resisted hamstring curl. Begin with light resistance for about 15reps for 3 sets. Progress only when you feel the hamstring doesn’t feel achy after completing the 3 sets. Dynamic stretches should be done at least 3x/day. Light jogging can begin at about the 6th day post-injury. Normal activities should be able to be resumed after the 8th day.

Do i need to see a doctor?
Depending on the extent of the strain, one might need to seek a review with either a Sports Physician or a Sports Physiotherapist. The extent of the strain can only be diagnose through a real-time ultrasound imaging (RTUI), which can be done by an experienced Sports Physician. However, in some situation, an MRI might be ordered if the strain cannot be detected through the RTUI.

Moderate to severe hamstring strain will need a more extensive rehab and a longer period of recovery and a referral to a sports physiotherapist is highly recommended to get you back to sports as soon as possible.

Physiotherapy managment
In the acute stage of management, a sports physiotherapist would assess the site of strain and deep tissue mobilization might be required to break down the excessive scar tissues that have been laid down over the site of strain. A therapeutic ultrasound would also be used to speed up the rate of healing and manage the any swelling, if present. Gentle stretches, closely monitored by the sports physiotherapist, would be taught to help align the scar tissues. Kinesiotaping may also be done to aid the healing process.

Following the acute stage (about 1 week), your sports physiotherapist will start to progress your hamstring stretches to dynamic stretches and also to start you on resisted hamstring strengthening exercises. Before you’re able to return to sports, your sports physiotherapists will have put you through some form of agility drills to prepare your muscles for the gruelling demands of the game. This process may take about 2 – 4 weeks, depending on the extent of your injury.

Stretch to prevent a recurrence

The key to prevent a recurrence of this injury is to ensure that you adequately warm up your muscles with static and dynamic stretches before the start of your game and during the half-time break. You should ideally hold each stretch for 15-20 seconds for 3-6 repetitions for the static stretches, and at least 15-20 reps for the dynamic stretches. Read on here for static hamstring stretches.

Enjoy your game.

What can i do for a hamstring “pull” is a post from: Musculoskeletal Consumer Review

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The biggest danger with concussion and head injuries is mis-management. This table indicates common mis-management and its danger.

The key to managing a head injury is speed. The faster you get to the injured athlete, the better the management and information gathered. A team approach is essential. Upon seeing an athlete sustaining a head injury, either through a clash of head or landing on the back of their head and lying on the ground, the following steps should be taken immediately upon reaching the athlete:

1. Stabilize the head and neck, in whatever position the athlete is in. Feel for any tenderness in the neck under your fingers. DO NOT attempt to turn or move the injured athlete.

2. Check for ABC (Airway, Breathing, Circulation) and consciousness. Commence CPR immediately if ABC absent.

3. Call the athlete’s name and observe for response. Note the time to respond, loudness of voice, quality of voice. If no response, keep calling the athlete’s name until there’s a response to your calling by the athlete and CALL for ambulance.

4. If blood is present, try to look for the source of bleeding and attempt to stop the bleeding.

5. Check whether the athlete is able to wriggle his/her toes and fingers, and followed by asking them to move their arm and legs. If athlete is unable to move, DO NOT MOVE them. CALL for ambulance. Stay with them until further medical assistance arrives.

6. If the athlete is able to move his/her fingers and toes and there’s an absence of tenderness over the neck, move them out of the field on a stretcher. While transferring the athlete onto the stretcher, ensure that the head is immobilized with a head collar.

If the athlete wasn’t lying on the ground and was able to walk around after the collision, take them off the field. When out of the field, check the following:

1. Ask them whether they remembered what happened. If they’re unable to recollect what happened, they SHOULD NOT be allowed to continue play.

2. Observe for any nystagmus of their eyes (i.e. quick shifting of their eye balls left to right) when you ask them to track your index finger as you move it left to right and up and down. Also note for any inability to track. If unable to carry out this action, they should NOT continue.

3. Check for any blurred vision, loss of hearing, nausea or pain over any other part of head other than the place of impact. Presence of any of these would require close monitoring and the athlete should leave the game.

4. Check for balance and ability to carry out footwork or skills required for sport.

The injured athlete should ONLY be allowed back into the game after all the above has been checked and they are normal.

If any of the above signs are present, you’ll need to repeat these tests at regular intervals of 5mins. These athletes should not leave your sight and you should monitor them very closely. Generally, the athlete should regain all normal functions in about 20-30mins. Nevertheless, refer them to the A&E Department if you’re in doubt. Also, it’s better to inform a family member or a teammate to observe for any vomiting or increase in headache or confusion for up to 72hours post injury. If noted, the athlete should be rushed to the hospital IMMEDIATELY.

Once found to have a concussion, the athlete should not be involved in any form of contact sports for a duration of about 3 weeks before returning back to sports. The return to sport should also be gradual and they should be not allowed to go back to a high level of competition immediately.

On-field management of Head Injuries and Concussion is a post from: Musculoskeletal Consumer Review

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