Ep 15: Benefits of Clinical Pilates

Voiceover (00:02):

Welcome to the Confident Body, where experienced health professionals discuss how to get the most out of your body for the lifestyle you choose. We believe everyone can exercise and get the most out of life, regardless of your injuries or health issues. Now here’s your host, senior physiotherapist, Michael Dermansky.

Michael Dermansky (00:24):

Hi everyone and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. My name’s Michael Dermansky. I’m Senior Physiotherapist at MD Health and I’ve got with me a special guest and a repeat guest to the show, Nicole Davis, who’s one of our Senior Accredited Exercise Physiologists and our branch manager in Templestowe. Welcome to the show again, Nicole.

Nicole Davis (00:44):

Thank you Michael.

Michael Dermansky (00:45):

All right, so now that you’re a veteran as well, you’ll be very confident being in the show again.

Nicole Davis (00:50):

Hardly.

Michael Dermansky (00:50):

Hardly. All right, well we are going to talk about a topic you do know something about as well. We’re going to talk about clinical Pilates and I guess why clinical Pilates is right for everybody. I guess it’s a statement and an opinion, but from your perspective, what do you see the purpose of clinical Pilates?

Nicole Davis (01:11):

It is really about a tailored exercise program. It’s very specific to the person and what they’re presenting with. It is also about, I think, working towards their goals, not just what we want them to do. Very much incorporating both of those for it to be enjoyable as well as realistically achievable. Then I think we’re also identifying a few weaknesses that we might not actually know about. Then if we actually address those, it’s all about injury prevention then. I feel like clinical Pilates is a very big term in my eyes. It’s not just about reformer based Pilates. The intentions that we have with clinical Pilates is bigger than most know about or our clients know about, the hats we put on with trying to actually achieve everything for them.

Michael Dermansky (02:18):

Okay. Well, what do you mean? I mean, for an example, sorry, someone does … Pilates is known for this core stability thing or working on your core. I mean, can you give us an example of what you mean by working towards a client’s goal specifically as well?

Nicole Davis (02:33):

Some of the clients assume that yes, the Pilates is all about the core, but core incorporates pelvic floor, back muscles, tummy muscles and your breathing muscles. Breathing is the way we live, that’s how we function. If we are talking about core muscles, it’s also about basically getting out of a chair, so our spinal control and stability. I think when we’re talking about it having its place, it is a multipurpose I guess, with what we need to do. And as our bodies change, that is also something that we can think more about in terms of controlling as much of the aging process as we can, with our specific exercise prescription that we’ll do when we’re doing our clinical Pilates.

Michael Dermansky (03:26):

Can you give me an example of a client that you’ve got either at the moment or you can think off the top of your head where a specific tailored approach to the clinical Pilates has made a difference in their lives or what you are thinking was with a particular client and what the result was?

Nicole Davis (03:42):

As we said, very commonly back injuries happen often and to a lot of us. We had this lovely lady who ended up having decompression surgery to try and help manage her pain and she was due to do another one and we managed to … Well, she came past our path and we actually have, with the specific tailored approach that we’ve had in terms of looking after her, she hasn’t needed to have that second decompression surgery and she is now lifting more than her body weight with her rack pulls and her dead lifts. For her to now function as a mom, as a grandmother, as a working wife, she is kicking goals and also knowing that with us, we are looking after her in the sense that we can progress her appropriately and if she does have a flare up, which is normal and the flare ups are a normal thing that we all have to go through, if she has one, she knows we are going to look after her. In terms of the clinical prescription from our Pilates sessions are going to be very specific to what she needs at that point in time.

Michael Dermansky (04:55):

What did a session for her look like at the start, say in the middle, and now?

Nicole Davis (04:55):

In the start, it was very much a bit more of the control and strength side of things and we kept things a bit more bilateral and there was a few more treatments involved. We’d go into the room, do a treatment, and then do a specific controlled exercise afterwards. Around midway we would introduce her into some of the more normal movements and being able to do single leg stance and to lift more weight than you would when you’re going shopping. Then now where we are, as I say, lifting more than her body weight with her rack pulls and functionally challenging her in ways that she didn’t even think about being. She comes three times a week now because she enjoys her sessions and knows she’s going to get looked after, but can also be pushed to some limits that she never thought she had or could get past.

Michael Dermansky (05:54):

Okay. I guess that’s the difference between a clinical approach and a general approach as well is that those different stages that she would go through would be very much tailored towards what her needs are. At the start, when she was very early down the track, it would be very specific, very small movements as well that what she could tolerate. And as she’s able to tolerate more, those exercises progressed further and further until the point there beyond her expectations, beyond what she originally thought she could do and seeing that change in people’s lives. The next question I guess as well is that, well we’re saying it’s for everybody. I don’t have an injury. Where does clinical Pilates fit in?

Nicole Davis (06:34):

That’s a very good question, Michael. And where I think some clients or patients we lose on the way because they don’t actually realise the importance of it. Like I said before, in terms of the goals that we need to focus on, but then also about that life management and injury prevention. It is very holistic with what we do here in the sense that we can also target heart rate. Looking at more of the higher intensity type sessions. But then also with our strength type sessions where we’re focusing a little bit more on bone density. Even if you don’t have an injury, we can target the sessions to your goals that you have, whether it be comorbidities or whether it be wanting to go overseas and travel.

Michael Dermansky (07:24):

I mean, it’s interesting cause one of the things that really stands out to me is that when we see clients particularly, and sadly enough, it’s often young moms who just aren’t strong enough. We’ll see them when they have an injury, but when you do the assessment you can see it a mile away. If they were so much stronger, we wouldn’t be having this conversation, we wouldn’t be needing to have this conversation. Because their strength isn’t there, the vulnerability to injury is there and that’s where they end up in our door when they’ve hurt themselves. We’d rather have seen them when they just wanted to work on their basic strength. Working on their core stability is one aspect, but working on their general strength to give them good stability around all their major joints, their backs, their hips, their shoulders and so forth, it would’ve been great to catch that before they had the injury so they can handle the life that they want to have.

Nicole Davis (08:19):

Yes, the prehab is gold, knowing that you’re going to go through such dramatic changes with pregnancy is a known thing. There’s plenty of time to actually prepare the body for it. It’s about knowing so and having that and making the choice to do so. With other injuries, obviously they can catch up on us and we don’t know about it. Pregnancy is one area that we can have a lot of control with, but it’s even the same with doing prehab pre a surgery or pre any kind of orthopedic event. It makes such a difference having very tailored exercises to prepare the body so that recovery is just so much quicker.

Michael Dermansky (09:03):

Well, let’s go back to the injury point of view now. I do have an injury. Where does clinical Pilates fit in? Where does it fit into the picture of managing an injury?

Nicole Davis (09:25):

 Then having some specific outcome measures that we use to be able to guide the sessions. With injuries, it’s also about looking after the person. Being able to build that trust knowing that we are going to push you beyond some of your comfortable ranges. But we know as clinicians that the body is going to be okay doing it, so building that trust relationship is very important with the injury side of things. And I think with clinical Pilates, we’re not just general instructors, that we have more of a wealth of knowledge with our background of studies that we need to do.

(10:05):

Therefore we have a bit more of insight of the psychology and the counting. But then also the tissue adaptation and healing that needs to happen with injuries. We know the timelines that we have to work with and the signs that we’ll see as we are progressing. And sometimes you need to take a little sideways step, but clinically knowing that makes a big difference with the journey that you go on with your rehab with injuries.

Michael Dermansky (10:29):

I see, I see. I mean, what I’m hearing very strongly from that is that with an injury, the specificity based on what people’s injuries are is a really big deal. Then on … Well, there’s two things on top of that too. Understanding the normal timeframes of healing. When do we expect to see what and when can I push you and when do I have to pull you back? The last aspect, which is it’s easy to miss, but a very important one is understanding the psychology that behaves behind an injury as well is that there’s a fear behavior that clinicians have to guide patients through and understanding what’s something to be worried about and something that becomes maladaptive over time. “I’m worried about hurting myself.” Well, there’s no good reason why you worry about this. Now the fear is the thing stopping you from moving forward, not the injury itself.

Nicole Davis (11:24):

Physical limitations. Absolutely.

Michael Dermansky (11:26):

Yep. And it’s a real balancing act. You have to really understand the nuances. Is this within normal healing times? “I want to go do a marathon next week.” You hurt your back last week, it’s not going to be healed yet. But then on the flip side, “Well, I hurt my back six months ago. I definitely can’t lift.” Well, from what I can see from testing, this is fairly stable. There’s actually no reason why we can’t try it out and see the results. And it’s unlikely going to hurt yourself now, because actually it’s healed.

Nicole Davis (11:55):

It’s healed.

Michael Dermansky (11:56):

Understanding that, what’s happening under the surface is a massive part of getting a good outcome or not a good outcome.

Nicole Davis (12:00):

Absolutely.

Michael Dermansky (12:07):

Is clinical Pilates only for back injuries? That’s what it’s really known for. Core stability, back injuries. What happens if I don’t have an injury, does it fit in? How does that work?

Nicole Davis (12:16):

And I think that’s where clinical Pilates is quite different because there is no generalizing of anything. The exercise prescription that will be chosen based on the assessments and outcome measures we have will be very specific to the control that’s needed for the knee injury. The knee is just the middle joint, the hip is also what needs to be addressed. Having that clinical reasoning and focusing on the weaknesses as part of the injury as well as the adaptive weaknesses. Because we tend to have a limp sometimes when we have a knee injury, therefore the opposite hip’s going to be part of the control that’s needed there. The pelvis is very important and this is where that global clinical reasoning is that I was talking about earlier, that you don’t come in with one ailment. We look at the whole body in terms of what’s going on. We clinically have to justify each exercise prescription so that it is going to achieve the outcomes we need to for the injury as well as then getting back to the goals and to normal life again.

Michael Dermansky (13:16):

Okay. Well, I know you’ve had a young boy who’s had a really significant injury recently and he’s gone from a very, very early stage to some pretty heavy stuff. Do you want to tell listeners a little bit about just the story of this person as well? You don’t have to give the names or anything like that too, but just tell listeners about the story about what’s happened at the start and how his program was changed over the period of time.

Nicole Davis (13:41):

Yes. This young boy had a nasty injury and had to have a very unusual knee surgery and he had to have two of them because of the amount of damage that he did. They went in to fix a few parts of the ligaments and tendons and then had to go back in and do the other few that hadn’t actually been addressed the first time around because of the ranges that they had to fix the knee in for that ligament to heal. They did the one side first and then they control the other side. But he came in and he was in a knee brace and he was in crutches and he was very, very restricted and obviously in a lot of pain. And this gentleman does calisthenics and parkour. This accident was a massive smack to his life in the sense that he can’t do anything that he enjoyed.

(14:40):

Us as a team clinically managing him, getting him through that brace and changing those angles as we progressed through the rehab before we got the brace off, before we got him off crutches, and then getting him doing body weight exercises and doing resistance with the reformer. Then he is now lifting a huge amount of weight. It’s so impressive what he’s been able to achieve in the six months. I feel like there probably should be a medical case study done on him based on how well he’s done. But he’s also been a perfect client. He’s been a perfect patient on his journey. He’s done his two or three sessions a week, he did all of his homework, he came in every day, he did his ice when he was sore. He also was a big contributor to his journey and that’s part of the education process we have as clinicians. Not just being clinical Pilates instructor, but being a clinician and being able to help explain the purpose of all of these steps in the journey.

Michael Dermansky (15:46):

Wow. That sounds like a really interesting case. Another question, though, when people think of clinical Pilates or any Pilates, they think of a 30s female wearing Lycra or a crop top. How does that fit into my life, say if I’m over 50? I don’t feel like a typical person that does Pilates. How does that work?

Nicole Davis (16:13):

Our space here is … Any clinical Pilates space I should say is very different to a gym. The environment should be very welcoming in the sense that any body type, any capability, any ages can come in and do a clinical Pilates session because it is so tailored to you. There will be someone within the clinic that is similar to you. There’s no reason why you can’t even connect with someone if you are feeling the space is uncomfortable. But over 50s is actually even more important than the under 30s because of how much the body is changing at that age. Whether it be male or female, our muscle composition is changing, bone density’s changing.

(17:05):

Unfortunately a lot of the comorbidities come out from our genetics at that age. There’s no reason why we can’t have the over 50s here and even older than that where we are looking at some of the falls prevention and looking at any of the comorbidities where we are managing the diabetes and the strokes and it’s a place for everyone because we are so tailored and clinical Pilates is and should be perfectly tailored to any individual, their restrictions, their body types, and then obviously working with the goals they have in mind. Age is just a number.

Michael Dermansky (17:46):

I see. I mean, it sounds like, again, we’re going back to that tailoring thing, is that the biggest thing that makes it work or not work for someone, is it tailored to their needs?

Nicole Davis (17:54):

Correct.

Michael Dermansky (17:55):

You’re not going to a general class, they’re going to something that’s … They’re doing something that’s tailored to their needs and based on the outcome they want to achieve. The class itself is not an outcome, it’s a means to an end. I guess then next question is then is clinical Pilates enough? Should I add any extra to my training? If my particular goal, is it going to be enough? I know it’s a very broad question.

Nicole Davis (18:21):

It is, yes. And I think we’ll circle back around to two goals. It depends on what your goals are. With the clinical sessions that you can run with Pilates, we’re focusing on the strength component, but as I said before, we can bring in that high intensity type component to work on your cardiac health and then the strength component can work on some of that bone density component. But if you are looking to run marathons, no, then you need to be able to doing some running sessions outside of what we’re doing. But in terms of where the clinical Pilates comes in, then we’re preparing the body to be able to do the outside work. And we are maintaining the body while you go through changes in load outside. But the clinical Pilates is enough for a lot of people to achieve the goals they want to achieve. And that’s because of the appropriate progressions that we go through with exercises so that it is as injury free as we can keep everyone with crazy lives we live, but then also being able to achieve our clinical goals that we want to with them.

Michael Dermansky (19:29):

Yeah, okay. Well, I mean, the answer to your question is what I’m hearing is that, is it enough? The answer is it depends. For some people it’s enough to give them a good base of strength for what they need to do in their everyday life and that’s actually a great outcome for them and they don’t need anymore. But for other people, if they want a bigger base of strength, they want to work on their bone density, adding specific classic strength conditioning exercise into it too, takes things to that next level and to what’s appropriate for them. The boy you talked to before, he was lifting quite significant weights as well at the end of this … Well, towards the end of his program because that’s what he needed to be able to get back to the activities he wanted to do.

Nicole Davis (20:07):

Wanted to do, yes.

Michael Dermansky (20:10):

Or adding in specific cardio training on top on top of like HIT is what some people need, if that’s what they want to work on aerobic fitness. It really depends. And finally, as you said, if someone wants to be a marathon runner, they need to go see a running coach, they need to be a good … They need to see a good running coach to be able to get great outcomes. And we’ve got a client at the moment who took him a long time to get to see a running coach, but now that he has his running program is so much better. But our job is to get his body prepared.

Nicole Davis (20:43):

Prepared, yeah.

Michael Dermansky (20:43):

Give the raw material for the running coach-

Nicole Davis (20:45):

[inaudible 00:20:46].

Michael Dermansky (20:46):

… for him to work on to get them to the next level.

Nicole Davis (20:48):

Yeah. For that client, that’s very much been the prep for the journey and maintaining him while he is going through his progressive overload with his running. Because every time you either run a bit faster, run a bit longer, the body he needs to adapt. And that’s where we work on some of the stability and the global side of things where we can help him continue his progressive loading so that we have as little injury insight of his plans there. That’s a great story too.

Michael Dermansky (21:19):

Yeah. Finally, I guess, what’s the difference between clinical Pilates with a health professional such as a physio, accredited exercise physiologist or osteopath compared to just Pilates instructor?

Nicole Davis (21:30):

I guess with the Pilates instructor we don’t know their level of study or what their background is. As accredited professionals we’ve chosen to work in the healthcare industry, we’ve chosen to look after our clients, whichever background field we have, but we have that base of knowledge with our anatomy and physiology, a specific orthopedic assessments that we need to do. Then as before we spoke about some of the tissue time healing, we know that physiology about the body. It is quite different having a generic Pilates session. You will not achieve the outcomes that you could if it was done by a professional and very clinically and tailored. Of course you’ll have a good session, you’ll probably feel good because you worked hard, but is it actually targeting your weaknesses? Is it actually focusing on your goals or is it just a general exercise session?

(22:28):

The problem with just an instructor, they might not be able to adapt things that you might need adapted, which can cause a higher rate of injury then, because we don’t all move the same. We don’t have the same lever lengths in terms of how long our legs and arms are. We might not have the same control if we’ve had children or not, or have previous back injuries. And that’s where we really need to tailor the routine so that it is for that person and that body type. There is no same program that two people can do. There will always be differences.

Michael Dermansky (23:02):

I see. Again, we’re going back to the tailoring. The biggest thing is the tailoring. The tailoring. The fact that we can tailor … The role of the health professional is not just to deliver the exercises, but to make sure those exercises are specific to that person’s need-

Nicole Davis (23:15):

Needs, yeah.

Michael Dermansky (23:16):

… based on their goals and having a good understanding of the background, the anatomy, physiology, soft tissue healing, all that stuff changes, allows you to be very specific about the outcomes. One exercise could be great for someone, terrible for someone else or vice versa, or just the wrong timing can make a difference between a great-

Nicole Davis (23:34):

In the process, yes.

Michael Dermansky (23:34):

… outcome and just doing the exercise.

Nicole Davis (23:36):

Yep, spot on.

Michael Dermansky (23:37):

Finally, Nicole, any last thoughts you want to tell listeners as well?

Nicole Davis (23:41):

I suppose if you haven’t tried it yet, you really need to give it a go. I think looking for clinical Pilates will make a big difference, and we know that from clients that have referred family members and friends because they’ve trusted the process because it’s been so perfectly tailored to them that they have the trust then to refer somebody else. And I don’t think that happens in the generic environment because it’s just a gym session. It’s just exercise. There is the purpose and intention isn’t quite there and that’s where clinically we bring that all together. If it’s something you haven’t tried yet, please do give it a go.

Michael Dermansky (24:37):

All right. Well, thank you very much for your time, Nicole. I hope everyone learned quite a lot about what … Whether clinical Pilates is for everybody or not. I think it is, but I’ve got a biased opinion too. And how it’s different for different population groups as well. Different if you have an injury, when you don’t have an injury, whether you’re younger or you’re older as well. There is definitely a place, but it really depends on what your goals are and how things are adjusted for you. Thank you very much. We’ll continue on The Confident Body Show next time. Again allowing you to keep doing the things that you love. Thank you very much.

Audio (25:12):

Thank you for listening to The Confident Body. For practical articles to help you build a confident body, go to mdhealth.com.au/articles.