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Pilates Research: Emphasize strength, flexibility, coordination and adaptability when working with people who have nonspecific low-back pain.

Many clients come to you with low-back pain, a condition that affects 80% of Americans at some point in their lives (Andersson 1999). For many, the pain occurs only occasionally. In contrast, chronic low-back pain—defined as persistent pain and disability lasting longer than 3 months—affects approximately 2%–8% of Americans (Andersson 1999). And it’s one of the leading causes of disability and work absenteeism for adults aged 45 and younger in modern, industrialized societies worldwide (Miyamoto et al. 2011). Pilates has grown in popularity among healthy individuals and athletes, as well as people seeking recovery and rehabilitation from injury. It’s not surprising, therefore, that researchers are interested in examining the effectiveness of Pilates for helping people with low-back pain. In addition, many doctors and physical therapists recommend Pilates to their clients as a way to maintain a healthy back. Always advise clients with back pain to consult with their healthcare providers. If clients are following an expert’s guidance, ask specifically what movements their health professional has recommended or advised against. For a person with a herniated or bulging disk, extension movements may be contraindicated while flexion is permitted. For someone else, the reverse may be true.

Research and Practical Application

When determining which moves could promote back health in your clients, consider what researchers have learned. Cristina Maria Nunes Cabral, PT, PhD, led a randomized controlled study at the Universidade Cidade de São Paulo, Brazil (Miyamoto et al. 2011). The study recruited 86 subjects with chronic, nonspecific low-back pain and found that Pilates promoted improvement in pain and function in those who completed 12 individual sessions over 6 weeks. “These benefits are not maintained if the patient stops [the Pilates training],” says Cabral. Cabral says the most beneficial Pilates exercises for people with low-back pain involve movements in every plane of motion—flexion, extension, side bending and rotation—and are moves that improve muscular conditioning and flexibility. She emphasizes, however, that exercise programs should be tailored to the individual. In general, she recommends the following:

  • shoulder bridge preparation (core and lower-body conditioning)
  • breast stroke preparation (prone spinal extension)
  • mermaid (side bending)
  • criss-cross (rotation, conditioning for external obliques)
  • spine stretch forward (flexion)

Cabral believes Pilates is effective for low-back pain because Pilates activates the deep abdominal muscles—and there is evidence that patients with back pain may have a strength deficit in these muscles.

Gisela C. Miyamoto, PT, MS, of the Universidade Cidade de São Paulo, the physiotherapist responsible for the treatment protocols in the study, offers the following advice on how to help clients who want to improve their back strength: “Perform a posture evaluation, [and] consider posture and back mobility. The exercise program must include exercises in all planes of motion [assuming that none of them are contraindicated for the individual]. Each program must be individualized and progressive. Instructors should also note pain and disability.” Both Cabral and Miyamoto point out that targeted muscles are components of the powerhouse, popularized by Joseph Pilates. Researchers have identified powerhouse muscles as those that have a primary role in stabilizing the lumbopelvic system. These include the transversus abdominis, internal obliques, diaphragm, lumbar multifidus and pelvic-floor muscles, among others. The Pilates method of breathing and movement stimulates these muscles.

When it comes to preventing and managing back pain, Pilates practitioners have much to offer clients. Clinical practice guidelines issued jointly by the American College of Physicians and the American Pain Society do not yet recommend Pilates specifically as a complementary therapy for individuals with chronic low-back pain, but they do include recommendations for exercise and the practice of Viniyoga-style yoga, among other options such as acupuncture, massage, progressive relaxation and cognitive-behavioral therapy. As research evidence grows, the many benefits of Pilates are being realized; as such, its practice may be recommended on a wider scale in the future.

Effects of Pilates-Based Exercise on Life Satisfaction, Physical Self-Concept and Health Status in Adult Women

Women & Health, Volume 51, Issue 3, 2011, pages 240-255
Ana Cruz-Ferreira MA, Jorge Fernandes PhD, Dulce Gomes PhD, Lisa Marie Bernardo PhD, Bruce D. Kirkcaldy PhD, Tiago M. Barbosa PhD & António Silva PhD


The objective of this study was to determine the effect of Pilates-based mat exercises on life satisfaction, perception of appreciation by other people, perception of physical appearance, perception of functionality, total physical self-concept, and perception of health status in healthy women. A randomized controlled trial was conducted in Évora, Portugal, in 2008, in which 62 healthy adult women were randomized to a Pilates-based mat (experimental group) (n = 38, mean age ± SD, 41.08 ± 6.64 years) or a control group (n = 24, mean age ± SD, 40.25 ± 7.70 years). Experimental group participants performed the Initial Mat of Body Control Pilates twice per week, 60-minutes per session. Repeated measurements were performed at baseline, 3 months and 6 months. No significant differences between the two groups were observed in life satisfaction, perception of appreciation by other people, perception of physical appearance, perception of functionality, total physical self-concept, and perception of health status at three time point measures (baseline, after 3 months, and after 6 months). No significant differences were observed in the control group over time. The experimental group showed significant improvements between baseline and six months in life satisfaction (p = .04), perception of appreciation by other people (p = .002), perception of physical appearance (p = .001), perception of functionality (p = .01), total physical self-concept (p = .001), perception of health status (p = .013) and between three and six months in life satisfaction (p = .002), perception of appreciation by other people (p = .05), perception of physical appearance (p = .001), perception of functionality (p = .02), and total physical self-concept (p = .001). Life satisfaction, perception of appreciation by other people, perception of physical appearance, perception of functionality, total physical self-concept and perception of health status may improve after 6 months of Pilates-based mat exercise.

KEYWORDS: Pilates method, Psychological well-being, healthy women, quality of life, life satisfaction

Sportverletz Sportschaden. 2012 Dec;26(4):218-22. doi: 10.1055/s-0032-1325478. Epub 2012 Oct 9.

Extracorporeal shock wave therapy for patients suffering from recalcitrant Osgood-Schlatter disease

Lohrer H, Nauck T, Schöll J, Zwerver J, Malliaropoulos N.

Source: Sportmedizinisches Institut Frankfurt am Main e. V., Frankfurt/Main.


BACKGROUND: Intensive physical load can damage epi-/apophyseal growth. Osgood-Schlatter disease is a well-known and sport-associated overuse injury of the tibial tuberosity apophysis. Long-lasting load-associated pain and a reduced ability to play sports can be the consequence.

AIM OF THE STUDY: The aim of this study was to analyse the safety and effectiveness of extracorporeal shock wave therapy (ESWT) for recalcitrant Osgood-Schlatter disease.

PATIENTS AND METHODS: 14 adolescent patients, median age 14 (13.2-14.7) years, suffering from recalcitrant Osgood-Schlatter disease (16 symptomatic knees) were treated with radial extracorporeal shock waves. The nine boys, median age 14 (13.5-15.0) years and the five girls, median age 12 (10.8-15.2) were retrospectively followed up 5.6 (3.4 - 6.7) years later using the disease specific VISA-P-G questionnaire which is validated for jumper's knee.Results: At follow up the median VISA-P-G score was 100 (82.9-100.9). Twelve of 16 knees (75%) reached 100 out of 100 VISA-P-G points. Four patients changed their sports activity due to persisting problems at the distal patellar tendon insertion. Four knees had persisting tibial tuberosity pain when playing sport. Pain induced by activities of daily living (stair climbing) was stated in two cases. No side effects or long-term complications were reported.

CONCLUSIONS: This pilot study demonstrates that radial ESWT is a safe and promising treatment for adolescent athletes with recalcitrant Osgood-Schlatter disease.


Shockwave Therapy in the treatment of Osgood Schlatter Disease

Authors: B. Corrado, MD; O. Galasso MD; S. Russo, MD.

University of Naples, Federico II Medical School, Department of Orthopaedics and Traumatology, ITALY

Introduction: Among juvenile osteochondritis, also known like nucleus-apophisitis of the growth, Osgood Schlatter disease is one of the most frequent; this illness affects mainly sporting teen-agers, that practise soccer, artistic gymnastic, volleyball or other sports implying a functional overload on the knee extensor apparatus. Treatment of Osgood Schlatter disease is mainly conservative in view of its favourable development. Therapy consists on temporary abstention from sport activities and rarely on immobilisation of the limb by means of stiff knee-pads. In some rare cases the persistence of the pain with an X-ray image of ossification in the context of the rotuleus-pretibialis tendon could be observed in spite of an adequate treatment.

Material and Methods: The Authors present the results achieved in the treatment of Osgood Schlatter disease output by means of Shock Waves. 28 patients, with age included between ten and sixteen years, no responders to conservative therapy and free from treatment for at least two months, have been treated.

Results: In 8 patients the complete disappearance of the ossification combined with the total pain solving has been achieved. In 10 cases the Authors observed a notable reduction of the calcification size and of the pain level. In the remaining patients no changes have been observed either about the ossification or about the pain.

Conclusions: Shockwave therapy is an effective aid for the specialist which has to treat the strongest shapes of the Osgood Schlatter disease.

Arch Phys Med Rehabil. 2009 Dec;90(12):1983-8. doi: 10.1016/j.apmr.2009.06.021.

Effect of pilates training on people with fibromyalgia syndrome: a pilot study.

Author information: Altan L1, Korkmaz N, Bingol U, Gunay B.


OBJECTIVE: To investigate the effects of Pilates on pain, functional status, and quality of life in fibromyalgia, which is known to be a chronic musculoskeletal disorder.

DESIGN: Randomized, prospective, controlled, and single-blind trial.

SETTING: Physical medicine and rehabilitation department.

PARTICIPANTS: Women (N=50) who had a diagnosis of fibromyalgia syndrome (FMS) according to the American College of Rheumatology criteria.

INTERVENTION: The participants were randomly assigned into 2 groups. In group 1, a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks. In group 2, which was designed as the control group, 25 participants were given a home exercise (relaxation/stretching) program. In both groups, pre- (week 0) and posttreatment (week 12 and week 24) evaluation was performed by one of the authors, who was blind to the group allocation.

MAIN OUTCOME MEASURES: Primary outcome measures were pain (visual analog scale) and Fibromyalgia Impact Questionnaire (FIQ). Exploratory outcome measures were number of tender points, algometric score, chair test, and Nottingham Health Profile.

RESULTS: Twenty-five Pilates exercise and 24 relaxation/stretching exercise participants completed the study. In group 1, significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks. In group 2, no significant improvement was obtained in pain and FIQ at week 12 and week 24. Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24.

CONCLUSIONS: We suggest Pilates as an effective and safe method for people with FMS. Our study is the first clinical study designed to investigate the role of the Pilates method in FMS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method.

FIFA exercises can reduce the cost of soccer injuries: Journal of Physiotherapy

New research has shown that an injury prevention program developed by FIFA could substantially reduce the cost of soccer injuries. The independent study ‘Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster-randomised trial’ will be published in this month’s Journal of Physiotherapy. The study investigated the economic value of the injury prevention program The11, developed by the FIFA Medical and Research Centre (F-MARC). The study’s authors, a team of Dutch investigators, found that the prevention program significantly reduces the costs associated with injuries in soccer players. The findings suggest that the program could be a valuable tool for soccer clubs that currently use a more traditional warm up of running exercises, dynamic and static stretching, and sprinting.

It is known that 75–85 per cent of all soccer injuries affect the lower limbs. To prevent soccer injuries, The11 program consists of 10 exercises designed to improve stability, muscle strength, co-ordination and flexibility of the trunk, hip, and leg muscles, and advice to promote fair play. ‘It is probable that the economic benefit occurs because there is a marked reduction in knee injury among those participating in the FIFA program,’ said Journal of Physiotherapy editor Dr Mark Elkins. ‘Knee injuries are often associated with lengthy and costly rehabilitation, resulting in high expenditure for medical care and substantial costs due to productivity losses,’ said Dr Elkins. ‘The findings of this study suggest that the FIFA intervention program reduces the costliness of the injuries, which could be explained by the program having a preventive effect on knee injuries. From an economic perspective, The11 could be much more valuable than a regular warm up in soccer.’

The financial loss due to soccer injuries in the professional English football leagues during the 1999–2000 season was roughly estimated at €118 million (AUD$146 million). Our Shelbourne Physiotherapists love treating soccer injuries for Victoria players of all ages and levels. Call us at 250-598-9828 to book an appointment.

‘Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster- randomised trial’ - Journal of Physiotherapy, 2013, 59(1):15-23. 


Postural Health in Women: The Role of Physiotherapy

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