Pilates at Star Physio!!!

“Clinical Pilates”

“Just as a tree needs a strong trunk to support its branches, the human body needs a strong core to support all its limbs”. The term “core” has been misused over many years by health professionals, including physiotherapists the world over!

We once believed that there were a group of small “core” muscles that needed to be carefully contracted and controlled to assist or prevent back pain. Research and evidence has shown that our previous beliefs in this area were incorrect. Except for a very small group of clients, who have a condition called a spondylolisthesis, specific control of these muscles does not seem to help back pain any more than general exercise

A better description of these muscle is “trunk” muscles. There is little question that strong trunk muscles protect our spine and allow us to lift, twist and sustain postures. These muscles are strengthened with exercises that place load on the area, not by trying to isolate contractions of small muscles. To make muscles strong, they need to be appropriately loaded for the task that they need to do. Unfortunately, most Pilates exercise classes and equipment do not provide this for most people.

The other key message in most Pilates, whether it is “Clinical Pilates” run by a qualified health professional, or a Pilates session run by a “pilates instructor” is about posture. Specific or ideal postures for the pelvis and spine have also be shown to not be important for either injury prevention or long term management of lower back pain, neck pain or any other injury. The spine is developed to bend and adopt a wide range of postures, and if the posture you are in is comfortable, and you are happy with how you look, there is little argument against it! Occasionally an expert physiotherapist will instruct a client in pain on specific posture to unload sensitive tissue to ease pain, but this is usually a temporary solution for pain relief. Read some of the information from our lower back expert Dr Kevin Wernli (PhD Low Back Pain) in this article.

Now, we are not saying that Pilates is a bad exercise, and if you enjoy it and like the way you feel afterwards, go for it! However; if you are suffering from back pain, neck pain, shoulder pain or other injury, it may not provide enough stimulus to make you strong! In addition, many of the specific postures and small muscle contractions you may be asked to achieve are unlikely to help, and in fact may hinder your long term recovery.

What is Pilates?

PilatesThe Pilates method was developed to aid in rehabilitation of injured soldiers by Josef Pilates. We suspect that Josef’s ideas and exercises were based on good movement principals, which sadly have been changed by misinterpreted evidence over the last 20 or so years. For those who have done Pilates, and been taught this by our staff in the past, we are sorry, but we didn’t know any better!

Now, in the age of social media, we see celebrities doing it every day and claiming (while being paid handsomely!) that it alone has sculpted their svelte bodies! We suspect otherwise!!!

With a combination of floor work on an exercise mat and a reformer for resistance training, Pilates aims to improve strength, flexibility, posture and coordination. It may achieve some of this in the initial stages, but the lack of resistance and load means that often it will not progress enough. Progression of load is a key to both pain relief and getting stronger.

What should I do instead of Pilates at Star Physio?

Star Physio offers structured exercise and rehabilitation in our West Perth and Mosman Park Practice Gyms either as individual sessions or in small group classes. Our physiotherapists are experts on pain and injury, but also on evidence based rehabilitation and strength training.

We are often tasked with providing second and third opinions for patients with longstanding injury and we commonly find two major problems with the previous management.

  1. The patient has been told about “damage” to tissues that either doesn’t exist, or is not relevant to their pain, causing unnecessary fear and often avoidance of use and deconditioning
  2. Rehabilitation has been inadequate, commonly due to 1., and often as the previous health professional has not understood the principles or progressive loading and strength and conditioning. It is amazing how many experienced physiotherapists have poor understanding of this!

At the other end of the spectrum we see clients who believe they need to get strong, but either try to do it themselves with the wrong exercises, techniques and loads, or they enlist the services of health professionals who do not understand tjhat pain and specific tissue injury require the adaptation of exercises to the individual client.

Evidence Based Exercise Therapy and Rehabilitation

What we now understand is that pain and injury or tissue damage are often unrelated, for example you can have severe pain with no tissue damage or injury. We also understand that many of our clients have been given poor advice in the past regarding their pain, and particularly in patients with long term pain, significant deconditioning has occurred requiring specific rehabilitation and a structured strengthening program to recover from this.

Star Physio’s ongoing quest to provide the best, evidence based care for our clients is the reason we no longer run Pilates classes! Instead we have equipped both our West Perth and Mosman Park Clinics with high quality strength and conditioning equipment, allowing rehabilitation of the smallest, weakest client, through to elite athletes.

How can we show you that there is a better way?

We offer both small group training and one-on-one teaching for our gym based rehabilitation. Our experts will give you their personal attention and tailor every regimen to your current abilities, whether individually or as a group. All you need to do is give us a call and book an appointment to begin your journey to good health.  Bookings are required, so please contact us to arrange a session with one of our highly trained physiotherapists, or give the clinic a call on 64249578 if you would like further information.

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