by Mary Kay Hausladen Foley, PT, GCFP

Foley (r.) with a patientPilates instructors know well that the Reformer is an excellent tool to work on strength, flexibility, motor control and balance. For these reasons, the Reformer is also an extremely useful tool for working with people with multiple sclerosis. I have worked with a wide variety of MS patients over the last 23 years, as a physical therapist and as a Pilates Reformer instructor, in association with The Heuga Center for Multiple Sclerosis (the mission of which is to empower MS patients; its motto is “Can Do”). Some patients have such mild symptoms that an outsider would never guess that they have the disease, while others can be quite debilitated it. For the MS population, the Reformer can be invaluable for work on functional changes in areas where motor control or muscle function is compromised.

Multiple sclerosis is an autoimmune disease that affects the central nervous system. It is a chronic and usually progressive disease in which the immune system attacks the myelin—the layer of insulation around nerve fibers—in the brain and spinal cord. This leads to a decrease in nerve function, which causes symptoms that vary from patient to patient and in severity, such as weakness, fatigue, spasticity (a condition we’ll discuss later on in this article), bladder dysfunction, pain, vertigo, decreased balance, cognitive deficits and speech and swallowing difficulties. Because multiple sclerosis affects motor control, the majority of people diagnosed with the disease experience walking difficulty at some point. Research indicates that number is somewhere between 64 and 85 percent. In fact, 70 percent of MS patients report that walking is the most challenging aspect of their disease. Within 15 years of diagnosis, 50 percent of multiple sclerosis patients require assistance walking and, in later stages, up to a third of patients are completely unable to walk. More than 400,000 Americans have multliple sclerosis: most are between the ages of 20 and 50, and women are twice to three times as likely to be affected than men. Worldwide, MS may affect 2.5 million individuals.

Though Pilates exercise will not change the disease process, it can help people maintain strength and function longer than would otherwise be possible. There are, however, special considerations that a Pilates instructor should be aware of when working with someone with MS.

We caught up with Doreen Puglisi, founder of the Pink Ribbon Program, a Pilates-based rehabilitation program for post-operative breast cancer survivors, who explained why Pilates is such an effective form of exercise for this group. Doreen, a survivor herself, holds a master’s in exercise science, and is a Pilates instructor, certified personal trainer and chairperson of the health and exercise science department at Morris County College. Read on for a closer look at what Pink Ribbon provides—for the Pilates community and for breast cancer patients—and a taste of what’s ahead for the program.

Doreen PuglisiHow did you create the Pink Ribbon Program?
I started working with breast cancer patients around 2002. At the time I owned a small wellness studio, and when clients filled out a health history form, I would check the contraindications for programming. That’s when I found out there was no true rehabilitation program for breast cancer patients. Because I’m a physiologist, I looked at the research and at the time, there was nothing. Really, it was astonishing.

Then, in 2004 I was diagnosed with breast cancer myself, and I used my program for my own rehabilitation after a mastectomy. I did have a Pilates background before I was diagnosed. (I was actually trained through Stott.) I truly do feel lucky–I was diagnosed early and had this knowledge base before. It was so scary. None of my surgeons asked me if I needed physical therapy. I thought ‘How am I going to get my range of motion back?’ I had a dorky revelation moment [about creating the Pink Ribbon Program]. I realized that I needed to do something to reach more survivors. I realized I needed to get this out there, and help women who don’t have a rehab or movement background. If it’s hard for me, what are they doing?

Pilates was a great fit for this population: it worked in terms of full range of motion, integrated movement, proper breathing. A lot of what we work with is scapular stability and shoulder range of motion. And in the Pilates world, this was very welcome.

How does Pink Ribbon work?
Well, there are two programs really, for survivors/patients and for instructors. The first is designed as a six-week rehabilitative movement program. The goal is to get them to move beyond Pink Ribbon to a mainstream form of exercise and move forward.

photo by Bob GoberBy Elizabeth Hanson 

As Pilates instructors we know that restoring balance, strength and flexibility in the body will help anyone improve in their favorite sport. For equestrians of all disciplines and levels this is particularly true, as riding can be hard on the body. Until recently, riders have not given much credence to cross-training as a way to improve their performance. Fortunately, this is changing and more equestrians are realizing that if they want to get the most out of their ride, they need to spend some time off the horse improving their physical condition.

Having worked with riders for many years, I have found that the best way to get their attention is to learn how to “speak equestrian” in Pilates sessions. They want to know how each exercise will help them with their particular riding issues. If you understand what the imbalances in their bodies cause them to do incorrectly on horseback, you can make their Pilates workouts more effective, and most importantly, give them big incentive to come back. Knowing how to assess pelvic imbalances and spinal conditions and apply correctives, as I do for my equestrian clients, is a great tool for any Pilates instructor.

 
In the third installment of Pilates on Call—our month-long open Q&A with Pilates experts—we’re thrilled to welcome the owners of Core Conditioning in Los Angeles: Dawn-Marie Ickes, MPT (l); Allyson Cabot, PT (m); and Gabrielle Shrier, MPT (r). The three physical therapists/Pilates instructors founded Core Conditioning, a pair of integrated wellness centers, in 2003, where they combine physical therapy with Pilates and Gyrotonic for rehabilitation, as well as offer group classes.

This month, they will be taking your questions on joint injuries and issues—hips, knees, shoulders, feet, spine, neck, etc. Chances are you have encountered clients with problems with all of the above and more. Or perhaps you have a new client with an injury you’ve never dealt with before. Here’s you chance to get the PT-Pilates perspective on how to help them. Post your questions in the comments section below or email editor@pilates-pro.com. Dawn-Marie, Allyson and Gabrielle will get to them as quickly as possible, but might need a day or two to respond.

How to help pregnant clients have a smooth delivery

By Debbi Goodman, MSPT
Pilates can be a wonderful tool to help women feel great during and after pregnancy. A modified Pilates program with emphasis on diaphragm and transversus abdominus strengthening will help to support the growing uterus, prevent low back pain and improve posture. Many people don’t realize it, but core strengthening also helps pregnant women during the pushing phase of delivery.

Prenatal Pilates instructors are in a great position to help pregnant women obtain the strength for pushing as well as to educate women on how to push properly. I’ll explain how after the jump.

By Suzanne Martin, PT, DPT

Scoliosis is a chronic spinal condition, not particularly a disease. It’s a hot topic in the Pilates world, and in the hands of a skilled instructor, Pilates can excel in the long-term training needed to help change the many factors involved in the distorted spine and unbalanced musculature associated with scoliosis. In this article, I’ll introduce you to scoliosis and provide some guidelines and Pilates exercises for working with these clients.

Here at Pilates-Pro.com, we’re always on the lookout for the newest trend in the Pilates industry. Even though the economy has been sour lately, studios around the country are reporting a growing demand from pet-crazed clients for animal-adapted Pilates exercises for pets of all kinds, including Hubie, an American Short Hair Guinea Pig.

By Debbi Goodman, MSPT

The postpartum time period is very exciting for most women, but it can be very stressful as well. Women are going through the process of healing their bodies after the birth, dealing with drastic hormonal changes, and adjusting to life with a newborn. Most women are physically exhausted and may have extreme emotional swings. Regaining their prepregnancy body is often a main concern.

In order to work with postpartum clients, Pilates instructors should have knowledge about the physical transformations of pregnancy and how they impact the musculoskeletal system.* It is common knowledge that the abdominal muscles stretch a great deal over the course of the pregnancy, and it is our challenge to help women restore the proper length, strength and tone of these extremely important muscles.

By Caroline Anthony

As Pilates instructors, we are seeing many more middle-aged women in our classes, and they are an energetic, dynamic group to say the least. Women today are much more active, informed and focused on their health and fitness than they were several decades ago. Many have been exercising for years and are not about to stop now that they are reaching their menopausal years.

The onset of menopause does, however, bring several changes to women’s lives, and from what I’ve found, they appreciate all the help they can get with navigating through it. It is interesting to look at some of the symptoms of menopause and how exercise can help alleviate some of them. It is even more interesting to look at the ways in which Pilates can help many of these symptoms.