Clinical Pilates

What is Clinical Pilates

Pilates is a method of exercising that was originally developed by Joseph Pilates in the 1920’s. The main aim of Pilates is to target the deep postural muscles of the abdomen and spine to improve overall central core stability and posture. The mind and body are brought together to achieve these aims through the following eight sound principles: Concentration, centering, breathing, isolation, routine, precision, control and flowing movement. Physiotherapists have adapted Pilates based exercises to make them more suitable and specific for patients with back pain, neck pain, upper limb and lower limb pain. Clinical Pilates is a gentle form of exercises carried out on a mat or in standing, and is a clinically proven way to condition and strengthen muscles while also increasing mobility and flexibility. The principle behind Pilates is to engage and strengthen your core muscles (muscles around your stomach, waist and lower back) which will help to improve posture and prevent injury. When the body is tested (for example losing your balance in daily life) you are more likely to be strong and flexible enough to withstand this and not end up injuring yourself. If you are practicing regular sport, by introducing Pilates to your training routine you will have a stronger core and be able to work with the body in a more effortless, safe and powerful way.

Some of the benefits of Clinical Pilates:

  • Improved flexibility
  • Greater strength and muscle tone (stomach, buttocks, thighs and arms)
  • More efficient respiratory system
  • Lower stress levels
  • Better posture
  • Fewer incidence of back pain
  • Fewer headaches (where they are postural based)
  • Increased bone density – Greater joint mobilityLower back pain (LBP) and neck pain (NP) can result in a weakening of the muscles that support the spine (Hides et al, 1994). This is due to a mechanism in the body called Pain Inhibition where the muscles around the painful site dont function to their optimal levels and as a result tend to weaken. This weakness can then lead to further LBP/NP as the spine doesnt have adequate stability (core stability). This is also true of the abdominal muscles (Transversus Abdominus and Pelvic floor muscles) and the hip muscles (gluteal muscle group). If any of these muscle groups are weakened through injury, postural related weakness (such as sitting at a desk all day!) or lack of training it will leave the individual at higher risk of developing an injury.However, all is not lost! Research by Hides et al (1996) has shown that specific retraining of these groups of muscles can help to resolve and prevent LBP/NP from returning. Clinical Pilates is an integral part of therapeutic rehabilitation as it aims to retrain and strengthen the lower back muscles, abdominal muscles and the hips. It consists of a progressive range of mat based exercises designed to focus specifically on some key elements such as:
  • For example, in healthy individuals the abdominal muscles activate prior to limb movements during activities of daily living; i.e. when walking, climbing stairs, and turning over in bed. This is to provide postural support to the lumbar spine (Hodges & Richardson 1997). However, in patients that suffer from LBP, abdominal muscle activation is delayed and occurs after the limb movement. As a result the lumbar spine has less stability during functional activities of daily living. Further studies found that recovery of these muscle groups does not happen automatically after LBP/NP has resolved (Hides et al., 1996).
  • What is the Evidence behind Clinical Pilates?
  • Retraining of neutral spine (lumbo-pelvic alignment) and activation of the key lumbo-pelvic stabilising muscles
  • Correct ribcage/thoracic alignment
  • Scapulo-thoracic stabilisation
  • Deep neck flexor retraining to stabilise the cervical spineHides, Julie A. PhD; Richardson, Carolyn A. PhD; Jull, Gwendolen A. MPhty, Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First-Episode Low Back Pain [Exercise and Functional Testing] Spine, Volume 21(23).December 1, 1996.2763-276Hodges P and Richardson C.A, Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement, Experimental Brain Research, vol. 114, no. 2, pp. 362370, 1997
  • Hodges P, Cresswell A, Thorstensson A;. Preparatory trunk motion accompanies rapid upper limb movement. Exp Brain Res 1999;124:6979.
  • Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH.; Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 1994 Jan 15;19(2):165-72.
  • References:
  • (Australian Physiotherapy & Pilates Institute)


Joe Normoyle