Benefits of Pilates

By: Emily Hafer, DPT

joseph-pilatesThe practice we now call Pilates was developed in the early 20th century by Joseph Pilates as the name “Contrology,” or the complete coordination of mind, body, and spirit. Joseph’s practice had the three following guiding principles:

  1. Whole Body Health – development of the mind, body, and spirit
  2. Whole Body Commitment – mental and physical discipline
  3. Breath

By utilizing the above principles, Pilates aims to increase control over one’s body, both mentally and physically.

Pilates for healthy individuals

Aside from the obvious benefit to strength and flexibility that a structured Pilates program has to offer, other positive effects may also occur. With the start of the new school year upon us, we will begin to see a shift in the mood and sleep habits of the younger population. Gone are the days of going to bed at 1AM and waking up at lunch time (at least until next summer). While sleep habits are different for everyone, research suggests that sleep quality changed from ‘insomniac’ level, to what is considered ‘normal’ in college students who participated in a 15-week structured Pilates class. The same study, by Caldwell et al. showed an increase in positive moods, as well as a decrease in negative moods. Also noteworthy, another recent study by Küçük et al. found positive effects on both self-esteem and body image as a result of participation in Pilates. In addition to the favorable outcomes Pilates has to offer for healthy individuals, it also offers many advantages to the plan of care those with a disease or injury.

pilates-reformer

Pilates for special populations

Completing a Pilates program provides an additional challenge for individuals who are restricted from, or limited in, their daily activities as a result of injury or diagnosis. A large number of the exercises have variations in order to cater to multiple needs and patient types (Pilates For Kids). As many know, an injury to any ligament of the knee (whether it requires surgical repair or not) can lead to limitations in a patient’s activity level. One of the main goals of physical therapy for a patient with a ligamentous injury is restoration of the quadriceps muscle. According to a recent study by Ҫelik and Turkel, there is evidence to support that there is significant improvement in quadriceps strength after a structured 12-week Pilates class, as opposed to no treatment at all. Scoliosis, or abnormal curvature of the spine, is another diagnosis that could see potential benefits from the concepts and completion of a structured Pilates program. Alves de Araújo et al. found a reduction in both pain and muscle shortening, as well an increase in flexibility in individuals with functional scoliosis after completion of a 12-week Pilates program.

Register here for our next available 12-week Pilates mat class.

References:

  1. Pilates JH, Miller WJ. Pilates’ Return to Life through Contrology. Incline Village, NV: Presentation Dynamics Inc.; 1998.
  2. Caldwell K, Harrison M, Adams M, Triplett T. Effect of Pilates and taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students. Journal of Bodywork and Movement Therapies. 2009;13(2):155-163.
  3. Küçük F, Livanelioglu A. Impact of clinical Pilates exercises and verbal education on exercise beliefs and psychosocial factors in healthy women. Journal of Physical Therapy Science. 2015;27(11):3437-3443.
  4. Ҫelik D, Turkel N. The effectiveness of Pilates for partial anterior cruciate ligament injury. Knee Surgery, Sports Traumatology, Arthroscopy. August 2015:1-8.
  5. Alves de Araújo ME, Bezerra da Silva E, Mello DB, Cader SA, Inoue Salgado AS, Martin Dantas EH. The effectiveness of the Pilates method: Reducing the degree of non-structural scoliosis, and improving flexibility and pain in female college students. Journal of Bodywork and Movement Therapies. 2012;16(2):191-198.
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Don’t forget to test myotomes!

By: Ashley Koto, DPT, ATC

myotomesHave you ever worked with a patient or athlete with unexplained pain, no known injury or cause of the pain? You have treated the area of pain and surrounding muscles/joints and they have not gotten completely better. Did you test to see if a possible spinal segment is involved? This post will review the myotomes for both the upper and lower quarter to help determine if the pathology is related to the nerve root or peripheral muscle/nerve.

A myotome is defined as a distribution of musculature that is innervated by a given segmental motor nerve. The difference between manual muscle testing and myotomal muscle testing is applying force slowly and gradually increasing over time to test the myotome. This allows the proximal nerve root to show recruitment and summation of muscle fibers.

Upper Quarter Chart

Nerve Root

Muscle Muscle Action

Peripheral Nerve

C4

Levator Scapulae Neck side bending

Dorsal Scapular n.

C5

Deltoid
Biceps
Shoulder abduction
Elbow flexion

Axillary n.
Musculocutaneous n.

C6

Biceps
Extensor Carpi Radialis Longus
Supination
Wrist extension
Musculocutaneous n.
Radial n.
C7 Triceps
Flexor Carpi Ulnaris
Elbow extension
Wrist flexion

Radial n.
Ulnar n.

C8

Extensor Pollicis Longus
Flexor Digitorum
Thumb extension
Grip
Radial n.
Median n.
T1 Intrinsics Finger abduction and adduction

Deep Ulnar n.

Testing Examples:

  1. If a patient breaks with supination and wrist extension testing, but has good elbow flexion strength then you should address C6.
  2. If a patient is strong with wrist extension and shoulder abduction, but weak with supination and elbow flexion then you should treat more peripherally.

Lower Quarter Chart

Nerve Root

Muscle Muscle Action Peripheral Nerve
L2 Psoas Hip flexion

Anterior Rami L2-4

L3 Quadriceps
Adductor Longus and Magnus
Knee extension
Hip adduction

Femoral n.
Obturator n.

L4

Anterior Tibialis Ankle dorsiflexion Deep Peroneal n.
L5 Glut Medius
Peroneals
Extensor Hallicus Longus
Hip abduction
Ankle eversion
Great toe extension

Superior Gluteal n.
Deep Peroneal n.
Superficial Peroneal n.

S1

Gastrocnemius
Hamstrings
Ankle plantarflexion
Knee flex
Tibial n.
Sciatic n.
S2 Glut maximus Hip extension

Inferior Gluteal n.

Testing Examples:

  1. If a patient breaks with hip abduction and great toe extension testing it could be related to an L5 nerve root issue.
  2. If a patient breaks with ankle dorsiflexion and great toe extension, but is strong with hip abduction the pain is most likely peripheral in nature.

References:

  1. Conable KM, Rosner AL. A narrative review of manual muscle testing and implicaations for muscle testing research. Journal of Chiropractic Medicine.(2011)10:157-165.
  2. Palmer ML, Epler ME, Epler MF. Fundamentals of Musculoskeletal Assessment Techniques. (1998).
  3. Starkey C, Brown SD, Ryan J. Examination of Orthopedic and Athletic Injuries. 3rd 2010.
  4. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1 and 2. 1993.
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When “Shin Splints” Become More Serious

By: Lauren Crockett, MS, ATC, VATL

Medial tibial stress syndrome (MTSS) is commonly referred to as “shin splints” and is an overuse or repetitive stress injury from which a variety of athletes suffer. MTSS is the stress reactions that occur on the tibia and in the surrounding musculature in response to repetitive muscle contractions and limited healing time. The most common area of pain is along the medial aspect of the inferior tibia, but some athletes have pain that is anterior and more proximal on the tibia.

shin-splintsAthletes in the early stages of MTSS will complain of diffuse pain that occurs primarily at the beginning of the workout or practice and gets better as the workout progresses or within a few minutes of the workout ending. As MTSS progresses, it takes less activity for the pain to begin and more time for the pain to cease post activity. MTSS is caused by improper training and abnormal biomechanics of the knee, ankle and foot. Running on hard or uneven surfaces, wearing old or improper shoes, and increasing workout intensity too quickly are common risk factors. MTSS is a common injury in athletes that participate in sports that involve a lot of running such as track, cross country, soccer, basketball and field hockey. Dancers and football players are also at a higher risk. Early treatment consists of gastrocnemius and soleus stretches along with icing the painful area. Ankle strengthening with resistance bands and proprioception exercises are also utilized. As MTSS progresses, athletes will have a reduction in practice and play time to allow for healing. Athletes might be removed completely from competition depending on the severity of the injury. Pool and bike workouts are often used to allow the athlete to maintain their fitness levels when they are required to rest. Biomechanical errors should also be addressed, regardless of the stage of the injury.

While MTSS is a common injury that seems relatively harmless, it can progress into a more severe stress reaction. Stress fractures can occur if proper healing of the tibia is not allowed. Females are 1.5 to 3.5 times more likely to suffer from a stress fracture due to eating disorders, amenorrhea, and bone density loss. People in the military are also very susceptible to developing stress fractures. Stress fractures most commonly occur in the tibia but can also be seen in the metatarsals, fibula and navicular.

tibial-stress-fracture

Clinicians should be concerned when athletes complain of localized pain along the tibia because this is indicative of more than MTSS. Athletes who have had a sudden increase in activity with minimal rest are more at risk for developing stress fractures. Patients will present with localized pain on the anterior tibia and associated edema. Tuning fork tests are commonly used to help diagnose stress fractures when imaging is not readily available. Athletes suspected of having a stress fracture should be removed from play immediately and sent for further diagnostics, including x-rays or an MRI. X-rays will not show a stress fracture unless the fracture has been there for several weeks, but they are low cost and readily available. MRIs are one of the best tools for diagnosing stress fractures. Healing time for stress fractures varies between athletes, ranging from 4-12 weeks. Athletes will be non-weight bearing for a period of time and will progress to weight bearing as healing occurs. Many athletes are also placed in a boot to help with pain reduction and will slowly be allowed return to play based on follow up exams and diagnostics.

In summary, MTSS is a common overuse injury that many athletes will experience during their athletic career. They will complain of diffuse pain either on the lateral or anterior aspect of their tibia that usually only lasts a couple of days. Some may last longer if they do not have proper rest periods. Ice, stretching, rest and rehab exercises normally resolve the injury. However, when an athlete complains of localized pain and has associated edema, they need to be sent for imaging and removed from play.

References:

  1. Galbraith RM and Lavalee ME. Medial tibial stress syndrome: conservative treatment options.  Curr Rev Musculoskelet Med. 2009 Sep; 2(3): 127–133.
  2. Patel DS, Roth M and Kapil N. Stress Fractures: Diagnosis, Treatment and Prevention.  Am Fam Physician. 2011 Jan 1;83(1):39-46.
  3. https://www.freelapusa.com/shin-splints-how-smart-coaches-avoid-them/
  4. http://www.healio.com/orthopedics/journals/ortho/2014-4-37-4/%7B6dd3d359-8ec2-447b-ade4-5a1a2748f210%7D/multiple-anterior-tibial-stress-fractures-complicated-by-acute-complete-fracture-of-the-distal-tibia
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Sports Specialization and Intensive Training in Young Athletes

AAP Infographic

Does your young child dream of becoming the next big Olympic star or pro athlete? While you might share those goals, the American Academy of Pediatrics reminds parents to take a common-sense approach to sports training.

CHKD sports medicine specialist Dr. Joel Brenner has authored a report by the American Academy of Pediatrics warning parents about the negative effects, both physically and emotionally, of encouraging young athletes to specialize in one sport at an early age. Read more about Dr. Brenner’s report at this link.

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Strong Girls: ACL Injury Prevention for Girls

Strong Girls Fall 2016

Strong Girls Comprehensive Class
This comprehensive small group or individual training program will give athletes the skills they need to decrease their risk of tearing an ACL while learning movement efficiency to increase their performance on the field or court.

Register here for any of our fall classes!

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