By Beth Scalone, PT, OCS
What is Pilates?
Pilates exercise was originally developed by Joseph H. Pilates in the early 1900’s. He first developed his “mat work” exercise to be done on the floor, calling this regimen “contrology.” Later, during World War I, he was based in a camp where he became a nurse/caretaker to those struck with wartime disease and injury. It was here he began to develop equipment to allow his patients to perform the exercise. Pilates exercise emphasizes core strength and stability. It strengthens, tones, improves posture, enhancing muscle flexibility and balance while uniting the body and mind. Unlike some exercise programs, quality of movement is emphasized over quantity.
Benefits of Pilates
- Safe and effective exercises
- Increased flexibility with stability
- Improved postural alignment
- Increased abdominal activation and lower back strength
- Increased pelvic stability and muscle balance in larger muscle groups
- Improves performance in sports
- Increased cervical and thoracic stability
- Increased motivation and self-confidence
Types of Pilates
There are two main types of Pilates: First, the traditional/New York school in keeping with the original work (exercises and sequencing) of Joseph Pilates. Second, STOTT PILATES, a program that incorporates modern biomechanical principles and spinal rehabilitation principles with the original work, creating a safer, more effective technique for a wide range of individuals.
The term Pilates refers to a type of exercise and not a trademark, therefore be sure the individual you choose to work with is properly trained. This includes a comprehensive training course through a reputable training facility (see resources at the end of this factsheet). Since instructors can be trained on floor exercises and various pieces of equipment, it is important that your instructor has been properly trained on the equipment you will use during your workouts. Properly trained instructors will be able to adapt the program to meet your needs.
Pilates Equipment
Equipment used in Pilates creates versatility and improves effectiveness of the exercises. The equipment allows for modifications for those with injuries or limitations. The main pieces of equipment utilized are the Reformer, Cadillac/ trapeze table and the stability chair. These larger pieces of equipment use springs to provide various levels of tension. Smaller pieces of equipment are used for increasing or decreasing the difficulty of an exercise. These include the arc barrel, spine corrector, fitness circle, foam roll, rotational discs and resistance bands.
Adapted Pilates
Pilates is ideal for persons with disabilities. There are hundreds of exercises and modifications can be made. The exercises involve concentration, control, precision and fluidity of movement, and coordinated breathing patterns within the individual’s ability to maintain central core stability.
To gain the most benefit from Pilates exercise, individuals are encouraged to work with a trained professional. Learning the basic principles and how to modify the exercises is the key to safe and successful training.
Pilates for Individuals with Spinal Cord Injury
Unlike typical weight training, Pilates training (mat work and equipment-based exercise) focuses on facilitating the smaller stabilizing muscles. These smaller muscles are necessary to restore normal function. The resistance is kept low enough for the correct muscles to activate without overworking larger muscle groups, thus preventing overuse injuries, especially at the neck and shoulders, an area in constant use for individuals with SCI.
Sample Warm-Up for SCI with Emphasis on STOTT Pilates Five Basic Principles
Before starting any exercise program, get clearance from your physician. The following is a general warm-up for individuals with paralysis and may require modification based on individual abilities. To get the most out of Pilates, it is recommended you work with a qualified instructor to develop an individualized program. Having a solid understanding of the basic principles will increase your skill level and mindfulness and allow for increased control in performing Pilates exercises.
Breathing:
A primary component of Pilates is the mind-body connection and the use of breathing to relax and release neck tension while facilitating abdominal muscle contraction. Encouraging a full breath for improved oxygenation while focusing the mind on the muscles that should be activated can facilitate healing and improve body awareness.
Breath control warm-up– Starting position: Sit tall with upper back away from chair back, ears over shoulders, shoulders over hips, neutral spine, eyes and head level. Try to minimize the pressure through your arms. (This can also be done lying on your side or back with knees over a pillow or arc barrel.)
Take a deep breath in through the nose, expanding your rib cage out and back, release blowing out through your mouth (you should hear the air as it passes through your mouth; if not, you are not exhaling with enough effort). As you exhale, engage your abdominal muscles, drawing your belly button towards your spine. Make sure your neck muscles stay relaxed. Repeat 3 to 5 times.
Pelvic Placement:
The ability to achieve good postural alignment in an upright position is directly related to pelvic stability. This involves a balance of abdominal, lower back, and pelvic floor musculature. A person with paralysis will require assistance and support for ideal alignment. Often, individuals with SCI have lost the ‘connection,’ but with training can often gain some awareness and improved balance and posture.
Tilt and release– Lying on your back with hips and knees flexed over a pillow or arc barrel, inhale to prepare. On the exhale, draw your lower ribcage and front of your pelvis closer together using your abdominals, creating a slight flexion (gentle lengthening) of your lower spine. Inhale and release back to neutral. Repeat 5 to 8 times.
Rib Cage Placement:
The abdominal wall attaches to the lower ribs. The abdominal muscles must often be recruited to maintain the ribcage and, indirectly, the thoracic spine in good alignment.
Arm Raises– Start on your back with knees and hips flexed over a pillow or arc barrel. Inhale and reach both arms over your head as far as you can without the front of the ribcage lifting toward the ceiling. Exhale and return arms to your sides. If you are unable to perform this exercise, reverse the breathing pattern and exhale to tighten the abdominals as you lift the arms. This will assist in keeping the ribcage in place. Repeat 5 to 8 times.
Scapular Movement and Stabilization:
Stabilizing the scapulae (shoulder blades) on the ribcage is very important. When this does not occur, there is a tendency to overwork the upper trapezius and other muscles around the neck and upper shoulders.
Scapular movements– To become more aware of your shoulder blades, move them up towards your ears and then relax the shoulders and gently draw your shoulder blades down and back in a V pattern. Next, bring your shoulders forward and then draw back and down. At no time should you be jamming or pinching the shoulder blades.
Head and Cervical Placement:
The cervical spine should hold its natural curve, with the ears in line with the shoulders when sitting in neutral. Many individuals with trunk weakness and paralysis tend to bring the chin forward and overuse the cervical muscles to help maintain balance. In most instances during Pilates exercise, the cervical spine should continue the line created by the thoracic spine.
Head nods– On your back, inhale and gently nod your head without lifting from the surface, gently lengthening the back of your upper cervical spine. Exhale and return to neutral. You may require a pad or towel under your head to avoid excessive tension of the neck muscles. Repeat 5 times.
Special Considerations in Respect to Exercise and SCI
- Some individuals with SCI have rods and other hardware implanted to stabilize the spine. There will be decreased movement at these spinal segments, and forces through these areas should be minimized. End range of bending and extending (arching back) should be avoided. Positioning in neutral will allow the individual to work the appropriate muscles while minimizing stress to the joints.
- For important considerations on exercise for individuals with SCI, please refer to NCHPAD’s resource on Spinal Cord Injury and exercise.
- When using Pilates equipment, a trained instructor should be spotting the individual at all times to ensure safety.
Additional Equipment for Adapted Pilates
Straps, grip-assistive gloves (for those individuals with inadequate grip strength), wedges and pads may all be needed in addition to the basic Pilates equipment. The wedges and pads can be used to support the spine to assist the client in maintaining proper alignment.