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EVALUATION of PILATES PROGRAMS

by Ivon Dahl

Most people have at one time or another become involved in an exercise program, perhaps at school or at a health club.
Information about exercise routines is found in magazines, on videotapes and in books.
These routines are designed by anyone, from the physician to the shapely movie personality, either with or without consultation from someone trained in safe exercise techniques.
Well-intended people advise others in exercise routines to stretch, tone, strengthen, prepare for this or that, slim down, or build up.
Today, with the popularity of Yoga, weight training and Pilates exercise programs, many people with good intentions try various forms of exercising without adequate preparation or guidance, only to find that they develop injuries or muscle soreness form over exercising or exercising improperly.
They either become discouraged and feel defeated, or try to work through the pain and injure themselves.
Usually the reason is that some of the exercises chosen are not biomechanically safe (even in Pilates), or they are the wrong exercises to accomplish the intended purpose.
Popular exercise programs may be the precipitating factor in complaints, not because exercising should not be done, but because the exercises are done improperly or for the wrong purpose.
This article is designed to help the Pilates’ instructor, critically analyze commonly used exercises in terms of how they can be used to evaluate problems, and then be adapted to accomplish a desired goal.
The intent is not to describe the ideal exercise protocol, there is no such thing, but to help the Pilates instructor recognize that to accomplish an exercise goal as safely as possible, exercises have to be adapted to the individual level of the person involved and must be balanced with other appropriate exercise activities the client may participate in.

Two concerns should be addressed when designing a balanced Pilates program

  1. What goals and kinds of exercise make up a well-designed program?
  2. Do the Pilates exercises safely and effectively accomplish the intended goals?

OBJECTIVES

  1. Look at specific exercises used for testing and determine if they are evaluating appropriate factors safely and correctly.
  2. Look at specific exercises and determine if they are safely accomplishing the intended goals.
  3. Identify misconceptions in common Pilates exercises and Pilates exercise programs.
  4. The client’s medical history should be documented with a ‘Health History Questionnaire’.
  5. Perform a ‘Fitness Test’ to establish a baseline by which improvement can be measured.
  6. Realistic testing can serve as a motivational tool when progress is noted.
    NOTE: Physical Therapists routinely use manual muscle testing" and other objective forms of testing such as tensiometer readings and torque output readings in order to obtain a baseline of muscle strength. Goniometric measurements are taken to obtain an objective baseline of range of motion and flexibility. These testing procedures have been standardized and are commonly accepted as reliable indicators of change and will not be discussed here.
    Other tests commonly used in Pilates programs are not as objective and can be misleading.

Tests used for Pilates programs need to be scrutinized by asking the following questions

  1. Does the test in fact test the intended muscle or function?
  2. Will the test grade improve as muscle function improves?
  3. Is the test biomechanically safe?

Re-evaluate at Frequent Intervals to See if the Baseline Has Changed
Use the same testing procedures for consistency in interpreting the results. If there is no change, either the exercises are not being carried out properly or they are not appropriate. As improvement occurs, the satisfaction of improved function is immeasurable.

Strength Testing
The test should have various grades of difficulty so that the person can be tested at a level where at least one repetition can be accomplished safely and correctly.
Then, as strength improves, progress is noted first by increasing the number of repetitions to 3 or 5, then by progression to the next level of difficulty at a lower number of repetitions.

Strength testing with Pilates

  1. 'Hundreds' are used to test core muscle strength.
  2. 'Salute', 'Shave the back of the head' and 'Biceps curls' are used to test arm strength.
  3. 'Swans' with the PTB and 'Pull-ups' with the Trapeze Bar on the Cadillac are used to test back muscle strength.
  4. 'Leg Presses' on the Reformer with heavy spring resistance are used to test leg strength.
    NOTE: If the above exercises are not done correctly, they can be biomechanically unsafe, or they may not test the muscles intended. If continued as an exercise, the appropriate muscle will not be strengthened, or supporting structures will be stressed and damaged. Increased strength may result in decreased muscle endurance and flexibility. Also, if the person is unable to do a strength test, the antagonist muscle may be too tight. If progress cannot be measured in the early stages of the Pilates program; a simpler form of the test needs to be used. Other Pilates exercises than the ones listed here may also be used to test strength, but just these will be analyzed to illustrate what needs to be considered when choosing an activity for testing.

Suggestions for a SAFE strengthening program
• First, identify which muscle groups need strengthening and choose exercises that, when properly executed, will strengthen those muscles.
• Begin at a safe level; use less spring resistance if the client is straining to complete the exercise or simplify the exercise if it is too difficult.
• When fatigue occurs do not push to the point of straining.
• Balance each exercise between antagonistic muscle groups in each region of the body.
• Do each exercise in a biomechanically correct manner so that the muscles to be strengthened are doing the prime motion or stabilization.
• If there is poor posture or flexibility, strengthen the muscles antagonistic to the tight muscles.
• Warm up the muscles to be strengthened by stretching or releasing excess tension of that muscle first.
• Finish the strengthening program by again stretching or releasing excess tension of each muscle group.
• The speed of the motion can vary and will depend on the client’s breathing pattern.

Endurance Testing
To test local muscle endurance: High repetitions of an exercise with low spring resistance are repeated until the muscles fatigue. The number of repetitions is counted.
To test cardiovascular endurance: The simplest method is to have the client perform a total body exercise for a period of time and to check the heart rate within one minute after performance. As endurance improves, the resting heart rate will decrease.
NOTE: In some testing procedures, speed is used to measure endurance (Speed may have some effect on endurance, but skill, agility, and coordination are also necessary for doing an activity with speed, and therefore, it is not a true indicator of endurance; for EXAMPLE- Jump Board).

Suggestions for a safe muscle endurance program
For local muscle endurance, an exercise is performed with many repetitions and minimal resistance to the point of muscle fatigue.
When signs of fatigue occur, do not push to the point of straining the supporting tissue.
NOTE: Increased muscle endurance may result in decreased strength and flexibility.

Suggestions for a safe cardiovascular endurance program
• Establish the target heart rate and maximum heart rate with the ‘Borg’ technique.
• Warm up gradually for 5 to 10 minutes; include stretching and repetitive motions at slow speeds, gradually increasing the effort.
• Increase the pace of the activity so that the target heart rate can be maintained for 20 to 30 minutes. Examples include fast walking, running, bicycling, swimming, cross-country skiing, and aerobic dancing.
• Cool down for 5 to 10 minutes with slow, total body repetitive motions and stretching activities.
• The aerobic activity should be done 3 to 5 times per week.
• To avoid injuries from stress, use appropriate equipment, such as correct footwear, for proper biomechanical support. Avoid running, jogging, or aerobic dancing on hard surfaces such as asphalt and concrete.
• To avoid overuse syndromes to structures of the musculoskeletal system, proper warm-up and stretching of muscles to be used should be done. Progression of activities should be within the tolerance of the individual. Overuse commonly occurs when there is an increase in time or effort without adequate rest (recovery) time between sessions. Increase repetitions or time by no more than 10 percent per week. If pain begins while exercising, heed the warning and reduce the stress.
• Individualize the Pilates program. Never follow pre-scripted Pilates routines! Not all people are at the same fitness level and therefore cannot do the same exercises. Any one exercise has the potential to be detrimental if attempted by someone not able to execute the exercise properly. Begin at a safe level for the individual and progress as the individual meets the desired goals. Always give priority to the clients needs and abilities.
WARNING- Never use the Jump Board as a WARM-UP; the Jump Board requires awareness, focus, concentration, control and coordination.

To Test Skill
Skill encompasses coordination, agility, balance, timing, and speed as in professional dancing. Often, speed is used as the measure of ability to do a skilled activity, implying that the faster one can do an activity, the more skillful she is. This is not easily resolved because it holds true for some skills but not others. Prior to testing, the person should have adequate instruction and should practice choreography so that he knows what is required in the skill. Use the JUMP BOARD to test skill in Pilates with these parameters.
WARNING- Use a light spring load to test skill on the Jump Board.
WARNING- Do Not use moderate-heavy spring resistance as in Power Jumps when testing skill.
WARNING- Using heavy spring loads may cause injury; articular compression, muscle strain, systemic nerve damage or retaining ligament sprain.

Suggestions to increase Skill safely on the Jump Board

Suggestions for a safe flexibility program
• If a subject is excessively mobile in a segment or region of the body, selectively stretching tight structures is safer than total body stretching. Isolate stretching of the hamstring, the low back, and the upper back muscles as described in ‘Flexibility Testing’.
• Maintain a balance in flexibility between antagonistic muscle groups. If there is decreased flexibility because of poor posture, emphasize stretching the tight muscles. Typically, they are the hip flexors, trunk flexors, shoulder flexors, and scapular protractors.
• Use AIS or PNF stretch techniques or follow ‘Reciprocal Enervation Principles’ rather than bouncing or ballistic stretches used in Classic Pilates modalities.
• Stretching (flexibility exercises) should be used prior to, during and after a strengthening or muscular endurance program.
• Do not stress joints and ligaments at the end of the range; protect vulnerable joints with ‘Articular Traction Principles’.
• Releasing excess muscle/emotional tension rather than stretching; do not stretch clients, instruct them how to, or assist with stabilizing and allow them to adjust the oppossition within their comfort zone.
• Never increase the joint ROM beyond a normal range; hyper-flexibility is more dangerous than hypo-flexibility.
• Focus on stretching-releasing muscles at the origin and not at the insertion; this is why Pilates exercises often pull the hip back to stretch the hamstrings rather than extending the knee or pressing the foot forward, which may lead to locking out or hyperextension of the knee.


ESTABLISHING REALISTIC GOALS
Review the results of the testing procedures to determine the goals of the exercise program. In other words, what muscles need to be strengthened, what regions need to be stretched, does endurance need to be improved, or do skills need to be developed or improved? The goals then can give a realistic picture of what Pilates exercises need to be included in the program. Exercises used to accomplish the goals need to be scrutinized with the following questions:
• Is the proposed exercise able to meet the goal?
• If the exercise cannot meet the goal, what is the best and safest way to do so?
• Are there any client considerations that require special precautions or modifications of the exercises? NOTE; some Classic Pilates trainers discourage adapting to client needs and ability with exercise modification, but do require all clients to adapt to their standardized pre-scripted routine, spring load and number of repetitions.

Summary; any exercise can be biomechanically unsafe if performed by an unprepared client, or by a person with musculoskeletal predispositions or instructed by an uneducated or unaware trainer.

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