Last month I attended Mariska Breland’s 3-day workshop to become more knowledgeable in Pilates-based education for neurological conditions. This workshop educates Pilates professionals on how to specifically train Pilates clients who have been diagnosed with Multiple Sclerosis, Parkinson’s Disease, and Stroke. Individuals with neurological conditions have difficulty with standing up from a chair due to lack of strength, flexibility, force generation, neuro-muscular control, and balance required for successful sit to stand (STS) transfers. As a Pilates instructor and physical therapist, one of Mariska’s Pilates-based exercises that resonated most with me was the assisted STS utilizing two long springs, a short-box foot strap, and tower/cadillac. Mariska’s assisted STS utilizing Pilates apparatus allows clients or patients to build strength and confidence in their functional mobility. Sit to stand is a critical transfer influencing a person's functional independence. A recent study conducted a movement analysis of the complex STS transfer and found that muscle strength, balance, foot position, chair height and the movement strategy are all major factors influencing STS performance. (Gunilla et al, 2015)
As you analyze my mother’s STS movement strategy you can see that she has a difficult time trying to get her center of gravity over her base of support (i.e. forward trunk lean) secondary to fear of falling forward out of her wheelchair and not having the adequate lower extremity strength and stability for safe, independent standing. She also has a difficult time with bilateral terminal knee extension (TKE) due to decreased quadriceps strength and tight hamstrings contributing to poor dynamic balance control and increased fear of falling. In the video, I am blocking my mother’s knees from buckling, which allows for increased firing of her gluteal muscles for standing. I am also assisting her knees into TKE upon standing and at the same time applying posterior to anterior (P-A) pressure at her sacrum or ischial tuberosities (i.e. “sits bones”). This P-A pressure helps increase hip flexor extensibility for proper upright posture and balance.
With persistent STS practice my mother will slowly start to progress in her overall strength, stability, and movement sequencing. As she becomes stronger and more stable, I am able to progress the Pilates-based STS exercise by either lowering the spring tension by moving springs down the tower or lowering the chair height by taking away the flex-cushion in the wheelchair. Always keep in mind that progression happens on the edge of comfort, so do not be afraid to challenge your clients or patients within reason.
“Pilates shows me where my weaknesses are. The assisted STS is very challenging for me, but allows me to slowly build up the confidence to independently practice on my own. My recovery from paralysis due to the removal of a cancerous tumor on my spinal cord has required a refining process of my mind and body. I have had to re-learn how to use my muscles. Through Pilates I have learned to engage certain muscles, like deep core and gluteal activation, to fire a movement chain that has been asleep for a long time. Pilates has been instrumental in my recovery leaving me feeling more energized and more aware of my posture and alignment. I am convinced that practicing Pilates is key for standing and walking again!” - Deanna
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With Love, Scrubs, and Sidekicks,
