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Pilates: Ancient Secrets for Modern Rehabilitation

By Yoav Nagar, DC

We are only beginning to understand the bio-mechanics of the human body. Advanced technology has helped us uncover new ways to find balance and treat the whole body, not just the part that hurts. And as we begin to scratch the surface of new treatment options, more and more practitioners, physical therapists, chiropractors, and MDs, are creating functional rehabilitation programs for their patients.

Functional bio-mechanics is the science of the totality of the human body. The body, of course, comprises complex systems that interact constantly. We are beginning to understand the relationship and interactions between the carious systems, what effect they have on each other, and how a problem in one system might cause a malfunction in another. Functional bio-mechanics is the framework we need in order to begin to comprehend the complexity of human function.

Human function is 3-dimensional. We function within three planes of motion: the sagittal plane (forward and backward motion), the frontal plane (side-to-side motion), and the transverse plane (rotational motion). Everything we do, every move we make, requires an integrated neuromuscular system (NMS) that reacts and moves properly in all three planes simultaneously.

Pilates Principles

Pilates is much more complex than other forms of exercises. It is a fusion of Eastern and western and eastern philosophies that teaches you about breathing with movement, body mechanics, balance, co-ordination, positioning of the body, spatial awareness, strength, and flexibility. You will learn to flow from one movement to the next, building stamina and cardiovascular fitness, always keeping in mind the basic principles of the Pilates exercise repertoire:

Centering

Alignment

Breathing

Control

Precision

Flowing Movement

Relaxation

The Pilates approach views the body as a whole. When you begin, you learn to work the upper and lower musculature in conjunction with the body’s center, to dramatically improve strength, flexibility, posture and co-ordination.

If you cannot stand the thought of a step class or mindless hours on the treadmill, you are not alone. And if you have suspected for years that there was a better way to get, and stay, fit, you are right. The idea behind Pilates conditioning is to make people more aware of their bodies as single integrated units, to improve alignment and breathing, and to increase efficiency of movement. Unlike other exercise programs, Pilates does not require the mindless repetition of boring exercises that most people tire of quickly and subsequently abandon.

So how does it work? The method consists of a sequence of carefully performed movements, some carried out on specially designed equipment. Each exercise is designed to stretch and strengthen the muscles involved, opening the joints and releasing tension. There is a specific breathing pattern for each exercise to assist in directing energy to those areas while relaxing the rest of the body.

Pilates works many of the deeper muscles together, improving coordination and balance, to achieve efficient and graceful movement.

Who can benefit from Pilates? Just about anyone, including you.

Are you discontent with the “gym scene” and in need of a more focused program?

Do you want specific, hands-on guidance for your exercise programs?

Are you recovering from and injury and in need of a specific physical rehabilitation?

Do you want to improve sports performance or dance technique?

Are you older and looking for a gentle, yet effective, exercise regime?

Do you need to stretch and strengthen your musculature?

Do you suffer from back pain or other joint or muscular problems?

Do you want an injury prevention program?

Do you want to reduce the mental and physical stress in your life?

If you answered yes to even one question, you could benefit from an introductory Pilates class.

The Benefits Of Pilates Exercise In decreasing Low Back pain during and after pregnancy, By Yoav Nagar, D.C.

Studies have shown that about half of all pregnant women suffer from low back pain. The pain usually starts around the twelfth week and continues up to six months postpartum. Pain medication together with ice and ergonomic modification are some of the more common ways to treat back pain in pregnancies. A good low back exercise program will help decrease stress on the low back making pain less likely. A prenatal fitness regime that includes low back strength exercises is the key to pain prevention. One of the most effective ways to achieve this goal is with Pilates based exercise.

Low-back pain during pregnancy can be classified into three types:

1. Lumbar pain: This pain can originate from multiple sites, most commonly the facet joints, low back muscles or the supporting ligaments. As the uterus expands it also moves up and forward in relation to the pelvis. The abdominal muscles become less effective at maintaining neutral posture, so their ability to help stabilize the pelvis decreases. The burden shifts to the low back muscles, which become strained.

2. Sacroiliac pain: As pregnancy progresses, the amount of the hormone relaxin, which allows pelvic expansion to accommodate the enlarging uterus, increases, reaching its peak concentration at the 14th week. Movement in the sacroiliac joints can cause discomfort when the pain-sensitive ligamentous structures are stretched.

3. Night back pain: Some women have night back pain exclusively. As muscle fatigue accumulates throughout the day, it culminates in back pain at night. Another cause of night back pain is daylong bio-mechanical stress from sacroiliac dysfunction or mechanical low-back pain from altered posture produces symptoms at night. Circulatory changes during pregnancy may also contribute to low-back pain at night.

Proper posture can prevent unnecessary mechanical stress on the low back. Pregnant women should understand that weight gain and hormonal changes place more stress on their low back and pelvis at a time when ligaments and joints are becoming more lax. Improved posture can be achieved with typical Pilates exercises. Women should start Pilates prior to becoming pregnant and continue throughout the pregnancy. Pilates exercises help women maintain neutral spine posture that avoids excessive low back curvature. Pilates exercises are prescribed to improve the strength and condition of supporting structures. The exercises help the patient maintain a neutral spine posture, promote bio-mechanical efficiency, and minimize stress on the back. Pilates exercises may prevent and relieve lumbar and sacroiliac pain.

Because Pilates is known for improving posture by strengthening abdominal and back muscles, it is important for a healthy pregnancy. Training the lower abdominal muscles helps provide muscle memory, which will help to shorten the pushing stage of delivery. Pilates also trains the abdominal wall so that it returns to a flatter shape more quickly after delivery.

THE IMPORTANTANCE OF PROPRIOCEPTION AND BALANCE TRAINING AS PART OF YOUR REHABILITATION PROGRAM.

By Yoav Nagar, D.C.

Modern rehabilitation practitioners are starting to understand the importance of proprioception training as an integral part of the post injury training.

Proprioception is the position sense of the joints provided by the receptors, sensory devices, located throughout our bodies in the muscles, tendons, ligaments and joints. We need proprioceptors to provide the brain with information about joint position and movement, and in that way reposition them for the continuation of the movement. Proprioceptors assist the musculoskeletal system in generating the appropriate movement to meet the demand that is placed upon the system by gravity, momentum and other external forces, and by that to enhance the quality of the movement.

Impaired joint position sense is overlooked in many rehabilitation programs and may be a major risk factor for recurrent injuries after the integrity of the muscles and ligaments has been restored. The patients, therefore, need a general understanding of the proprioceptive system, its importance to joint integrity, and how to emphasize it during rehabilitation and training.

Injury to a joint may cause direct or indirect alterations in sensory information provided by proprioceptors. Direct trauma may lead to ligament and capsule tearing, which may damage the receptors in that area and also rupture the nerve fibers because they have less tensile strength than other tissues in the body. The consequent destruction of these receptors and the nerve endings will cause lack of communication between the joint and the brain. These physiological changes will lead to an immediate muscle inhibition around that joint.

In order to help us enhance the rehabilitation program, we need to carefully examine the degree of proprioception loss, the consequent muscle inhibition, and the parts of the body including muscles and joints that are compensating for this loss.

Proprioception is tested by the ability of the patient to balance on both legs with eyes open and closed, single leg balance, and by combining balance with movement in different directions. After we establish a base line, we can use the tests as exercises and add different devices, which we call drivers.

Proprioception training should be done before or in conjunction with rehabilitation exercises. In most cases the improvement from proprioception training will be quick and dramatic, and it will enhance the patient’s regular exercise regimen. The patient will continue to stimulate and enhance the proprioception system if done in combination with specific types of rehabilitative exercises such as pilates training.