Introduction[edit | edit source]

Pilates mat.jpg

Pilates is a system of exercises using special apparatus, designed to improve physical strength, flexibility, and posture and enhance mental awareness[1]. The method was designed by Joseph Hubertus Pilates from Germany whose father was a Greek ancestry Gymnast and mother was a Neuropath. In his childhood, Pilates was weak and sickly (he suffered from asthma, rickets and rheumatic fever). He strongly needed to take care of his physical health and that is why he became very interested in practicing body building, gymnastics, yoga and ‘kung fu’. At 14 years old he had perfectly developed his musculature and was asked to pose for pictures of anatomical charts.

Before he turned 30 he moved to England where he worked as a boxer, circus performer and self-defence trainer. When World War I began he was interned to an internment camp where he has been teaching and improving his system of mat exercises he called ‘Contrology’. [2] [3] [4] After the war, Pilates returned to Germany where he collaborated with Rudolf Laban and other important experts of dance and physical exercise. At the age of 42 he moved to United States where (with his wife Clara) he opened his first Studio. Soon his method become popular between well known dancers who wanted to become more aware of the sage of mind to control muscles and who needed help with proper training, recovery and rehabilitation.[3]

In his life he published 2 books related to his method:

• Your health (1934)
• Return to life (1945) [2]

"I must be right. Never an aspirin. Never injured a day in my life. The whole country, the whole world, should be doing my exercises. They'd be happier." - Joseph Hubertus Pilates, in 1965. He died in United States in 1967.[3]

Pilates Method   [edit | edit source]

Pilates, as a method and an exercise movement, yields numerous benefits.[4] Its systematic practice leads to increased lung capacity and circulation. It also improves joint health and bone density. When exercising Pilates it is important to remember that every movement should be done slowly and include each of the 6 basic principles. 

  1. Concentration - Pay attention to starting position, slow and smooth movements, as well as each part of the body. Stay focused and do not let yourself be distracted.[5]
  2. Breathing - Oxygen inhalation refreshes brain and body. Deep breaths clear the lungs, bring on relaxation, and give a better focus. Coordinate breathing with movement to understand body work.
  3. Control - Exercises need to be done with a full control of muscle work.
  4. Centering - All movements start from centering – engaging core muscles (deep muscles such as diaphragm, lumbar multifidus, transversus abdominis, pelvic floor muscles and their assistants: erector spinae, latissimus dorsi, gluteus maximus, oblique abdominis, rectus abdominis). Centering helps to improve balance and posture. In-other words it is called power house of the body. One of the primary goals of Pilates is to strengthen the 'powerhouse' or core-stabilisation[6].
  5. Precision - Focus attention on each exercise. They need to be done properly to benefit from them.
  6. For movement - Every movement should start from a strong center and flow gently and slowly. [7][8]


Pilates Classic Exercises [edit | edit source]

In Joseph Pilates book, 'Return to Life', he describes his original 34 matwork exercises. For the first time, the book was published in 1945.[10]


Today there are plenty of different schools offering teaching and training in modern Pilates. In Modern Pilates, Joseph Pilates original Exercises have been changed and some new equipment has been added. [2] Pilates is popular within fitness and physiotherapy industries.

Pilates in Physical Therapy[edit | edit source]

  • The interest and popularity of Pilates is increasing worldwide. In addition to being used in fitness programs, it is being used in some rehabilitation programs.[12] There is a significant amount of research and clinical evidence supporting the benefits of Pilates exercises.
  • Pilates also incorporates set breathing patterns. Set breathing patterns are when inhalation occurs during one phase of a specific movement/ exercise, and exhalation during another phase of the movement. Active breathing is also proven to increase respiratory muscle strength and performance[13].
  • People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilizing muscles, is popular as a form of exercise with people with MS and therapists.[14] MS symptoms such as fatigue sensation can be reduced and physical performance can improved in MS patients by Pilates exercises.[15]
  • Studies have shown the effectiveness of a few weekly Pilates sessions as helping to reduce lower back pain. Improvements in pain, disability and physical and psychological perception of health in individuals who completed daily sessions of Pilates have been found. [16]
  • Modern Pilates mat and ball exercises were effective in reducing obesity, body composition parameters and flexibility in sedentary obese women. [17]
  • The use of Pilates was found to improve ongoing Low Back Pain (LBP) in patients who received conventional physiotherapy treatment, the improvement was most obvious in the female population group. [18]
Back pain image.jpg

Pilates and Low Back Pain[edit | edit source]

Pilates as a rehabilitation programme is used in treatment of chronic low back pain (CLBP) and its results could be compared to exercise program results [19] . A Cochrane Review shows that there is a low to moderate quality evidence that support the effectiveness of Pilates programme on pain and disability in cases of low back pain (LBP) [20]. However, recent studies shows that Pilates training program for 3-9 weeks, including 1 -2 sessions per week, which consist of core and strength exercises or mind-body exercises, found to be the most advantageous coping with pain and disabilities resulting chronic LBP[21]. Most of Pilates programmes for LBP depend on improving or activating the core muscle group or 'power house'[22]. Mainly it consists of isometric contraction of the deep abdominal muscles, pelvic floor muscles, gluteus maximus and multifidus.[20] Exercises consisted of 5 min of warm-up (breathing and mobility exercises), 50 min of Pilates exercises (stretching and strengthening exercises for muscles of the trunk and lower and upper limbs) and 5 min of cool down (relaxation exercises and massage with ball). Exercises were performed with concentric and eccentric contraction of trunk, spine, upper and lower limb muscles in all planes of movement. Each exercise was done with a single series, with a 2 min interval between exercises, and the number of repetitions varied from 8 to 12, corresponding to approximately 60% to 70% of one maximum repetition as assessed with the Borg scale.The exercises were performed at three levels of difficulty: basic, intermediate and advanced. The basic exercises were adapted to the conditions of each patient by reducing or increasing resistance (e.g, the roll-up exercise using the tower bar on the Cadillac can be performed with the spring in the high position to make the movement easier or in the low position to make the movement more difficult)[20][23] [24].

A study explored the effectiveness of Pilates exercise for treating people with chronic low back pain (CLBP) is yet to be found out. 30 Australian physical therapists experienced in the use of Pilates exercise were surveyed in 3 questionnaires. Participants were agreed that people who have poor body awareness and maladaptive movement patterns may benefit from Pilates exercises and they also agreed that Pilates exercise may improve functional ability, movement confidence, body awareness, posture and movement control. [25]

Another randomized controlled study was conducted to find out the effect of Pilates on postural alignment for adult women. The results have shown that the Pilates-based exercise enhanced some aspects of the postural alignments measured by frontal alignment of the shoulder and sagittal alignment of the head and pelvis.[26]

Pilates during Pregnancy[edit | edit source]

Pregnancy is a specific stage in women’s life, a time when they face physiological and biomechanical changes that, without proper monitoring, lead to the emergence of musculoskeletal discomforts. Most of these issues are associated with postural changes, balance, ligament laxity, body weight increase and cardiorespiratory disorders. The Pilates method provides several benefits such as increased respiratory capacity, improved muscle strength and the strengthening of torso-stabilizing muscles, flexibility, spine mobility, postural alignment, coordination, proprioception, balance and motor control. Given the specific condition of pregnant women and the variations derived from such condition, Pilates may positively contribute to these women's health within their physical and psychological limitations. Pregnant women are known for the several physiological changes they go through; thus, Pilates can make important contributions to their health, such as the promotion of quality of life and well-being to improve their adaptation to each gestational week[27].

A study conducted to address the importance of Pilates, clinical guidelines and physical activities practiced in the main pregnancy periods (trimesters) through a bibliographical analysis concluded that the knowledge about the physiological and psychological changes affecting pregnant women, in association with the training in Pilate’s techniques, may promote and contribute to a gestational period with no complications and to reduce the risk of low-back pain and osteoarticular discomforts.

Stabilization, strengthening and stretching exercises should be performed, but the gestational week and the patient's physical and emotional limitations must be respected. It is possible seeing that physical activity is beneficial to pregnant women. Thus, such practice should be encouraged by health professionals.[27]


Pilates for Pelvic Health[edit | edit source]

Pilates exercise programs have been assessed for the potential to have a positive effect on pelvic health in women. Modified Pilates (MP) for Urinary Incontinence have been assessed by Lausen et al. (2018). This study aimed to assess the effectiveness of a 6-week course of MP classes as an adjunct to standard physiotherapy care for urinary incontinence through a randomized control trial. Women who attended the modified Pilates classes and who had lower symptom severity at baseline showed: improved self-esteem, decreased social embarrassment and lower impact on normal daily activities. Alternatively, women with higher symptom severity showed improvement in their personal relationships.[29] However, when measuring the improvement in continence in the ICIQ-SF , Yoga exercises activating the pelvic floor and core muscles were found to be more beneficial than Pilates exercises.[30]

Additionally, Pilates has also been found to be beneficial in males post-prostatectomy dealing with urinary incontinence, and the results showed that ten sessions of Pilates can increase muscle strength, accelerate the return to continence, and improve quality of life.[31] Another study examined the effect of a Pilates exercise program and a pelvic floor muscle-training (PFMT) program on improvements in pelvic muscle strength in women, and the authors found improvements in both groups, with no significant difference between them.[32] These findings are not consistent and require further research, as some studies have found no difference between groups completing Pilates training compared with those remaining sedentary.[33] It has been shown that it may be necessary to incorporate exercises into the Pilates program to evoke voluntary pelvic floor muscle contractions in order to see a positive impact on the strength of the pelvic floor muscles.[34]

References[edit | edit source]

  1. Oxford Dictionaries, Definition of Pilates in English. Available from: http://oxforddictionaries.com/definition/english/Pilates (accessed 20 Oct 2013).
  2. 2.0 2.1 2.2 Owsley A. An introduction to clinical Pilates. International Journal of Athletic Therapy and Training. 2005 Jul 1;10(4):19-25.
  3. 3.0 3.1 3.2 Latey P. The Pilates method: history and philosophy. Journal of bodywork and movement therapies. 2001 Oct 1;5(4):275-82.
  4. 4.0 4.1 Pilates Method Alliance, An Exercise in Balance: The Pilates Phenomenon. Available from: http://www.pilatesmethodalliance.org/i4a/pages/index.cfm?pageid=3277 (accessed 20 Oct 2013).
  5. Wells C, Kolt GS, Bialocerkowski A. Defining Pilates exercise: a systematic review. Complementary therapies in medicine. 2012 Aug 1;20(4):253-62.
  6. Muscolino, J.E. and Cipriani, S., 2004. Pilates and the “powerhouse”—I. Journal of bodywork and movement therapies8(1), pp.15-24.
  7. Powers S. Stefanie Powers, Guide to Longevity and Well - being through Pilates. London: Gaia Books Ltd. 2005.
  8. Ackland L. Body Power, a unique system of exercise developed from work of Joseph H Pilates. London: Thorsons, 2001.
  9. Brad Leeon. 6 Basic Principles. Available from: http://www.youtube.com/watch?v=mO0mKsDmP8M (accessed 20 Oct 2013).
  10. Joseph Pilates Original 34 poses from Return to Life. Available from: http://www.easyvigour.net.nz/pilates/h_pilates_classic.htm (accessed 4 Sept 2013).
  11. Charles Kenner. Joseph Pilates Classical Mat Exercises. Available from:http://www.youtube.com/watch?v=5ShtfZp3Mwg (accessed 20 Oct 2013).
  12. Di Lorenzo CE. Pilates: what is it? Should it be used in rehabilitation? Sports Health 2011;3(4):352-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23016028 (accessed 20 Oct 2013).
  13. Giacomini MB, da Silva AM, Weber LM, Monteiro MB. The Pilates Method increases respiratory muscle strength and performance as well as abdominal muscle thickness. Journal of bodywork and movement therapies. 2016 Apr 1;20(2):258-64.
  14. Freeman J, Fox E, Gear M, Hough A.Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial. BMC Neurol 2012;12:19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22480437 (accessed 20 Oct 2013).
  15. Sánchez-Lastra MA, Martínez-Aldao D, Molina AJ, Ayán C. Pilates for people with multiple sclerosis: A systematic review and meta-analysis. Multiple sclerosis and related disorders. 2019 Feb 1;28:199-212.
  16. Notarnicola A, Fischetti F, Maccagnano G, Comes R, Tafuri S, Moretti B. Daily pilates exercise or inactivity for patients with low back pain: a clinical prospective observational study. Eur J Phys Rehabil Med 2013. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24104699 (accessed 20 Oct 2013).
  17. Cakmakçi O.The effect of 8 week pilates exercise on body composition in obese women.Coll Antropol 2011;35(4):1045-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22397236 (accessed 20 Oct 2013).
  18. Quinn K, Barry S, Barry L. Do patients with chronic low back pain benefit from attending Pilates classes after completing conventional physiotherapy treatment?. Physiotherapy Practice and Research. 2011 Jan 1;32(1):5-12.
  19. Wajswelner, H., Metcalf, B. and Bennell, K., 2012. Clinical Pilates versus general exercise for chronic low back pain: randomized trial. Medicine & Science in Sports & Exercise44(7), pp.1197-1205.
  20. 20.0 20.1 20.2 Yamato, T.P., Maher, C.G., Saragiotto, B.T., Hancock, M.J., Ostelo, R.W., Cabral, C., Costa, L.C.M. and Costa, L.O., 2016. Pilates for low back pain. Sao Paulo Medical Journal134(4), pp.366-367.
  21. Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, Torres-Costoso A, Pozuelo-Carrascosa DP, Reina-Gutiérrez S, Pascual-Morena C, Martínez-Vizcaíno V. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022 Aug;52(8):505-21.
  22. Miyamoto GC, Franco KFM, van Dongen JM, et al Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation Br J Sports Med Published Online First: 10 March 2018. doi:10.1136/bjsports-2017-098825
  23. Muscolino, J.E. and Cipriani, S., 2004. Pilates and the “powerhouse”—II. Journal of bodywork and movement therapies8(2), pp.122-130.
  24. Balady, G.J., Berra, K.A., Golding, L.A., Gordon, N.F., Mahler, D.A., Myers, J.N. and Sheldahl, L.M., 2003. Diretrizes do ACSM para os testes de esforço e sua prescrição. Rio de Janeiro: Guanabara239.
  25. Wells C, Kolt GS, Marshall P, Bialocerkowski A. Indications, benefits, and risks of Pilates exercise for people with chronic low back pain: a Delphi survey of Pilates-trained physical therapists. Physical therapy. 2014 Jun 1;94(6):806-17.
  26. Cruz-Ferreira A, Fernandes J, Kuo YL, Bernardo LM, Fernandes O, Laranjo L, Silva A. Does pilates-based exercise improve postural alignment in adult women?. Women & health. 2013 Aug 1;53(6):597-611.
  27. 27.0 27.1 Martin AC, Alvares RF, Nascimento TR, Paranaiba SSW, Da Silva-Morais TK, Santos C.D. Pilates for Pregnant Women: A Healthy Alternative. Journal Women's Health Care. 2017 April 6:366.
  28. Women's health. 8 Pilates Abs Exercises from Women's Health. Available from: https://www.youtube.com/watch?v=42r0A-WUiNY [last accessed 2/2/2019]
  29. Lausen A, Marsland L, Head S, Jackson J, Lausen B. Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: a mixed methods pilot for a randomised controlled trial. BMC women's health. 2018 Dec;18(1):16.
  30. Kannan P, Hsu WH, Suen WT, Chan LM, Assor A, Ho CM. Yoga and Pilates compared to pelvic floor muscle training for urinary incontinence in elderly women: A randomised controlled pilot trial. Complementary therapies in clinical practice. 2022 Feb 1;46:101502.
  31. Gomes CS, Pedriali FR, Urbano MR, Moreira EH, Averbeck MA, Almeida SH. The effects of Pilates method on pelvic floor muscle strength in patients with post‐prostatectomy urinary incontinence: A randomized clinical trial. Neurourology and urodynamics. 2018 Jan;37(1):346-53.
  32. Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, Vangeli M. A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. International urogynecology journal. 2010 Apr 1;21(4):401-8.
  33. Ferla L, Paiva LL, Darki C, Vieira A. Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study. International urogynecology journal. 2016 Jan 1;27(1):123-8.
  34. Torelli L, de Jarmy Di ZI, Rodrigues CA, Stüpp L, Girão MJ, Sartori MG. Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial. International urogynecology journal. 2016 Nov 1;27(11):1743-52.