Pilates and the current literature – opinions, interpretations and facts.
Pilates is growing in popularity in recent times especially within clinical physiotherapy settings and within the fitness industry with various classes popping up in gyms. The method of pilates is based on the stabilization of the spine during performance of specific exercises. The pilates method uses conscious activation of the deep abdominal muscles- transverse abdominus and the pelvic floor in order to stabilize the spine.
Pilates was founded by Josef Pilates (an early exercise physiologist) in the early 20th century as a method to help rehabilitate soldiers by adding springs to their beds enabling them to perform resistance based exercises while they were bed bound and recovering. It is based on the principles of centering, control, flow, breath, precision and concentration. Pilates is a form of exercise that emphasizes quality of movement, alignment, stability and attention to what the body is doing and optimal movement patterns to achieve pain-free, stable, strong and long musculature. Since this time, particularly in the last few decades with advancements in technology/knowledge and studies into deep abdominal/pelvic floor activation there has been a growth in pilates as a tool for injuries and for optimal strength and fitness (Liebenson 1998).
In current literature there has been a number of studies into the activation of the transverse abdominus and the pelvic floor. In a study by Hodges & Richardson 1996, activation of transverse abdominus was associated with reduced lower back pain. Another study found that an increased ratio of rectus abdominus to deep abdominal muscles- transverse abdominus and internal oblique correlated directly with lower back pain (O Sullivan et al 1997). This supports the need to be performing pilates with good technique for it to be producing the benefits. A lot of people think of their core as bracing their superficial abdominals- the rectus abdominus instead of relaxing this muscle and engaging their deep core muscles. This is common in the fitness community where people are not properly educated on what their core actually is and consequently are quite weak in their deep abdominal musculature. This is why it is important to see a fully qualified pilates instructer/physiotherapist to be trained properly on the techniques of your core especially if thinking of going into a pilates gym class with no previous knowledge of your pelvic floor and transverse abdominus activation.
A study researched pilates based therapeutic exercise over a 12 month period on 39 individuals compared to a control group who received no specific exercise training and continued with usual care defined as consultation with a physician, other specialists and healthcare professionals as necessary. The outcome was that the pilates exercise based intervention group saw greater improvement than the control with it reducing acute pain and changes that were also maintained over a 12 month period (Rydeard et al 2006).
Of course as is healthy within any scientifically based practice there can be conflicting articles/opinions such as in recent years with articles by Cook and Allison et al. Allsion claims that transverse abdominus may work unilaterally in response to spinal rotations rather than as a premovement bilateral stabiliser. Cook goes onto quote this in her opinion piece article in which she discusses her doubts about the benefits and efficacy of transverse abdominus activation- quoting only this one article. Hodges goes onto discuss in his piece this is not new evidence, it is an interpretation of the evidence and in fact does not refute the original hypothesis of the function of transverse abdominus. Professor Paul Hodges is a doctor of science and medicine, also holding a bachelor of physiotherapy and a PhD from UQ. He has researched extensively in this field and is an authority in the area (Allison et al 2008, Cook 2008, Hodges 2008).
Hodges discusses and challenges the opinion and interpretations of Allison et al and the consequent opinion piece by Cook. He discusses a number of the assumptions which were incorrect made by Allison et al including that a muscle can only do one thing at a time and in unilateral arm movements transversus abdominus can only contribute to rotation. Hodges discusses that there is abundant literature that shows muscles can be activated to achieve two or more goals at once and goes on to extensively discuss that TA can act to achieve two goals at once. In summary Hodges concludes that Allison et al’s data did not refute the original hypothesis of the role of transverse abdominus in trunk control (Allison et al 2008, Cook 2008, Hodges 2008).
Pilates and its recent increase in popularity has increased public awareness about the importance of core strength, but the risks of poor instruction are present- so keep this in mind when looking into starting your pilates journey. Also keeping in mind that there will always be new literature coming out but it is important to do your research and not look at one source as your basis for opinions.
Allison GT. Transversus abdominis and core stability: has the pendulum swung? Br J Sports Med 2008;42:630–1
Cook J. Jumping on bandwagons: taking the right clinical message from research. Br J Sports Med 2008;42:863.
Hodges P. Transversus abdominis: a different view of the elephant. Br J Sports Med 2008;42:941-944
Hodges PW, Richardson CA. Insufficient muscular stabilization of the lumbar spine associated with low back pain. Spine 1996;21: 2640-2650.
Liebenson C. Spinal stabilization training: the transvers abdominus. Journal of bodywork and movement therapies 1998;2: 218-223.
O’Sullivan P, Twomey L, Allison G, et al. Altered patterns of abdominal muscle activation in patients with chronic low back pain. Australian Journal of Physiology 1997; 43: 91-98.
Rydeard R, Leger A, Smith D. Pilates based therapeutic exercise: effect on subjects with non specific chronic low back pain and functional diability: A randomised controlled trial. Journal of Prthopaedic & Sports Physical Therapy 2006;36:472-484.