PILATES – Multiple Sclerosis

Introduction:

Pilates has long been recognised as an appropriate mind-body conditioning method for people of all ages and levels of fitness. The repertoire offers total body conditioning through the use of the correct functioning and strength of the deep muscles of the abdomen, spine and pelvis. It uses dynamic tension, self or loaded resistance, and controlled range of movements to facilitate improved body awareness, strength, flexibility, coordination and stamina.

In recent times, the Pilates Method has gained recognition in the medical, scientific and allied health community as offering an effective and safe form of rehabilitation and injury management.

Multiple Sclerosis (MS) has confounded the medical profession and scientists alike since it was first described in 1868 by a French neurologist Charcot (MS Australia 2005, online). Since that time, it has been the focus of intense worldwide research, but its cause is still unknown and a cure remains elusive.

The National Multiple Sclerosis Society regularly publishes clinical bulletins of the most recent findings as to the efficacy of exercise for the management of MS. In a recent article, reference is made to the pivotal work done on the subject by Petajan and his colleagues in 1996. His study demonstrated the tolerance for and the benefits of aerobic training for some people with MS and thus called into question the historical belief that exercise was ‘something to be avoided’ by persons with MS. In an effort to prevent fatigue and overheating, generations of MS sufferers became de-conditioned prematurely due to inactivity. Since Petajan’s study, the literature has slowly increased in quality and volume, showing positive statistical outcomes for various interventions, Pilates amongst them, which aim to improve balance, gait, strength and quality of life.

More recent studies have also shown that the Pilates Method is a safe and appropriate exercise modality specifically designed to address the more common symptoms of balance, gait and muscle function disturbance (Rodrigues et al. 2010).
It seems reasonable to extrapolate from these published results, despite their being few in number to date, that the Pilates Method has as much to offer a person with MS, as it offers someone with any other condition requiring musculoskeletal or neurological rehabilitation. There is now pleasing empirical evidence suggesting that carefully monitored and prescriptive Pilates exercises, particularly within a studio setting, provide measurable benefits for people living with Multiple Sclerosis.

Recommendations in the Pilates studio:

• primum non nocere: first do no harm
• avoid fatigue
• avoid overheating and provide a cool and well ventilated environment
• assess the client’s muscular imbalances and functional difficulties
• recognise the importance of proprioceptive stimulation for motor learning improvement, using the powerhouse (Anderson & Spector, 2000), especially transversus abdominus, obliques and multifidi muscles
• repetition of correct movement to achieve greater motor performance and decreased risk of injury
• allow for sufficient warm up and warm down in each session
• encourage VMO activation to control extension
• encourage correct pelvic position and knee tracking for all leg and footwork
• include appropriate stretches in a reduced ROM
• include static stretches for hip flexors, hamstrings, quadriceps, gluteal muscles, adductors, ITB and calves
• limit ROM to prevent extension of lower limbs caused by hyper tonicity of quadriceps
• avoid high impact movements (no jump board jumping)
• use caution with thoracic flexion to prevent any occurrence of ‘L’Hermitte’s sign’, which is a ‘spine buzzing sensation’ most often triggered by lowering the head towards the chest.
• adjust the order of categories to avoid unnecessary changes in position
• use assists whenever necessary and allow for rest between exercises
• be flexible in exercise prescription
• modify or set limits where necessary and avoid high intensity
• constantly assess and review client progress and clinical status; and finally,
  encourage a positive movement experience in order to achieve a healthy outcome and continued wellbeing.

Positive outcomes from exercise and/or Pilates programs for people with MS:

• significant improvement in personal functional autonomy for active daily living (ADL)
• significant improvement in static balance
• an observable trend suggesting improvement to quality of life
• significant improvement in arm and leg strength
• improvement in ambulation, gait and walking speed
• reduced perception of the impact of MS on physical function in daily living
  moderate evidence of mood elevation; and finally,
• no evidence to suggest adverse physical or psychological risk to participants.

General information:

Multiple Sclerosis is a disease that affects the central nervous system (CNS) and can often interfere with nerve impulse transmission throughout the brain, spinal cord and optic nerves.

Sometimes the disease is relatively benign and, in rare cases, may completely disappear after one or two outbreaks of mild to moderate symptoms. In other cases, it can progress inexorably over many years, causing a slow disintegration of an individual’s capabilities. Sometimes, though rarely, it develops rapidly, does not respond to treatment protocols, and is fatal.

Over 18,000 people have been diagnosed with MS in Australia and a sixfold increase in age-standardised MS prevalence has been shown from Queensland to Tasmania. In fact, it is the most common neurological condition affecting young people in Tasmania today. The onset of symptoms generally occurs between the ages of 20 to 50 years, and MS is twice as common in women as it is in men.

MS Australia does not recommend any particular therapy but suggests that the treatment decision making process is best handled by the neurologists and treating clinicians. However, in more recent years, there has been a noticeable swing towards combining pharmacological interventions with exercise therapy, physiotherapy, occupational therapy and psychotherapy.

The Pilates Method is gaining increasing support as a beneficial exercise modality for improving balance, muscle function and wellbeing (Way Ahead, 2008).

Mary McArthur
Secretary
Pilates Alliance Australasia