Part of the Vivir Healthcare’s ‘orange-paper’ series.
In the latest of Vivir’s orange paper series, Alyssa Borja, a physiotherapist specialising in aged care working with Vivir Healthcare, has recently completed the DMA Pilates Level 1 course as part of her professional development. These are part of her learnings.
Clinical Pilates (CP) is gaining popularity amongst physiotherapists, not only as an exercise intervention, but as a specific method to treat low back pain. I undertook the DMA Clinical Pilates course to find out why this approach is so effective and if it can be applied to the elderly population.
What is Clinical Pilates?
DMA Clinical Pilates was created by Craig Phillips (B.App.Sc (Phty) MPhysio (Sports) M.A.P.A) in the late 1980s. He applied the original work of Joseph Pilates to the growing body of research on spinal stability and rehabilitation. He has developed CP into a specific physiotherapy diagnostic tool and treatment method. This is what sets CP trained physiotherapists apart, from instructors who use pilates, for general fitness.
A patient’s treatment is individualised by initially assessing the patient for a preferred movement, or “bias”. This bias is used to treat the patient’s pathology, with non-aggravating movement patterns, which also help to form a safe exercise program.
What is the theory behind Clinical Pilates?
CP works because it ensures all exercises are effective in developing spinal stability. To develop spinal stability is to enhance the overall biomechanical efficiency, or smoothness, of movement from a stable core. Achieving this requires continuous cortical planning of multiple muscle actions, until the central nervous system automises these motor patterns. CP does this by prescribing repetitive complex movement patterns that involve all the core muscles required for spinal stability, working in synergy.
Unfortunately, many exercises still taught by physiotherapists, intended to develop spinal stability, target only isolatory core muscles in a static position. These exercises do not develop motor patterns for spinal stability and instead may result in muscle overactivity, inefficient motor patterns and a rigid neuromuscular system1,2.
What is the research behind Clinical Pilates?
Wajswelner et al. (2012) conducted a single-blinded randomised controlled trial, which compared the benefits of physiotherapy-delivered Clinical Pilates, versus general exercise, for chronic low back pain. All participants attended a one-hour exercise session, twice weekly, for six weeks, then performed follow up exercises at home. The CP group received an individualised direction-specific exercise program prescribed by the physiotherapist. The general exercise (GE) group received a multi-directional generic set of exercises. At six weeks, the CP group were 46% better compared to the GE group at 29% better, in terms of their Quebec scale for pain and disability3. While this was not a statistically significant difference, it has paved the way for more research to be conducted on Clinical Pilates4.
Can Clinical Pilates benefit the elderly population?
DMA has developed an evidence-based method of assessing and treating low back problems. Physiotherapists utilising a CP approach have the clinical reasoning to ensure their elderly patients receive a safe and realistic intervention. It enables physiotherapists to prescribe an exercise intervention that is simple, modifiable, sustainable and time-efficient.
Applying Clinical Pilates to the elderly population
It is essential to consider the elderly patients’ goals and tailor their exercise progression accordingly. The aim with CP is to always achieve what is functional.
In the older population, it is often more challenging to find a pilates movement that is pain-free for assessing and prescribing as an exercise, due to multiple painful regions. However, there is a wide selection within the DMA level one pilates exercises which can be modified and slowly be progressed (diagram 1).
Diagram 1: Level 1 DMA Pilates biased exercises.
Consider the following when choosing CP as a treatment modality for elderly residents in an aged care facility:
Are there any injuries that may affect the ability of the resident to complete the exercises?
Will the resident require standing exercise alternatives?
Does the resident understand my instructions?
Can the resident transfer from the treatment surface?
Does the resident require supervision for the exercises? How frequently?
Will I need to involve carers or family members?
Do the necessary people have access to an exercise sheet and precautions?
What are my goals for the resident? What is functional?
DMA Clinical Pilates is an effective tool for the assessment and treatment of elderly patients with spinal stability issues. In particular, finding pain-free ways to initiate exercise for older adults suffering with low back pain, is invaluable for patient compliance.
1 Morris SL, L. B. (2012). Corset Hypothesis Rebutted–Transversus Abdominis Does Not Co-Contract In Unison Prior To Rapid Arm Movements. Clinical Biomechanics, 27(3):249-54.
2 Eversull BS, S. M. (2001). Neuromuscular Neutral Zones Sensitivity To Lumbar Displacement Rate. Clinical Biomechanics, 16(2):102-13.
3 Wajswelner H. (2012). Clinical Pilates Versus General Exercise For Chronic Low Back Pain:
A Randomised Trial. Medicine & Science In Sports & Exercise, 44(7):1197-1205.
4 Tulloch E, P. C. (2012). DMA Clinical Pilates Directional-Bias Assessment: Reliability And Predictive Validity. The Journal Of Orthopaedic And Sports Physiotherapy , 42(8):676-87.