Therapeutic Pilates. Introduction to Pilates. Joseph H. Pilates. Improving Core Stability, Kinesthetic Awareness and Supporting Spinal Integrity

Transcription

1 Therapeutic Pilates Improving Core Stability, Kinesthetic Awareness and Supporting Spinal Integrity Introduction to Pilates Pilates exercise is designed to mobilize and strengthen the body, helping to restore and maintain correct posture and alignment, as well as improving and enhancing balance and control of movement. Joseph H. Pilates 1920s Sickly childhood, rickets, rheumatic fever,asmtha Inspired by both Eastern and western philosophies, combined mental focus and breathing (yoga), physicality of gymnastics Art of Contrology dedicated to mat exercises Now called Pilates method Emphasis of the body working as a Whole

2 Photograph Joseph Pilates First Cadillac Machine Components of the Cadillac Current Pilates Reformer

3 Older Clients Involved in Pilates Pilates Pilates is an integrated approach to movement requiring activity and awareness throughout the whole body in every exercise. Pilates exercises do not aim to work the body in isolation but instead focus the mind to the activity in the body as a whole.

4 Pilates as a Rehabilitation System For the back, knee, hip, shoulder, and repetitive stress injuries. Corrects body asymmetries Chronic weaknesses to prevent injury Goal in using Pilates as an Alternative Treatment Protect the vulnerable area while focusing on helping the client to be at ease in functional activities Joe Pilates Go about our activities with zest and ease. Therapeutic Benefits of Pilates Improves mm. strength, endurance, flexibility and overall joint mobility Improves posture and alignment Reduces stress and fatigue Improves balance between the anterior and posterior musculature Improves emotional states/ mental focus Praxis

5 Stamina and Muscular Endurance Pilates exercises are usually only performed for a low number of repetitions as the focus is always on quality not quantity. As the exercises are mastered more exercises are added to the routine to challenge the endurance of the muscular system. Body Building Alignment Correct alignment and precision of movement are absolutely essential factors in every Pilates exercise. By correctly aligning the body and bringing the joints and soft tissue into their natural neutral zones, sound recruitment patterns are encouraged and the joints remain healthy.

6 Poor Posture Verses Proper Posture Relaxation Relaxation of the mind and body is an essential part of any Pilates session. Focusing on releasing areas of tension within the body before and during each exercise is important as it allows constructive change to occur. Over dominant recruitment patterns will continue to dominate the way an individual moves unless time is taken to release areas of tension and overuse. Focused relaxation of overactive muscles forms a key part of Pilates exercise, thus enabling less active muscles to be recruited and developed. Lab 1 Identify area of vulnerability Mark with masking tape Over recruitment/ asymmetry Noodle use

7 Relaxed at Business Coordination/Precision/Control purposeful with precision and control. Focusing on the quality and detail of each movement that makes up an exercise, coordination, control, mobility, strength, and the overall efficiency of the whole body are improved more effectively. Coordination/Precision/Control

8 Flowing movements Muscles are recruited with control and precision through large ranges of movement across different planes. This helps develop longer, leaner muscles which are stronger through their entire range, which in turn results in a more efficient movement system across the whole body. Flowing Movements Proprioception/Kinesthesia/Body Awareness/Balance Definitions Neural Structures

9 Normal Aging Process impacting on Balance Less tolerance to vestibular sensation Decrease proprioception, body awareness, decrease stabilization Slower postural reactions, more postural instability; gravitational insecurity Structural and muscular changes Decreased motor planning and sometimes cognitive changes Vestibular Apparatus

10 Lab 2 Experience vestibular loading Vestibular loading Balance eyes closed/ eyes open Dynamic balance/ sitting/ standing

11 Pilates Incorporates Praxis The mind/body relationship Praxis Ideation What do I need to do? Association to past experiences (kinetic engrams) Selection of movement for the sequence Cognitive effort of mm. group used for action Comparison to ideation (cerebellum) Series of motor actions Combine the sequence of actions Compare and correct to ideation Interplay between cortex/cerebellum/vestibular systems Cognitive efforts involved in a motor plan

12 Pilates Imagery Helping the body to assume the correct position Lab 3 Praxis Follow directives/ imagery/ alternatives Pull your navel toward the spine A string at your head pulls you up to the sky Shoulder back and down Keep your ears growing away from the shoulders and shoulders dropping from ears Lower your ribcage Imagery creates the ideation for Motor Planning Use pictures to show pts the images Need to use this for Ideation and initiating a motor plan

13 The Basic Principles Involved in Mat work Pilates Philosophy of Form Principals Breathing 2 types Nose mouth/ 4 pt breath Lateral breathing Core Control anterior/ posterior trunk Pelvic floor Neutral pelvis Imprinting for movement Scapular Movement and Stabilization Head and Cervical placement Lab 4 Nose/mouth breathing

14 Breathing Principle In through nose, exhale through gently pursed lips Grounding Breath Lateral Breathing

15 Lateral Rib Cage Breathing Sitting/ Supine Inhale ribcage expands laterally Exhale ribcage deflates/ comes together Props Avoid rib popping Supine Breathe Lateral breathing Lab 5 Use noodle, ace or Theraband to facilitate

16 Powerhouse Activation sitting, standing Often referred to as 'The Powerhouse', centering, stabilizing or core control The core stabilizing complex (lumbar pelvic, lumbar thoracic, and scapular stabilizing complex) includes many of the muscles known to be involved in the stability process. Muscles of the Trunk Powerhouse Collective mms of the abdominals, gluteus and lower back; Girdle of Strength Pelvic Floor engagement/ Supinecoccyx and 2 ischium bones More easily felt in sitting

17 Lab 6 TVA initiate flexor chain Theraband, ace demo and practice Sit/stand /quad/supine Core Stabilizers Pelvic Floor most imp. mm Levator Anti Necessary for low back health The pelvic floor muscles support the inferior organs of the pelvis; bladder,prostate,uterus and rectum.

18 Lab 7 Pelvic floor activation Sitting/ dynamic surface Sit to squat Pelvic Control Rocking pelvis Neutral Imprint Use ant/post tilts to find neutral spine, tailbone Neutral spine Place where spine rests preserving all of its natural curves CLOCK TIP/ Bowl of Water Transversus to Supine Neutral spine thumbs toward the the ASIS and fingertips down by the pubis. When lifting head appearance of hands should be level. Triangle formed by ASIS and symphysis pubis Parallel to mat, optimum and best shock absorbing position

19 Triangle Form/ Neutral Pelvis Different Pelvic Alignments Pilates box Shoulder to shoulder hip to hip Ensures that body is working symmetrically

20 Lab 8 Supine Pelvic rocking Neutral Triangle Check box Pilates Box Imprinted Position Slight posterior tilt with slight pelvic flexion, used if neutral position can not be stabilized. Particularly helpful for open chain movements With lower extremities

21 Lab 9 Testing and assessment of neutral Toe tapping Single leg lift Initiate a Sit up As you exhale peep the spine off the mat articulating each vertebrae Keep feet planted on floor Knees bent a 90 degrees C curve Scooping action

22 Scapular Movement and Stabilization Movements demonstrate principles of scapular movement and stabilization Supine Isolation/ Protraction/retraction Supine Isolation Elevation/ depression Postural Analysis Lab 10 Scapula mobility Retraction/protraction Elevation/depression Noodle sit/supine

23 Head and Cervical placement Neutral cervical alignment Head and neck in neutral position String pulling toward horizon Lab 11 Practice concepts Breathe, pelvic neutral, toe tap, imprint, movement Art of Contrology Concepts/ Props

24 Muscle Contractions used in Pilates Understanding what occurs during each exercise Types of Contractions To understand what muscles are working at any given time during an exercise we need to consider the movements that are taking place and the direction of the forces needed to perform those movements.

25 Fabricated Assisted Devices Proximal Stabilizers used with Ace bandages Muscle Re education Ace bandage proximal stabilizers Scapula/ Pelvis Make stabilizers Lab 12

26 Proximal Stabilizer Ace bandage Proximal Stabilizer Scapula Proximal stabilizer scapula Anterior view

27 Proximal Stabilizer Proximal Stabilizer Proximal Stabilizer Ace bandage Pelvic Stabilizer

28 Pelvic Stabilizer (Anterior) Scapular/ Pelvic Stabilizers Proximal Stabilizer pelvis

29 Pelvic Proximal Stabilizer Pelvic Proximal Stabilizer Proximal Stabilizer Pelvis

30 PROGRESSIONS Progression during Pilates Establish a base Fundamental/preparatory exercises are the base for the exercises to follow Natural progressions to improve strength and flexibility Progressive exercises performed in a specific order similar goal Each exercise has a variation to progress and challenge Progression Non wt bearing to weight bearing Bilateral to unilateral Simple skills to more complex Slow to fast Age, gender and expectations are factors to consider Injuries lead to disuse due to pain, swelling, spasm

31 Progression Use open and closed chains during training Progressive program with emphasis on quality, strength and increasing range of motion Principles of Exercise Design 4 P s 1. Purpose 2.Position/Posture 3.Progression 4. Population/Modifications Guidelines for therapists before starting a Pilates program Avoid Diagnosis Treatment Advice Early programming without medical clearance Cautionary signs Shortness of breath, open wounds, swelling, functional loss, apprehension/fear, no ROM, tingling/numbness, radiating pain

32 Self Regulation from Patients Required During the Self Evaluation Symmetry during movement Box square TVA to scoop abdominals Pull down wings Spine articulate vertebrae too vertebrae Flow, timing and sequencing for precision Lab 13 Progressions identify objectives participate 1. Progressions Ab Bracing

33 2. Modified Hundreds Hundreds 3. Roll Ups 4. Roll Downs

34 Lab 13 Mid range facilitation of sit up and roll down Noodle 5. Rolling Like a Ball Rolling like a ball video

35 Modification for Rolling Like a Ball Stretch Eze Band 6. Leg Circles

36 7. Single leg stretch Single Leg Stretch Basic Preparatory Pilates Exercises Many patients will gain strength and stability using preparatory Pilates exercises and then move toward the classical mat exercises

37 Pilates Supine Exercises Mat Series Spinal Curl Spinal Curls Video

38 Modification for spinal curl Hundreds The Hundred

39 Classical Pilates Hundreds video Modification for Hundreds Leg Slide

40 Leg Slide Leg Slide Hip Rolls Video

41 Modification for Hip Roll Single Leg Circles Modification

42 Roll Ups/ Roll Downs Roll Ups Spine Stretch Forward

43 The Saw The Saw Pilates Prone Exercises Mat Series

44 Swimming Swimming video Modification for swimming Separate upper from lower body Smaller lifts Work upper body first, then lower

45 Swan Dive The Dart Dart Video

46 Modification for Dart Side Lying Series Pilates Mat Exercises Side kick circles

47 Side kick series Modification for side lying leg circles Standing Pilates Series Beginner Series

48 Waist Twists Video Roll Downs Side Leg Kicks Front, Back, Circles

49 Body Roll downs Video Standing Leg Series Putting it all Together Patient goals Based on weaknesses that impede function Rationale for therapeutic exercise Length of therapy; functional outcome Objective findings Plan Continue /DC

50 Documentation/Reimbursement For Physical and Occupational Therapy bill for Pilates using CPT codes and description of code being billed for. Each 15 minute segment is billed as one unit See CPT codes for OTs/PTs and descriptions in course manual Final Group Lab Using the principals of exercise design, create a Pilates program for clients with the following musculo skeletal issues Frozen Shoulder Hip replacement post surgery 1 month ACL Tears post surgery 2 weeks Carpal Tunnel Syndrome Incorporate the 4 P principals into the program and include CPT codes used for billing. dssot@aol.com My Feel free to contact me at my address for questions Thank you for attending this seminar Hope you enjoyed it and learned a lot!

51 End of presentation Hope you enjoyed! Feel free to me Thank you