The effect of Pilates on pelvic floor muscle strength in women with urinary incontinence: Difference between revisions

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<div class="editorbox"><div class="editorbox">'''Original Editor '''- [[User:Eugenie Lamprecht|User Name]] </div>'''Lead Editors''' &nbsp; 
<div class="editorbox"> '''Original Editor '''- [[User:Eugenie Lamprecht|Eugenie Lamprecht]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>  
</div>


== Introduction ==
== Introduction ==
The prevalence of Urinary Incontinence (UI) is approximately 48.3 and 46.4%, and only 26% of women, presenting with UI symptoms, consulted a doctor. Stress UI seems to be more common under younger women and urgency UI dominate more common among women older than 80 years. Women with a body mass index (BMI) ≥35 had the highest prevalence of UI<ref>Schreiber Pedersen L, Lose G, Høybye MT, Elsner S, Waldmann A, Rudnicki M. Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark. Acta obstetricia et gynecologica Scandinavica. 2017 Aug;96(8):939-48.</ref><ref>Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. International urogynecology journal. 2012 Aug 1;23(8):1087-93.</ref>.
The prevalence of Urinary [[Urinary Incontinence]] (UI) among women varies widely but is approximately 55%. Many women feel embarrassed and believe it's a normal part of womanhood. For this reason, many cases of UI go undiagnosed.  


Conditions such as; urinary incontinence, pelvic organ prolapse, pain and sexual disorders; are associated with weakness of pelvic floor muscles (PFM)<ref>Martinez CS, Ferreira FV, Castro AA, Gomide LB. Women with greater pelvic floor muscle strength have better sexual function. Acta obstetricia et gynecologica Scandinavica. 2014 May;93(5):497-502.</ref>.
UI has a large impact on the socioeconomic burden worldwide. UI is associated with lower Quality of Life (QoL), depression and extremely high annual medical-care costs.  


== Clinically Relevant Anatomy  ==
Risk factors include;
The bladder, uterus, rectum and the urethral- and anal sphincters are surrounded by a dome-shaped striated muscular sheet called the Pelvic Floor Muscles (PFM). This dome-shaped structure plays an important role in storing and elimination of urine and stool<ref name=":0">Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterology & Motility. 2006 Jul;18(7):507-19.</ref>.
* Pregnancy and [[Childbirth and the Pelvic Floor|childbirth]]
* [[Hysterectomy]]
* Higher body-mass-index (BMI)
* Advanced age
* Family history
* Smoking
* Caffeine
* [[Diabetes]]
* [[Constipation]]
* [[Urinary Tract Infection|Urinary tract infections]] (UTI)<ref name=":3">Wood LN, Anger JT. [https://pubmed.ncbi.nlm.nih.gov/25225003/ Urinary incontinence in women]. Bmj. 2014 Sep 15;349:g4531.</ref>


The PFM mainly consists of the levator ani and coccygeus muscles<ref name=":0" />.  
== Clinically Relevant Anatomy and Physiology  ==
The [[Pelvic Floor Anatomy|Pelvic Floor]] muscles' (PFM) main function is control over bladder, bowel, sexual function, pregnancy in women and providing support to pelvic organs<ref name=":4">Eickmeyer SM. Anatomy and physiology of the pelvic floor. Physical Medicine and Rehabilitation Clinics. 2017 Aug 1;28(3):455-60.</ref>.


The levator, coccygeus and urogenital diaphragm are innervated by S2, S3, and S4 nerve fibres; while the external anal sphincter is innervated by the pudendal nerve <ref>Percy JP, Swash M, Neill ME, Parks AG. Electrophysiological study of motor nerve supply of pelvic floor. The Lancet. 1981 Jan 3;317(8210):16-7.</ref>.[[File:1115 Muscles of the Pelvic Floor.jpg|alt=https://commons.wikimedia.org/wiki/File:1116_Muscle_of_the_Female_Perineum.png|left|thumb|Muscles of the Pelvic Floor|544x544px]]
The PFM mainly consists of the levator ani and coccygeus muscles<ref name=":0">Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterology & Motility. 2006 Jul;18(7):507-19.</ref> and are innervated from the lumbosacral plexus<ref name=":4" />.
[[File:Sacral and coccygeal plexus.png|center|thumb]]
<br>


== Mechanism of pelvic floor Injury ==
==== Mechanism of pelvic floor Injury ====
Literature indicates a strong association between vaginal childbirth and pelvic floor disorders however, further research is necessary to determine which aspects of childbirth contribute most<ref>Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstetrics and gynecology. 2011 Oct;118(4):777.</ref>.
Literature indicates a strong association between vaginal childbirth and pelvic floor disorders however, further research is necessary to determine which aspects of childbirth contribute most<ref>Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstetrics and gynecology. 2011 Oct;118(4):777.</ref>.


Pregnancy and childbirth may lead to pelvic floor injury due to compression, stretching or tearing of nerve, muscle, and connective tissue.
[[Physiological Changes in Pregnancy|Pregnancy]] and childbirth may lead to pelvic floor injury due to compression, stretching or tearing of nerve, muscle, and connective tissue.


The following pelvic floor-complications may occur due to pregnancy and childbirth;
[[File:1115 Muscles of the Pelvic Floor.jpg|alt=https://commons.wikimedia.org/wiki/File:1116_Muscle_of_the_Female_Perineum.png|thumb|Muscles of the Pelvic Floor|350x350px|left]]
* neural injury (due to compression during labour and vaginal delivery),
[[File:Sacral and coccygeal plexus.png|center|thumb|330x330px]]The following pelvic floor-complications may occur due to pregnancy and childbirth;
* levator ani and coccygeus muscles injury,
* Neural injury (due to compression during [[labour]] and vaginal delivery),
* fascial injury, and  
* Levator ani and coccygeus muscles injury,
* impaired connective tissue remodelling (increased synthesis of collagen and elastin causes an alteration in soft tissue biomechanics during pregnancy)<ref>Handa VL. Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth. UpToDate2014. 2015.</ref>.<br>
* Fascial injury, and  
<blockquote>For further information regarding clinical presentation and diagnostic procedure, please read [https://physio-pedia.com/Incontinence 'Incontinence]'<br></blockquote>
* Impaired connective tissue remodelling (increased synthesis of collagen and elastin causes an alteration in soft tissue biomechanics during pregnancy)<ref>Handa VL. Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth. UpToDate2014. 2015.</ref>. <br>


== Pilates-centred Pelvic Floor Muscle Training (PFMT) ==
== General UI management plan ==
<u>Lifestyle interventions</u>
* Reduce fluids, caffeine and carbonated drinks
* Regular and timed urination
* Treating constipation
* Reduce BMI (<25)
* '''Pelvic floor muscle training (PFMT)'''
 
<u>Pharmacology</u> (urgency urinary incontinence)
* Anticholinergics
* Beta 3 agonist
 
<u>Surgery</u> (stress urinary incontinence)
* Injectable bulking agents
* Burch colpo-suspension
* Fascial slings
* Mid-urethral synthetic slings
<u>Other</u>
* OnabotulinumtoxinA injection
* Sacral neuromodulation
* Posterior tibial nerve stimulation
* Incontinence pessaries<ref name=":3" />
 
== Pelvic Floor Muscle Training and Pilates  ==
It's important to understand that PFM function in synergy with abdominal muscles, chest wall and diaphragm, and not in isolation. Throughout each day, the intra-abdominal pressure and trunk muscle activity alternate regularly. The PFM have to respond rapidly to these changes to prevent incontinence or prolapse of pelvic organs.
It's important to understand that PFM function in synergy with abdominal muscles, chest wall and diaphragm, and not in isolation. Throughout each day, the intra-abdominal pressure and trunk muscle activity alternate regularly. The PFM have to respond rapidly to these changes to prevent incontinence or prolapse of pelvic organs.


The pilates concept is based on 'centre'(core) and 'control'. The pilates method focusses on the following muscles when referring to the 'core';
The pilates concept is based on 'centre'(core) and 'control'. The pilates method focusses on the following muscles when referring to the 'core';
* PFM (inferiorly),
* PFM (inferiorly),
* diaphragm (superiorly),
* Diaphragm (superiorly),
* transverse abdominis (TrA) and oblique muscles (anteriorly)
* Transverse abdominis (TrA) and oblique muscles (anteriorly)
* multifidus (posteriorly)<ref name=":1">Pedriali FR, Gomes CS, Soares L, Urbano MR, Moreira EC, Averbeck MA, de Almeida SH. Is pilates as effective as conventional pelvic floor muscle exercises in the conservative treatment of post‐prostatectomy urinary incontinence? A randomised controlled trial. Neurourology and urodynamics. 2016 Jun;35(5):615-21.</ref>
* Multifidus (posteriorly)<ref name=":1">Pedriali FR, Gomes CS, Soares L, Urbano MR, Moreira EC, Averbeck MA, de Almeida SH. Is pilates as effective as conventional pelvic floor muscle exercises in the conservative treatment of post‐prostatectomy urinary incontinence? A randomised controlled trial. Neurourology and urodynamics. 2016 Jun;35(5):615-21.</ref>
Therefore, when rehabilitating the PFM, it is important to do so in conjunction with the other muscular groups named above.
Therefore, when rehabilitating the PFM, it is important to do so in conjunction with the other muscular groups named above.


=== Pilates exercise program vs. conventional PFM exercise program ===
=== Pilates exercise program versus conventional PFM exercise program ===
A Pilates exercise - and conventional PFM exercise program seems to be equally effective, in improving the recovery time of UI, as well as improve quality of life (QoL). However, higher rates of fully-recovered individuals, diagnosed with UI, are found among individuals following Pilates exercise programmes<ref name=":1" />.
[[Pilates|A Pilates]] exercise - and standard PFM exercise program seems to be equally effective, in improving the recovery time of UI, as well as improve quality of life (QoL). However, higher rates of fully-recovered individuals, diagnosed with UI, are found among individuals following Pilates exercise programmes<ref name=":1" />.


Why might the Pilates method be better?
# A lower financial impact on the healthcare system
# Less discomfort (no internal devices)
# An alternative for individuals disliking conventional PFM exercises<ref name=":1" />
Current best available evidence states that individuals, diagnosed with UI, can benefit by doing as little as one session per week, for 8 to 52 weeks<ref name=":1" />.
Current best available evidence states that individuals, diagnosed with UI, can benefit by doing as little as one session per week, for 8 to 52 weeks<ref name=":1" />.


Clinicians often apply activity restrictions among women suffering from pelvic floor disorders. This is due to the association of increased intra-abdominal pressure (IAP) with pelvic floor loading. Fortunately, a study completed by Coleman et al. (2015), determined no statistically significant difference between the IAP in sit-to-stand and fundamental Pilates exercises and therefore recommends Pilates exercises to women desiring a low intra-abdominal pressure exercise routine<ref name=":2">Coleman TJ, Nygaard IE, Holder DN, Egger MJ, Hitchcock R. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. International urogynecology journal. 2015 Aug 1;26(8):1123-30.</ref>.  
Clinicians often apply activity restrictions among women suffering from pelvic floor disorders. This is due to the association of increased intra-abdominal pressure (IAP) with pelvic floor loading. Fortunately, a study completed by Coleman et al. (2015), determined no statistically significant difference between the IAP in sit-to-stand and fundamental Pilates exercises and therefore recommends Pilates exercises to women desiring a low intra-abdominal pressure exercise routine<ref name=":2">Coleman TJ, Nygaard IE, Holder DN, Egger MJ, Hitchcock R. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. International urogynecology journal. 2015 Aug 1;26(8):1123-30.</ref>.  


Modified Pilates (MP) as an adjunct to conventional physiotherapy care seems to be even more beneficial in improving self-esteem, decreasing social embarrassment and lowering impact on normal daily activities<ref>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.</ref>.   
Modified Pilates (MP) as an addition to standard physiotherapy care seems to be even more beneficial<ref>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.</ref>.   
 
=== Examples of Pilates exercises ===
 
===== 1. Activation (supine/ crook-ly) =====
 
===== 2. Pelvic Clock (supine/ crook-ly) =====
moving pelvis like a clock to facilitate spinal flexion, extension, lateral flexion and rotation
 
===== 3. Bridging (supine/ crook-ly) =====
posterior pelvic tilt pelvis, then elevate the pelvis
 
===== 4. Chest-lift (supine/ crook-ly) =====
hands interlaced behind the head, followed by segmental flexion with cervical and thoracic spine
 
===== 5. Hundred (supine) =====
legs at table-top, Cx and Tx spine in flexion with bilateral arms pumping up and down by the sides of the trunk
 
===== 6. Roll-up (supine) =====
segmental flexion of Cx -, Tx and Lx spine
 
===== 7. leg-circles (supine) =====
unilateral perpendicular leg circles clockwise and anti-clockwise while maintaining a stable pelvis
 
===== 8. Side-kick (side-ly) =====
elevate the superior leg to hip height and pulse anteriorly and then posteriorly


===== 9. Adductor Squeeze (supine/ crook-ly) =====
== Examples of Pilates Exercises ==
contract muscles by squeezing a ball between knees


===== 10. Bent Knee fall out (supine/ crook-ly) =====
=== [[Pelvic Floor Dysfunction|Activation]] (supine/ crook-lying) ===
unilateral abduction with pelvic stabilization


===== 11. Supine Arm series (supine/ crook-ly) =====
===Pelvic Clock (supine/ crook-lying) ===
arm work in flexion, abduction and rotation with trunk stabilization
Moving pelvis like a clock to facilitate spinal flexion, extension, lateral flexion and rotation.
{{#ev:youtube|UfTf6FdJ2Ao}}<ref>Pelvic Clock Pilates Exercise from yoopod.com. Available from: https://www.youtube.com/watch?v=UfTf6FdJ2Ao [last accessed 2/14/2020]</ref>


===== 12.4 point kneeling position =====
=== Bridging (supine/ crook-lying) ===
elevate one limb with trunk stabilization or maintaining a neutral spine
Posterior pelvic tilt pelvis, then elevate the pelvis.


===== 13. Roll down series (seated) =====
=== Chest-lift (supine/ crook-lying) ===
segmented spinal flexion and back up maintaining PFM activation
Hands interlaced behind the head, followed by segmental flexion with cervical and thoracic spine.


===== 14. Standing Leg Pump =====
=== Hundred (supine) ===
1 leg dissociation (hip and knee flexion) with trunk and pelvic stabilization
Legs at table-top, Cx and Tx spine in flexion with bilateral arms pumping up and down by the sides of the trunk.
{| width="100%" cellspacing="1" cellpadding="1"
|-
|{{#ev:youtube|bOgwn-AwYzs|300}} <ref>PilatesAnytime. Pilates Chest Lift Exercise Demonstrated. Available from: https://www.youtube.com/watch?v=bOgwn-AwYzs [last accessed 2/14/2020]</ref>
|{{#ev:youtube|cO4vb678un8|300}} <ref>PilatesAnytime. Pilates Hundred Explained and Demonstrated. Available from: https://www.youtube.com/watch?v=cO4vb678un8 [last accessed 2/14/2020]</ref>
|}


===== 15. Assisted Squat =====
=== Roll-up (supine) ===
squat with trunk stabilization and co-contraction of core <ref name=":1" /><ref name=":2" />
Segmental flexion of Cx -, Tx and Lx spine.


== Related articles    ==
=== Leg-circles (supine) ===
Unilateral perpendicular leg circles clockwise and anti-clockwise while maintaining a stable pelvis.
{| width="100%" cellspacing="1" cellpadding="1"
|-
|{{#ev:youtube|JBGpZAvRUyY|300}}<ref>PilatesAnytime. Teaching the Pilates Exercise Leg Circles. Available from: https://www.youtube.com/watch?v=JBGpZAvRUyY [last accessed 2/14/2020]</ref>
|{{#ev:youtube|kdptw8GW5BQ|300}}<ref>PilatesAnytime. Demonstration of Pilates Exercise Roll Up. Available from: https://www.youtube.com/watch?v=kdptw8GW5BQ [last accessed 2/14/2020]</ref>
|}


[[Pilates]]
=== Side-kick kneeling  ===
Elevate the superior leg to hip height and pulse anteriorly and then posteriorly.


Original Editor - Magdalena Klosowska
(modification: side-ly)


Top Contributors - Magdalena Hytros, Sam A. Ayeni, Kim Jackson, Shaimaa Eldib and Nicole Sandhu
{{#ev:youtube|hgLDMHCcw4k}}<ref>PilatesAnytime. Side Kick Kneeling Pilates Exercise - Monica Wilson. Available from: https://www.youtube.com/watch?v=hgLDMHCcw4k [last accessed 2/14/2020]</ref>


[[Pelvic Floor Anatomy]]
=== Adductor Squeeze (supine/ crook-ly) ===
Contract muscles by squeezing a ball between knees.


Original Editor - Laura Ritchie
=== Bent Knee fall out (supine/ crook-ly) ===
Unilateral abduction with pelvic stabilization.


Top Contributors - Laura Ritchie, Venus Pagare, Redisha Jakibanjar, Siobhán Cullen and Uchechukwu Chukwuemeka
=== Supine Arm series (supine/ crook-ly) ===
Arm work in flexion, abduction and rotation with trunk stabilization.


[[Pelvic Floor Dysfunction]]
=== 4 point kneeling position ===
Elevate one limb with trunk stabilization or maintaining a neutral spine.
{{#ev:youtube|huOASwAQmUM}}<ref>Royal Free London NHS Foundation Trust. Four point to two point kneeling. Available from: https://www.youtube.com/watch?v=huOASwAQmUM [last accessed 2/14/2020]</ref>


Original Editors - Sarah Barnes Chris Van Wyk Amy McCarthy Gina McLoughlin,John Lavin Claire Ramsden and Carolinne Cieslak
=== Roll down series (seated) ===
Segmented spinal flexion and back up maintaining PFM activation.


Top Contributors - Sarah Barnes, Carolinne Cieslak, Gina McLoughlin, Kim Jackson and Claire Ramsden
{{#ev:youtube|zTqCd39YcbE}}<ref>Howcast. How to Do the Half Roll Down | Pilates Workout. Available from: https://www.youtube.com/watch?v=zTqCd39YcbE [last accessed 2/14/2020]</ref>


[[Incontinence]]
=== Assisted Squat ===
Squat with trunk stabilization and co-contraction of core <ref name=":1" /><ref name=":2" />.


Original Editor - Kirsten Ryan
== Conclusion ==
Each patient is different, therefore it is extremely important to individualize each session to the patient's specific needs and abilities. Pilates can be a great addition to standard Physiotherapy care by modifying exercises to ensure the correct technique and contraction of the PFM.


Top Contributors - Kirsten Ryan, Nicole Sandhu, Nicole Hills, Wendy Walker and Vidya Acharya
Adding Pilates exercise to standard Physiotherapy care has been found to lower financial strain on the healthcare system, providing less discomfort (no internal devices) and can be used as an alternative for individuals disliking conventional PFM exercises<ref name=":1" />


== References  ==
== References  ==


<references />
<references />
[[Category:Womens Health]]
[[Category:Pelvic Health]]
[[Category:Pelvis - Conditions]]
[[Category:Pelvis - Interventions]]

Latest revision as of 16:28, 16 June 2022

Original Editor - Eugenie Lamprecht Top Contributors - Eugenie Lamprecht, Shaimaa Eldib, Kim Jackson and Vidya Acharya

Introduction[edit | edit source]

The prevalence of Urinary Urinary Incontinence (UI) among women varies widely but is approximately 55%. Many women feel embarrassed and believe it's a normal part of womanhood. For this reason, many cases of UI go undiagnosed.

UI has a large impact on the socioeconomic burden worldwide. UI is associated with lower Quality of Life (QoL), depression and extremely high annual medical-care costs.

Risk factors include;

Clinically Relevant Anatomy and Physiology[edit | edit source]

The Pelvic Floor muscles' (PFM) main function is control over bladder, bowel, sexual function, pregnancy in women and providing support to pelvic organs[2].

The PFM mainly consists of the levator ani and coccygeus muscles[3] and are innervated from the lumbosacral plexus[2].

Mechanism of pelvic floor Injury[edit | edit source]

Literature indicates a strong association between vaginal childbirth and pelvic floor disorders however, further research is necessary to determine which aspects of childbirth contribute most[4].

Pregnancy and childbirth may lead to pelvic floor injury due to compression, stretching or tearing of nerve, muscle, and connective tissue.

https://commons.wikimedia.org/wiki/File:1116_Muscle_of_the_Female_Perineum.png
Muscles of the Pelvic Floor
Sacral and coccygeal plexus.png

The following pelvic floor-complications may occur due to pregnancy and childbirth;

  • Neural injury (due to compression during labour and vaginal delivery),
  • Levator ani and coccygeus muscles injury,
  • Fascial injury, and
  • Impaired connective tissue remodelling (increased synthesis of collagen and elastin causes an alteration in soft tissue biomechanics during pregnancy)[5].

General UI management plan[edit | edit source]

Lifestyle interventions

  • Reduce fluids, caffeine and carbonated drinks
  • Regular and timed urination
  • Treating constipation
  • Reduce BMI (<25)
  • Pelvic floor muscle training (PFMT)

Pharmacology (urgency urinary incontinence)

  • Anticholinergics
  • Beta 3 agonist

Surgery (stress urinary incontinence)

  • Injectable bulking agents
  • Burch colpo-suspension
  • Fascial slings
  • Mid-urethral synthetic slings

Other

  • OnabotulinumtoxinA injection
  • Sacral neuromodulation
  • Posterior tibial nerve stimulation
  • Incontinence pessaries[1]

Pelvic Floor Muscle Training and Pilates[edit | edit source]

It's important to understand that PFM function in synergy with abdominal muscles, chest wall and diaphragm, and not in isolation. Throughout each day, the intra-abdominal pressure and trunk muscle activity alternate regularly. The PFM have to respond rapidly to these changes to prevent incontinence or prolapse of pelvic organs.

The pilates concept is based on 'centre'(core) and 'control'. The pilates method focusses on the following muscles when referring to the 'core';

  • PFM (inferiorly),
  • Diaphragm (superiorly),
  • Transverse abdominis (TrA) and oblique muscles (anteriorly)
  • Multifidus (posteriorly)[6]

Therefore, when rehabilitating the PFM, it is important to do so in conjunction with the other muscular groups named above.

Pilates exercise program versus conventional PFM exercise program[edit | edit source]

A Pilates exercise - and standard PFM exercise program seems to be equally effective, in improving the recovery time of UI, as well as improve quality of life (QoL). However, higher rates of fully-recovered individuals, diagnosed with UI, are found among individuals following Pilates exercise programmes[6].

Current best available evidence states that individuals, diagnosed with UI, can benefit by doing as little as one session per week, for 8 to 52 weeks[6].

Clinicians often apply activity restrictions among women suffering from pelvic floor disorders. This is due to the association of increased intra-abdominal pressure (IAP) with pelvic floor loading. Fortunately, a study completed by Coleman et al. (2015), determined no statistically significant difference between the IAP in sit-to-stand and fundamental Pilates exercises and therefore recommends Pilates exercises to women desiring a low intra-abdominal pressure exercise routine[7].

Modified Pilates (MP) as an addition to standard physiotherapy care seems to be even more beneficial[8].

Examples of Pilates Exercises[edit | edit source]

Activation (supine/ crook-lying)[edit | edit source]

Pelvic Clock (supine/ crook-lying)[edit | edit source]

Moving pelvis like a clock to facilitate spinal flexion, extension, lateral flexion and rotation.

[9]

Bridging (supine/ crook-lying)[edit | edit source]

Posterior pelvic tilt pelvis, then elevate the pelvis.

Chest-lift (supine/ crook-lying)[edit | edit source]

Hands interlaced behind the head, followed by segmental flexion with cervical and thoracic spine.

Hundred (supine)[edit | edit source]

Legs at table-top, Cx and Tx spine in flexion with bilateral arms pumping up and down by the sides of the trunk.

[10]
[11]

Roll-up (supine)[edit | edit source]

Segmental flexion of Cx -, Tx and Lx spine.

Leg-circles (supine)[edit | edit source]

Unilateral perpendicular leg circles clockwise and anti-clockwise while maintaining a stable pelvis.

[12]
[13]

Side-kick kneeling[edit | edit source]

Elevate the superior leg to hip height and pulse anteriorly and then posteriorly.

(modification: side-ly)

[14]

Adductor Squeeze (supine/ crook-ly)[edit | edit source]

Contract muscles by squeezing a ball between knees.

Bent Knee fall out (supine/ crook-ly)[edit | edit source]

Unilateral abduction with pelvic stabilization.

Supine Arm series (supine/ crook-ly)[edit | edit source]

Arm work in flexion, abduction and rotation with trunk stabilization.

4 point kneeling position[edit | edit source]

Elevate one limb with trunk stabilization or maintaining a neutral spine.

[15]

Roll down series (seated)[edit | edit source]

Segmented spinal flexion and back up maintaining PFM activation.

[16]

Assisted Squat[edit | edit source]

Squat with trunk stabilization and co-contraction of core [6][7].

Conclusion[edit | edit source]

Each patient is different, therefore it is extremely important to individualize each session to the patient's specific needs and abilities. Pilates can be a great addition to standard Physiotherapy care by modifying exercises to ensure the correct technique and contraction of the PFM.

Adding Pilates exercise to standard Physiotherapy care has been found to lower financial strain on the healthcare system, providing less discomfort (no internal devices) and can be used as an alternative for individuals disliking conventional PFM exercises[6]

References[edit | edit source]

  1. ↑ 1.0 1.1 Wood LN, Anger JT. Urinary incontinence in women. Bmj. 2014 Sep 15;349:g4531.
  2. ↑ 2.0 2.1 Eickmeyer SM. Anatomy and physiology of the pelvic floor. Physical Medicine and Rehabilitation Clinics. 2017 Aug 1;28(3):455-60.
  3. ↑ Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterology & Motility. 2006 Jul;18(7):507-19.
  4. ↑ Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstetrics and gynecology. 2011 Oct;118(4):777.
  5. ↑ Handa VL. Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth. UpToDate2014. 2015.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Pedriali FR, Gomes CS, Soares L, Urbano MR, Moreira EC, Averbeck MA, de Almeida SH. Is pilates as effective as conventional pelvic floor muscle exercises in the conservative treatment of post‐prostatectomy urinary incontinence? A randomised controlled trial. Neurourology and urodynamics. 2016 Jun;35(5):615-21.
  7. ↑ 7.0 7.1 Coleman TJ, Nygaard IE, Holder DN, Egger MJ, Hitchcock R. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. International urogynecology journal. 2015 Aug 1;26(8):1123-30.
  8. ↑ 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.
  9. ↑ Pelvic Clock Pilates Exercise from yoopod.com. Available from: https://www.youtube.com/watch?v=UfTf6FdJ2Ao [last accessed 2/14/2020]
  10. ↑ PilatesAnytime. Pilates Chest Lift Exercise Demonstrated. Available from: https://www.youtube.com/watch?v=bOgwn-AwYzs [last accessed 2/14/2020]
  11. ↑ PilatesAnytime. Pilates Hundred Explained and Demonstrated. Available from: https://www.youtube.com/watch?v=cO4vb678un8 [last accessed 2/14/2020]
  12. ↑ PilatesAnytime. Teaching the Pilates Exercise Leg Circles. Available from: https://www.youtube.com/watch?v=JBGpZAvRUyY [last accessed 2/14/2020]
  13. ↑ PilatesAnytime. Demonstration of Pilates Exercise Roll Up. Available from: https://www.youtube.com/watch?v=kdptw8GW5BQ [last accessed 2/14/2020]
  14. ↑ PilatesAnytime. Side Kick Kneeling Pilates Exercise - Monica Wilson. Available from: https://www.youtube.com/watch?v=hgLDMHCcw4k [last accessed 2/14/2020]
  15. ↑ Royal Free London NHS Foundation Trust. Four point to two point kneeling. Available from: https://www.youtube.com/watch?v=huOASwAQmUM [last accessed 2/14/2020]
  16. ↑ Howcast. How to Do the Half Roll Down | Pilates Workout. Available from: https://www.youtube.com/watch?v=zTqCd39YcbE [last accessed 2/14/2020]
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