Meghann Koppele Duffy helps a client improve spinal stability, core activation, and hip differentiation. This client’s goal is to create an at-home program, so Duffy uses the same equipment in the studio that the client has at home. (All photos courtesy of TheNeuroStudio.)
By Elizabeth Woods, PT, DPT, MSCS
The treatment of neurological conditions and orthopedic injuries has been popular in physical therapy clinics for years and is now on the rise in so many other areas of health and wellness.
Currently, there are nearly 1 million people in the United States with multiple sclerosis. This year, nearly one million more will be diagnosed with Parkinson’s disease, and more than 800,000 will be diagnosed as having had a stroke. As staggering as those statistics are, they do not even include other neurological conditions such as ALS, peripheral neuropathy, Alzheimer’s disease, and so many others. As for orthopedic injuries, a new study presented at the 2018 Annual Meeting of the American Academy of Orthopedic Surgeons found that by 2030, primary total hip replacements are projected to grow 171% and primary total knee replacements are projected to grow by up to 189%, for a projected 635,000 and 1.28 million procedures per year, respectively.
As the number of people living with neurological conditions and orthopedic injuries grows drastically with more daily diagnoses, physical therapists who specialize in these conditions are rising in demand. The need for advanced therapists that have a varied and well-rounded background and scope of treatment techniques is necessary. A qualified physical therapist can stand out in this saturated market by offering results-driven modalities that relate to function, such as Pilates. So let’s discuss what Pilates is and how physical therapists can use this practice to enhance the services they offer to their patients.
What is Pilates?
Meghann Koppele, a Pilates teacher and Specialist in Exercise for Neurological Conditions for more than 18 years, began one teacher training course by first asking the audience, “What is Pilates?” And among a group of physical therapists, exercises professionals, and yoga teachers, no one seemed to have an answer. Koppele waited for a reply, looking around the room for someone to raise their hand and wondered, how could a room full of people getting certified in a specific form of exercise not have the answer? How was it that no one could describe Pilates? When no one in the class was able to answer her simple question, she replied with a simple answer: “Pilates can be a form of exercise that challenges selective stabilization of certain joints while mobilizing others, with a great emphasis on the spine and core.” She went on to explain that the method was designed to move the body in all ranges and planes of motion and to keep people moving.
When Joseph Pilates created Contrology (which is now simply called Pilates), he taught that physical and mental health were equals, which is why the Pilates method is both a physical and mental workout. Pilates focused on correct alignment, breathing, control of positions, ease of movement, and concentration. His later practice focused on technique and with much less concern for specific amount of repetitions. Often the more advanced the exercise, the less repetitions to help facilitate the proper form.
At the center of his methodology was breath and spinal health, which he felt were crucial components to our overall mental and physical well-being. He had the understanding that without strong spinal and “core” muscles, life’s daily tasks—even the most simple of movements—would become very difficult. Joseph Pilates was quoted to say, “A man is as young as his spinal column,” and you can see this displayed in his method of practice and teaching.
Meghann Koppele Duffy helps a triathlete improve his gait mechanics and spinal mobility on the Fuse Ladder and Core Align.
Movement with a Purpose
Each exercise in Pilates has a purpose, a goal and breath. The spine is discussed in every exercise along with the desired joint movement. Upon first observation, there is a great focus on flexion-based exercises, and because most spinal flexion occurs at the abdominal area, it became the reason Pilates is often confused as a series of purely abdominal exercises. This is also because at the time, Joe believed flexion was the key to spinal health. He include all spinal motion in the traditional 34 original mat exercises. But as time passed, more contemporary teachers recognized that although Joseph Pilates was ahead of his time, there are some gaps in his method. Many contemporary teachers, such as Koppele, often adapt the method to include more modifications with extension, lateral flexion, and rotation at the spine and other joints which connect to the spine.
Neurological Applications
The traditional methodology along with Koppele’s definition of Pilates intuitively makes sense to PTs because there is a common knowledge and understanding that without proper stability of the spine, hips, and shoulders, a person’s functional, daily movements will be affected. One in particular would be a person’s gait pattern. Without stability of the core muscles and joints, improper, unstable movement could, and often, leads to overuse injuries of other areas, especially the extremities.
Years ago, Koppele was drawn to Pilates because she knew its methods and principles could be used to address gait, balance, spasticity, and weakness seen in many of her clients and people she was looking to help improve their mobility. It so happened to be the symptoms of patients that many neuro-focused physical therapists see daily. The exercises she knew of from Pilates could be done with or without equipment, creating many options for PTs and their patients. If a therapist is able to incorporate Pilates equipment into their facility, the use and versatility of the springs and pulleys for resistance can be game-changing. This is especially true when working with clients in wheelchairs that have hemiparesis, weakness, and/or spasticity.
Meghann Koppele Duffy works with this client on a Pilates Cadillac to help improve scapulohumeral rhythm and spinal extension. The client presented with some back pain in extension, so Duffy chose this exercise to introduce it safely.
Modifiable for Rehabilitation
The beauty of Pilates as a rehabilitative method is that it is easy to modify the exercises for each patient’s specific needs while incorporating a full-body approach. For example, when a client comes in with foot drop, many therapists and techniques to treat foot drop are focused on improving foot biomechanics, especially dorsiflexion. The Pilates approach can enhance that work by adding and incorporating exercises that ensure the hip is moving optimally to allow for better lower extremity and more foot movement with carry-over to improved overall functional movement. Foot exercises are often unsuccessful without challenging them in a full-body gait-like pattern. On the Pilates equipment, which we will discuss later, there are many exercises which address a foot to hip connection in multiple positions such as supine, prone, side-lying, and standing. The combination and variation of exercises in different positions and planes of movement accelerates the functional results.
Joseph Pilates created much of his method while living as a German alien in an internment camp in England during World War II. Acting as a nurse in the camp, he used his previous knowledge of the body to help rehabilitate soldiers by attaching springs to the beds and developing exercises to help rebuild strength and movement that these soldiers has lost with injury.
His method continued to develop further when he moved to New York and began creating his own equipment to help people better facilitate the exercises he developed. The Cadillac, which resembles a canopy bed with springs, offers countless options to get weaker muscles stronger and clients moving from all angles and positions through the assistance of springs and pulleys to assist proper movement. There are also a number of standing and gait exercises that can be performed on the Cadillac using the support of the frame in a similar way to parallel bars and can also be used with an adjacent wheelchair.
The Reformer, another piece of Pilates equipment, differs from the Cadillac because it has a moving base. This can be helpful for vestibular training and challenging movements while standing, sitting, or kneeling. Similar to the Cadillac, the entire body can be challenged on one piece of equipment. However, it can be a better piece of equipment if the mover is more advanced.
Wider Scope of Practice
Working with people who have neurological conditions and serious orthopedic concerns can be challenging work, but combining Pilates with current physical therapy techniques can increase your scope of practice, resulting in much success in healing and strengthening. It is not only rehab effective, but carry-over after discharge shows much success in people being able to independently follow through with a home exercise program and community fitness with long-term benefits. RM
Elizabeth Woods, PT, DPT, MSCS, graduated undergrad, masters and doctorate in rehabilitation medicine/physical therapy from Northeastern University. She has been employed for over 7 years at Kessler Institute for Rehabilitation, specializing in all neurological rehabilitation and as Senior PT managing outpatient MS, Pediatric and Assistive technology program clinics. A Certified MS Specialist since 2009, she was employed at the International MS Management practice for over 5 years managing outpatient MS clinic as senior PT and MS Rehab specialist. She also worked as device specialist consultant and trainer for Smart Step Biofeedback device and Bioness neuroprosthetic device. Woods is certified in Mat Pilates by the Kane School Pilates at Kinected Pilates studio, under Meghann Koppele. For more information, contact [email protected].
