Pilates for Physical Therapy

More balanced shots in basketball. Better jumping. Increased power. Decreased running times. These are just some of the benefits Pilates has brought college athletes. Once a niche exercise, Pilates has gone mainstream and is available at almost every gym. Athletes in numerous sports have discovered its training and rehabilitative powers. Among the younger, college-aged set, this total-body exercise can help increase strength and flexibility.

In a survey of 1,477 American College of Sports Medicine members, Pilates was ranked ninth on a list of the top 20 fitness trends for 2010.1 Several studies have examined the effects of Pilates on fitness.

Pilates and Cardiovascular Fitness At the University of Wisconsin La Crosse, Stefanie Spilde and John Porcari, PhD, studied 15 healthy women between the ages of 18 and 26 who self-identified as having intermediate Pilates experience. The women performed two 50-minute Pilates mat routines-one basic and one advanced-following Joseph Pilates’ original sequencing method. During the exercises, testers measured their heart rates and oxygen consumption and subjects ranked their perceived efforts using the Borg scale.

The intensity level of the beginning routine showed an average maximum heart rate of 54 percent, below the ACSM minimum recommendation of 64 percent for cardiovascular fitness. Subjects’ VO2 max rates were calculated at 28 percent, again lower than the recommended guidelines of 50 to 85 percent. The aerobic benefits of these routines are similar to the effects of walking two miles per hour. Interestingly, though, the subjects believed their efforts to be higher than they really were. They ranked their rate of perceived exertion at 14 on the Borg scale.2 The amount of muscle work needed to successfully execute Pilates exercises fooled the participants into believing they worked harder than their oxygen consumption dictated.

The advanced routine modified the pacing and positioning of the sequence. This time, subjects showed a 62 percent heart rate and 43 percent maximum VO2 rate, equal to the energy it takes to walk approximately four miles per hour. The average self-measurement of their exertion was 16.5 on the Borg scale.2

Spilde and Porcari concluded that Pilates is an ideal exercise for people looking to improve flexibility and strengthen their core. On the court or field, think of all the advantages increased flexibility and more powerful core muscles can bring a collegiate athlete.

Proof of Impact Pilates has long been believed to develop the core-the transverse abdominis and internal obliques. But where is the scientific proof? Michele Olson, PhD, an exercise physiologist at Auburn University Montgomery, recruited subjects at her university’s Human Performance Lab to test the theory. Olson tested 12 participants, ranging in age from 26 to 60. Unlike the Spilde and Pocari study, her subjects included some Pilates novices. During a series of visits, the subjects each performed a random series of exercises that included the Ab Prep, the Hundred, the Roll-up, the Double Leg Stretch and the Side Bend.

Olson had physical therapists help her locate the precise spot on subjects’ abdomens to attach electrodes. Low in the pelvis there is a spot, free of outer-layer muscles, where correctly placed electrodes on the skin can measure transverse abdominis and internal oblique activity. Her findings justified what Pilates enthusiasts ;have known for years and what physical therapists that incorporate Pilates have begun to realize. The Roll-up showed a high level of RA activity. Any exercise that requires the upper body to completely flex away from the floor can be expected to work those muscles. The other exercises, particularly the Ab Prep and Side Bend, were shown to have a greater impact on the internal obliques. Either way, these deep abdominal muscles showed measurable activity during Pilates routines.

Conditioning Tool Pilates is a lab-tested, legitimate method of fitness. But what happens when physical therapists and Pilates instructors take it out of the lab and into the training room? Can Pilates-based physical therapy serve as an effective conditioning tool for university athletes? The answer, according to several therapists and teachers, is yes.

Amy Broekemeier, DPT, CMPT, principal Polestar educator, PMA certified instructor, owner Pinnacle Performance, Salt Lake City, described Polestar as evolved Pilates. The Polestar method looks at Pilates from a rehab perspective. The exercises apply current medical research about the transverse abdominals, diaphragm, pelvic floor, and the biomechanics of joints to the exercises. In classic Pilates most exercises are performed supine. “Clients don’t get it unless I bring it back to a function, like throwing or kicking,” said Dr. Broekemeier. Her exercises mimic the specific sport of her client, but she always focuses on bringing what they learn back to a standing position.

About six years ago, she was asked to create a Pilates training program for the University of Utah’s women’s basketball team. The athletes attended mat class twice a week in addition to regular practices, incorporating Pilates core strength and flexibility training with traditional weight training and shuffle drills. The players focused on alignment of their hips, knees, and ankles, which led to improved jumping. Alignment of head, neck and shoulders helped them to be more balanced in their shots. During games, coaches noted an improvement in the athletes’ agility and speed. However, when funds to women’s basketball were cut, the university dropped the Pilates program.

Dr. Broekemeier continues to treat athletes of all sports and levels at her practice. She launched a 12-week training program for skiers that focuses on Pilates principles. Participants will use the reformer and the tower and engage in the cardio and finesse training needed for skiing. “They’re skiing at levels they’ve never skied before,” she said.

Pilates is not only about conditioning. It can be an effective rehabilitation method for injured athletes. There is often a disconnect between the ribs and the pelvis because most people are not trained to think of them moving in unison. Pilates can help athletes think about how their pelvis sits in space. With an injured client, Dr. Broekemeier breaks everything down into its components and then puts it together into a traditional routine. All training, she said, “comes back to the powerhouse; that is, the core.” Femur arcs, arm arcs, ab series, plank pose, spinal twists and squats are just some examples of rehabilitative exercises.

Just for Dance? The University of Utah is not the only school to offer Pilates training. Goucher College in Baltimore offers an academic course in Pilates. The class consists of small-group work in the apparatus room plus mandatory mat classes at the college’s Pilates Center.

Julia Clime, CPI, Pilates Center and instructor in the dance department at Goucher College, noted that students often repeat the course because they like the benefits of Pilates. Two of those return visitors were a cross-country runner and a tennis player. For the runner, work on the reformer was very helpful. Pilates exercises focused on the alignment of her feet, ankles and knees. Post-training, her personal best time dropped significantly.

The tennis player came to the class as a way to rehab from an abdominal strain. “When we have someone with an injury, the philosophy is to work the body as a whole,” Clime said. Initially, instructors avoid the injured area and work the rest of the body to get circulation pumping. When it’s safe to work the injured body part, instructors focus on building strength and flexibility, as a means of preventing future injuries and rehabbing the current injury.

Despite these results, Goucher athletic coaches haven’t been very receptive to Pilates, Clime said. She suspects this is because Pilates is housed in the dance department. While Pilates has long been known to help dancers, some athletes and coaches are unaware of its cross-over potential. The instructors at Goucher invite coaches to classes to try and change their perspective.

Meghan B. Tierney, PT, MPT, OCS, owner of One Physical Therapy and Wellness in Bryn Mawr, PA, already has a clear perspective about the benefits of Pilates for athletes. Tierney likes Pilates because it focuses on multiple muscle groups. She said, “Traditional sports training leaves out smaller core and local muscles. If you get these to work as well, you’ll be better on the field.” In her previous job in southern California, Tierney treated Pepperdine University basketball, volleyball and water polo players who initially sought her out at the recommendations of doctors following injuries. Later, some returned of their own accord for conditioning treatments.

Preventing Injury Pilates is effective at preventing injuries through getting muscles involved in the hips, back and core, noted Tierney. It incorporates aspects missing from general weight training. “Pilates focuses on everything,” she said.

Tierney appreciates the efficiency of Pilates, noting that clients don’t have to do many repetitions to feel the effects of the exercises. The routines she teaches or equipment she uses differs based on the specific athlete. For example, golfers or tennis players use the reformer because it mimics their swings. Across the board, Tierney noticed improved posture and muscle control with her athletes. Pilates helped them to focus on getting the brain to operate the correct muscles for a particular activity. During games or matches, the effects of the training can lead to increased power and endurance.

Sydney James, PT, MS, CPI, Presidio Sports and Medicine, San Francisco, echoes Dr. Broekemeier’s thoughts about the value of the core. “If you have a strong core, everything works that much more efficiently,” she said. At her practice, James has treated athletes from Stanford University and Colorado College and has noticed that among the college athlete population, flexibility and core training are not given the proper attention.

With her clients, James uses the reformer and the chair, noting that “students like gear and gadgets.” Pilates is a way for trainers to assess movement patterns and figure out where there is an imbalance, using the reformer as a stable base. Again, the focus and equipment vary based on different sports. Swimmers, for example, exercise on their stomachs on the reformer. Soccer players focus on improving their lower extremities.

No matter the sport, choosing an effective Pilates instructor is crucial. “Find someone with a background in physical therapy or at least certified in Pilates Method Alliance,” advises James. Whether it’s basketball, cross-country or tennis, Pilates has been shown to help college athletes improve their on-court and on-field performance. It can be a complement to traditional training regimens or a method of rehabbing from injuries.

References 1. Thompson, W. (2009). Worldwide survey reveals fitness trends for 2010. ACSM’s Health & Fitness Journal, 13(6), 1-7. 2. Can Pilates do it all? (2005). ACE FitnessMatters, Nov.-Dec.; 10-11. 3. Greene, T. (2008).The doctor is in. Pilates Style, July-August; 52-54.

By Danielle Bullen