What Can It Offer The EDS Patient? Crystal Seamon, PT, DPT, OCS, ATC Comprehensive Physical Therapy Center
Transcript
What Can It Offer The EDS Patient?
Crystal Seamon, PT, DPT, OCS, ATC Comprehensive Physical Therapy Center
Presenter
Presentation Notes
Hello! My name is Crystal Seamon. I attended The Ohio State University for both my undergraduate degree in Athletic training and my doctorate in physical therapy. I then went on to complete an Orthopaedic physical therapy residency to become a board certified specialist in orthopedic physical therapy. Prior to moving to Cincinnati in 2011, the last clinic that I worked at in Columbus had a Pilates reformer. It was my first exposure to it – andhonestly I had no idea what to do with it – over time I began to take private reformer sessions to learn more about how I could utilize this large piece of equipment in my clinic– and quickly fell in love with it. Since then I have devoured as much information as possible about pilates and went on to receive training to become an instructor. I have completed my reformer training with Balanced Body and also completed training in modified pilatesmatwork through Australian Physiotherapy and Pilates institute – which is primarily geared toward working with individuals with pain or other physical limitations.
+ Pilates & EDS
Pilates, along with Yoga, Tai Chi, and other low impact exercises are often recommended to individuals suffering from pain or hypermobility to “strengthen your core”
This presentation will explore… What is Pilates? Define the “core” Review the principles and benefits of Pilates Discuss simple modifications for traditional Pilates exercises Review what to look for in a Pilates Instructor
Presenter
Presentation Notes
As a physical therapist I am often asked whether or not someone should do pilates – perhaps they have been dealing with low back pain or have heard that it is a great exercise to strengthen your core. Often my response is – it depends – it depends on the type of pilates you want to do, the level of difficulty, the skill of your instructor, and what your overall goals are. Specifically when we talk individuals with EDS – Pilates can be great but at the same time in the wrong hands it can be terrible. So my goal today is first to simply educate you about what pilates is, what the principles and benefits are, what our core is, how to make simple modifications, and what to look for in an instructor. If we have time at the end I would also like to share a personal statement written by an individual with EDS who has been working on the pilates reformer for about 2.5 months now. What today is not meant to be is how to perform Pilates – or what exercises you should get started with – everyone in general does not begin their journey with pilates at the same point and is challenged by different areas of strengths and weakness. That is even more so true with EDS. What seems simple as you know may leave you in severe pain for several days.
+ Disclaimer
Get approval from your doctor or physical therapist before starting any Pilates program
The information presented in this presentation is meant to serve as general recommendations for participation in Pilates and may not be intended for everyone
Presenter
Presentation Notes
So with that being said remember to….
+
IT SEEMS LIKE EVERYONE IS EITHER DOING PILATES, OR INTERESTED IN STARTING A PILATES EXERCISE PROGRAM…
Presenter
Presentation Notes
Chancesare you have probably heard someone talking about Pilates at some point in your life – maybe a friend, a coworker, your doctor or even your physical therapist has recommended that you try it – either because they are doing it and think it is the greatest thing since sliced bread – or because you’ve tried just about everything without fail but have found the magic trick yet. For some of you this will be the first time you are hearing about Pilates, Either way hopefully you will learn that when done carefully Pilates can be a wonderful exercise for individuals with EDS – but bear in mind this doesn’t happen without some bumps along the way just like with anything else as your learn your body’s limits and capabilities.
+ The History of Pilates
Invented by Joseph H. Pilates
Plagued by his own physical limitations and aliments he created his own method of training and fitness
Original program consisted of a series of mat exercises designed to build abdominal strength and develop control of the body
Later went on to develop equipment designed to add resistance through the use of springs
Presenter
Presentation Notes
Many people think that pilates is a relatively new exercise fad developed in the last decade or so when in fact Pilates was first invented by Joseph Pilates in 1912. Plagued by his own physical and health limitations Joseph Pilates studied several different types of exercise which went into to creating this method of exercise which he then later went on to use it to rehabilitate injured WW1 soldiers. Joe believed that injuries were caused by imbalances in the body and habitual patterns of movement. He observed that when a person had a weakness or maligned area, that person overcompensated or overdeveloped another area to achieve a certain functional movement. Thus, he found it was critical to correct the malalignment and to re-educate the body to prevent recurrence. Certainly ahead of his time, this is a belief that 50 years later is being haled as the phenomenon of the muscle imbalance theories of physical therapy today. Eventually he moved to New york with his wife Clara and set up the first pilates studio as we know it now – with a primary emphasis on working with dancers. In a small way if you think about it many dancers are very flexible and mobile – sometimes almost too much for their own good. Pilates was a way that they could improve their strength without compromising their form or art of dancing. Originally the focus of his program was on 34 original mat exercises – which still continue to be included in mat classes today. From a rehabilitative sense not all of these exercises come close to looking or being considered safe as you will see in a few slides for even the healthiest person without EDS. He eventually went on to develop several pieces of equipment that allowed people to add resistance their exercise routine.
+ Matwork Pilates
Strengthening, mobility, and stretching exercises completed on an exercise mat.
Promotes core stability, flexibility, endurance, postural and body awareness, and correction of muscle imbalances.
Presenter
Presentation Notes
No surprise, MatworkPilates is done on a mat. It is the most widely know and accessible form of Pilates because it is relatively inexpensive approx $10-15/hr or obviously free if you practice on your own, requires minimal equipment, and can be performed anywhere – all you need is yourself and a mat. One thing to keep in mind though is that matworkmay actually be more challenging on your body since you do not have resistance from the equipment helping guide your body and give you feedback to perform correct movement patterns.
+ Equipment based Pilates
Assists with achieving proper alignment and control while providing appropriate resistance for strengthening and endurance
Allows for weight bearing exercise and gives proprioceptive feedback to enhance stability and muscle control
The most widely used Pilates machine is the Reformer
Other machines include the Cadillac table, Wunda Chair, and Barrel
Presenter
Presentation Notes
My personal preference for pilates is to practice on a reformer – as someone who struggles with neck pain and headaches it allows me to modify my routine to avoid stressing my neck and back, but at the end of the day still get a great workout. So if the reformer is so great why isnt everyone doing it? Oneof the largest downsides for practicing Pilates on equipment is usually the price – private sessions can cost anywhere from $55-95/hr depending on the studio and instructor. And while Group classes are less expensive at approx $25-40/hr – it requires a greater understanding of your body’s limits, knowing how to modify classes, and may provide you with as much hands on feedback or corrections. Here is a short video demonstrating some leg and arm work that can be done on the reformer
+ Pilates Reformer
+ A different kind of workout…
A gentle, non-aerobic exercise method, which lengthens and strengthens the muscles, and improves posture without stressing the joints or the heart.
It focuses on a mind-body connection that emphasizes a balanced body through core strengthening and awareness.
The intensity of each exercise is adjusted through the use of arm/leg movements and internal or external resistance
Presenter
Presentation Notes
Pilates has become widely popular because it can be a gentle non-aerobic workout which lengthens and strengths our muscles, improves our posture – and most importantly does all of this without stressing our joints. Similar to tai chi and yoga it also focuses on the mind body connection that emphasizes a balanced body through core strengthening and improved awareness. The exercises can be adjusted or modified by adding more or less resistance through our own body weight or adding springs,weights, or bands
+ Traditional Pilates Exercises
Designed for fit and healthy individuals
Large focus on outer or global core muscles
Requires very good muscle flexibility and control of end of range joint movements
Reliant on good proprioception and body awareness
Presenter
Presentation Notes
That being said…. One of the important things to remember about traditional pilates or pilates practiced in a group setting is that it is that it was originally designed for healthy and fit individuals. There are several exercises that are extremely advanced and require not only good control of our muscles but also good awareness and proprioception of where our body is in space – especially for an individual with EDS initially this may be very difficult– and may be dangerous for you to perform.
+ Contraindicated Pilates Exercises
Presenter
Presentation Notes
In my world as a physical therapist there are several pilates mat exercises with similar variations performed on the reformer which contradict my personal training and beliefs in regards to what is healthy for our bodies….some of these include: �rocker with open legs, neck pull, roll over, jack knife, corkscrew, control balance, boomerang, rocking, bicycle Obviously you can see a common theme across these pictures – there is significant pressure and weight being borne across the neck as well as many of these positions place our nervous system on significant tension which can be very harmful for our nerves.
+ Modified Pilates Exercises
Designed to make Pilates more adaptable for a vast range of abilities and level of fitness
Modified movements of the original exercises that are safer, achievable, and more in line with the way our bodies are supposed to function
Presenter
Presentation Notes
So what does that mean for you – as an individual with EDS you want to look for modified or therapeutic pilates exercises. Which simply means you modify the movements of the original exercises that are safer, achievable, and more inline with the way our bodies are supposed to function. This may be achieved by designing a program with your physical therapist or working privately with a skilled and knowledgeable pilates instructor who can adapt your exercise routine to your specific strength and weaknesses.
+
Modification is the key to Pilates success! All exercises are developed with modifications that can make a workout safe and challenging for a person at any level
Presenter
Presentation Notes
When you are beginning a new exercise remember that modification is key to success.
+ Modifications
Modifications should always be made to maintain appropriate alignment and muscle engagement Decrease motion or resistance Perform less repetitions until endurance and control improves
Avoid end range stretching It may feel good in the moment, but over the long term you need to
find a sense of connection, internal support, and structure in your body
+ Modifications
If you experience neck pain…
Avoid “C” curve or lifting your head with abdominal work
+ Modifications
Your arms and legs are heavy!
Cross your arms over your chest Keep legs in tabletop or on the floor and avoid lowering them to close to the ground
+ Modifications
Bend your knees or place a small lift under your hips for hamstring tightness, nerve tension, or back pain
+ Modifications
Place a foam wedge, towel roll, or folded edge of the mat under your wrists
Bear weight through your elbows
+
Many types of people, at many levels of fitness, who have begun doing Pilates say they’ve seen improvements in range of motion, flexibility, circulation, posture, and abdominal strength – as well as decrease in pain.
“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 H. Pilates, Age 86
Presenter
Presentation Notes
At the age of 86 Joseph Pilatessaid….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. And I too believe that with good form and appropriate progression ofpilates exercises many types of people, at many levels of fitness, can participate in pilates and see improvements in ROM, flexibility, circulation, posture, abdominal strength, and decreased pain.
+ Benefits of Pilates for EDS
With regular committed Pilates workouts you can expect to: Increases the efficiency and effectiveness of exercising Develop a strong core Learn stability and controlled flexibility Create an well balanced body and prevent injuries Develop body awareness to transfer to everyday functional movement Reduce stress, relieve tension, and boost energy Restore postural alignment
It’s gentle and low impact…but also challenging
It is an extensive exercise repertoire that can be modified to fit the needs of everyone
Presenter
Presentation Notes
Develop a strong core – which on the next two slides we will discuss what exactly our core is.
+ Get to know your body
The local muscles are essential to provide continuous support all day for our movements.
The primary role of these muscles is to provide stability.
These muscles are the “center” or “powerhouse” of your core.
Presenter
Presentation Notes
Our core is made up of two systems – the small local muscles and the large global muscles. The local muscles are comprised of our diaphragm – which highlights the importance of proper breathing techniques with exercise or exertional activities The transvereseAbdominus, our multifidus, and the pelvic floor. Together these four muscle groups work to create a cylinder or corset like mechanism of stability around our spine. There primary role is to provide stability and support the movements of our body throughout the day. These muscles are commonly found to be weak or dysfunctional in most individuals who experience spinal pain or hypermobility
+ Get to know your body
The global muscles are comprised of the larger, outer layer of muscles.
The major role of these muscles is to produce movement and generate force and power.
Presenter
Presentation Notes
In contrast, our rectus abdominus, glut max, erector spinae, lats, and obliques are our global or power producing muscles. Most often we see that individuals with back pain tend to overactivate these muscles – which can become very compressive on our spine – eventually causing more pain and compensations. Pilates teaches us to increase activation of our local system and utilize our global system only when we need it – to generate force or power to strenuous activities – not at rest or with low level activities.
+
The 6 Principles of Pilates
“As to methods there may be millions and then some, but principles are few. The man who grass principles can successfully select his own methods. The man
who tries methods, ignoring principles, is sure to have
trouble.”
Ralph Waldo Emerson
Presenter
Presentation Notes
Before you start it is important to understand the principles of pilates to maximize your results. Because as ralphwaldoemerson once said….as to methods there may be millions and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles is sure to have trouble.
+ Principles of Pilates
Presenter
Presentation Notes
Understanding the6 Pilates principles are essential to a safe and efficient workout. The emphasis is always on quality over quantity. These principles teach us the ability to concentrate and be aware of how our body is moving with precision so that we utilize our muscles as efficiently as possible. To learn how to center or activate our abdominals or core while we move our arms or legs To possess control over how we move our body And on top of it all Master correct breathing patterns And if we can put these all together you will create a graceful and smooth flowing movement.
+ Beginning Pilates
Once you have decided to try Pilates, the next question is where? Health and fitness clubs Pilates studios Recreation centers Wellness centers and rehabilitation clinics At home
If you are new to Pilates, it would be ideal to start with private lessons Be wary of drop-in group classes where the instructor cannot know
the backgrounds of all the participants
+ What to look for in an instructor He or she needs to….
Understand your hypermobility and monitor and adapt exercises accordingly
Be well qualified in Pilates Completed a comprehensive
training program Balanced Body Polestar Power Pilates PhysicalMind Institute
PMA Certified
Presenter
Presentation Notes
If you decide to do private lessons then the next step is to find a qualified instructor….that individual should understand your hypermobility and monitor and adapt exercises as needed. They should be well-qualified in Pilates… Ideally you want to work with someone who has completed a comprehensive Pilates training from a reputable source -
+ What to look for in an instructor Questions to ask…
Does the instructor have other movement-related teaching experience? Physical Therapist
How long have they been teaching Pilates?
What is their philosophy and specialty? Are they able to handle special
needs, injuries, and rehab?
+ Beginning Pilates Tips…
If you decide to participate in a Mat class… Make sure your mat is dense enough to protect the vertebrae of
your spine A thin yoga mat will not do!
What to wear Generally form fitting clothing is recommended to allow yourself and
the instructor ensure good form and alignment Ultimately though wear clothes that you are comfortable in and allow
you to easily move
+
“Patience and persistence are vital qualities in the ultimate successful accomplishment of any worthwhile endeavor” Joseph H. Pilates
Pilates is not a quick fix!
If done correctly you should start to feel some benefit after 4 to 6 weeks
It is worth persevering… There is much anecdotal evidence that
regular Pilates practice can dramatically reduce symptoms suffered by many individuals with hypermobility
Always approach Pilates with care Be aware of your own vulnerabilities Take time to choose an instructor
And remember…Pilates should never be painful!
+ Where can I find out more information? Pilates.about.com
Balanced Body www.pilates.com
Polestar Pilates www.polestarpilates.com
Back to Life with APPI Pilates: A six-week programme to refine, tone and strengthen your body by Elisa and Glenn Withers
Teaching Pilates for Postural Faults, Illness & Injury: A Practical Guide by Jane Paterson
35 year old female who has been affected by EDS for over 23 years Multiple disc herniations resulting in neck and low back pain and
weakness in her upper extremities Chiari Malformation Tethered Cord Dural Ectasia Neurally mediated hypotension
Has been participating in private Pilates reformer sessions 2-3x/week for 2 ½ months
Presenter
Presentation Notes
I have recently come into contact with a patient from our clinic who was interested in starting pilates at the suggestion of her physical therapist. She has been working with a Pilates instructor who was not initially aware of what EDS was. With a lot of communication between myself and that instructor she has been participating in private pilates reformer sessions about 2-3x/wk for the last 2.5 months. As you can see she has a fairly extensive medical history with significant complications affecting her spine primarily. I asked her if she would take the timeto write about her personal experience with Pilates so that I might share it with you all…and this is what she had to say… When I was younger, I was an athlete. Outside of school, my days were spent playing or practicing the sport, or sports, of the season. My friends were my teammates, my identity tied to athletics. Gradually, as the symptoms of EDS began to rear their ugly heads, I was forced to stop. As devastating as it was emotionally, my inability to stay physically active was as equally overwhelming.
+ A Personal Experience
Presenter
Presentation Notes
Over the years, I have tried numerous exercises and therapies in an effort to get some strength and stamina back. Professionals have recommended a variety of different workouts: Tai Chi, yoga, walking, isometric exercises, etc. And though I have tried them all in earnest, they have failed to work with my body in one way or another.
+ A Personal Experience
Presenter
Presentation Notes
Recently, however, I was fortunate enough to discover Pilates. Although adjustments still need to be made, I believe I have found a workout that doesn’t require several days of recovery time or leave me in agonizing pain afterwards. Through trial and error and constant communication with my Pilates instructors, we continuously adapt the exercises to find those that work with my body. With a condition as complicated and finicky as EDS, it is an uphill battle, but after two and a half months I’m definitely seeing and feeling a difference.
+
“For someone with EDS, Pilates appears to be tailor-made. As a workout in which most of the exercises are done lying down, it is helpful for those with orthostatic intolerance (I’ve found on several occasions that if you can make it to the Pilates studio, you can get a good workout). “
A Personal Experience
+ A Personal Experience
“In my introduction to Pilates, the correct way to stand and the proper body posture was reinforced, and I learned that, in order to do the exercises, my body must be aligned. Now, when I’m not doing Pilates, I will find myself realigning throughout the day—checking to make sure my shoulders are down, my stomach is in, my head isn’t jutting out, etc. After my many spinal surgeries, these corrections have helped to take pressure off of my lower back.”
+ A Personal Experience
So, if I had any advice for those with EDS who want to try Pilates it would be this: Do It! But, educate your instructor (and try to involve your physical
therapist in your conversations about exercises). And, communicate constantly with your instructor.
Hopefully, you’ll love it as much as I do!
Presenter
Presentation Notes
After being so active earlier in my life, it is imperative for me to maintain some level of physical fitness. Despite the limitations placed on me by EDS, I need a good workout, and Pilates is the best option I’ve found. However, communicating with my Pilates’ instructors has been, and will continue to be, vital in my experience. I have found that educating and re-educating an instructor about EDS, my symptoms and history, as well as my limitations has helped improve my experience.
