PilatesJessica Miller

Objectives• List the benefits of Pilates• List the 6 principles of Pilates• List 3 Pilates exercises that can be performed

when rehabilitating a TKA• List 3 Pilates exercises that can be performed

when rehabilitating a THA• List 3 Pilates exercises that can be performed

when rehabilitating LBP

What is Pilates?

• Low-impact, complete body workout• Develops body awareness• Strengthens core muscles• Improves stability and support in the body.

History• Joseph Pilates• Germany 1880• Sickly child• Skilled gymnast, skier, boxer and wrestler• WWI he taught Mind and Body = Contrology• U.S. in 1926, New York Ballet• Pilates (1967)• Became popular with Hollywood

6 Pilates Principles

BreathingConcentration

CenteringControl

PrecisionFluidity of Movement

Breathing• Diaphragmatic• Improve efficiency of lung function and blood oxygenation• Increase mental focus• Improve ability to relax• Increase overall ribcage mobility• Encourage efficient exhalation• Assist posture, musculoskeletal function and movement

patterns

Concentration

• All moves should be done as conscious acts• Conducive environment• Calming mood• Soothing background music• Don’t let the mind wander, keep focused on the

movement

Centering

• Abdominals should contract before initiating any movement

• Exercises centered on “Powerhouse”• Use proper alignment and form

Control

• Mind and body control• Slow and controlled movements• Constant speed• No jerky or meaningless movements• Several muscle groups engaged

Precision

• Body Awareness• Appropriate placement of limbs• Correct alignment• Execute each exercise as best you can• “Honor every movement”

Fluidity of Movement

• Continuous motion• Smooth and slow movement• No jarring repetitions• Energy flows through body evenly• No beginning or end• Body constantly in motion during each

exercise/transition

Pilates and Rehabilitation• Start integrating this principles into your interventions

• Encourage patients to implement these with their HEP

• "The principles of Pilates are awesome for rehabilitation, but if they aren't used in conjunction with proper therapy techniques it could aggravate the injury.”

• Benefits of Pilates

Benefits of Pilates

• Core strength and good posture• Balance and Coordination• Mobility and learning to move efficiently• Joint flexibility and long lean muscles• Create an evenly conditioned body• Gentle but challenging as well as adaptable • Refreshing mind and body workout

Pilates Rehab for TKA and THA• More THA and TKAs are being performed

• Shorter hospital stay and quicker recovery

• Less invasive surgical techniques allow rapid rehabilitation

• Pre-op and rapid post-op rehab may improve patient’s balance and coordination as well as gait adaptations

• Proposed advantages of utilizing Pilates:• Maximizing pre-op function• Develop a pathway for return to outpatient exercise• Promote whole body approach to post-op rehab

Pilates for Rehab Purpose• 1. Introduce Pilates into orthopedic community as

a safe way to restore function

• 2. Describe an improved program suited to all levels of skill that can be continued as a long term maintenance program

• 3. Review a series of patients having completed the rehab programs at 1 year follow-up

• 4. Pilates can be a viable option for rehabilitation

Pilates Field Observation Facts38 Patients (30 Women, 8 Men)

THA• 22 Patients, average

age 46 years• Pre-Operative

Diagnoses:• 16 Osteoarthritis• 4 Osteonecrosis of

femoral head• 1 Hip Dysplasia• 1 Lupus Erythematous

TKA• 17 Patients, average

age 55 years• Preoperative

Diagnoses• 14 Osteoarthritis• 3 Inflammatory Arthritis

Exercise RegimenPre-Operative

Regimen

• Adapted to meet pt needs

• Pre-op exercise 3-4x/week for 1-2 hours

• Exercises recommended: Week 2-6 in Tables

Post-Operative Regimen

• Early post-op exercises should be modified and begin 2 weeks after hospital D/C

• 3-4x/week for a minimum of 1 hour

• Progression can occur according to pain levels, quality of movement and as the MD permits

• Pilates can be an enjoyable approach that can be molded into a maintenance program

Pilates Rehab Protocol for TKA

Pilates Rehab Protocol for THA

Pilates Field Observation Results

• 1 year follow-up by charts and phone calls• 25 Extremely Satisfied w/ outcome• 13 Satisfied w/ outcome• 73% of women continued after rehab• Advantages:• Pre-op exercises to improve function• Implement exercises into HEP• Adaptability of exercises for joint precautions and

restrictions

Chronic Low Back Pain• 70% of adults suffer from LBP at some point

• 90% of LBP cases seem to be non-specific

• 15% of people develop LBP and have persistent pain one year after initial episode

• Exercise therapy is one of the most common recommended treatments for chronic LBP

Clinical Pilates• Theory based exercise regimen founded on rationale of

improving segmental stability and functional movement

• Adapted from traditional Pilates by physiotherapists

• Described as an exercise based on the Pilates Method adapted for rehabilitation purposes

• Treatment for chronic LBP using Clinical Pilates have shown a reduction in pain and improvement in function compared to no tx, but no significant difference compared to other forms

Pilates and LBP Pilot Study• 15 Participants

• Skilled Clinical Pilates Exercise Program • Spring resistance used with Reformer• Strength, Endurance and Stability Exercises• 1 hour 2x/week for 6 weeks

• Home Exercise Program• Floor Exercises• 30 minutes 3x/week for 6 weeks• New HEP for 26 weeks after skilled intervention

LBP Exercises• Pelvic Tilt• Bridge with Pelvic Tilt• Chest Lift• Swan Prep• Child’s Pose• Kneeling Arm and Leg Reach• Cat/Cow• Spine Stretch• The Saw

LBP Pilot Study Outcome• Statistically significant improvement in all measures

from the start of the intervention to the 6 weeks

• No significant differences from 6 weeks to 26 week F/U, note pt adherence had gone down

• Findings indicate improved function and decreased pain levels maintained for 26 weeks

• Clinical Pilates can be equally effective as other stabilization exercises

References:• Levine B, Kaplanek B, Jaffe W. Pilates training for use in rehabilitation after

total hip and knee arthroplasty: a preliminary report. Clinical Orthopaedics & Related Research [serial online]. June 2009;467(6):1468-1475. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 8, 2012.

• Swann J. The power of Pilates. Nursing & Residential Care [serial online]. October 2009;11(10):520-523. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 8, 2012.

• Taylor L, C., Dean S. Can clinical pilates decrease pain and improve function in people complaining of non-specific chronic low back pain? A pilot study. New Zealand Journal Of Physiotherapy [serial online]. March 2011;39(1):30-38. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 8, 2012.

• Bodylines Pilates, Orchard Hills Athletic Club. The Six Principles of Pilates. Bodylines Pilates. Available at http://www.bodylinespilates.com/principles.html. Accessed 14 Nov 2012

• Pilates Reformer Overview. Pilates Overview. Pilates Reformer. Oct 24 2012. Available at http://pilatesreformer.com/overview/. Accessed 15 Nov 2012

• http://www.youtube.com/watch?v=Fi72rEFT0zc