Pilates

1. Pilates Jessica Miller

2. 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

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

4. 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

5. 6 Pilates Principles Breathing Concentration Centering Control Precision Fluidity of Movement

6. 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

7. 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

8. Centering • Abdominals should contract before initiating any movement • Exercises centered on “Powerhouse” • Use proper alignment and form

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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Pilates Field Observation Facts38 Patients (30 Women, 8 Men) THA TKA 17 Patients, average age 55 years Preoperative Diagnoses 14 Osteoarthritis 3 Inflammatory Arthritis • 22 Patients, average age 46 years • Pre-Operative Diagnoses: • 16 Osteoarthritis • 4 Osteonecrosis of femoral head • 1 Hip Dysplasia • 1 Lupus Erythematous

17. Exercise Regimen Pre-Operative Regimen 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 • Adapted to meet pt needs • Pre-op exercise 3-4x/week for 1-2 hours • Exercises recommended: Week 2-6 in Tables

18. Pilates Rehab Protocol for TKA

19. Pilates Rehab Protocol for THA

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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