The Dirty Secret

April 4, 2015 — 11 Comments

Or, ‘Clinicians, what have you done to Pilates?’100910doctor

“We only hire experienced Physiotherapists trained in Pilates to teach in our Pilates studios: we dig the bloke that started it, but can’t understand how you’d let anyone who can’t relate your pain and pathology to your problem come anywhere near you!” 

(‘Clinical Pilates’, http://www.sixphysio.com)

There seem to be frequent scuffles in the Pilates teaching world (at least in the forums that I see) between ‘classical’ and ‘contemporary’ Pilates teachers. I’ve no interest in pursuing that particular debate here, not least because I think it may not be the right on to be having. Rather, I’m interested in the influence of physiotherapy and ‘clinicians’ on Pilates, and the profession of teaching Pilates.

It seems appropriate that, over the years, different teachers developed what may be termed ‘pre-Pilates’ exercises, to provide a kind of ‘on-ramp’ to the original work for those who may need it, for whatever reason. I guess that this is how some ‘contemporary’ Pilates developed. However, I suspect that ‘contemporary’ Pilates is routinely intermingled with ‘clinical’ Pilates, and the ideas that underpin the various ‘clinical’ Pilates brands (yes, there are lots of them) are increasingly exerting a pernicious influence on much of Pilates teaching.

Why the ‘Dirty Secret’ title? I was recently listening to an interview with Kelly Starrett, a physiotherapist particularly well know in the CrossFit community. In the interview he refers to what he calls the “dirty secret” of physiotherapy – the phrase “within normal limits”. He describes the tenets of physiotherapy training as getting the patient functional -‘can you do your daily activities’, and resolving pain. Clearly these aren’t bad things but, as Kelly says, “within normal limits” does not mean “full function”. So, allowing for the fact that this is a generalisation, and that there are many excellent physios in the world who are committed to their clients high achievement, the fundamental measure of a successful outcome for a physiotherapist might well be ‘can you walk to the shops without pain?’

Joseph Pilates wrote of his method: “You will develop muscular power with corresponding endurance, ability to perform arduous duties, to play strenuous games, to walk, to run or travel long distances without undue body fatigue or mental strain. And this is by no means the end.” His ambitions were a little higher than ‘can you walk to the shops without pain?’

The term ‘evidence based exercise’ seems to be increasingly popular, and probably underpins a lot of the colonisation of Pilates by clinicians. Clinical Pilates™ have a video on YouTube called “What is Clinical Pilates™” which makes reference to “recent research into spinal stability“. The APPI (The Australian Physiotherapy and Pilates Institute) website tells us that “Pilates focuses on building an efficient ‘central core’. In Pilates, ‘central core’ refers to the TrA, multifidus, pelvic floor and diaphragm. In Pilates, abdominal hollowing techniques are utilized to activate this central core.” (About Pilates, http://www.ausphysio.com) The Clinical Pilates™ video goes on to explain that “Some of the original exercises have been cut from the regime, as research cannot support their efficacy. What’s left over is a set of proven, effective exercises, now known as ‘Clinical Pilates’“. (What is Clinical Pilates™, dmaclinical pilates, YouTube). So, research tells us that we can prove the efficacy of certain exercises, but not others. Best practice is therefore to exclude anything that we cannot prove is efficacious. This may be a line of reasoning that appeals, but does it have anything to do with Pilates, or real life, for that matter? I’m in no position to question the merits of research, like Hodges’ & Richardson’s ‘A motor control evaluation of transverses abdominis’ (published in 1996), that concluded “The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.” In case you are unfamiliar with this, their research found that in healthy subjects – those without back pain – EMG readings showed that their TVA fired in anticipation of movement, whereas the back pain suffering subjects showed delayed TVA firing. I do wonder, though, about it’s application to Pilates.

This happened before my introduction to Pilates, but I imagine that, because Pilates was recognised to help people with back pain, it was then deemed necessary (by whom – who knows?) to incorporate conscious, isolated TVA contraction into Pilates. As APPI told us above, Pilates uses ‘abdominal hollowing techniques’, though I can’t find any reference to it in Pilates’ own writing. I recently had an online conversation of sorts with a former Pilates teacher and studio owner who described herself as a ‘master trainer’. The conversation started because she had blamed Pilates for her ‘weak’ rectus abdominis, and she explained to me that: “The pilates priciple of navel to the spine creates an imbalance in the abdominal muscles.” I have no wish to impugn the integrity or sincerity of this lady, presumably her view is a reflection of what she was taught herself. But where did it come from? I’d be very interested to hear if anyone who was trained by Romana, Kathy, Eve, Ron, Carola or any of the other first generation teachers ever heard a ‘navel to spine’ or abdominal hollowing cue. Again, Pilates himself never mentioned any such thing in ‘Return to Life’. I know from other exchanges that I’ve had on Facebook forums that, amongst plenty of teachers, the importance of cueing transversus, and the correct usage of transversus are, beyond question, fundamental to Pilates.

So, research appearing to indicate that transversus contraction is normally reflexive, we find that it is being cued nearly constantly in Pilates. The truth is that, having had a lumbar disc injury, I probably benefited greatly from some simple spinal stabilisation/hip dissociation exercises when I first started Pilates, but these were in preparation for doing Pilates, not central to it. In other words, these were pre-Pilates exercises that seem to have somehow morphed into what Pilates is perceived to be. Indeed, organisations like APPI and Clinical Pilates™ will teach their students that this is how Pilates should be – “The APPI Pilates Method provides Physiotherapists and equivalent degree therapists with a clinical and user friendly tool for retraining correct activation of the Multifidus, TrA muscles and pelvic floor muscles.“(The APPI Pilates Method, http://www.ausphysio.com) I should say here that, of course, physiotherapists do a very important job of helping people to be pain-free, and I am sure too that there are many great and dedicated teachers trained under these and similar methods. My concern is, to revert to the analogy above, that the on-ramp becomes the freeway, first in the perception of teachers trained in this thinking, and then in the public perception.

I’ve written recently about our willingness to believe that we understand bodies and movement better than Pilates did, and I assume this is the reason that Pilates teachers were apparently so willing to adopt clinical concepts in their teaching. The slightly bizarre thing to me is that at the same time some of those clinicians were busy declaring that physiotherapists are the natural bearers of the Pilates flame – that they are the people best qualified to teach Pilates. It’s an idea that is routinely promoted now -“Pilates instructors may be able to teach Pilates but are they qualified to give rehabilitation to someone who has an injury or medical diagnosis? We would suggest not. Physiotherapists can give full rehabilitation and can be taught to teach Pilates.” (The Benefits of Physiotherapist Led Pilates, http://www.pilatesandtherapy.co.uk) and, of course, in the quote at the top of the page.

Intertwined in this is the notion that actually Pilates is for people who are injured, or in pain. This brings us back to the ‘within normal limits’ outcome, and the idea that repertoire that hasn’t been validated by research should be discarded – “We don’t know for sure that this will help to resolve your pain, or increase the efficacy of your spinal stabilisation strategies, so you shouldn’t do it.” What was devised as a system is reworked (unsystematised, perhaps) and then, weirdly, appears often not to work. I have a strong suspicion that there are plenty of teachers who have arrived at Pilates after pain or injury, followed the unsystem approach and failed to enjoy the outcomes that Pilates intended. They’ve trusted the clinicians instead of the system, and thus find themselves ‘within normal limits’, when Joseph was trying to offer “godlike attributes” – what a compromise!

 

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11 responses to The Dirty Secret

  1. 

    Thanks Mike. I just can NOT believe the quote from Six Pilates!!! What goes through someone’s head when they post such an arrogant and ignorant statement on their website?? Unbelievable!

  2. 

    Really great article opening up the topic for discussion.
    I am a Pilates teacher, I came into the field after an injury in a car accident when I was 8 months pregnant. I sort advice from my UK Dr to no avail and then a private Oestopath who gave me some relief. It was from their recommendation I sought out a Pilates teacher (who was also a PT & massage therapist). Again I gained some insight to my body but was still in pain. A move to the USA, two comprehensive Pilates programmes, Gyrotoinic & Gyrokinesis, numerous Chiropractors, Osteopaths, Myofascial therapists, Acupuncturists,Massage Therapists, Rekii, Watus, Rolfers, Alexander technique & Continuum. Again, all adding to my understanding but no constant relief. I moved back to the UK and I enrolled in Fletcher Pilates programme & I met a fantastically gifted Oestopath Kiran Floura. The combination of the two along with my background in counselling/therapy enabled me to find a place of stability in my body and mind.
    I think it is about finding the right modality for you, be it Physical Therapist, Pilates Teacher, Yoga, Counsellor whatever. If we limit ourselves to one way being ‘the right way’ then we lose the ability to be progressive. I am very clear to my clients what I teach and have a network around me to reference on when I know their issue is out of my professional field. Perhaps we could work with what is best for our clients rather than pointing out that we are better, more capable than another modality? That would be the way forward in such discussions, looking at what each skill set can offer. Offering support, knowledge, education and in the future raising the standard of care for our clients for us all.
    Respectfully
    Emma

  3. 

    Brilliant article Mike! I am a professional Pilates instructor but not a PT. I have spent at least seven years training and contining my education in the Pilates method (I should be the equivalent of a doctor by now!) but of course my qualifications and experience are sometimes under valued. My first job as a Pilates instructor many years ago was at a Clinical Pilates studio (in Melbourne Australia) but I was horrified by what I experienced. Whilst the classes were ‘physio supervised’ this only meant the physio saw the client for an initial consult and wrote a program and then a Pilates instructor (they preferred DMA but any qualification was acceptable) actually supervised up to eight clients who mostly took themselves through the program. Firstly, I have to say the programs did not follow the Pilates philosophy or principles therefore lacked the holistic balance that the classical system provides. There was no flow and whole body parts and ROM were neglected with the focus mainly on the injured area only and little integrative work or meaningful progressive. As you stated, return to ‘normal function’ was a very limited concept. Secondly, there were up to eight, often elderly, people in a class all requiring significant attention to ensure they were performing the exercises correctly. I can tell you this was not possible with just one instructor on the floor. This experience was not at all in line with what I had learned of the Pilates method, needless to say I didn’t stay long in this job. Not all physios operate this way of course, I have since had fantastic experiences with PT lead Pilates, Polestar trained in particular. The example above was of PTs who only did a short course in ‘clinical’ Pilates which omitted the fundamental principles that make the Pilates method unique and not just a set of exercises to replicate and modify haphazardly. I have read Joseph Pilates book many times and of course he never mentions navel to spine, a clinical Pilates invention and a variation to his technique that does not build the strength required to perform moderate to high level body weight movements e.g. a sustained hollow body hold, essential for the progression to such things a front supports/planks and at a higher level a static freestanding handstand. The modern technique of minimizing rectus abdominal with this type of cuing, or the expectation of recruiting TrA only is not doing us any favors if we wish to move outside ‘normal’ function which Joseph Pilates intended us to do. I have done several workshops with Ido Portal and am currently doing Gymnastics Strength Training under a Coach Sommer’s Gymnasticbodies program and I can tell you if I don’t recuit RA I will never be able to achieve even the most basic body weight resistance exercises, which by the way are awesome fun, prepare me for all sorts of movement, and look super cool when you can pull them off (effortlessly!). I am not a gymnast by the way, far from it. These experiences have since changed the way I teach and cue Pilates exercises and I believe it is more in line with Joseph Pilates expectations given that a lot of his work was designed for gymnastic, circus and dance performers, but why can’t we all strive to a level of this. In addition to this, as Ido Portal says, sh*t happens and you want to prepare your body to move beyond normal limits, regardless of your age and recreational pursuits, so that when you trip over that crack in the footpath, fall down a curb or have your legs taken out from underneath you (I think Ido was referring to martial arts but I see it happen at the dog park often enough!) then the range of motion you are exposed to is not a surprise for your body and you can pick yourself up and continue on with what you were doing rather than lie broken on the ground. I love Pilates and it has been monumental in helping me recover from a hip injury, I will always practice it, but we do need to progress ourselves and our clients beyond the ‘normal’ limits that modern conservative practices dictate and we do need to recruit RA for core control. In Joseph Pilates words, ‘to achieve the highest accomplishments within the scope of our capabilities in all walks of life we must constantly strive to acquire strong healthy bodies and develop our minds to the limit of our ability’, note that he did not state ‘normal ability’ but to the limit of our ability and that is potentially limitless for all of us! By the way, I am a huge fan of Ido Portal and in a quite moment he confessed to me that he greatly admires the work of Joseph Pilates, but not in its contemporary form, rather in the way Joseph designed and executed it himself. Ido reminds me of a young Joseph Pilates, ahead of his time!

    • 

      Thanks Erica, it sounds like we’re on a similar path.
      The rectus comment that I referred to, which was the catalyst for me writing the blog, came from her ‘review’ of attending one of Ido’s workshops. It’s good to hear that he shared that with you, as Pilates work seems like something that Ido ‘should’ admire….
      Perhaps you’ll be at the hand-balancing workshop in Finland..?

      • 

        Yes, it seems we are very much on a similar path! Pilates, Paleo and gymnastics strength training ….an incredible combination. Unfortunately I won’t be in Finland for the hand-balancing workshop, its a bit far away for me to attend and I’m not ready for it yet. Thanks for your great blog, I discovered you by chance a few weeks ago and have been catching up on all your entries over the past few weeks and loving your point of view and no-nonsense responses!

      • 

        Thank you so much Erica.
        Not sure that I’m ‘ready’ either, but sure I will get a lot from it.
        If you haven’t already done it and you get the chance, ‘The Corset’ with Ido is brilliant.

  4. 

    Research is fine,until new research disproves the old research.I do believe Pilates teachers should keep learning how the body works in order to understand Joe Pilates work better.I didnt come from a movment background and learnt the work in my body first,have taken masses of training but continue to read and study as the human body is fascinating.There is loads of pre Pilates in classical training which prepares bodies that need it.However its worth watching some of the legacy videos on PA as some of Carolas students talk about how she insisted on a flat back which caused problems and pain.I believe in Joes work but I believe in creating bodies that have great functional movement to do the classical work correctly rather than teaching a dysfunctional body to barrel through the classical work which I have seen and experienced many times.

  5. 

    Aha, good luck to you then! Thank goodness Ido has long lunch breaks on his course, it will give you a bit of recovery time before the gruelling afternoon sessions. Will you write a blog about this experience? I’d really love to hear about it. How have you prepared for wrist mobility/strength? I injured my left wrist during my Adv. Dip. Pilates training as there were lots of supports and some handstand work but no pre-Pilates to prepare my wrists for this load. I am doing GST training with Gymnastic Bodies but it is slow progress of course.

    I did the Corset workshop with Ido in January and it was fantastic! I have been incorporating a lot of this stuff into my Pilates classes as warm up/mobility drills, you can see so many similarities between this work and Pilates. I feel like it is a very natural progression. Much to my surprise my clients are loving it too and have been really open to some of the tougher stuff. Who would have thought!

    I must say that Ido’s courses have further opened my eyes to the great system Joseph Pilates created. Doing this work has helped me to value more than ever the classical roots of the Pilates method and the huge benefits it provides in preparing for higher level movement and rehabilitation. Pilates certainly was a man ahead of his time!

    • 

      Mostly using drills from The Corset for wrist prep, and I’ve realised that it needs to be very regular. I agree about the long lunch breaks – especially when we wound up finishing an hour and a half late.
      I agree – while at first I thought Ido’s approach didn’t really fit with Pilates, or vice versa, having had more time to play and digest I value Pilates’ work all the more, and it reinforces the value of a systematic approach and all the other stuff I’ve written about in the last couple of months.

      • 

        Thanks for sharing Mike and enjoy the hand balancing workshop, I look forward to hearing and seeing your progress!

Trackbacks and Pingbacks:

  1. What’s Your (Pilates) Dogma? « paleolates - September 19, 2015

    […] I will argue for the importance of a systematic approach to Pilates, I will rail against the encroachment of ‘current knowledge and research’ into the Pilates teaching profession, and […]

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