Clinical Pilates at the Tonbridge Clinic, Kent, UK : Bronwyn Claassen

Bronwyn Claasen, B. Phty. MCSP;MAPA
Clinical Pilates Specialist

What is Clinical Pilates?

Drawing on the original work of Joseph Pilates, Clinical Pilates focuses on injury diagnosis, management and rehabilition. The Pilates principles have been adapted to improve the safety and effectiveness of the exercises and highlight the key elements that actually do improve back pain.

The aim of Clinical Pilates is to assess the movement and control of the lower back and pelvic region, then use specific exercises to help correct the problem areas. These basic exercises use sub-maximal muscle co-contraction. This means gentle low-level muscle work of several muscles at the same time. This is difficult to 'feel', so the key is in concentrating and being aware of how and where the body and individual joints move or don't move. The focus is more on teaching the brain to recruit the correct muscle groups to find the correct pattern of movement than on the strength and length of muscles and joints.

Clinical Pilates and it's role in physiotherapy

The Clinical Pilates programme was begun in the 1990's by Australian physiotherapists and has continued to develop in the light of new research. The reasoning behind Clinical Pilates is in its ability to efficiently recruit the muscles needed for CORE or PROXIMAL STABILITY. There has been a lot of useful research into stability and it's role in low back pain over the past 10-20 years that supports the theory that poor control of the spine and pelvis, and lack of endurance of the deep trunk musculature are associated with low back pain. Local deep stability sequencing is essential before thinking of moving on to the more traditional global bracing of the Pilates exercises.

In Clinical Pilates specific exercises are prescribed for each patient after a thorough assessment is done. Exercises are often 'direction and bias specific' meaning that a position is used that allows the body to learn and be stable and pain-free before challenging the stability in other positions.

We aim to target an early-onset low-level endurance contraction of the local deep stability muscles (transversus abdominus, deep multifidus) with a specific movement task; then the more superficial global stabilizers (obliques, superificial multifidus, latissimus dorsi, etc.) are stimulated by increasing difficulty of the task. The exercises facilitate and challenge these muscles regardless of whether the patient is consciously aware of the muscle activity or not.

What is Pilates?

Pilates first began in the 1920’s when Joseph Pilates, a German immigrant to the USA, opened an exercise studio in New York City. He called his system of exercise Contrology and based it on these 8 principles:

Concentration on what you feel your body is doing
Breathing with movement
Centering using the deep local stabilizing muscles of the spine and pelvis
Control of all movement
Precision with where a movement initiates and continues
Flowing Movement
Isolation of body parts
Routine of movement

Joseph H. Pilates was born in Germany in 1880 and died in New York in 1967. The "kulture physique" era of Europe of the early 20th century led him to devise an exercise programme that would improve his own body for gymnastics and circus performance.

Prior to the First World War he was working in London training Scotland Yard detectives in self-defense. When war broke out he was interned in the UK and used his past experience to devise exercise and rehab programmes for his fellow inmates and patients using springs attached to.

He migrated to the USA in the early 20's and set up his studio in New York where he gained a strong following from some of the best-known actors, dancers, singers and performers of the day. Performers generally don't rest when injured and he managed to help many through their problems with his exercises when the only medical advice was to rest.

The method has become very popular in recent years and has continued to develop since Joe's death. Now Clinical Pilates with its basis in scientific research is discovering ‘why’ it works so well in the treatment of pain and injury.

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Bronwyn Claasen, B. Phty. MCSP;MAPA Clinical Pilates Specialist

Bronwyn Claasen, B. Phty. MCSP;MAPA
Clinical Pilates Specialist