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Fascia and Pilates

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Barnes Myofascial Release and Polestar Pilates – a Life Changing Partnership

Guest post by Dr. Carol Davis

In 2013, Brent Anderson and I explored the idea about treating patients with myofascial release at his Polestar Pilates center in Coral Gables across the highway from my office at the University of Miami. I told him I thought that there was a great opportunity for us to collaborate. Manual therapy techniques that offer sustained soft touch and elongation to help release facial restrictions might prove to be a wonderful adjunct for those Pilates patients who can’t seem to smooth out their leg circles or to lie comfortably flat on the reformer bed. And indeed, a wonderful partnership developed over a period of 15 years, where clients and teachers and patients all came together to appreciate and heal in the presence of two powerful therapeutic modalities, Polestar Pilates and JF Barnes Myofascial Release, working in concert for ease and flow and function.

What is myofascial release according to the Barnes sustained soft pressure and elongation approach?

Fascial science has grown exponentially in the last 20 years ever since the emergence of the International Fascia Research Congress in 2007 in Boston, and the premier of Jean-Claude Guimberteau’s groundbreaking video of an endoscopic view of fascia, Strolling Under the Skin,  (https://youtu.be/eW0lvOVKDxE?si=ZuNXZaM7mmZ7mY36)  living fascia that reveals a fascia never before really experienced outside the human body.

Since that time, many have struggled to find words to adequately describe this living vibrating crystalline tissue, found in one continuous web from the top of our heads to the bottom of our feet.  Contiguous, with no beginning and no end.  Many definitions have emerged to try to describe fascia, and each one seems to fall short based on the limitations fostered by the discipline trying to harness this tissue for its own revelations. Anatomists often speak of fascia and layers, but Jean-Claude Guimberteau in his endoscopic view declares there are no layers; fascia exists in us in one continuous web with no spaces and no separations. But try to teach anatomy without identifying layers!  Fascia, all agree, is uniformly made of a mucopolysaccharide Type II gel composed of crystalline water, elastin, collagen, fibroblasts and other cells that are relevant to the area that fascia is supporting.

My own definition of fascia emphasizes the fact that fascia serves as a pathway for the many energetic flows within the body/mind. I maintain that, “Fascia is the living vibrating crystal matrix system within life forms that unites all other systems functionally. This communication flow of information with all systems by way of facial vibration is also known functionally as the mind ; It works to facilitate homeostasis and elevates the importance of fascia to great significance, a hierarchy within heterarchically equal systems of biotensegral energy flowing within and through the architecture of the fascial system.”

Emphasizing the role of energy resonance within and throughout the body connecting every cell, every organ, every system one to another in ongoing communication opens the pathway for consideration of how the energy flowing within us is transmitted through the facial system to our biofield. Fascial vibration offers a hypothetical explanation for how our thoughts and emotions can be transmitted nonverbally to another person. Interesting research is revealing that the intention and attention of the therapist can be energetically, non-verbally received by the interoceptive nervous system of the receiving patient or client.   

Dr. Carol Davis is an author, has been studying with John F. Barnes, PT since 1988, and has been assisting with Myofascial Release Seminars since 1997. To learn more about Fascia from Dr. Davis, please join us this weekend in her 3-hour Online “All Things Fascia” workshop. May 17th, 12-3PM Eastern.

Breast Cancer and Pilates Rehabilitation Choices

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Extract from The Pilates Journal
By Jennifer Guest

To date in 2023, there have been 20,600 new cases of Breast Cancer recorded in Australia (20,395 females and 205 males). The average age of diagnosis is 62 years old, with one in eight being diagnosed before the age of 85 years old.   

The incidence of Breast Cancer is increasing, due to accurate diagnosis with improved screening and hormonal factors which I will elaborate on below. But pleasingly, the mortality rates are reducing as early detection and treatment options are improving.   

Let us look at the hormonal factors. The more estrogen in your body, the higher the risk of developing breast cancer. If you start menstruation prior to 12 years old and do not move through menopause until post 55 years old, you are at higher risk. Those women who have never had a pregnancy also present as a higher risk. 75 per cent of breast cancer is in the ages 50 years plus and those most at risk are women who are post-menopausal.   

There is one genetic factor for Breast Cancer. The BRCA 1 and BRCA2 gene predispose a person to Breast Cancer. If there are changes to these genes, cancer cells will proliferate.   

To read the full article, please visit The Pilates Journal.

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About The Author

Jennifer Guest is an Examiner and Faculty for Polestar Pilates Australia as well as the Director of Smart Health Training and Services in South Australia. You can read more about her here!

Register for this week’s episode of Pilates Hour and join Dr. Brent Anderson and Monica Larcada in a meaningful conversation on breast cancer as Breast Cancer Awareness Month comes to a close.

How Pilates Transforms Dancers & Preserves Their Bodies

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By: Ana Bolt Turrall

Pilates has long been a transformative practice for dancers, and I can personally attest to its impact! This method offers a unique blend of strength, flexibility, body awareness, and an understanding of body mechanics that traditional dance training often lacks. Cross-training with Pilates not only enhances performance but also protects dancers from common injuries. Below, I will share a few examples of the benefits Pilates offers dancers. 

Enhanced Core Strength and Stability

One of the fundamental principles of Pilates is ‘Movement Integration,’ which is essential for building overall strength. This principle emphasizes the cohesive movement of the body throughout space with precision. Equipment like the reformer and other versatile apparatuses offer a wide range of exercises that involve pushing and pulling through resistance and assistance, guiding the body through different planes of motion. For dancers, strengthening this principle is essential for maintaining dynamic balance, executing precise movements, and performing complex choreography with ease. 

Note: one important area where dancers can see improvement through Pilates, as I did when I first discovered it, is in proper breathing techniques and understanding the role of a neutral spine in effective external and internal rotation. Pilates exercises target these areas to balance the deep foundational muscles essential for strong technique, particularly the core muscles of the trunk. Mastering this will help dancers develop the stability needed for improved control and fluidity, enhancing their technical abilities. This core-centric approach ensures that dancers can sustain their performances with grace and power, reducing the strain on other parts of the body. 

Injury Prevention and Rehabilitation

The repetitive nature of dance movements often leads to overuse injuries, particularly in the hips, knees, and ankles. Pilates addresses these vulnerabilities by promoting balanced muscle development and joint stability through resistance and load. Equipment like the Cadillac helps in aligning the body correctly, strengthening the muscles around vulnerable joints, and enhancing overall flexibility. Pilates mat work can also help improve overall body strength and address weaknesses without equipment. This not only helps in preventing injuries but also provides a structured method for rehabilitation, allowing dancers to recover more quickly and return to their practice with renewed strength. 

Improved Flexibility and Range of Motion

Flexibility is a cornerstone of dance, and Pilates excels in enhancing it through controlled, precise movements that stretch and lengthen muscles. Sometimes, working with dancers, I have had to work in smaller ranges of motion to maintain the strength required for on-demand muscle reaction, instead of working with their available ambit. Unlike static stretching, Pilates promotes dynamic flexibility, which is more applicable to dance. Dancers often find that Pilates helps them achieve greater extension, higher jumps, and more fluid movements. This improved range of motion allows dancers to explore new dimensions in their performances, making their routines more captivating and expressive. 

Increased Body Awareness and Alignment

Pilates fosters a heightened sense of body awareness, which is crucial for alignment in motion for dancers to maintain performance and prevent injury. Dancers who practice Pilates often report a stronger connection between their mind and body, enabling them to execute movements with greater precision and confidence. 

As an older dancer myself, I have benefited from the Pilates method well into my adult life. At 55 years old, I still have music left to play! Pilates has allowed me to evolve as a dancer, maintaining my passion and physical practice. My goal is to inspire others like me to not forget the beauty of movement and to express it, proving that age is no barrier to the joy and language that dance brings. Incorporating Pilates into dance training enhances a dancer’s physical capabilities and enriches their overall artistry. By building strength, preventing injuries, and preserving the body, Pilates empowers dancers to reach their full potential and sustain long, healthy careers in the demanding world of dance.  

About the Author

Ana Bolt Turrall is a movement educator and artist whose journey spans continents and disciplines. Originally from Nicaragua, Ana’s life has been shaped by experiences in Spain, Honduras, Canada and the U.S., where she now channels her passion for movement, faith, and education into inspiring others. As an adjunct professor at FSCJ, she teaches Humanities for the performing arts, blending dance, fitness, Pilates, and holistic well-being. Through her brand, The Bolt Movement, Ana empowers people of all ages to embrace healthy movement and creativity. With certifications from Polestar® Pilates and as a nationally certified Pilates instructor (NCPT®), her expertise is supported by continuous learning, including a Master’s in Fine Arts and studies in advanced movement methodologies.

Beyond the studio, Ana’s influence extends to artistic collaborations, performances at events like the Theology of the Body Congress, and the creation of works such as “The Vessels of Grace & The Graces of Aging.” She is committed to serving others through children’s dance programs and movement programs for survivors of domestic abuse. Recognized with numerous awards, including Teacher of the Year and Hispanic Artist of the Year, Ana’s legacy is defined by her compassion, creativity, and dedication to using movement as a means of transformation and healing.

Follow Ana on Instagram here and read more about The Bolt Movement here.

Fitness Guidelines for Adults with Spinal Disorders

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By: Lise Stolze

Introduction

The research community coined the term “Adult Spinal Deformity” (ASD) to represent specific abnormalities of the lumbar or thoracolumbar spine in adults. ASD includes scoliosis, a 3-dimensional spinal condition, and hyper-kyphosis, a sagittal plane spinal condition. In this discussion we will refer to ASD as Adult Spinal Disorder – a more sensitive characterization of the term. ASD is of growing interest in healthcare because of its prevalence in a population that has expanded due to increased longevity. 

Adult Scoliosis Types 

ASD includes 3 types of adult scoliosis1: 

Type 1: Primary degenerative scoliosis is attributed to asymmetric disc disorder and/or facet joint arthritis, with predominantly back pain symptoms, often accompanied by signs of spinal stenosis. It is often classified as ‘‘de novo’’ scoliosis and occurs mostly as a lumbar or thoracolumbar curve with a sagittal deviation in the form of flat back or lumbar kyphosis. 

Type 2: Idiopathic adolescent scoliosis is thoracic and/or lumbar spine scoliosis which progresses in adult life and is usually combined with secondary degeneration.  

Type 3: Secondary adult curves: 

  • Due, for example, to a leg length discrepancy or hip pathology. 
  • Due to a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures.  

All three types of scoliosis may appear as degenerative scoliosis, and the primary cause is often difficult to determine once the degeneration has significantly progressed.  

Progression 

People with ASD are at risk for progression resulting in spine instability, pain and disability. Research by Weinstein et al14 examined progression of scoliosis based on the cobb angle: 

  • > 30 deg Cobb: probable progression .5-.75°/year.
  • > 50 deg Cobb: certain progression of 1°/year.

Spine instability refers to excessive movement at vulnerable spinal segments. In scoliosis and hyper-kyphosis these segments tend to be transitional areas of the spine that occur above and below the curve apex – which is more rigid. Progression of spinal disorder occurs with lack of stabilization at these vulnerable transitional segments and results in degeneration and further compression of the concavities. 

Exercise 

Exercise has been shown to improve muscle mass and strength, both of which tend to decrease in older adults. There are 3 main exercise categories:  

  • PSSE: Physiotherapy Scoliosis Specific Exercise is provided by physical therapists certified in this evidence-based intervention. PSSE such as the Schroth Method is considered a “corrective” form of exercise intervention. General principles of PSSE are “elongation and expansion” – principles that can also be applied to fitness activities.   
  • Fitness: strength and flexibility exercises to maintain overall health and independence, or to prepare for sports and/or recreation. While fitness exercise is not corrective in nature, the health benefits are numerous. Adults with spinal disorder are vulnerable to progression, and care must be taken to reduce risk when selecting exercises. 
  • Sports and recreation: “competitive games or active leisure” that enhances quality of life.   

What Type of Exercise is Recommended? 

Current exercise recommendation for ASD is vague. So my collaborators (Hagit Berdishevsky, Sanja Schreiber and Jean Claude de Mauroy) and I conducted a Scoping Review in search of any research articles that refer to exercise recommendations for adults with scoliosis. After finding no studies that fit our criteria, we developed an algorithm based on risk to help adults with spinal disorders make safe exercise choices. 

Exercise Recommendation Based on Risk Assessment 

Ideally, the client with scoliosis would receive scoliosis specific exercises (PSSE) with a PSSE trained physical therapist, then progress to a home program including fitness exercises that support their PSSE training. They could then theoretically continue their sport activity. 

A conflict occurs when a fitness program focuses on sport mastery, such as improving golf swing, and then the selected exercises contribute to spinal compression, sheer forces and scoliosis progression. The fitness program design should be based on risk assessment, where exercises are selected according to the adult’s stabilization requirement. A fitness program serves as “stability cross training” to allow the adult to continue the sport/activity they love, for as long as possible. 

Medical Research:  Classification System 

Research on ASD and progression has been done primarily in the surgical management of ASD. Classification systems have been designed to help guide management choices for spinal disorders. In 2006 Schwab and others8 developed a classification system for ASD that was validated in 2012.9 This large retrospective cohort study examined people with ASD who consulted a surgeon about their pain and disability.  Some eventually received a surgical fusion (the ultimate stabilization). Those who were not fused received a conservative plan of care that often included PT and exercise. 

Characteristics shared by those who had fusion surgery were analyzed. A classification was established based on their shared characteristics.  These shared characteristics were then used to help predict which patients would be more likely to benefit from fusion surgery. High-risk patients shared the following radiological criteria.9 

Summary of Radiological Risk Factors 

  • Sagittal Plane Imbalance: 
    • a more forward flexed posture (offset of trunk in relation to pelvis) 
    • increased posterior pelvic tilt  
    • reduced lumbar lordosis  
  • Coronal Plane Imbalance:   
    • the presence of a lumbar curve 
    • increased coronal offset of the pelvis in relation to the trunk 

Radiological risk factors are called “adult spine modifiers” in surgical terminology and may be used by therapists and fitness instructors to determine the risk of spinal instability for a patient/client. Modifiers may be used with a physical examination focusing on gait, posture and movement competence to obtain a risk stratification to determine optimal treatment planning that includes fitness exercises: 

  • When the level of risk is high due to the presence of modifiers, a stability program is recommended.
  • When there are no spine modifiers, there is less risk and no need to restrict spinal motion in a fitness program.   

What if there is no X-Ray? 

Sometimes there is no x-ray available. This is mostly true in a fitness setting. The fitness instructor must determine if their adult client is at high-risk for pain and disability in the future. When no x-ray is available, the following clinical tests may be used.  These tests correlate with three of the radiological criteria: 

  • Scoliometer assessment4 to find the presence of primary lumbar curve  
  • C7 to Wall Distance2 to determine the presence of Sagittal Imbalance  
  • Plumb Line5 to determine the presence of Coronal Imbalance  

Movement Competence Risk Factors 

Movement Competence describes the effectiveness of a person’s underlying processes of movement including coordination, control and movement quality. Movement competence improves reaction to any destabilizing forces on the spine. 

Movement Competence Assessment can be: 

  1. A formal standardized test such as the Functional Movement Screen (FMS)12 or a formal non-standardized test like the Polestar Assessment Tool: 
Courtesy of Polestar Pilates
  1. An informal test such as:
    • any movement examination that would inform the exercise plan 
    • a person’s change of position or location 
    • a judgement or evaluation 
    • an estimation of ability 

What are the outcomes of a Movement Competence Test and what do they tell us about risk assessment?   

  • Challenged Mover:  A person who requires on-going coaching to maintain optimal alignment during fitness exercises: mod-high risk  
  • Competent Mover: A person who is appropriate for a self-guided exercise program based on their Movement Competence Assessment: low risk 

Exercise Selection 

Now we can use risk factors (both structural and movement) to develop an exercise plan that includes the following exercise categories: 

  • Basic Spine Stability category.
  • Advanced Spine Stability category.
  • Controlled Spine Movement category.

This flow chart depicts exercise selection and advancement based on risk: 

Additionally, fitness exercises can be modified to reduce compressive forces on concavities (collapsed areas in ASD) in the frontal and sagittal planes:  

Pain 

Pain is a complex experience and differs from person to person. It is a warning that something is not quite right.  It can cause a person to avoid certain actions (fear avoidance). Pain is part of the vicious cycle of ASD as described by Weinstein in 1986.14   ASD vicious cycle starts with: 

  1. Symmetric and/or asymmetric degeneration (that can be new from degenerative changes in adulthood or an add-on to existing scoliosis from adolescence).   
  1. Asymmetric load will continue and most likely create instability of the spine: listhesis in 3D which can give rise to progression, pain and disability.   

Does Exercise Help? 

Exercise reduces pain perception and can affect mental health, mood elevation and reduction of stress and depression.  It can produce an analgesic effect through activation of the central nervous system inhibitory pathways. Pain has both physical and psychological components.6  Adults tend to have mild to moderate pain as part of their daily life. If pain continues despite an appropriate fitness program based on an assessment, then we call this “persistent” pain. Ultimately, if the adult has failed to improve and pain is no longer tolerated, then referral to a specialist in ASD is recommended.  

Delphi Study 

My colleagues and I tested our theory of exercise selection based on structural and movement competence risk factors to see if experts in our field agreed with us. We sent an anonymous survey to 50 physical therapists around the world who specialize in PSSE for adults with spinal disorder. Two rounds of questions were sent, and respondents were provided results and feedback from the first round to help them achieve consensus in the second. 21/50 experts in ASD responded and a consensus of 75% agreement on all questions was achieved, resulting in the following exercise recommendations: 

Exercise Recommendations for People with Adult Spinal Disorder 
Adults with persistent pain should consult a specialist in ASD, preferably prior to beginning a general fitness exercise program 
Adults with modifiers verified radiographically or clinically should perform spine stability exercises 
Adults without modifiers who lack movement competence should begin primarily with spine stability exercises and may advance to unrestricted exercises if movement competence improves 
We are currently preparing a larger Delphi study to increase the strength of these findings. 

What About Sports? 

Recreational sports have a positive impact on quality of life, perhaps even justifying any potential risks they may impose on those with scoliosis and adult modifiers. It would be prudent for adults with ASD and risk factors who want to continue their sport, to work with a qualified fitness instructor who can provide an exercise program emphasizing stability as cross training. The adult with higher risk for instability should understand its ramifications and make an informed decision about continuing their sport. If they decide to continue their sport, they should be supported. We can help them be happy and safe! 

About the Author

Lise Stolze, MPT, DSc, is a scoliosis and spinal conditions specialist for adolescents and adults and an SSOL-Schroth educator. She is certified through the Barcelona Scoliosis Physical Therapy School (BSPTS C2) and Scientific Exercise Approach to Scoliosis (SEAS 2). Dr. Stolze owns Stolze Therapies: Scoliosis, Spine and Movement Arts in Denver Colorado, an orthopedic physical therapy clinic and studio for Pilates, fitness and movement. She is an active member of the International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). Dr. Stolze co-created the course: Scoliosis and Spinal Conditions Pilates Master Course: Supporting the Principles of the Schroth Method. She has recently completed the collaborative research study: Best Practice Fitness Exercise Guidelines for Adults with Spinal Disorders: A Delphi Survey, which helps to establish fitness exercise recommendations for physical therapists and fitness professionals working with adults who have scoliosis and other spinal disorders. 

You can follow Lise on Instagram and Facebook and catch her on some of our Pilates Hour episodes.

References

  1. Aebi. The adult scoliosis.  Eur spine J 2005 Dec;14(10):925-48. Pub 2005 Nov 18. 
  1. Amatachaya P, Wongsa S, Sooknuan T, Thaweewannakij T, Laophosri M, Manimanakorn N, Amatachaya S.  Validity and reliability of a thoracic kyphotic assessment tool measuring distance of the seventh cervical vertebra from the wall. Hong Kong Physiother J. 2016,13;35:30-36.  
  1. Berjano P, Lamartina C. Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J. 2014;23(9):1815-1824.  
  1. Cote P, Kreitz BG, Cassidy JD et al.  A study of the diagnostic accuracy and reliability of the Scoliometer and Adam’s forward bend test.  Spine. 1998, 1;23(7):796-802. 
  1. Grunstein E, Fortin C, Parent S, Houde M, Labelle H, Ehrmann-Feldman D.   Reliability and validity of the clinical measurement of trunk list in children and adolescent with idiopathic scoliosis.  Spine Deform. 2013, Nov;1(6):419-424. 
  1. Lima LV, Abner TSS, Sluka KA. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J Physiol. 2017 Jul 1;595(13):4141-4150. doi: 10.1113/JP273355. Epub 2017 May 26. PMID: 28369946; PMCID: PMC5491894. 
  1. Pope MH, Panjabi M. Biomechanical definitions of spinal instability. Spine. 1985 Apr;10(3):255-6 
  1. Schwab F, Farcy JP, Bridwell K, Berven S, Glassman S, Harrast J, Horton W. A clinical impact classification of scoliosis in the adult. Spine. 2006, 31:2109-2114. 
  1. Schwab F, Ungar B , et al.  Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study.  Spine.  2012, 20;37(12):1077-82. 
  1. Silva B, Rodrigues LP, Clemente FM, Cancela JM, Bezerra P. Association between motor competence and Functional Movement Screen scores. PeerJ. 2019,7:e7270. 
  1. Suwannarat P, Amatachaya P, Sooknuan T, Tochaeng P, Kramkrathok K, Thaweewannakij T, Manimmanakorn N, Amatachaya S.  Hyperkyphotic measures using distance from the wall: validity, reliability, and distance from the wall to indicate the risk for thoracic hyperkyphosis and vertebral fracture.  Archives of Osteoporosis.  2018, 13 (1): 25.   
  1. Teyhen DS, Shaffer SW, Lorenson CL, Halfpap JP, Donofry DF, Walker MJ, Dugan JL, Childs JD. The Functional Movement Screen: a reliability study. J Orthop Sports Phys Ther. 2012 Jun;42(6):530-40. doi: 10.2519/jospt.2012.3838. Epub 2012 May 14. PMID: 22585621. 
  1. Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, Fu KM, Burton D, Hostin R, Klineberg E, Gupta M, Deviren V, Mundis G, Hart R, Bess S, Lafage V; International Spine Study Group. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery. 2013 Oct;73(4):559-68. 
  1. Weinstein SL. Idiopathic scoliosis. Natural history. Spine (Phila Pa 1976). 1986 Oct;11(8):780-3. doi: 10.1097/00007632-198610000-00006. PMID: 3810292. 

The Real Causes of Chronic Pain

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By: Juan Nieto

Much has changed in the paradigm of chronic pain in recent years. It seems that the message that “pain does not always mean that there is damaged tissue” is finally beginning to permeate and it no longer seems crazy to talk about contextual, environmental, psychological and social factors as the greatest predictors of chronic pain. 

We can say that the best way to manage and understand how to help a person who is in a situation of chronic or persistent low back pain is to try to understand how all the factors that influence the pain are interrelated. This is what is called the biopsychosocial model in the biomedical field. 

In this post we are going to discuss the fundamental aspects of each factor that influences this model, and how they relate to each other. 

Genetic Factors

It is important to keep in mind that isolated factors would not be the only ones that contribute to the development of chronic pain. As we have commented before, chronic pain development is generally multifactorial, and environmental, biological, psychological and social factors play an important role. 

That said, genetics can, in some cases, be a significant factor in the development of chronic pain. There is growing evidence that suggests that certain genetic variations may influence how people experience and process pain (Diatchenko, 2006). There are specific genes that may be associated with an increased risk of developing chronic pain. For example, some genetic variants have been identified in genes related to the function of neurotransmitters, such as serotonin and dopamine, that could affect the way pain signals are transmitted in the central nervous system (Nielsen, 2012). 

Additionally, genes involved in the inflammatory response may also play a role in chronic pain. Genetic variations in these genes can influence how the body handles inflammation and affect the pain response. Therefore, the interaction between genetic, environmental and psychosocial factors can determine whether a person is at increased risk of developing chronic pain and how they will respond to treatments (Nielsen, 2009). 

Pathoanatomic Factors  

Pathoanatomical factors may also significantly influence the development of chronic pain. These factors refer to pathologies or physical alterations that can contribute to the persistence or exacerbation of pain in the long term. It is important to note that, according to the available scientific evidence, only in 5%-15% of cases can a finding in a diagnostic image be directly related to the main cause of pain (Dillingham, 1995). 

For this reason, we cannot say that all pathologies of the locomotor system are susceptible to producing chronic pain; however, poor management of the acute phase of pain or the development of maladaptive beliefs or behaviors can favor the exacerbation of pain and the presence of painful symptoms beyond the normal healing period of the tissues. 

Some of the most frequent situations in which a trauma or illness is the cause of pain include: 

  • Injuries or trauma: An acute injury, such as a car accident or fall, can cause tissue damage and trigger an inflammatory response. In some cases, this can result in chronic pain due to the development of negative beliefs, poor management of the situation, persistent inflammation, or the formation of scar tissue. 
  • Degenerative diseases: Conditions such as osteoarthritis, degenerative disc diseases or rheumatic conditions such as rheumatoid arthritis can cause chronic pain. 
  • Structural factors: The presence of malformations or structural abnormalities in the body, such as spina bifida, can also be causes of chronic pain. 

Once again, pathoanatomical factors will influence the development and persistence of chronic pain, especially when they interact and feedback from other factors, such as genetic, psychological and social ones.  

Neurophysiological Factors  

Neurophysiological factors play a crucial role in chronic pain development. This refers to alterations in the nervous system that can contribute to the persistence and amplification of pain in the long term. 

This topic is immense, but as an introduction, the processes we point out below are the most common in the development of chronic pain: 

  1. Central sensitization: this is a process in which neural circuits in the central nervous system become more sensitive to painful stimuli. This may result in an increased pain response and amplification of the pain signal. 
  2. Neural plasticity: refers to the ability of the nervous system to change its structure and function in response to stimuli and experiences. In the case of chronic pain, neural plasticity can lead to long-lasting changes in the connectivity and activity of neural networks related to pain perception. 
  3. Dysregulation of pain modulation systems: The pain modulation system, which includes endogenous opioid systems and other pain inhibition mechanisms, may be altered in chronic pain. This can result in a decrease in the body’s ability to regulate and control pain, contributing to its persistence. 
  4. Changes in the transmission of pain signals: In chronic pain, there may be alterations in the transmission of pain signals along neural pathways. This may involve an increase in the excitability of sensory neurons, an increased release of pain-related neurotransmitters, and changes in the response of pain receptors in the peripheral and central nervous system. 

Although we usually look for the explanation of pain in purely physical aspects, especially looking for the origin of pain in pathologies or changes in tissues, the reality is that psycho-social factors are those that generate a greater positive correlation with the persistence of pain. 

Social and Contextual Factors   

Some of these social or contextual factors are often quite unintuitive and often remain “invisible.” Below you can find three examples of situations that can lead to chronic pain and that are normally not considered by patients or health professionals: 

  1. Family and social relationships: Close relationships can have a significant impact on chronic pain. Good emotional support from family and friends can help manage pain and improve emotional well-being. On the other hand, if relationships are conflictive or lack support, this can increase stress and worsen pain. 
  2. Medical advice: When a doctor, as an authority figure and supposedly an expert on the subject, overemphasizes the possible negative side effects of a physical activity, this can generate insecurity, fear and anxiety in the patient. These negative expectations can have a real impact on the patient’s experience, causing symptoms or an aggravated perception of existing symptoms. Of course, this negative effect is not intentional on the part of the physician and likely arises from legitimate concern for patient safety. However, the way this information is communicated can influence the patient’s perception and response. 
  3. Emotional compensation: A person can maintain their chronic pain situation due to the emotional attention they receive from their close circle. This relates to the concept of “secondary gain,” and refers to the benefits or rewards that the person may receive because of their chronic pain situation. In some cases, the emotional attention and compassion received from family, friends or caregivers can create a sense of support and make the person feel heard, understood and emotionally cared for, which can be comforting and satisfying. There could be a situation where people find a sense of identity in their role as a “sick person” or “person with chronic pain.” This can create a dynamic in which chronic pain is perpetuated to maintain attention, care, and emotional connection with your immediate environment. 

Psychological Factors  

The interaction between the mind and the body is complex and influences the perception, intensity and duration of pain. Situations such as chronic stress, anxiety, depression and especially negative beliefs about pain can amplify the sensation of discomfort and make it difficult to resolve. 

For example, the personality type of patients is a determining factor in the prognosis in a situation of chronic pain. We can subclassify two types of patients based on their attitude towards the disease: active copers or “confronters” and passive copers or “avoidants.” 

Active copers tend to confront pain directly. They are more willing to recognize and confront it, typically seeking more active coping strategies such as seeking medical information, participating in therapies, or learning strategies to help them manage their pain. A proactive approach can help them feel more control over their pain and take steps to mitigate its impact. 

There is other “overly active” copers who tend to ignore symptoms and refuse to modify their behaviors when pain occurs. We refer to patients who live their lives under the motto “no pain, no gain.” This type of personality tends to make symptoms chronic, not for psychological reasons, but rather by continuously excessively stressing tissues without allowing the necessary rest and recovery. 

However, avoidant patients, also known as passive copers, tend to avoid making decisions necessary to manage their pain. Very often they stop doing activities that they think could trigger their pain and the only medical treatment that interests them is one that passively eliminates the symptoms. By avoiding actively facing pain and not making changes to their beliefs, habits, and behaviors, they are more likely to prolong their experience of pain and experience greater difficulty managing it. 

There are other factors that we know are key in the development of chronic pain. The most studied due to their clinical relevance are the following: 

  • Kinesiophobia: the feeling of fear and avoidance of movement or physical activity due to the fear that it may cause pain or worsen an injury. 
  • Catastrophizing: a pessimistic mental state in which the worst is anticipated in relation to pain or injuries. People who experience catastrophizing may magnify pain, feel a lack of control, and believe that their injury is irreversible. 
  • Self-efficacy: the confidence that certain people have in their ability to successfully undertake a task or objective. It is a key factor in pain management, as it influences the perception of control and the adoption of effective strategies to cope with it. 
  • Hypervigilance: a state of excessive and constant alertness towards bodily sensations, especially pain. Hypervigilant people are more attentive and sensitive to pain signals, which can amplify the painful sensation. 

Chronic pain is a complex health problem that involves an interaction of contextual, biological, psychological and social factors. Throughout this article, we have briefly presented some of these factors and how each of them can contribute to the development and maintenance of chronic pain. 

Conclusion  

We hope that, if you have come this far, you are more aware that psychological factors and emotions, thoughts and beliefs or behaviors can influence the intensity and perception of pain. Additionally, social factors, such as social support, family environment, and cultural experiences, can influence how chronic pain is experienced and managed. 

It is important to recognize that chronic pain cannot be addressed alone but requires a multidisciplinary approach that considers all these interrelated factors. Health professionals and patients themselves must consider not only the biological and physical aspects of pain, but also the psychological and social factors that influence the patient’s experience. 

Para leer el Blog en español, haz click aquí  

About the Author: 

As a trained physiotherapist, Juan Nieto professionally identifies as a practitioner, student, and teacher of movement. His main goal is to help individuals regain their agency, alleviate their fears, and enjoy the freedom of movement in their lives. 

He has founded and is involved in several companies related to movement and health. He is the founder of NEPO Movement Studio in Madrid, the creator of “Movimiento Desencadenado” podcast, the co-founder of Runity.run, and the Spanish representative for Polestar Pilates. 

Follow Juan on Instagram and read more about Polestar España 

Watch Juan on the Pilates Hour here and stay tuned for more episodes 

Unlocking Neuroplasticity Through Pilates

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By: Kate Strozak

Pilates instructors hold a unique position to positively impact clients not just through their bones, muscles, and fascia but also neurologically. This blog post dives into neuroplasticity, the brain’s remarkable ability to adapt and form new neural connections. Understanding neuroplasticity and how Pilates fosters it can elevate your practice, helping clients achieve holistic well-being.

What is Neuroplasticity?

Neuroplasticity, also known as brain plasticity, signifies the brain’s capacity to adapt and change throughout life. This adaptability is crucial for learning new skills, recovering from injuries, and improving cognitive function. If you’re looking to create long lasting or permanent impact for a client’s movement patterns, neuroplasticity is what you’re looking to promote. This involves two key processes:

  • Structural Plasticity: Refers to physical changes in the brain, such as the growth of new neurons (neurogenesis) and strengthening or awakening of synapses.
  • Functional Plasticity: Refers to the brain’s ability to shift functions from damaged areas to healthy ones, facilitating adaptability and recovery after injuries or strokes.

Many factors can influence neuroplasticity and when you understand these, you can optimize your Pilates sessions. Learning, physical exercise, mental challenges, and recovery are some factors influencing neuroplasticity. This is where Pilates shines.

How Pilates Could Enhance Neuroplasticity

Pilates, emphasizing quality movement and mindfulness, offers numerous benefits that directly contribute to neuroplasticity:

  • Improved Movement Efficiency: Pilates exercises require precise movements, engaging the brain in motor control. This focus could strengthen or refine neural connections, leading to better overall improved movement efficiency and control (Consider keyword phrases like “Pilates exercises for coordination” or “Pilates for balance”).
  • Enhanced Mind-Body Connection: One of Pilates’ core principles is mindful movement, requiring focus on breath and awareness. Diaphragmatic breathing stimulates the vagus nerve which helps people access the parasympathetic state, the state of rest and digest. Chronic stress can prevent neuroplasticity. By decreasing stress levels through accessing the parasympathetic nervous system, you could support neuroplasticity. Awareness or alertness is also a key component of supporting neuroplasticity.
  • Motor Learning: Learning new things, such as learning new exercises in Pilates, helps support neuroplasticity. When people learn something new, it sparks alertness and motivation. In this process, people will make mistakes, and the process queues the brain to be attentive to learn. This whole process is key in driving neuroplasticity. Repetition then solidifies new neural connections which could enhance both physical and cognitive abilities.

Physical Exercise Benefits of the Brain

As a form of physical exercise, Pilates:

  • Increases blood flow to the brain.
  • Reduces inflamation.
  • Releases neurotrophic factors (supporting neuron growth and survival).
  • Cognitive Challenges: The variety and progression of Pilates exercises require continuous mental engagement and problem-solving, further stimulating neuroplasticity and keeping the brain sharp and adaptable.

Practical Applications for Pilates Instructors

Understanding this connection can transform your approach:

  • Rehabilitation: Pilates can be an effective tool for stroke or brain injury rehabilitation. Learning new movements, being challenged and frustrated in that process, aids in retraining the brain and body for functional recovery. Pilates can be wonderfully tailored to an individual’s needs, can provide qualitative movement assessment and training, and support daily function.
  • Aging Populations: Pilates can help maintain and enhance cognitive and physical function in older adults, counteracting age-related declines in balance, coordination, conditioning and cognitive function.
  • Mental Health: Pilates has the potential to promote gratitude, mindfulness, and body appreciation. Research suggests that gratitude and mindfulness can decrease amygdala activity, a region of the brain that corresponds to aggression, anger, and stress.

Implement Neuroplasticity-Enhancing Techniques

  1. Vary Exercises Regularly: Introduce new movements and sequences to keep the brain engaged and challenged.
  2. Focus on Mindfulness: Encourage clients to concentrate on their breathing and sense of presence during exercises.
  3. Promote Coordination and Balance: Include exercises that require balance and precise movements to stimulate neural connections.
  4. Customize Programs: Tailor routines to the specific needs of clients, maximizing neuroplasticity benefits.
  5. Integrate… challenge, play, mindfulness, and sensation into sessions. I like integrating these four specific factor into every session to help foster neuroplasticity.

Conclusion

By understanding and leveraging neuroplasticity, Pilates instructors can create a transformative experience for their clients along with positive, permanent impact. Pilates is more than just physical exercise; it’s a powerful tool for enhancing neuroplasticity and promoting holistic well-being. Embrace the mind-body connection and unlock the full potential of your practice!

If you are interested in learning more, you can join me on my ‘Neuroanatomy in Motion’ course starting this October 5th! Use code ‘polestar’ to get $25 off and sign up to my mailing list to hear of future courses.

About the Author

Kate Strozak is a movement professional specialized in neuroscience as it relates to human movement. She has a Master’s in Applied Neuroscience from King’s College London and has dedicated her career to studying and applying neuroscience to movement training. Her movement education background includes Pilates, Oov, athletics, dance, yoga, Gyrotonic®, and functional strength training.

Kate has a deep passion and curiosity for her work which drives her to continue learning. Kate strives to find a balance between evidence and science supported along with real life application in her work.

She is committed to supporting students and other movement professionals in their educational endeavors through her work as a faculty member of Polestar Pilates, Oov Education, and The Center for Women’s Fitness. Her priority is to encourage critical reasoning, questioning, and curiosity in her professional education offerings.

Follow Kate on Instagram.