Breathe Clinical Pilates | Melbourne Australia | Info for therapists | ClinicaL Pilates

The Breathe evidence-based approach to Clinical Pilates rehabilitation

At Breathe we use a combined motor control and muscle rebalancing approach for lumbo-pelvic rehabilitation. This approach incorporates the latest research by Hodges, Richardson and Hides at the University of Queensland as well as that of Stuart McGill, and rests solidly on the foundation of the current body of evidence contained in the texts listed at the bottom of this page.

Initial Assessment
Initial assessment is allocated 45 minutes, and takes into account the following:
History of symptoms/injury
Aggravating/mitigating factors
Diagnosis, if one has been given previously
Scan results, if available
Static posture assessment
Muscle length and strength tests (as per Kendall et. al.)
Dynamic Assessments (as per Sarhmann)
Specific testing for function of the deep stability system (as per Hodges, Richardson and Hides)

Stage 1: Establishing effective function of the deep stability system, and downtraining overactive global muscles
If there is reflex inhibition of the deep stability system (eg: TrA, pelvic floor, Lx Multifidus, Diaphragm in the lumbo-pelvic region) the first stage is to re-establish correct functioning of this deep joint protection system. Generally this phase includes exercises that adhere to the following guidelines:

Low load (i.e. gravity reduced)
Closed kinetic chain
Small range of motion (around the neutral joint position)
Slow speed of movement
High levels of proprioceptive feedback via inflatable pressure biofeedback unit, instructor tactile or verbal feedback, mirrors, props etc.

During Stage 1, we also work to reduce any over-activity in the multijoint, non-weightbearing muscles (i.e. TFL, hamstrings). We use combinations of various techniques including:

Self trigger point release with pocket physios, tennis ball, theracane, foam roller etc.
Faciltated stretching (i.e. PNF stretching where the client takes themself actively into the new range).
Passive tissue glide techniques
Ergonomic advice to eliminate, as far as possible, exacerbating lifestyle factors such as poor sitting positions, deloading etc.

Stage 2: Integrating the Global stability system
Once effective joint protection strategies have been invoked, stage 2 starts to integrate the 1 joint, antigravity muscles into the stability strategy. Stage 2 includes work in both upright (vertical) and flexed-hip positions, to challenge the extensor system progressively against gravity in functional movements with the following guidelines (as per McGill and Hodges et. al.):

Erect posture (either seated or standing)
Neutral spine alignment
Closed kinetic chain
Weightbearing in various positions i.e. bilateral stance, lunge, unilateral stance etc.
Challenging lumbo-pelvic stability with gentle to moderately resisted arm or leg movements, including bilateral, unilateral, reciprocal and contralateral loads
Focus is on achieving effective, well-timed isometric contraction of local and global stability muscles, without gripping or compensation by multijoint muscles
Progressing to work on unstable and/or uneven surfaces (Bosu, Duradisc, Rotational disc, Foam Roller, Stability Ball etc.)

Stage 3: Integrating the multijoint muscles
Once neutral spine stability has been established in functional positions (i.e. upright and flexed hip, in various stances) we begin working to integrate the speed and power muscles into 3 dimensional, ballistic movements with stability. This stage will include the following:

Plyometric work (jumps, throws, lunges etc)
High speed work
High resistance
High complexity movements
Large range of motion
Progressing to functional movements for sport/daily living (i.e. running, cycling, martial arts kicking etc.)

Info for Therapists

The Breathe evidence-based approach to Clinical Pilates rehabilitation

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