Pilates

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.

Pelvic Organ Prolapse and Pilates

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By: Claire Sparrow 

At least 50% of women pre-menopause experience symptoms of prolapse, and up to 85% of women post-menopause experience prolapse. I wanted to share these statistics right off the bat because, as Pilates teachers, we are often working with women who may or may not know or disclose that they have prolapse. Many women will not see their class or private session with you as relevant to their prolapse or realize that what you do together could help or hinder their symptoms. Additionally, women may not know the symptoms to look out for. 

I know this might feel worrying or surprising and you may not currently have the tools you need to start a conversation and support women with prolapse.  

What is prolapse?

Prolapse is often defined as a dropped or fallen organ due to the weakness of the pelvic floor muscles. I would suggest that this is not entirely true because we know based on the principles of biotensegrity that we are a suspension system where tension is what supports us. What that really means is that it is not strength alone that supports our organs, it’s the balance of tension, for example not too much strength and not too much laxity. Balance.  

With this understanding I redefined prolapse in my bestselling book, HOPE For Your Pelvic Floor:  

“Pelvic Organ Prolapse is the displacement of one or more pelvic organs, such as the uterus, bladder or bowel due to an imbalance of the tensional support in or influencing the pelvis.”  

I also suggest a new name for it, Pelvic Organ Displacement (POD). (Sparrow. C. HOPE For Your Pelvic Floor. Pp53)  

What are common causes of prolapse?

That balance is what leads us to what can go wrong and cause an organ to displace. One of the most common causes of imbalance is scar tissue from a birth injury. 95% of women who have a vaginal delivery will experience some degree of injury from a graze to a tear or episiotomy. If in your screening a woman tells you that she had a normal birth, it is worth asking if she had any intervention because if she had an assisted delivery she would have had an episiotomy. It’s important to note that scar tissue is essential to bring the tissue together and promote healing, however, it is like an iceberg where the surface scar is the tip, and it spreads far and wide and can pull a pelvic organ out of place. This has been proven by my colleague Anna Crowle and you can find her work here.  

What are the symptoms women may report?

You may be surprised to know that incontinence is not a common symptom of prolapse because the displaced organ prevents this. The main symptoms women experience is heaviness, tissue that feels out of place like a tampon is stuck and low back or sacrum pain.  

The three most common types of prolapse are:

  • Cystocele: the bladder displaces/bulges into the vagina and can create pressure into the lower abdomen.
  • Rectocele: the rectum displaces/bulges into the vagina and can feel like they haven’t fully emptied their bowels.
  • Uterine: prolapse, the uterus displaces/bulges into the vagina can often feel like they have a tampon or toilet tissue stuck or their internal folds of skin are in the wrong place.  

What can you do?

Now that you have a basic understanding of prolapse and appreciate how many women you teach may in fact be experiencing prolapse, how can you support them? I have created a basic three-step process to help you have a way to support those women.  

  1. Step One: Add the question to your intake form.  
    • Adding these questions will open up the conversation and give you the information you need to plan appropriately for your client. Do you have pelvic organ prolapse? Do you suspect you may have pelvic organ prolapse?  
  1. Step Two: Address and assess their breath.
    • Due to the fear and worry women carry around their organs falling out they will often go into a gripping and holding pattern that inhibits their diaphragmatic breathing process. This is something you can assess with them seated or standing to find out if they are allowing their breath to move into their pelvis. If not, you have the tools to create a positive movement experience that allows breath into the pelvis.  
  1. Step Three: Stimulate their pelvic floor through movement.
    • Instead of the traditional route of recruiting consciously, use your exercise choice, cues and intelligent imagery to help them access their spontaneous dynamic pelvic floor muscle recruitment. This might mean doing more exercises in quadruped, seated and standing where you are activating the diaphragmatic system or challenging it.  
    • Some of my favorites are double leg pump on the chair seated on the Oov, hamstring one kneeling cat variation, squats from the push through bar standing on the Oov and introducing pulses. There are so many to choose from.  

Considerations  

These three steps are a great start and even if you didn’t do these things, you may just need to know if there is anything to avoid, go with caution or be aware of:  

  • If they have pressure in their lower abdomen, it may feel uncomfortable to lie prone. 
  • They may feel embarrassed doing rolling or inversion exercises where they may pass gas due to lack of control.  
  • For some women, loaded adduction like horseback may be uncomfortable or increase their symptoms.  

I hope that you find this an eye-opening starting point and if you would like to find out more or join me in my membership or mentorship you can reach out to me or find out more at my website.

If you would like to learn more during the month of June, you can join me FREE every Wednesday at 8pm BST for Prolapse Awareness month.  

About the Author: 

Claire Sparrow is the Author of the bestselling book HOPE For Your Pelvic Floor, a Podcaster, Educator, Second Generation Teacher, & Pilates Studio Owner with over 20 years of experience.  

Claire founded her Whole Body Pelvic Health Method in 2018 after restoring her own prolapse and has helped thousands of women worldwide to restore their pelvic health so that they can step off the sidelines, into the spotlight and achieve their dreams. She has reinvented pelvic floor exercises, presents internationally and has mentored teachers in her method. Claire has created two pelvic health series’ for Pilates Anytime US, has been featured in Refinery 29, Natural Way, and Stylist Magazine and is the go-to recommendation for many leading women’s health physiotherapists.  

Claire is a Scotswoman, a mum of 3 and lives in Leeds. Her positive and humorous approach is refreshing, inspiring and fueled by empathy.  

She is the voice of HOPE. 

You can follow Claire on Instagram and Facebook.

Pilates for Hip Osteoarthritis: A Guide for Instructors

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By: Beth Kaplanek

As a Pilates instructor, you play a pivotal role in helping clients manage various conditions through targeted exercise programs. One common condition you may encounter is osteoarthritis (OA) of the hip. Understanding how to tailor Pilates exercises to support clients with hip OA can make a significant difference in their quality of life. This blog post will provide you with valuable insights and practical tips for working with clients dealing with hip osteoarthritis.

Understanding Osteoarthritis of the Hip

The hip is a ball-and-socket joint bathed in synovial fluid. The hip is one of the largest weight-bearing joints in the body with a large degree of range of motion in all planes. It relies on congruency and alignment to maintain its architecture and nourish the articular cartilage; a smooth, slippery substance that protects and cushions the ends of the bones and enables them to move efficiently.

Osteoarthritis (OA) is a degenerative joint disease affecting the articular cartilage of the joint. It is a form of arthritis that occurs in people over 50 years of age but can occur in younger people, too. One in four individuals may experience OA of the hip in their lifetime.

It is considered to be a wear and tear disorder whereby microscopic pits and fissures begin to affect the articular cartilage that overtime left untreated can create bone surface changes, cartilage thinning, joint space narrowing, leaving bone rubbing on bone and creating osteophytes (bone spur formations). The synovial fluid that bathes the joint becomes irritated and loses its consistency and ability to nourish the cartilage efficiently.

Osteoarthritis develops slowly and the pain it causes worsens over time. Factors such as aging, genetics, obesity, previous injuries and developmental dysplasia can contribute to hip OA development.

Symptoms to Watch For

  • Pain in the groin that can radiate to the buttocks or knee.
  • Difficulty navigating stairs.
  • Antalgic gait – abnormal walk that causes a limp to avoid loading the joint.
  • Decreased range of motion.
  • Morning stiffness that decreases after an hour of movement.
  • Difficulty with prolonged sitting, driving and painful squatting.
  • Pain that worsens at night.
  • Decreased activities of daily living: dressing, lifting and chores.

The Role of Pilates in Managing Hip OA

Pilates is a low-impact exercise that focuses on whole body movement that enhances adaptability and control. It provides strengthening, increases endurance, improves posture, flexibility and stability making it an excellent choice for clients with lower extremity OA. A growing body of research suggests Pilates can significantly improve pain, function, and quality of life in individuals with hip osteoarthritis.

Here’s how Pilates can benefit your clients:

  1. Strengthening Muscles: Pilates focuses on building core stability and control, which helps stabilize the hip joint and alleviate pain. Strong muscles around the hip can reduce the load on the joint itself.
  2. Improving Flexibility: Gentle stretching exercises in Pilates can increase the range of motion and reduce stiffness in the hip.
  3. Enhancing Balance: Improving overall balance through Pilates can help prevent falls and further injuries, which is crucial for clients with compromised hip joints.
  4. Reducing Pain: Low-impact movements in Pilates provide a safe way to manage pain and improve joint function without causing additional stress to the hip.
  5. Promoting Posture: Proper postural alignment alleviates unnecessary stress on the hip joint, contributing to pain relief and improved movement patterns.

Key Pilates Exercises for Hip OA

Incorporating the right exercises is essential to ensure the safety and effectiveness of your Pilates sessions. Below you will find some exercises particularly beneficial for clients with hip OA.

  • Pelvic Clock
  • Bent Knee Fall Opening
  • Bent Knee Internal Rotation
  • Bridges
  • Side Kick Series – Short Lever and Long Lever
  • Hip Capsule Guides
  • Single Leg Circles Modified

Contraindications & Modifications

Not all exercises are suitable for everyone. It’s crucial to avoid exercises that may aggravate a client’s hip pain. Always try to create a movement experience with no pain.

Modifications are key. Each of the key exercises can be modified to cater to different pain levels and client abilities. Work within a range of motion applicable for the client and creates a positive movement experience.

Tips for Working with Clients

  • Consultation: Always ensure clients have consulted with their healthcare provider before starting a Pilates program.
  • Proper Alignment: Emphasize correct alignment and hip disassociation as tolerated with all movements.
  • Gradual Progression: Start with basic exercises and gradually increase intensity based on the client’s comfort and ability.
  • Use of Props: Incorporate props like resistance bands, balls, towels, soft rollers and Pilates rings to assist and modify exercises for added support as needed.

Conclusion

As a Pilates Practitioner, your expertise can significantly improve the lives of clients with osteoarthritis of the hip. By incorporating tailored exercises and focusing on strength, endurance, flexibility, balance, and proper alignment, you can help your clients manage their condition effectively and enhance their overall well-being. Remember, the goal is to create a supportive and adaptable Pilates program that addresses the unique needs of each individual by giving a positive movement experience while promoting long-term health and mobility.

Learn more about hip osteoarthritis by joining us on a 3-hour online workshop with Beth Kaplanek where you can earn 3 NCPC Credits.

About the Author

Beth A. Kaplanek, RN, BSN, NCPT is a Practitioner of Pilates for Rehabilitation. She is a post-rehabilitation specialist at the Polestar Pilates headquarters in Miami and works as an educator for Polestar Education. She is serving on the education committee for Bone Health Osteoporosis Foundation. Previously, Kaplanek served for more than 20 years as a registered nurse working in various capacities within emergency room care, operating room care, intensive care, drug counseling, rehabilitation and hospice care.

After undergoing her first hip replacement in 2001, Kaplanek began using Pilates as a form of low impact exercise for strength and flexibility training. She has been teaching Pilates for 23 years and has had the opportunity to see and demonstrate the positive impact that the Method can have on individuals in both the pre-habilitation and post-operative rehabilitation stages.

Beth teaches, shares, and showcases her techniques and work in her course,” The Pilates Teacher’s Perspective of Lower Extremity Pathologies and Joint Replacements.”

Follow Beth on Instagram @bethkaplanek and join her on her online workshop to better understand hip osteoarthritis!

Watch Beth on the Pilates Hour here!

How The Spinefitter Empowers Pilates and Physical Therapy

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By Alexander Bohlander

Elevate Your Practice and Empower Your Clients: The Spinefitter Advantage

At Polestar Pilates, we understand the dedication Pilates instructors and physical therapists have to their clients’ well-being. We’re constantly seeking innovative tools to enhance your practice and empower you to deliver exceptional results. The Spinefitter by SISSEL – a revolutionary tool to enhance Pilates and physical therapy sessions – stands out as a versatile and effective tool, celebrated for its ability to improve spinal health, core strength, and overall client progress. 

As proven by SISSEL’s 2022 case study, spine mobility, pain, and tension were significantly improved in participants after incorporating the Spinefitter into their practice.

Here’s how the Spinefitter can revolutionize your Pilates or physical therapy sessions:

  • Enhanced Spinal Alignment and Mobility: The Spinefitter’s ergonomic design cradles the natural curvature of the spine, promoting better posture and improved mobility in your clients. Consistent use can increase flexibility, reduce stiffness, and contribute to a healthier back – a fundamental goal for many clients. 
  • Targeted Muscle Activation and Relaxation: The unique structure, featuring rows of massage balls, delivers deep tissue stimulation, promoting muscle relaxation and recovery. It’s particularly adept at activating hard-to-reach muscle groups, ensuring a well-rounded and effective workout for your clients. 
  • Effective Therapeutic and Rehabilitative Support: For clients experiencing back pain or recovering from injuries, the Spinefitter offers a gentle yet effective approach to pain relief and rehabilitation. Its design facilitates safe, controlled movements, making it ideal for therapeutic settings. 
  • Unleash Versatility in Your Sessions: Suitable for beginners and advanced clients alike, the Spinefitter integrates seamlessly with various exercise levels. This adaptability ensures dynamic and engaging sessions tailored to individual needs, a must-have for any instructor or therapist. 
  • Boost Client Body Awareness: Utilizing the Spinefitter can heighten a client’s body awareness, particularly regarding spinal alignment and movement. This amplified awareness is crucial for mastering Pilates techniques and achieving long-term benefits for your clients. 
  • Seamless Integration into Group or Private Sessions: The Spinefitter adds value in both group classes and private sessions. It allows for synchronized group activities or personalized routines, making it a perfect choice for all Pilates and physical therapy environments. 

“If your spine is completely flexible at 60, you are young.”  
— Joseph Pilates

Ready to Take Your Practice to the Next Level?

Are you interested in incorporating the Spinefitter into your Pilates or physical therapy sessions? Visit Polestar Pilates to discover specialized training that will equip you to master this tool and maximize client results. We currently offer a course on the Spinefitter and registrations are open! To acquire your own Spinefitters, head over to the Balanced Body store. 

At Polestar Pilates, we’re committed to providing the tools and knowledge to empower you to elevate your practice and empower your clients. The Spinefitter by SISSEL is just one example of how we can help you achieve optimal client health and peak performance. Join us and unlock the transformative power of Pilates or physical therapy with the right tools at your fingertips! 

About the Author:

Alexander Bohlander, a dedicated Osteopath, PT and Polestar Pilates licensee in Europe who has gained experience and extensive positive results over the last 4 years using the Spinefitter by Sissel. In his 6 health centers, Pilates studios in Germany the Spinefitter is used for: 

  • Chronic back pain conditions 
  • Fascial restriction pathologies 
  • Scoliosis treatment 
  • Athletic conditioning 
  • Spinefitter Pilates group classes 
  • Spinefitter  Pilates equipment combinations. 

The Polestar Pilates meets Spinefitter curriculum is taught worldwide with unseen success. Alexander has filled courses in China and Australia in 2024 with enthusiastic students, reporting of almost unlimited success with clients and patients. 

Follow Spinefitter on Instagram and be part of the global movement.