Pilates assessment

A one-to-one assessment is advised prior to entering a class, especially for cases where

• patients are in pain
• patients are unable to activate their central core. (This includes selectively activating my local stabilizing system e.g. transversus abdominus or pelvic floor muscles without bracing through the whole stomach area/ activating global muscle system)
• patients who have not done Pilates before and are going to do our online classes

Pilates is an excellent method of improving core stability

• Low back pain
• Groin, conjoint tendon
• Hamstring
• Pelvis
• Women´s health – pelvic floor and peri-natal period
• Hip /knee/ Shoulder injuries

Core Stability refers to the ability of the body to control the trunk or `core´. It involves control of deep stabilising muscles and more superficial global muscles. Good core stability is using the right muscles at the right time at the right intensity to control the trunk appropriately for the task at hand. The muscles of the body are either stabilisers (local) or movement (global) movement muscles.

Global muscles are very important for movement of the limbs and trunk. Their job is to move the body. They generate a lot of force, move the body then relax.

• Attach directly into the lumbar spine at each level
• Turn on before you move to support the spine and pelvis
• Turn on and stay on as you move
• Work at a low intensity and stay on for long periods of time
• Work independently of the global movement muscles

From the first episode of back pain the deep stabilisers change how they function. The spine and pelvis are no longer protected by the deep stabilisers as well as they should be.

The deep stabilisers now:

• Have delayed activation, turning on after you start to move
• Turn on and off as you move – working as the global muscles work rather than all the time
• Work in short bursts rather than staying on as you move.

When the deep stabilisers don´t work well to stabilise the spine, the brain recruits the global muscles to compensate. If the body didn´t compensate the spine would be unable to resist the force of gravity and would collapse. Pain around the lower back and pelvis or groin often results from these compensatory strategies. Treating the painful areas only gives short term relief. To treat the pain effectively you need to stop the reason why the compensations occur by improving the deep stabiliser muscles.

A local stabilising strategy involves using muscles that attach directly to the spine. The deep stabilising muscles insert directly or via their fascial attachments directly onto the lumbar spine. The global muscles in the same area attach from the ribs to the pelvis. The direct connections of the deep stabilising muscles allows them to have a great deal of control over the lumbar spine and pelvis. The more remote connections of the global muscles means they are less able to stabilise the lumbar spine and pelvis. The global muscles can hold the spine rigid and compress it, but can´t give the fine tuned control of the deep stabilisers. Assessing and treating issues with core stability involves assessing both the local and global systems. It is important to find what is underactive, what is overactive and make the muscles function more normally. Generally there is a deficit in the local system that needs to be improved and the subsequent compensatory strategies of the global muscles reduced. It is this reduction in the compensatory strategies that will generally make you feel better.