This post is prepared by West 4th Physiotherapy associate Jenny Lehmann
What is “Clinical Pilates”?
Traditionally, “Pilates” was stigmatized as a yoga-like exercise for women, emphasizing core stability. Current research supports its utility in conjunction with conventional physiotherapy to treat various injuries. “Clinical Pilates” is the delivery of classic pilates by a pilates-trained Physiotherapist in the context of rehabilitation. Using their clinical background, your physio can individualize exercises and provide tactile feedback to correct pain provoking movement patterns at the root of your injury.
In attempt to further explain the role of clinical pilates in injury rehabilitation, it’s helpful to understand the term core stability.
In order to achieve mobility, we need stability and vice versa. Mobility explains our ability to move one bone relative to another through our joint’s full available range. Stability is the ability of various muscles to work together as a team to control this range of motion. Small muscles in our body, ie. our “core”, are meant to be constantly active at a low level to stabilize our movements, while larger muscles power these movements. Due to a number of factors, including poor posture and past injuries, our muscles tend to reverse their roles leaving us with stiffness overlying insufficient stability. Clinical pilates aims to optimize our bony alignment, such that we can retrain our muscles to perform their intended role.
Let’s make sense of this with chronic shoulder pain and instability. If the rotator cuff muscles (stabilizers) of our shoulder are insufficiently centering our arm bone in it’s socket, then large muscle groups, such as our lats and pecs start to pick up the slack. Unfortunately, unlike our rotator cuff, they aren’t equipped to stabilize our shoulder all day long. They become tight and fatigued, compressing our ribcage, creating stiffness throughout our thoracic spine all the while ineffectively performing their own job. Have you ever noticed that shoulder pain is often promptly followed by neck pain? This is because, inadequate thoracic/rib cage mobility, dysfunctionally recruits neck muscles to assist with arm movements and breathing
So, what’s the solution? Despite what you may have heard, we can’t always simply strengthen in response to dysfunction and pain. We first need to retrain our muscles to perform their respective roles with an appropriate level of activation, and thus allow our joints to move freely, before we can then control those movements.
In the case of shoulder instability, your physiotherapist may choose to implement clinical pilates to optimize your alignment and retrain your rotator cuff muscles, thus allowing your overworking pecs and lats to return to their day job, all the while improving your ribcage mobility and breathing mechanics- goodbye neck pain!
Let’s also consider the role of clinical pilates in treating three other groups of athletes: Gymnasts have lots of mobility, with relatively inadequate muscular stability. This can lead to inappropriate use of large (power) muscles to offer secondary stability, creating dysfunctional movement patterns leading to injuries such as disc herniations, muscle strains, and dislocations.
The golf swing, which is rarely ambidextrous, utilizes a large range of thoracic spinal rotation in a stooped over position. Due to age or poor posture, many of us lack this thoracic range of motion. As a result, we are forced to move more through adjacent joints, including our lumbar spine, which is relatively intolerant of rotation, and hips. In consideration of these rotational stresses placed on our spine, combined with inadequate core stability to control rotation at our spine and pelvis- you can see how lower back, hip and sacroiliac joint pain are common among this population.
Cyclists, especially triathletes who ride in an aerodynamic position, require a significant amount of hip mobility. This necessitates a high level of endurance of our lumbar and pelvic stabilizers, as both a force platform for power output, but also to allow adequate hip mobility. Insufficient lumbo-pelvic stability, can lead to asymmetrical activation and tension of our hip flexors and gluts in attempt to provide secondary stability. They then become fatigued and not only impair power output, but can lead to various chronic injuries.
In all these cases Clinical Pilates can be effective for both injury prevention and rehabilitation. It aims to optimize our breathing pattern and alignment such that we can recruit appropriate muscle groups to allow us to move through our full available range of motion with adequate stability. It can help us build a strong platform from which to then build strength and power- ultimately enhancing our performance.
Still not sure if clinical pilates can help you? Book a consult with your Jenny Lehmann at West 4th Physio for assessment and a program to get you on the road to recovery.