Injury Prevention: Pilates

Use the six core principles of Pilates to teach a safe Pilates class.

Pilates is one of the fastest-growing mind-body offerings and is practiced daily by millions of Americans. In any growing fitness trend that has a rush of new participants, there is also a rush of injuries—and Pilates is no exception. The media tout Pilates as a gentle, nonimpact exercise that will reform your body and heal backaches and other pains. This is true; however, Pilates exercise places great demand on the musculoskeletal system and requires good biomechanics to be successful. The increased exposure that Pilates is enjoying has sparked the interest of deconditioned participants, who may be older, may already have an injury or may be new to exercise.

Directing clients to the appropriate Pilates exercises is half the battle. Generally, clients have no idea what they need, and you have the opportunity to lead them in the right direction.

Pilates exercise demands joint mobility and stability. High-risk areas for deconditioned and postrehabilitation clients are the neck, back, shoulders and hips. Participants who are deconditioned or recovering from injury need personal attention and highly specific instruction to avoid overchallenging these high-risk areas.

As a fitness professional and a Pilates instructor, you have an obligation to provide proper instruction and to keep clients safe. The following tips are by no means a comprehensive look at Pilates injury prevention and are meant as a starting place for reference.

Adhere to the Six Core Pilates Principles
Joseph Pilates defined his powerful discipline with six specific guiding principles. To create an effective and safe environment for clients, Pilates teachers must continuously return to these underlying principles.

1. Centering requires holding specific muscles in order to maintain a static position while performing an Pilates exercise. As an instructor, you must cue correct alignment. Accuracy is vital. Be able to identify clients’ bony landmarks and cue clients into the proper position. Also be able to identify when alignment is lost so that you can adapt the Pilates exercise to meet their needs. This requires a watchful eye. You should know anatomy and understand how to identify each client’s position, and how to modify or progress the exercise. Teach clients the bony landmarks so the clients themselves can assist you in checking their alignment.

2. Breathing is part of every Pilates exercise. Encourage both inhalation and exhalation, with the emphasis on inhalation. The correct method of “breathing in” allows the diaphragm to help stabilize the trunk, maintaining the thorax in a tall position (Hodges & Gandevia 2000). This involves laterally expanding the rib cage and lifting the upper abdominals without lifting the shoulders or excessively bulging the abdomen. Make sure clients do not force expiration, as this will make the external obliques overwork and pull the thorax into flexion. The preferred timing is to inhale with the initial movement, or the one that requires the initiation of stability. Tensing the diaphragm will increase intra-abdominal pressure and immediately activate the transversus abdominis (Hodges & Gandevia 2000).

3. Precision means following instructions exactly. Joseph Pilates directed practitioners to study carefully and to follow the instructions down to the last detail (Pilates & Miller 2000). One area in which precision is vital for Pilates injury prevention is core alignment. Do not teach clients to flatten the lumbar spine into the mat, as this position encourages a posterior pelvic tilt. This inhibits the deep multifidus and may lead to lumbar-disk problems. The spine is better protected by activating the multifidus with the pelvis in a neutral position for both exercise and daily activities.

4. Control implies proper Pilates technique, not intensity. Learn to recognize “out of control” signs, such as jerky movements, loss of alignment, and pain. Teach participants to limit movement to their own midrange, where core alignment is not compromised. The more attention you give to these signs, the less likely it is that superficial muscles will compensate. Be aware of ways to “personalize” instructions. For example, in side-lying leg lifts, instruct participants to “lift your leg as high as you can while maintaining core alignment” rather than “lift your leg higher than your hip.” Each participant will have his own personal range, limited by his own ability to maintain alignment.

5. Concentration is the all-important mind-body connection. Each of the skills we’ve mentioned so far relies on the ability to incorporate brain focus. The visualization used in Pilates cuing is key to success here. Offer descriptive cues to help students visualize the activity as well as feel it in their bodies. For example: “Draw the scapulae down the back as if you were putting them in the back pockets of your pants,” or “Reach out of the top back of the head to create length in the neck.” Avoid performing the exercises with your students. When they are required to listen to verbal cues and turn them into physical movements, the mind is active. They cannot merely mimic your physical activities.

6. Flow comes from working smarter, not harder. Repetition reinforces good movement patterns. Promote this principle by breaking exercises into smaller, more manageable parts, approaching the movement from as many directions as possible and reminding clients to be patient.

Limit Pilates Class Size
With the increasing demand for Pilates comes larger class sizes. To help prevent Pilates injury, it is crucial to know clients and keep a watchful eye on them. This is not possible in a class of 30. Limit Pilates class size, and follow a group personal training format. Here are some guidelines:

Have no more than six to 12 participants per Pilates instructor.
Instead of performing the Pilates exercises yourself, actively move around to observe and assist each participant.
In facilities where Pilates class size must be 20–30 participants, have two or three instructors monitor participants. Another option is to require several one-on-one sessions prior to allowing participants to enter the group Pilates class. In either scenario, the individualized attention will significantly reduce the risk of Pilates injury.

Maintain Control
A Pilates class should include a system of building blocks. Each Pilates exercise should be introduced and built from a basic to an intermediate level. At the basic level, review and reinforce alignment and breathing cues; those who lose control can maintain the basic move while other students progress. If you follow this system for every Pilates exercise in every class, you will ensure a safe and effective environment. Repetition is a key to success. If a participant is losing control, never hesitate to hold her back by having her maintain the basic level while others progress. It is your job to keep participants safe, and they will adhere to your direction if you maintain control. Keep reminding the class that it is not the quantity but the quality of movement that will help them reach their goals.

The Pilates method of movement offers a lifetime of learning. It is a study that will be ongoing and ever-changing. Remain hungry for information, seek it out in every way that you can, watch and listen to your clients, and keep them safe by following the guidelines outlined here.

Pilates Instructor Safety Tips

Before starting, ensure that all participants understand “neutral posture” and are able to establish correct body alignment.
Review the proper use of the selected Pilates equipment.
Emphasize proper body mechanics and technique through verbal and visual cuing.
Encourage students to work at their own pace and to compete only with themselves.
Remind students to slow down or rest if they are tired or feel excessive discomfort.
Have fun!

Christine Romani-Ruby, MPT, ATC, is a licensed physical therapist and assistant professor at California University of Pennsylvania. An international presenter, she is the chief executive officer of PHI Pilates and the co-author of nine videos and five books—including, with Marci Clark, Pilates Mat Work (Word Association Publishers 2003).

References
Hodges, P.W., & Gandevia, S.C. 2000. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. Journal of Applied Physiology, 89 (3), 967–76.
Pilates J.H., with Miller, W.J. 2000. The Complete Writings of Joseph H. Pilates: Return to Life Through Contrology and Your Health—The Authorized Editions. Philadelphia: Bainbridge Books.