Introduction to Pilates-based PT for Low Back Pain for DPT1 Students

Introduction to Pilates-based PT for Low Back Pain for DPT1 Students

Developed by: Krissy Ayers, SPT

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Background

For 4 years, I have been practicing Pilates and my passion for this method of exercise has grown tremendously. I also have been observing Pilates-based physical therapy (PBPT) for 2 years. My career goal is to become a Pilates-based physical therapist, and this has inspired me to complete a 450-hour Pilates training program through The Pilates Center out of Boulder, Colorado.

Throughout my outpatient clinical rotation, I saw many patients with chronic, non-specific low back pain. To supplement traditional therapeutic exercises, I turned toward my Pilates education and was able to incorporate evidence-based Pilates exercises into my treatment. My treatment was new, exciting, and successful in improving outcomes.

For this project, I wanted to share my love for Pilates and PBPT. I believe there is a significant need for DPT students to be introduced to Pilates and educated on the benefits  of incorporating classical Pilates exercises into traditional physical therapy. Currently, in the Exercise and Prescriptions course the first years are taught about aquatic therapy, exercise basics, obesity, diabetes, nutrition, functional movement systems, exercise devices, and exercise for athletes and older adults. A Pilates presentation in the Exercise and Prescriptions course would be a wonderful addition to these topics.

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Overview

Low back pain is the leading cause of disability worldwide, and it is the number one cause of lost work days in the U.S.. (4)  Furthermore, approximately 25% of people in the U.S. have reported having low back pain. (5) Out of these low-back pain cases, approximately 90% is classified as non-specific back pain. (6)

When treating patients with non-specific low back pain, many factors can affect the mechanical balance of the lumbar region leading to instability that can trigger low back pain. (6) Some factors are: motor control impairment of the trunk muscles, strength imbalance of the trunk muscles and/or overall decrease of the trunk muscle strength. Of the trunk muscles, the transverse abdominis is especially important.

Research has found that the transverse abdominis is one of the first muscles to be activated in many activities of daily living, and if the contraction is weak and/or delayed that is indicative of deficits in motor control and inefficient muscular stabilization of the spine. (7) There is also evidence that shows the improved strength of the transverse abdominis is associated with clinically important long-term back pain reduction. (7)

The goal of Pilates is to create a uniformly developed body with a well-balanced holy trinity of body, mind, and spirit. (8) The founder of Pilates, Joseph Pilates, said his exercise intention was “that each muscle may cooperatively and loyally aid in the uniform development of all our muscles. Developing minor muscles naturally helps to strengthen major muscles.” (9) Uniform development is dependent on powerful abdominal muscles, specifically the transverse abdominis, to support a strong, stable spine.

So, Pilates effectively works to strengthen the transverse abdominis, and thus decrease low back pain. The Pilates method emphasizes becoming conscious and able to control the activation of the transverse abdominis through the performance of various tasks in the Pilates session. The transverse abdominis is also included in the Pilates term the “Powerhouse.” The “Powerhouse” is the “Pilates designated area of the torso between the lower ribs and hips,” and also includes the pelvic floor muscles and the multifidis. (9) The Pilates method believes the “Powerhouse” is crucial to master the Pilates method of body conditioning, and it forms the foundation for all Pilates movements. (9)

The current best evidence suggests that Pilates can result in greater low back pain reduction compared to minimal intervention. (10) Pilates, delivered through a Pilates certified physical therapist, is also an appropriate and safe alternative to general exercise. (10)

The purpose of this project was to introduce the UNC DPT first years to the benefits of Pilates, specifically in treating chronic, non-specific low back pain, and to provide them with introductory simple Pilates exercises that they can use in their clinical rotations when treating those with nonspecific, low back pain.

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Project Development

My personal experiences, my Pilates training education, and the work I did in EBP2 helped me to establish the plan for this project. In EBP2, I developed a PICO question to research if the Pilates method can effectively reduce chronic, non-specific low back pain in adults. This PICO question became the foundation for my EBP2 critically appraised topic. Prior to developing my capstone presentation, I conducted additional research pertaining to Pilates and low back pain, the history of Pilates, and the fundamental principles behind Pilates exercises. Some of the most up-to-date research I included in an evidence table. I also surveyed the students in PHYT 726 to determine their Pilates knowledge level and to ensure my presentation met their educational needs.

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The Project

I developed an interactive presentation to present to the 30 eDPT students at the University of North Carolina- Chapel Hill during their Exercise Foundations and Prescriptions course (PHYT 726), as well as the course’s lead faculty members. The presentation introduced Pilates, Pilates-based physical therapy, the evidence behind Pilates and treating low back pain, and the resources to get further professional Pilates education. The presentation consisted of a Powerpoint, an exercise handout, and many live demonstrations and hands-on activities. I also asked the first years to complete an evaluation after the presentation. A summary of all of the evaluations can be found here.

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Acknowledgements 

I first would like to give a huge sincere thank-you to my academic advisor and Capstone committee member, Jon Hacke, PT, DPT, MA, OCS. I am so grateful for your time, patience, guidance, motivation, and encouragement throughout my DPT education and Capstone project development.

I also would like to thank my Pilates mentor and PBPT role model, Mischa Decker, PT, DPT, OCS, PMA-CPT, and co-owner of InsideOut Body Therapies in Durham, NC.  Thank you for guiding me throughout my Pilates training, and sharing your PBPT knowledge and skills.

Additional thank-yous to the other Pilates teachers and Pilates-based PTs at InsideOut Body Therapies for letting me observe and learn from you! Many thanks to my Capstone advisor, Mike Gross, PT, PhD, FAPTA. Thank you for helping me create a successful Capstone project. And thank you to my family and fiancee for always being my cheerleaders and biggest supporters!

Finally, thank you to all of my amazing DPT classmates! Thank you to the first years for being a wonderful audience to my Capstone presentation, and to all of my fellow third years, I am blessed to have such great, intelligent, and kind classmates! 🙂

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References

1. Pilates Apparatus. (n.d.). Retrieved from http://www.absolutepilateswithleslie.com/pilatesapparatus.htm
2. Advanced Exercises on the Cadillac. (n.d.). Retrieved from http://www.jenniferkries.com/pilates-workshops/advanced-exercises-on-the-cadillac/
3. PILATES REFORMER. (n.d.). Retrieved from http://marichadumont.com/portfolio-view/pilates-reformer/
4. Low Back Pain Leading Cause of Disability Worldwide: Study. (n.d.). Retrieved from http://consumer.healthday.com/bone-and-joint-information-4/backache-news-53/low-back-pain-leading-cause-of-disability-worldwide-study-686113.html
5. Physical Therapist’s Guide to Low Back Pain. (n.d.). Retrieved from http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=d0456c65-7906-4453-b334-d9780612bdd3
6. MUSCLES OF THE CORE. (n.d.). Retrieved from https://www.acefitness.org/blog/3562/muscles-of-the-core
7. Critchley, et al. (2011). Effect of pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial. Manual therapy, 16(2), 183–189.
8. Joseph Pilates. (n.d.). Retrieved from http://www.formpilates.com/tag/joseph-pilates/
9. Alpers, A. T., & Segel , R. T. (2002). The Everything Pilates Book: The ultimate guide to making your body stronger, leaner, and healthier. Avon, MA: F+W Publications.
10. Ayers, K. (2015). Pilates and Low Back Pain Critically Appraised Topic.