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Pilates Reformer Exercises

Pilates Reformer exercises can be used to gain optimal control between the lower and upper limbs whilst maintaining control over the pelvis and core. We frequently use the Reformer as an interim progression between 'floor exercises' and 'Swiss Ball exercises'.

The bright and bubbly Brazilian Physiotherapist Brunna Cardoso offers one-on-one and small group Pilates assessments and exercise programs.

Brunna 

 

Specific one-on-one exerices with the use of EMG biofeedback and Real-Time Abdominal US can be useful to encourage acurate cognitive processing of the individual components of the task. This is usually done in conjunction with 'hands on' treatment using "Muscle Energy techniques" to ensure symmetrical loading of the spine, hip and pelvis.

 

 

Mind and body fitness programs are gaining popularity with medical professionals for the rehabilitation benefits they offer patients who are in need of physical therapy. Physiotherapy practitioners often opt to take more of a holistic approach when addressing factors that may be causing a patient to have chronic pain. Treatment plans are generally devised to start with an exercise regimen before any other major procedures are performed.
Physiotherapy exercises are used as a means to strengthen one’s tendons as well as for the restoration of the patient’s flexibility in a specific area of the body. There are various exercise techniques and stretches designed for therapeutic benefits with Pilates and Yoga gaining lots of recognition for their somewhat choreographed movements that provide natural healing powers for those who have sustained an injury or who may be recovering from surgery.
Physiotherapists are using some elements of Pilates and Yoga exercises in a gym-style setting for people with injuries that are a direct result of how people may be overworking or misusing certain joints or muscles within their bodies. Pilates and Yoga can both be used to help a patient condition the brain to move muscles in a more appropriate and comfortable direction and to improve posture in functional activities including but not restricted to sitting and standing. (Ref 1) This type of physical training has additional benefits as well to help with the realignment of the spine for less overall strain on the back during normal everyday activities.
In essence, specific physiotherapy exercises and hands on techniques are designed to reduce muscle spasms, and hence compression, around a joint or spine. Pilates, Yoga, Alexander technique and modifications and/or combinations of all three are designed to activate the muscle groups which act as slings across the body. Similar to a person lying in a hammock, the bones lie in a bed of muscles. Some of these muscles are deep internal stabilisers whilst others are dynamic mobilisers working in synergy with one another in an oscillatory manner obeying Newtons Third Law of action-reaction.
The exercises performed in Pilates are somewhat similar to The Alexander Technique, which also focuses on the individual’s awareness of bodily tension. The ultimate intentions for practicing Pilates and The Alexander Technique is to bring the body and mind together in a way that enhances awareness and improves one’s general mental and physical health, much like Yoga. However, Pilates goes at a much quicker pace than yoga, offering more of a cardio workout and focusing on core strength rather than flexibility. The Alexander technique is particularly popular amongst the performing arts, with a strong emphasis on breathing, elongation through the superior axis of the spine, lightness of movement, as well as the integration of body awareness with sympathetic muscle tone. The movements for both Pilates and The Alexander Technique, focus on the diaphragm as well as conscious activation of the muscles that are located deep within the abdomen and around the spinal column to improve the lymphatic flow, myofascial tension, neural gliding, and circulation which in turn reduces pain caused by tension in the neck, upper and lower back.
Studies have shown that mind and body exercises have super healing powers for those who are seeking relief from back pain or help heal any other problematic area of the body. Yoga, Pilates, and The Alexander Technique are receiving accolades from around the world as a reliable treatment option for many physiotherapy patients.
The Feldenkrais Method is considered a gentler alternative and is most similar to Yoga. This method can also be labelled as a leading disciple within the mind and body category of naturally healing exercises. However, The Feldenkrais Method is not as ancient as the practice of Yoga, but both aspire to teach a form of sense and reaction awareness. Yoga instructors take pride in their practice of being able to focus predominantly on breathing, relaxation, and meditation. Yoga and The Feldenkrais Method are also considered therapeutic for a physiotherapy patient who may be experiencing an overload of stress that is causing pain in a specific muscle.
The Feldenkrais Method is like Yoga in ways that both programs offer new ways for one to learn how to cultivate (or retrain) joint and muscle movements. Depending upon the type of Yoga it involves holding various static poses with an emphasis on flexibility (Hatha or Iyengar) rather than strength (Ashtanga or Power Yoga). Yoga allows for one’s senses to become soothed and has also been known to ease arthritis and lower levels of cortisol (the stress hormone) after just one session.
Exercise treatments that are utilized by physiotherapists are likely to be led verbally through a sequence of movements inspired by any number of the programs mentioned above. People who are seeking to address areas of chronic pain or who are recovering from an injury or surgery are likely to notice a significant amount of relief without the need of any other unnecessary measures. Though all of the above exercises may vary in form, professional physiotherapists take careful precautions with how they may approach the specific needs of individual patients.

Further Options include Whole Body Vibration by Alfio Albasini and Martin Krause

The use of the Swiss Ball for assessment and treatment

 

Updated : 26 December 2016


 

Trending @ Back in B Physio

  • Thu 22 Dec 2016

    Ehlers Danlos Syndrome

    Is your child suffering Ehlers Danlos Syndrome? Hypermobile joints, frequent bruising, recurrent sprains and pains? Although a difficult manifestation to treat, physiotherapy can help. Joint Hypermobility Syndrome (JHS) When joint hypermobility coexists with arthralgias in >4 joints or other signs of connective tissue disorder (CTD), it is termed Joint Hypermobility Syndrome (JHS). This includes conditions such as Marfan's Syndrome and Ehlers-Danlos Syndrome and Osteogenesis imperfecta. These people are thought to have a higher proportion of type III to type I collagen, where type I collagen exhibits highly organised fibres resulting in high tensile strength, whereas type III collagen fibres are much more extensible, disorganised and occurring primarily in organs such as the gut, skin and blood vessels. The predominant presenting complaint is widespread pain lasting from a day to decades. Additional symptoms associated with joints, such as stiffness, 'feeling like a 90 year old', clicking, clunking, popping, subluxations, dislocations, instability, feeling that the joints are vulnerable, as well as symptoms affecting other tissue such as paraesthesia, tiredness, faintness, feeling unwell and suffering flu-like symptoms. Autonomic nervous system dysfunction in the form of 'dysautonomia' frequently occur. Broad paper like scars appear in the skin where wounds have healed. Other extra-articular manifestations include ocular ptosis, varicose veins, Raynauds phenomenon, neuropathies, tarsal and carpal tunnel syndrome, alterations in neuromuscular reflex action, development motor co-ordination delay (DCD), fibromyalgia, low bone density, anxiety and panic states and depression. Age, sex and gender play a role in presentaton as it appears more common in African and Asian females with a prevalence rate of between 5% and 25% . Despite this relatively high prevalence, JHS continues to be under-recognised, poorly understood and inadequately managed (Simmonds & Kerr, Manual Therapy, 2007, 12, 298-309). In my clinical experience, these people tend to move fast, rely on inertia for stability, have long muscles creating large degrees of freedom and potential kinetic energy, resembling ballistic 'floppies', and are either highly co-ordinated or clumsy. Stabilisation strategies consist of fast movements using large muscle groups. They tend to activities such as swimming, yoga, gymnastics, sprinting, strikers at soccer. Treatment has consisted of soft tissue techniques similar to those used in fibromyalgia, including but not limited to, dry needling, myofascial release and trigger point massage, kinesiotape, strapping for stability in sporting endeavours, pressure garment use such as SKINS, BSc, 2XU, venous stockings. Effectiveness of massage has been shown to be usefull in people suffering from chronic fatigue syndrome (Njjs et al 2006, Man Ther, 11, 187-91), a condition displaying several clinical similarities to people suffering from EDS-HT. Specific exercise regimes more attuned to co-ordination and stability (proprioception) than to excessive non-stabilising stretching. A multi-modal approach including muscle energy techniques, dry needling, mobilisations with movement (Mulligans), thoracic ring relocations (especially good with autonomic symptoms), hydrotherapy, herbal supplementaion such as Devils Claw, Cats Claw, Curcumin and Green Tee can all be useful in the management of this condition. Additionally, Arnica cream can also be used for bruising. Encouragment of non-weight bearing endurance activities such as swimming, and cycling to stimulate the endurance red muscle fibres over the ballistic white muscles fibres, since the latter are preferably used in this movement population. End of range movements are either avoided or done with care where stability is emphasized over mobility. People frequently complain of subluxation and dislocating knee caps and shoulders whilst undertaking a spectrum of activities from sleeping to sporting endeavours. A good friend of mine, Brazilian Physiotherapist and Researcher, Dr Abrahao Baptista, has used muscle electrical stimulation on knees and shoulders to retrain the brain to enhance muscular cortical representation which reduce the incidence of subluxations and dislocations. Abrahao wrote : "my daughter has a mild EDS III and used to dislocate her shoulder many times during sleeping.  I tried many alternatives with her, including strenghtening exercises and education to prevent bad postures before sleeping (e.g. positioning her arm over her head).  What we found to really help her was electrostimulation of the supraspinatus and posterior deltoid.  I followed the ideas of some works from Michael Ridding and others (Clinical Neurophysiology, 112, 1461-1469, 2001; Exp Brain Research, 143, 342-349 ,2002), which show that 30Hz electrostim, provoking mild muscle contractions for 45' leads to increased excitability of the muscle representation in the brain (at the primary motor cortex).  Stimulation of the supraspinatus and deltoid is an old technique to hemiplegic painful shoulder, but used with a little different parameters.  Previous studies showed that this type of stimulation increases brain excitability for 3 days, and so we used two times a week, for two weeks.  After that, her discolcations improved a lot.  It is important to note that, during stimulation, you have to clearly see the humerus head going up to the glenoid fossa" Surgery : The effect of surgical intervention has been shown to be favourable in only a limited percentage of patients (33.9% Rombaut et al 2011, Arch Phys Med Rehab, 92, 1106-1112). Three basic problems arise. First, tissues are less robust; Second, blood vessel fragility can cause technical problems in wound closure; Third, healing is often delayed and may remain incomplete.  Voluntary Posterior Shoulder Subluxation : Clinical Presentation A 27 year old male presented with a history of posterior shoulder weakness, characterised by severe fatigue and heaviness when 'working out' at the gym. His usual routine was one which involved sets of 15 repetitions, hence endurance oriented rather than power oriented. He described major problems when trying to execute bench presses and Japanese style push ups.  https://youtu.be/4rj-4TWogFU In a comprehensive review of 300 articles on shoulder instability, Heller et al. (Heller, K. D., J. Forst, R. Forst, and B. Cohen. Posterior dislocation of the shoulder: recommendations for a classification. Arch. Orthop. Trauma Surg. 113:228-231, 1994) concluded that posterior dislocation constitutes only 2.1% of all shoulder dislocations. The differential diagnosis in patients with posterior instability of the shoulder includes traumatic posterior instability, atraumatic posterior instability, voluntary posterior instability, and posterior instability associated with multidirectional instability. Laxity testing was performed with a posterior draw sign. The laxity was graded with a modified Hawkins scale : grade I, humeral head displacement that locks out beyond the glenoid rim; grade II, humeral displacement that is over the glenoid rim but is easily reducable; and grade III, humeral head displacement that locks out beyond the glenoid rim. This client had grade III laxity in both shoulders. A sulcus sign test was performed on both shoulders and graded to commonly accepted grading scales: grade I, a depression <1cm: grade 2, between 1.5 and 2cm; and grade 3, a depression > 2cm. The client had a grade 3 sulcus sign bilaterally regardless if the arm was in neutral or external rotation. The client met the criteria of Carter and Wilkinson for generalized liagmentous laxity by exhibiting hyperextension of both elbows > 10o, genu recurvatum of both knees > 19o, and the ability to touch his thumbto his forearm Headaches Jacome (1999, Cephalagia, 19, 791-796) reported that migraine headaches occured in 11/18 patients with EDS. Hakim et al (2004, Rheumatology, 43, 1194-1195) found 40% of 170 patients with EDS-HT/JHS had previously been diagnosed with migraine compared with 20% of the control population. in addition, the frequency of migraine attacks was 1.7 times increased and the headache related disability was 3.0 times greater in migraineurs with EDS-HT/JHS as compared to controls with migraine (Bendick et al 2011, Cephalgia, 31, 603-613). People suffering from soft tissue hypermobility, connective tissue disorder, Marfans Syndrome, and Ehler Danlos syndrome may be predisposed to upper cervical spine instability. Dural laxity, vascular irregularities and ligamentous laxity with or without Arnold Chiari Malformations may be accompanied by symptoms of intracranial hypotension, POTS (postural orthostatic tachycardia syndrome), dysautonomia, suboccipital "Coat Hanger" headaches (Martin & Neilson 2014 Headaches, September, 1403-1411). Scoliosis and spondylolisthesis occurs in 63% and 6-15% of patients with Marfans syndrome repsectively (Sponseller et al 1995, JBJS Am, 77, 867-876). These manifestations need to be borne in mind as not all upper cervical spine instabilities are the result of trauma. Clinically, serious neurological complications can arise in the presence of upper cervical spine instability, including a stroke or even death. Additionally, vertebral artery and even carotid artery dissections have been reported during and after chiropractic manipulation. Added caution may be needed after Whiplash type injuries. The clinician needs to be aware of this possibility in the presence of these symptoms, assess upper cervical joint hypermobility with manual therapy techniques and treat appropriately, including exercises to improve the control of musculature around the cervical and thoracic spine. Atlantoaxial instability can be diagnosed by flexion/extension X-rays or MRI's, but is best evaluated by using rotational 3D CT scanning. Surgical intervention is sometimes necessary. Temperomandibular Joint (TMJ) Disorders The prevelence of TMJ disorders have been reported to be as high as 80% in people with JHD (Kavucu et al 2006, Rheum Int., 26, 257-260). Joint clicking of the TMJ was 1.7 times more likely in JHD than in controls (Hirsch et al 2008, Eur J Oral Sci, 116, 525-539). Headaches associated with TMJ disorders tend to be in the temporal/masseter (side of head) region. TMJ issues increase in prevelence in the presence of both migraine and chronic daily headache (Goncalves et al 2011, Clin J Pain, 27, 611-615). I've treated a colleague who spontaneously dislocated her jaw whilst yawning at work one morning. stressful for me and her! Generally, people with JHD have increased jaw opening (>40mm from upper to lower incisors). Updated 18 May 2017  Read More
  • Fri 09 Dec 2016

    Physiotherapy with Sharna Hinchliff

    Physiotherapy with Sharna Hinchliff    Martin is pleased to welcome the very experienced physiotherapist Sharna Hinchliff to Back in Business Physiotherapy for one on one physiotherapy sessions with clients in 2017.  Sharna is a passionate triathelete and mother and has had several years experience working locally and internationally (New York and London) in the field of physiotherapy. Originally from Western Australia, Sharna graduated from the world renowned Masters of Manipulative Physiotherapy at Curtin University. read more Read More
  • Mon 07 Nov 2016

    Pilates – with Brunna Cardoso

    Pilates – with Brunna Cardoso Martin is pleased to welcome the bubbly Brunna Cardoso to Back in Business Physiotherapy for Pilates Classes in February 2017.  Brunno is an experienced pilates instructor and has had several years experience training with pilates instructors in Brazil. Read more Read More

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Updated : 10 May 2014

No responsibility is assumed by Back in Business Physiotherapy for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or ideas contained in the material in this and it's related websites. Because of rapid advances in the medical sciences, the author recommends that there should be independent verification of diagnoses and exercise prescription. The information provided on Back in Business Physiotherapy is designed to support, not replace, the relationship that exists between a patient/site visitor and their treating health professional.

Copyright Martin Krause 1999 - material is presented as a free educational resource however all intellectual property rights should be acknowledged and respected