Pilates as Therapeutic Exercise
Professional athletes, amateur enthusiasts, and people of all ages and abilities alike want to increase their capabilities, avoid injuries, and improve their sport. Fortunately, no matter what level of athletic capability the client is at, staying injury-free and training at a high level of ability are inherently linked. Unfortunately, the endless loop of injury and partial recovery is also linked, and this is where many clients get stuck.
Without proper encouragement many people will choose to not include enough movement in their daily life, whether this is because they aren't sure what to do, they don't enjoy exercising, or they are in pain. When someone doesn't move enough, the muscles atrophy and the joints stiffen. It's the classic statement of if you don't use it, you lose it. The body stops being able to move in certain ways when it is sedentary. From this weakening, from being stuck in seated positions, the body then begins to ache and can cause significant pain. The feeling of pain then also becomes a deterrent to including daily movement because it hurts too much to move through it, so this cycle continues. The person doesn't move, so they hurt, so they don't move.
Any small amount of movement can begin to break this loop. Proper movement programming is necessary to increase strength for specific injury or sport-specific training, using Pilates Therapeutic Exercise.
There are three overarching umbrellas of Pilates as a Therapeutic Exercise training protocol. These are Maintenance, Performance, and Recovery. Within each, there are many subcategories, and each might overlap at times with another category, but these main categories help us help our clients to improve their game, recover from injury, reduce the likelihood of further injury, and improve physical functioning of activities of daily living (ADLs).
The phases aren't necessarily meant to be in a specific order, but rather must begin at whatever phase the client is currently at, and only move forward as they are able to do. In Maintenance we focus on coaching the client in how to modify their daily living, eliminating things that may be increasing their pain level, and adding to what will improve their functioning. We assess things such as workspace alignment, how the desk is set up, how the client's posture is, the client's schedule of sitting vs standing during a typical day, and basic movement education. Exercises for this phase focus on overall strength, balance, mobility, and increasing self-efficacy. A client looking for exercises to improve active aging may remain in this phase, whereas a client who is a professional athlete will use the maintenance phase during their off-season to remain physically active without being in peak sport-specific shape for the periodization of their training.
Within maintenance, we can use the biopsychosocial framework in order to assess the various elements in the client's life that may be negatively impacting them, keeping them from living their fullest life. This includes a physical assessment to see what may be causing any underlying pain such as chairs used, posture, gait, and daily activities; a psychological assessment of how the client thinks about themselves, exercise, and self-efficacy, and how they feel about their current state of physical capacity, pain level, strength, and mobility; a social assessment, how the client interacts socially, and the support network they have including family, friends, and colleagues. This framework allows us to see the whole person in order to best help them achieve their goals.
In the Performance phase, exercise training is sport-specific in order to strengthen the weaknesses often seen in the specific sport, and properly counter any overuse movements. Here, we focus on what is most needed to be successful within that sport. For dancers, the focus needs to be on hip control, abdominal control, foot and ankle stability, shoulder control, and lumbopelvic control. For golfers, the focus remains on thoracic rotation, core strength, shoulder mobility, hip mobility, explosive movements, and dynamic coordination. Overall, any athlete will benefit from full-body exercises, but for significant benefit, the athlete must focus on evidence-based, sport-specific training.
In Recovery, therapeutic corrective exercise assists in reducing painful stimuli, re-educating the motor control patterns of the body, and re-training out of chronic injury. This programming is based on a specific injury pathology which can include common chronic injuries or certain athletic injuries.
Unfortunately, physical discomfort and pain are expected at some point for most people, with cervical (neck) pain, and lumbar (low back) pain is extremely common. For many, minor adjustments to the day can significantly reduce nociception and discomfort, along with adding small bouts of exercise or gentle movement. For others, more specified programming is necessary in order to recover from injury and pain. Movement is vital to living a vibrant and capable life. Since the modern lifestyle is set up to reduce the amount of daily movement, it is necessary to consciously make space in the daily schedule to move the body in order to improve current injury, reduce the likelihood of new injury occurrence, and improve overall strength and functioning.
Do What Moves You!
