Pilates and After Injury Rehabilitation As a child, German-born Joseph H. Pilates suffered from several illnesses that resulted in muscular weakness. Pilates was determined to overcome his frailties, and dedicated his life to becoming physically stronger. He studied martial arts, yoga, Zen meditation, and Greek and Roman exercises, and worked with medical professionals including physicians and his wife Clara, a nurse. Joseph Pilates' experiences led to the development of his unique method of physical and mental strengthening, which Pilates brought to the U.S. In 1923 (Anderson & Spector, 2005).

Popular dance instructors and choreographers, including Martha Graham, George Balanchine and Jerome Robbins, all embraced Pilates' exercise method in the 1930s and 1940s. Dancers often suffered from injuries that resulted in a long recovery period and an inability to achieve peak performance. Pilates' method, which was unique at the time, allowed and encouraged movement early in the rehabilitation process by proving needed assistance. It was found that by reintroducing movement using nondestructive forces early in the rehabilitation process resulted in hastening the healing process (Anderson & Spector, 2005).

More than 70 years later, Pilates' techniques started to gain in popularity in the rehabilitation setting at large. By the 1990s, many rehabilitation practitioners used the Pilates method in multiple fields of rehabilitation, including general orthopedic, geriatric, chronic pain, and neurologic rehabilitation (Anderson & Spector, 2005).

Pilates is an exercise system designed around a specific regimen of movements, stretching, and breathing designed to improve overall strength and flexibility. Pilates' focus on flexibility and core strength training make the system well suited for athletes recovering from injuries (Cohen, 2009).

The Pilates philosophy focuses on the following key principles:

Core strength/Centering -- Pilates stresses the importance of the central muscles of the abdomen, lower back, and buttocks. This area is considered to be the body's center of power. Joseph Pilates and many modern trainers as well believe that core strength and stability are the keys to remaining injury free.

Concentration -- The Pilates method teaches active awareness of the body's movements. To maximize exercise results, the athlete must be aware at all times of his or her body position.

Breathing -- Pilates training stresses proper breath control. Pilates practitioners are trained to focus on deep, steady breathing to focus the mind, tighten the abdomen and rid the body of toxins.

Precision -- Pilates routines stress the use of good form while exercising. This generally accepted principle is important for injury prevention; Joseph Pilates was ahead of his time in recognizing it.

Flowing motion -- All Pilates exercises are intended to be performed with slow, fluid movement. Participants must take care to avoid rapid, jerking movements that increase the risk of injury (Cohen, 2009).

Pilates has become a common way to exercise. Pilates exercises are low-impact and do not induce inflammation and overuse syndrome. Pilates' emphasis on core strengthening, balance, and flexibility involve some of the same principles that are used in the rehabilitation of many common orthopedic problems. As a result, Pilates is more and more often being used in the prevention and rehabilitation of these orthopedic problems. It is even thought that performing Pilates on a regular basis may help to keep the athlete injury-free (Cluett, 2009).

Many physical therapists, chiropractors and orthopedists are learning the benefits associated with using Pilates exercises for their patients who suffer from sports injuries, or any soft tissue injury such as neck or back pain, sciatica, shoulder tendonitis, hip bursitis, ankle pain, or knee or hip replacement surgery. Pilates also helps individuals who suffer from repetitive stress injuries or from muscle strains (Using Pilates, 2009).

Pilates exercises have been shown over time to be safe for patients who have been injured. In fact, Joseph Pilates developed certain exercises specifically to help soldiers recovering from battle injuries. Modern doctors' findings show that Pilates exercises allow patients to focus on becoming more flexible and improving their strength in order to return to normal function again (Using Pilates, 2009).

Medical professionals have used Pilates to relieve...

Pilates also works well to complement other traditional therapy programs (Using Pilates, 2009).
Pilates has several advantages over other forms of exercise when recovering from injury. These advantages include the following:

Use of the body's own weight for resistance. Other forms of exercise, such as weight training, rely on dumbbells and barbells for resistance. These traditional bodybuilding-type exercises present a higher risk of re-injury than do body-weight exercises.

Emphasis on centering and core training. Athletes who are injured and inactive can quickly lose core strength when sidelined. The Pilates technique stresses core strength, thereby decreasing the risk of injury when normal activity is resumed.

Strict use of proper form and slow movements during training. Gentle, slow stretching and slow body weight strength moves provide the lowest risk way for an athlete to regain lost strength safely (Cohen, 2009).

The Christ Hospital physical therapy centers advocate the use of Pilates techniques to rehabilitate people of all ages and fitness levels for a wide variety of conditions, including surgical back conditions as well as knee and shoulder patients. Most injuries are caused by overuse or poor movement patterns resulting in pain. Pilates is unique in that it is a neuromuscular exercise that re-educates the body's movement patterns to resolve poor or pain-causing movements (Pilates for rehabilitation patients, 2011).

The Christ Hospital Web site (Documented benefits, 2011) lists the following studies that document the benefits of Pilates:

Increased spine mobility (Carr & Day 2004)

Increased muscle flexibility (Schroeder et al. 2002, Otto et al. 2004, Rogers et al. 2005, Segal et al. 2004)

Improved muscular endurance (Sewright 2004, Rogers 2005)

Improved posture (McMillan, 1998)

Improved tennis serve velocity (Sewright 2004), improved body awareness (Lange 2000)

Decreased low back pain (Anderson 2006)

Reduction in the need for lumbar surgeries (Cohen 2006)

Improved bone density (Betz 2005)

Improved ability to correctly contract the Transversus Abdominus (Herrington & Davis 2005)

Improved pelvic control (Herrington & Davis 2005)

Improved recruitment of Rectus Abdominus and External Oblique muscles (Esco et al. 2005)

Decreased lumbar paraspinal muscle activity in subjects with low back pain. (Quinn 2005)

Pilates, once favored by rock divas, actresses, and supermodels, is now popular among athletes in particular who have come to recognize the rehabilitative benefits of Pilates during their injury prone careers. J ason Kidd, the NBA superstar point guard, took up Pilates at the suggestion of his wife that it might help in his rehabilitation of a broken ankle. Kidd was so impressed with his improvement after working out with Pilates that he in turn recruited the Nets strength coach, Rich Dalatri, who introduced the exercise method to the entire team. The Nets subsequently invested in Pilates equipment for their weight room, and throughout the NBA playoffs in 2002, they had a leading Pilates equipment company to ship special equipment to the team's hotel on road trips (Lieber, 2003).

PGA Tour golfer Rocco Mediate credits Pilates with strengthening his back and prolonging his career. Following major back surgery in 1994, Mediate wasn't the same; he couldn't bend over for long periods of time to practice his putting, and his back always went out after lengthy plane trips. Mediate was sold on the value of Pilates to his rehabilitation efforts after just a few weeks. "I've got more motion in my shoulders, midsection and legs. I can repeat my basic swing more often. Pilates is going to add five, six, seven…years to my career." (Lieber, 2003). Mediate's wife Linda also had success with Pilates, overcoming injuries suffered in three car accidents.

With such impressive results in injury rehabilitation, it is easy to understand the rapid growth of Pilates in general in the last decade. In 2010 CNBC reported that Pilates was the nation's fastest-growing fitness activity, with 8.6 million participants. Growth may have peaked mid-decade at 10.5 million participants in 2004 (See Chart 1), but clearly Pilates has staying power, which is attributable at least in part to the…