Stabilizing The Core

Pilates emphasizes abdominal strength to support all body conditioning movements.
By Tisha Nickenig


When SUSAN MANN, MA,PI,CSTS, CGFI,FIRSI learned about Pilates, she couldn't help thinking how similar it was to many physical therapy techniques she taught her patients. Some of the upper and lower extremity mat work, for instance, mimicked the prone push ups or single leg lifts she had been teaching her clients for years. History explains why.

Joseph Pilates developed his exercises and techniques in 1915 by integrating many different fitness programs. Around the same time, physical therapy was introduced to our nation, says Mann, owner of the Pilates Center of Naples in Naples Fla. "It's like the chicken and the egg," she compares. "You don't know which one came first."

During Pilates workouts, patients concentrate on abdominal strength to support all body conditioning movements. The focus of the program - which can address asymmetries, imbalances, structural weakness and past or current injuries-is to produce the following results:
. fluidity and awareness of movement.
. mental focus and control over these movements without the need to concentrate on
them.
. a body that "thinks" for itself.
. a healthy body inside and out.

When rehabilitating patients, physical therapists try to concentrate on many of these areas as well. The main difference, offers Mann, is that Pilates takes the concept of core stabilization one step further. It incorporates core stabilization into the whole session, giving patients more power and control when exercising. Through a specific set of breathing patterns Pilates helps patients become more aware of their bodies. That's why it's so beneficial to combine this fitness method into rehab and wellness sessions, she explains.

Mann began incorporating Pilates into her own therapy sessions after doing the fitness techniques herself. "As we approach middle age, our bodies change," she says. "Pilates helps address these changes by creating a stronger and leaner body, counteracting the effects of aging."

It didn't take Mann long to realize that Pilates was a great exercise alternative for other baby boomers, who were also concerned about combating the effects of aging."Pilates is a great alternative to machine weight lifting and running, which cause joint stress," she says. It also can increase flexibility and muscular strength without packing on bulk, says Martine Scott, (BA Hons), a Pilates instructor and personal trainer who owns and operates a Pilates studio in London.

Aside from being a great exercise alternative for baby boomers, Pilates can benefit rehab clients, including people with chronic and acute low back pain, postural problems and osteoporosis.

Pilates

Joseph Pilates created his now-popular exercise program, which incorporates floor movements and specific equipment, to build life-long fitness. While living in England during World War I, he incarcerated with other German nationals many who were injured in the war. So he used his exercise knowledge to devise movements the soldiers could do while still in bed. He took the springs off he bottom of beds, for instance, and attached them to the wall or to the bedpost. The result was a series of resistive exercises and movements that focused on what he called the powerhouse of the body-the legs, abdominals and buttocks."

Over time, the practice has branched out into three schools of technique: West Coast, East Coast and Canadian. The differences basically involve slight changes in breathing patterns, foot placement on Pilates-specific equipment, wearing socks vs. not wearing socks and equipment modification.

Regardless of which techniques people practice, the core stabilization aspect of all the programs is key, says Mann. It provides a foundation off strength and balance that originates from the pelvic and shoulder girdle regions. By centering the body, clients can learn to align their feet, knees, pelvis, trunk, shoulder girdle and head. Addressing this postural alignment is key to rehabbing injuries, adds Scott.

Developing a Pilates program is similar to creating a physical therapy plan of care, says Mann. Therapists should select exercises based on client's abilities and restrictions, and should use basic exercises until the person improves and can progress to more advanced levels. Although Pilates takes more time and concentration than some other forms of physical therapy treatment, Therese McNerney, PT, is glad she offers it in her private practice clinic.

"People are willing to pay out of pocket for Pilates," says McNerney, who is a certified Pilates instructor and owner of Precision Health Fitness in Bethesda, Md. Besides gaining immediate cash revenue and avoiding the hassle of waiting for insurance reimbursements, many therapists offer the exercise program because they believe patients can benefit more from it than time-limited therapy sessions.

In clinical setting for instance, insurance companies might only cover six visits for 30 minutes each. This often isn't enough time to rehabilitate certain injuries. Pilates clients, however, aren't assigned a certain number of visits, says McNerney.

To get into the market, however, you first need to become certified, stresses Mann. "It's really important," she says. "You might think you know the techniques, but until you go to a seminar, you really don't."

Pilates isn't just a series of mat exercises and movements people perform on pieces of equipment, adds McNerney. More than 500 Pilates exercises exist, many of which take time to master. They're much different from teaching traditional exercises, such as leg presses. They're about learning to focus and control one group of muscles while another group is already working. To teach them, you need to understand them. "It's the perfect combination of strengthening, flexibility and body awareness, "McNerney says. But learning this "perfect combination" takes time.

When you seek certification, be wary of where you go, warns McNerney. Although several certification programs are available, many of them aren't discriminating against who becomes an instructor. The Professional Health and Fitness Institute created a certification program that is developed specifically for health care professionals.

The class takes nearly 15 months and costs about $3,000.for instructors to become certified to train in mat work and on the three standard Pilates machines. One standard Pilates machine, designed to increase spinal strength and flexibility, address core stabilization and postural alignment. Another standard device uses a gravity reduced setting to enable patients to focus on their core. And a third standard machine combines resistive springs and an upright pole to facilitate better posture and control. If you want to purchase three pieces of equipment, expect to spend nearly $7,000.

Despite the initial cash outlay, you quickly will earn it back, since a typical one-on-one session runs anywhere from $50 to $90 per hour, depending on where you're located.

Offering Pilates is a win-win situation. It can bring your facility a great stream of revenue, while significantly benefiting your clients. Clearly, no one can find fault with that.

For a list of references, go to www.ADVANCEforDR.com and click on the reference tool bar.