Principals of Pilates rehab


  • Health
  • Sunday, 25 May 2003

Pilates is not just a passing health fad. Its principals of core stabilisation, eccentric contraction and neutral spine fit hand-in-glove with the biomechanical principles practised by physiotherapists. That’s why Pilates rehab can help correct imbalances and prevent injury from recurring, writes SEE YEE AI. 

SUDDENLY Pilates is everywhere. Walk into any Klang Valley health club worth its salt and chances are you will see mat-based Pilates classes pencilled into their workout schedules – even if it’s just one dinky 45 minute session a week. While that’s the closest Joe Average will get to Pilates, the rich are beginning to discover Pilates studios that offer private, personal one-on-one classes.  

However Kathleen Keller, a Pilates instructor and trainer with more than 25 years in fitness and dance, sees Pilates as so much more than a passing fad.  

Pilates, the physical conditioning method pioneered by Joseph Pilates in the 1930s, first gained notice among New York dancers who often went to him to get back into shape after injury. Because of the dancer and later celebrity link, Pilates is often lumped into the fitness-weight loss category. However Joseph Pilates originally devised his methods to help hospitalised fellow German internees in England recuperate during World War I.  

Kathleen Keller ... 'Pilates helps to correct the imbalances that cause the injury in the first place and retrains the body to avoid bad habits.'

But it wasn’t until the 1980s that physiotherapists took notice of Pilates principles and techniques and incorporated them into rehabilitation. In North America, Australia and increasingly in Britain, Pilates is now an accepted module in physiotherapy. 

“It’s taken a while but Pilates has come full circle,” said Keller, who runs the Body Logic Studio at the Great Eastern Mall in Kuala Lumpur. 

In Malaysia where people still hold pretty arcane views on fitness and health (the plethora of slimming salons promising no drugs, no injections, no exercise – as if exercise was a bad thing – speak volumes but I digress), Pilates is only just gaining notice as a form of exercise. Pilates instructors like Keller find explaining Pilates usually involve a pretty drastic adjustment in expectations and commitment.  

“Clients come to me expecting a quick fix. They want to know how fast they’ll lose weight or achieve that washboard stomach look,” Keller said. “I tell them Pilates is not a quick anything. It involves an entire life’s work to get healthy inside out.” 

As a rehabilitation method, Pilates is almost unheard of in Malaysia. Keller found that when she had to give a talk to the Malaysian Physiotherapy Association, she had to start with the basics of what Pilates was before going on to specific examples about how Pilates could help in rehab.  

“Generally I would say that the level of awareness among physiotherapists in Malaysia is 70:30,” said Marc Daniels, president of the Malaysian Physiotherapy Association. “About 30% know and 70% don’t.” 

Synergistic role 

Still, physiotherapists who appreciate Pilates methods see it as the next step to physiotherapy and fulfils an important missing link.  

Thomas Stambough ... 'Pilates is an integral part of rehab in North America and Australia.'

“Many patients go for their requisite sessions with physiotherapists and then stop there,” said Keller. “At the end of their sessions, they don’t exercise or do anything anymore. There’s no continuity.”  

As Pilates rehab tends to be carried out in a less clinical setting, and in developed countries, cost less, people usually go for Pilates for total conditioning after their injury has been stabilised.  

“For example, I would treat someone with a slipped disc and when I get it all sorted out, the patient then goes for maintenance with Pilates,” Daniels said. 

As Pilates is a total body conditioning method, it also complements conventional physiotherapy very well. “While conventional physiotherapy treats the site of the injury, it doesn’t look at why the injury occurred in the first place,” said Thomas Stamborough, a Pilates instructor who specialises in rehab. “This is where Pilates comes in by helping to correct the imbalances and preventing the injury from reoccurring.” 

Typically the Pilates instructor will work with the doctor or physiotherapist to design a programme around what the doctors say the patient can or cannot do, Stamborough, who has worked with physiotherapists, chiropractors and orthopaedic surgeons in Australia before coming to Malaysia, added. 

Unlike yoga with its religious and mystical associations, many Pilates principles – core stabilisation, eccentric contraction, neutral spine – fit hand in glove with biomechanical principles practised by physiotherapists.  

And indeed, clinical studies have begun to confirm anecdotal evidence reported by physiotherapists and Pilates coaches – that Pilates does help to alleviate pain, strengthen the body as a whole and retrains the body away from bad habits.  

In North America, where Pilates rehab has gone mainstream, physiotherapists who have trained in Pilates do the rehab, said Sheila Draper, another Pilates instructor with Body Logic who has a degree in Massage Therapy. Draper worked as a therapist in Vancouver, Canada before joining Body Logic.  

Distinct advantages 

And indeed Pilates has many advantages: Pilates equipment are a lot more flexible and forgiving than conventional weight training equipment used in physiotherapy clinics. All the kinky looking springs, levers and pulleys play a pretty nifty role in altering resistance and centre of gravity according to the patient’s ability and progress.  

Also as Pilates places emphasis on movement patterns rather than isolated muscle training, it helps to correct faulty movement patterns – whether in a wobbly golf swing or poor muscle engagement while lifting pots and pans – that cause pain and lead to injuries.  

“The goal of any Pilates programme is to enhance functional movement so that clients get stronger to live life better,” said Stamborough. 

In addition, Pilates methods have evolved from Joseph’s original repertoire. While there are still studios that persist in teaching according to Joseph Pilates’ original gospel, Keller sees many advantages in adopting more up-to-date methods.  

“Joseph Pilates himself was always innovating,” she said. “He probably didn’t know about the pelvic floor (muscles) but if he did, he would have incorporated moves to engage them.” 

And with new add-ons like the jump-board, which addresses a major criticism of the Pilates method in rehab – the slow controlled movements don’t address the use or training of the fast-twitch muscles – Pilates rehab is developing greater acceptance and proving greater versatility in rehab.  

Pilates rehab is gaining momentum in everything from sports rehab for injured athletes to specialised rehab for specific problems. And indeed, Draper says that Pilates works for most things – muscular- skeletal problems, neurological problems, women’s health issues, spinal cord injuries, stroke, epilepsy, etc.  

Anyone who has tried Pilates will know the amount of relearning and engagement involved. Even moves that look simple – like the roll-down, involve muscles that most of us never feel or think about. In that way Pilates arouses body awareness during training that eventually translates into better body awareness while performing daily tasks.  

The verbal and tactile cueing that is part of any proper Pilates session helps to reinforce motor learning. Somehow the constant, steady cueing helps the body remember how the moves should be executed correctly even when the instructor is not around. 

However there are no standard moves in Pilates. A good Pilates instructor will start with a physical assessment and work with a client to strengthen weak areas or correct imbalances. “As Pilates works as a system, we modify exercises to adapt to the particular client,” said Stamborough. 

With a multitude of schools and techniques, there is just no one “right” way of doing things. “I know there are people out there who insist that their method is the best,” said Draper. “For me, I like to learn about all these methods because they give me greater choice with my patients.”  

Standards and qualifications 

However this lack of standardisation is one of the weaknesses preventing greater acceptance or more widespread development of Pilates in therapy.  

“There is no exam or standard certification procedure for Pilates rehab,” said Draper. “The divergence in methodology and approaches are part of the reason why the Pilates community is unable to come up with a standard.” 

For health professionals, this begs the obvious question: How would you know a Pilates rehab instructor is qualified to do what he or she claims to do? “This was one of the main questions physiotherapists want to know,” said Keller. “The last thing they wanted to do was to refer a patient to someone who wasn’t qualified to do what he was doing.” 

And that for Malaysia, at least for the moment, is a major limitation. Ideally, said Draper, Pilates rehab instructors should have a medical or physiotherapy background and have been a practitioner for a number of years.  

For the fledgling group of students who have taken courses in Pilates teaching, there is still a long way to go. Keller says that proper Pilates certification comes only after apprenticeship and teaching observation. “So far we have only been able to offer courses but not certification, which requires the student to undergo at least 450 hours of apprenticeship,” said Keller.  

And that is only for basic Pilates teaching, not Pilates rehab, for which students need to undergo more advanced courses.  

However Daniels said that until and unless Pilates practitioners form an association and come up with a standard of practice or code of ethics, it would be difficult to stop or even spot fly-by-nighters who cash in on the Pilates fad.  

Still, clients like Shahimah Idris have reaped the early benefits of Pilates in rehab. Pilates’ popularity in Malaysia has always been a matter of word-of-mouth. Increase in demand for Pilates rehab may fuel the increase of qualified and properly certified Pilates rehab therapists in the country in the near future. 

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