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Why Pilates works in injury rehab and prevention

This is an excerpt from Pilates for Rehabilitation by Samantha Wood.

Pilates is a great tool to assist or even enhance a physiotherapy program when someone is recovering from an injury. By strengthening the deepest muscles of the core, optimizing alignment, and creating correct movement patterns, we can also help to prevent reaggravation of those injuries and the development of new ones. PTs are always searching for a system that can take patients from the early stages of rehabilitation to the long-term goal of a conditioned, efficiently functioning body. Pilates is that system! Other rehabilitation professionals often ask me, why do you think Pilates works so well in injury rehab and prevention? Here are what I see as the 10 fundamental reasons, both scientific and practical, that Pilates is so effective in injury rehab and prevention.

10 Fundamental Reasons Why Pilates is Effective in Injury Rehabilitation and Prevention

1. Pilates focuses on the center or core muscles.
2. Pilates exercises emphasize both stability and mobility.
3. Pilates includes both closed-kinetic-chain and open-kinetic-chain exercises.
4. Pilates exercises work muscles statically and dynamically - emphasizing both concentric and eccentric muscular contractions.
5. Pilates exercises are functional.
6. Pilates places an importance on breathing appropriately.
7. Pilates is adaptable for many different patient populations.
8. Pilates is a mind - body form of conditioning.
9. Pilates equipment is safe and easy to use (with proper training).
10. Pilates is a wise business choice to expand your wellness services.

2. Pilates Exercises Emphasize Both Stability and Mobility

A strong, optimally functioning body must be both stable and mobile. Adequate stabilization proximally enables us to attain optimal function distally. Take, for example, a tennis player: he must have proximal strength and stability of his shoulder girdle, yet tremendous mobility in the arm to be able to efficiently hit the ball. If the shoulder is weak or unstable it is likely that an injury will occur over time. The common tennis injury lateral epicondylitis, or tennis elbow, is often caused by late strokes and "wristy" impact due to a lack of scapular stability, which places too much stress on the elbow and wrist joints. One of the ways we treat this is to strengthen the muscles of the arm, shoulder, and upper back to help take stress off of the elbow. Can we do this with Pilates exercises? Absolutely! However, if the shoulder girdle is so stable that it doesn't move, it is not possible to raise the arm overhead into the proper position to deliver a powerful serve. Thus, exercises that mobilize the shoulder complex are also important, and there are many of these in the Pilates repertoire as well.

Being too loose (hypermobility) or too tight (hypomobility) can both lead to injuries and pathologies. Weight-lifting regimens often emphasize stability to the point where the person is so stable he or she cannot move. Certain types of yoga or stretching programs, on the other hand, focus so much on stretching that people end up with a weak core and hyperflexibility, which can lead to conditions of instability.

In Pilates, some of the exercises focus on stability (front support), some focus on mobility (kneeling arm circles) and many provide a perfect combination of both (diagonal pull). Thus, Pilates emphasizes both stability and mobility, allowing us to achieve optimal performance and helping to prevent injuries.

Stability + Mobility = Agility. (Brourman, 2010)

5. Pilates Exercises Are Functional

The three previous fundamentals establish that Pilates exercises enhance both stability and mobility; include both open- and closed-chain exercises; and work the muscles statically and dynamically (emphasizing both concentric and eccentric phases). All of this leads us to reason 5: Pilates is a very functional type of exercise.

When functional movements such as walking or running are performed, a single muscle does not work in isolation. Such movements often involve multiple muscles - some working concentrically, some eccentrically, and some isometrically - in a highly coordinated manner to achieve the desired action. Many Pilates exercises simulate everyday activities, which makes them perfect for injury rehab and prevention. Looking again at the example of a biceps curl machine at the gym, the client is seated on a chair with the trunk completely supported and the arms resting on a platform. The motion is to bend the elbow against resistance, resulting in isolation of the biceps muscle and emphasis only on the concentric phase of the movement. How often in life do we need this type of strength? Not often unless we are arm wrestlers! More frequently we need to be able to perform such tasks as lifting our carry-on bag and placing it in the overhead compartment on a moving airplane. This takes not only dynamic (concentric and eccentric) upper extremity strength, but also scapular stabilization and core stabilization. An exercise such as the kneeling biceps on the reformer simulates this type of action.

The concept of functionality in rehab also means we must look at what the client needs and make our exercises task specific. Is your client a ballet dancer needing flexibility, a rugby player needing strength, a desk jockey needing postural exercises to reverse the effects of sitting all day, or an elderly woman who needs to be able to get up from a seated position? The huge repertoire of Pilates exercises provides endless options to allow us to make the exercises appropriate for all types of clients. If the exercise does not exist in the repertoire, we can design an appropriate exercise, using the equipment to either provide support or create additional challenge.

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