One of the challenges of teaching Pilates to patients is keeping all of your clinical skills front of mind. These skills include concepts of pathophysiology, pain science, biomechanics, load management and the biopsychosocial model to name but a few. When guiding a patient through a Pilates session, remembering the multitude of exercises, variations and cues, it can be easy to forget why the patient was doing Pilates in the first place.
Thinking about this ongoing challenge made be remember the 2001 classic film Zoolander. Stay with me here …
During the Slashie Award scene below, male model Fabio receives his award and thanks the audience for confirming that he is now seen as an actor/model and not the other way around.
So, how is this relevant you may ask?
Providing patients with best practice Pilates requires the clinician to start each session reminding themselves that they are a Clinician/Pilates teachers and not the other way around.
As a clinician, we should use our knowledge of Pilates repertoire to select the most evidence-based exercises based on our initial assessment, patient goals and current rehabilitation guidelines. For example, in leading a patient with patellofemoral pain through a Pilates session, a Physio/Pilates teacher would first consider what does the evidence suggest regarding the management of this condition. Once established they would then go on to think about which exercise series, pieces of equipment and/or principles are best indicated.
This may be in contrast to the Pilates teacher/Clinician who may skip the clinical reasoning step and use less efficacious exercises such as reformer leg press on a high foot bar (loading the knee in higher degrees of knee flexion), reformer feet in loops (nice exercises but may take time away from other more valuable ones) and fail to provide the appropriate education regarding load management during the weeks ahead.
To continually remind yourself of your Clinician/Pilates Teacher status, here are a few key points.
Before each session review the following:
the patient’s working diagnosis
which outcome measures (subjective and objective) need to be assessed
what your plan was following the last session
During each session, ensure you:
Remind your patient (and yourself) of the session’s goals
Reflect on your patient’s progress as if it is going to plan
Provide the relevant education
At the end of each session:
Highlight the positive aspect(s) your patient’s session (sometimes it may be that they turned up despite not feeling great)
Discuss the main parts that need to be address i.e. single leg balance
Establish a plan/goal for the next session i.e. introduce jump board exercises
One of the most common exercises used in physio based Pilates is the Reformer Scooter (aka Standing leg press). The scooter is a great exercise that challenges the standing limb while completing hip/knee extension with the moving (carriage) limb. However, one of the limitations of Scooter is that it’s limited to an isometric load on the stance limb. Though I am a big fan of isometric loading, when designing a patient’s periodised Pilates program, the question I ask is ‘so where to next?’.
An easy progression from the isometric challenge of Scooter is a Reformer Lunge. By making the movement more dynamic, we can easily increase the challenge to the variables of the exercises such as balance, coordination, endurance and/or mobility.
To see a video of the Reformer Lunge variations I use check out my instagram by clicking on the link below.
Variations: 1) Simple lunge:the main challenge is at the stance limb’s posterior chain (gluteals/hamstrings). I tend to use this as a co-ordination challenge aiming to isolate the movement to hip flexion/extension while maintaining trunk posture. Emphasis on driving the stance hip into extension to stand tall. However, keep an eye on clients with a tendency to extend their lumbar spine and add load to the anterior hip
2) Forefoot stance lunge: Increase the challenge by reducing the base of support. This also adds an increased demand of ankle / knee co-contraction throughout the movement. I use this variation as a simple way to asses if increased stiffness in the limb can assist with control and also to add time under tension to the calf and quadriceps. Keep an eye on those patients with restricted 1st MTP extension ROM.
3) Stretch-Shorten Cycle Lunge: See the instagram video as it’s a tricky one to do let alone teach. It’s all about timing and working with the light spring load. With the emphasis on controlling at both ends of the movement it’s a burner. Press the carriage out, pause, come back in and quickly push back out. There’s a hip extensor load when the carriage is pushed out, then a knee flexor load when the carriage is in as you need to actively knee the knee to stop the carriage pushing your forward. Make sure your patients have earnt the right to tackle this one. Just keep in mind the compressive load at proximal hamstring tendon
With many more variations possible, enjoy playing with the concepts and challenging your patients. Just keep in mind which specific variable(s) has you are challenging and why it’s important for your patient’s progress.
As the weather warms up many of us will reach for a trusty pair of thongs, but do you know what effect that have on your feet? Health professionals have been warning patients to limit their use for decades and now there is evidence to reinforce the message.
Research completed at Auburn University has found that thongs significantly change how you walk. When compared to bare feet, walking in thongs decreased stride length, decreased stance time, increased muscle activity in the lower leg, increased ankle dorsiflexion during swing and decreased hallux dorsiflexion. Furthermore when walking in thongs, plantar foot pressure is increased when compared to walking in runners (1)
What does this research mean? It is generally accepted that thongs don’t support or protect the foot. But what we now know is that thongs actually make more work for the foot. The research highlights how the wearer grips thongs by changing the angle of the foot and increasing muscle activity. These same muscles fatigue earlier and are less able to perform their primary role of supporting the foot.
Thongs have their place in any shoe closet as a ‘sometimes’ shoe. But what the research now confirms is they are not suited for long periods or for people with certain foot pathologies.
We do know that in the Australian summer it’s difficult not to reach for a pair of thongs or sandals when it gets hot however there are more supportive options available, something our podiatrists are trained to advise based on your foot type and footwear needs. If you have any questions about your footwear please make an appointment to see one of our podiatrists.
1. Justin F. Shroyer and Wendi H. Weimar (2010) Comparative Analysis of Human Gait While Wearing Thong-Style Flip-flops versus Sneakers. Journal of the American Podiatric Medical Association: July 2010, Vol. 100, No. 4, pp. 251-257.
We are excited to welcome Dr Lachlan Giles on board for the PFJ Symposium.
Lachlan is both a clinician and researcher, having worked in private practice since 2009 and completing his PhD at La Trobe University in 2016.
He has multiple peer-reviewed publications investigating rehabilitation strategies in patellofemoral pain and his research won best poster at the 2013 Sports Medicine Australia National Conference. Lachlan recently presented his work on Blood Flow Restriction training at the Australian Physiotherapy Association Conference and Sports Medicine Australia’s National Conference.
The Amy Gillett Share the Road Tour is sadly over. I have just ridden from the Gold Coast to Sydney. An amazing experience with a committed group of riders and advocates for safer roads – cyclists and motorists together. We rode 1080km over 7 days in rain, sunshine, on gravel, up and down hills, up to 180km per day.
Be an advocate for a change in legislation in Victoria, the only Australian state not to trial or adopt the 1m min distance Daniel Andrews et al need to be logical and make this happen. Ridiculous – drivers do this anyway!
Dr Jean-Francois Esculier is a leader in injury prevention & treatment for runners. He explains the findings of his randomized controlled trial (RCT) from his recent PhD in knee cap pain below. As he explains, education should be the cornerstone of your treatment.
WATCH THE VIDEO or join us at our PFJ SYMPOSIUM in March 2018 to hear him live!
Bill Vicenzino is the Chair of Sports Physiotherapy, Director of the Master of Physiotherapy (Musculoskeletal and Sports) programs and Director of the Sports Injuries Rehabilitation and Prevention for Health (SIRPH) research unit at the University of Queensland. Bill’s research interests include musculoskeletal health, pain and injury with an emphasis on sport and physical activity, with a focus on establishing evidence based approaches to rehabilitation and prevention. His latest research aims to gain a better understanding of persistent musculoskeletal conditions and impairments (including patellofemoral pain) and their management; these projects include a number of randomized clinical trials attracting NHMRC funding that are being published in high impact medical journals (BMJ, Lancet, JAMA).
Dr Jean-Francois Esculier – PT, PhD, Cert. Sport Physiotherapy (SPC)
Jean-Francois Esculier completed his bachelor of physiotherapy at the University of Ottawa, Canada, before undertaking graduate studies (Masters and PhD) at Laval University, Canada. Over the past few years, he has conducted studies on patellofemoral pain in runners (treatment approaches, biomechanics, footwear), and shows particular interest for clinical research. Jean-Francois is also an active clinician and currently practices as a physiotherapist at the Allan McGavin Sports Medicine Clinic in Vancouver, Canada. He is currently a post-doctoral research fellow at the University of British Columbia. Given his interest for knowledge translation, Jean-Francois enjoys teaching continuing education courses pertaining to the prevention and treatment of running injuries through The Running Clinic.
Professor Kay Crossley – PhD (Melb), BAppSci(Physio)
Professor Kay Crossley is the Director of the La Trobe Sport and Exercise Medicine Research Centre. Kay’s main research focus is on the prevention and management of patellofemoral pain and early-onset osteoarthritis after sports-related injuries. Kay is a physiotherapist with many years of experience in clinical sports physiotherapy. She has contributed to a number of sports medicine and physiotherapy texts, including every edition of “Brukner and Khan’s Clinical Sports Medicine”. Kay maintains a strong research interest in optimising treatments for patellofemoral conditions (pain and osteoarthritis). Additionally, she has developed a new focus of research, which encompasses three major fields. The major focus is on the development and prevention of osteoarthritis following sports related injuries, with fields in patellofemoral osteoarthritis following patellofemoral pain, knee osteoarthritis following ACL reconstruction and hip OA following hip-related injuries (including FAI and labral tears).