1. Modified Pilates – an introduction Katy Baines

2. Learning outcomes The student will: Be introduced to the history, method and technique of pilates Be able to identify the 5 key elements used in the modified pilates approach Explore the ‘neutral zone’ Observe and practise some commonly used pilates matwork exercises for use in the clinical setting Consider the evidence base to modified pilates

3. History Joseph Humbertus Pilates - born Germany 1880 Studied yoga, zen meditation and Roman exercise in attempt to enhance his immune system Applied his regimes in prisoner of war camps to good effect during WW1 1960s moved to USA and introduced technique into the world of ballet and opened the first pilates studio in NY Pilates died in 1967 leaving no will or line of succession Today various forms of pilates continue to evolve - APPI modified pilates provides a functional, dynamic treatment tool for physiotherapists

4. APPI method “A form of dynamic stabilisation retraining that reconditions the body from the central core to prevent reoccurrence of, and treat, a range of postural, musculoskeletal and neurological conditions “ »Withers and Stanko, 2001

5. Method Mind –body centering Breathing control Central core stability in lumbo-pelvic region From core, intensity of exercise is adjusted through use of levers (limb movts) and or resistance (theraband, pilates equipment) Focuses on correcting body imbalances and re-educating habitual patterns of movement

6. Technique Matwork exercise to promote core stability, flexibility, endurance, postural and body awareness to correct muscle imbalances Breathing control – for diaphragmatic and TrA activation; exhalation with the movement of greatest effort Concentration – workout for mind and body Control – movement control essential Centering – central ‘powerhouse’ Precision – routine techniques that lead to greater awareness and control Flow – even, continuous flowing motion to promote re-learning

7. 5 key elements Lateral breathing – lateral thoracic expansion not abdominal breathing Centering – neutral spine position; midpoint between lumbar flexion and extension; co-activation of inner core TrA, multifidus and pelvic floor Ribcage placement – aligned with pelvis; neutral thoracolumbar junction; dissociation arm and leg movts Shoulder blade placement – lengthen between clavicles; co-activation UFT, LFT and Ser A Head and neck placement – lengthen back of neck; activation DNF

8. Neutral zone Active physiological motion comprises neutral and elastic zones Neutral zone: small zone of motion around neutral joint posture requiring minimal restraint by the passive sub-system Elastic zone: end of the neutral zone to the end of the physiological motion where the passive sub-system provides restraint to control end of range motion Need a bit of motion in the neutral zone but too much can lead to clinical instability Clinically looking for stability not rigidity to allow flowing motion

9. Clinical stability Global muscle systems – long levers, at risk of overloading areas of weakness. Local muscle systems - short levers; beneficial Transversus abdonimus (TrA) links abdomen with thoracolumbar fascia (TLF), erector spinae and quadratus lumborum (QL) Stable neutral – spinal stabilisation via lateral fascial tension Multifidus – facet joint stabilisation posteriorly Psoas – the ventral multifidus? Diaphragm – assists TrA by preventing displacement of abdominal viscera, allowing TLF tension Pelvic Floor – activation with TrA

10. Transversus abdominus, TLF

11. QL, Psoas, Multifudus

12. Muscular slings Primary sling – TrA, multifidus, PFM, diaphragm (LMS) Posterior oblique sling – Latissimus Dorsi and contra-lateral Gluteus Maximus Anterior oblique sling – External Oblique and contra-lateral Adductors Deep longitudinal sling – Erector Spinae TLF Sacrotuberous and long dorsal ligt. Biceps femoris Lateral sling – Gluteus Medius and Minimus, TFL and contra-lateral adductors

13. Posterior and anterior oblique slings

14. Deep longitudinal and lateral slings

15. Clinical application Identify the dysfunction Re-train the LMS Incorporate the relevant slings Link to function

16. Example exercises Imprinting One leg stretch Shoulder Bridge Clam Breaststroke Preps Roll up Side leg lift, add kicking variation

17. Evidence base – to explore further Hides et al,2001 – correction of muscle imbalances in lumbar spine Hodges,1999 – benefits of local muscle system; TrA function O’Sullivan,2000 – lumbar segmental instability Panjabi, 2003 – neutral zone Pool-Goudzwaard et al, 1998 – lumbopelvic stability clinical, anatomical and biomechanical approach Richardson et al, 2002 – TrA, SIJ and LBP Urquart et al, 2005 – abdominal muscle recruitment Vleeming et al, 1995 – thoracolumbar fascia function