IMPACT OF

PILATES EXERCISE

IN MULTIPLE

SCLEROSIS

BASI PILATES ILKA VON WITZENDORFF SUBMITTED: OCTOBER 31ST 2018 COURSE: FEBRUARY -JUNE 2017 STUDIO: BEACH PILATES TORONTO, CANADA

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TABLE OF CONTENT

TABLE OF CONTENT PAGE 1

ABSTRACT PAGE 2

ANATOMICAL DESCRIPTION PAGE 4

CASE STUDY PAGE 9

EXERCISE SELECTION PAGE 10

BASI BLOCK PROGRAMM PAGE 11

CONCLUSION PAGE 14

BIBLIOGRAPHY PAGE 15

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ABSTRACT

There are 2.5 million people worldwide suffering from Multiple Sclerosis (MS) today.

The majority is to be found in Europe (around 500,000) and in North America

(around 400,000). So, it is obvious that there is a correlation between the number

of ill people and living in industrialized countries. Canada has one of the highest

rates of MS in the world. An estimated 1 in every 385 Canadians must live with the

disease. While it is most often diagnosed at young adults aged 15 – 40, younger

children and older adults are nowadays are more and more affected as well.

Multiple Sclerosis is currently classified as an autoimmune disease of the central

nervous system (CNS -brain, spinal cord). The disease attacks myelin, the protective

covering of the nerves, causing inflammation and often damaging the myelin.

Myelin is necessary for the transmission of nerve impulses through nerve fibres. If

damage to myelin is slight, nerve impulses travel with minor interruptions.

However, if damage is substantial and if scar tissue replaces the myelin, nerve

impulses may be completely disrupted and the nerve fibres themselves can be

damaged irreparable.

MS is unpredictable, shows different symptoms and causes various restrictions in

people. That is the reason why this disease is also called the disease with many

different faces. Depending upon where it develops to within the CNS, it can

manifest into various neurological and neuropsychological parts of the body and can

cause different symptoms. The frequency and duration of symptoms vary and may

include:

• Extreme fatigue

• Poor muscle coordination

• Weakness and tingling

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• Motor control

• Impaired sensation

• Vision problems

• Incontinence

• Cognitive impairment

• Sexual problems

• Depression/emotional changes

There are 4 types of MS. They are named accordingly to the way the disease acts on

the body over time1.

The 4 types of MS:

❖ Relapsing-Remitting (RRMS). This is the most common form of multiple

sclerosis. About 85% of people with MS are initially diagnosed with RRMS.

People with this form of MS have temporary periods called relapses, flare-ups

or exacerbations when new symptoms appear.

❖ Secondary-Progressive MS (SPMS). Symptoms worsen more steadily over

time, with or without the occurrence of relapses and remissions.

❖ Primary-Progressive MS (PPMS). Symptoms worsen from the beginning,

with no relapse or remissions.

❖ Progressive-Relapsing MS (PRMS). A rare form of MS. It is characterized

by steadily worsening disease state from the beginning, with acute relapses

but no remissions, with or without recovery.

1 Hooper, K. Managing Progressive MS. New York, NY; National Multiple Sclerosis Society; 2011

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MS is a disease that cannot be healed but some treatments help to ease the

symptoms of MS, while others control MS itself. It is believed that the addition of a

healthy life style including special diets, complementary and alternative medicines

and moderate physical activity can help to enhance and improve the quality of life

of the affected individuals. This is where Pilates can assist and may even play a major

role. As MS affects people in different ways, there is no one and only Pilates exercise

that can be considered a specific MS exercise or workout, however there are

recommendations from the MS societies worldwide that include:

• Core exercises

• Strengthening exercises

• Posture exercises

• Range-of-motion and mobility exercises

• Stretching exercises

• Balance exercises

An exercise program for someone with MS needs to be appropriate to the

capabilities and limitations of the individual. Age, overall physical constitution prior

to having MS and the type of MS are relevant. Above that, the program may need to

be adjusted as MS symptoms change over time2:

ANATOMICAL DESCRIPTION

For this case study, the client requires a full body exercise program with emphasis

on the core. The National Academy of Sports Medicine (NASM, USA) defines the

core as:

2 National Multiple Sclerosis Society. Exercise. http:www.nationalmssociety.org/living-with-multiple-sclerosis/healthy-living/exercise

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The “Cervical Spine, the thoracic spine and the lumbo-pelvic-hip complex”. There are

29 muscles that have attachments within this area. The main muscles that are

involved in the core movement are:

• Hip adductors

• Gluteus Medius

• Gluteus Minimus

• Gluteus Maximus

• Erector Spinae

• Rectus Abdominis

• Hamstring

• Piriformis

• Hip Flexors

• Transverse Abdominals

• Internal Oblique

• External Oblique

• Multifidus

• Pelvic floor

Essentially the core consists of everything within the center of gravity and where all

body movements begin. Therefore, core exercises strengthen the hips, back and

muscles in the midsection of the body. The goal is an overall improvement of the

use of the deeper abdominal muscles as well as the lower limb muscles and joints.

Besides the fundamental core training, the purpose of this study is to determine the

effect of Pilates on the walking performance. The client therefore needs a program

that will focus on strength, control, flexibility, mobility and movement in general.

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CASE STUDY

My clients name is Anke. She is a 55 years old female, married and has no children.

She has been diagnosed and came public with Primary Progressive MS (PPMS) at

the age of 50 but has lived with the disease for at least 10 years. “Progressive” is the

word to be used to describe the change towards more disability in MS and although

Anke’s disability increases the rate at which this happens varies. Her symptoms were

minor in the beginning but since approx. four years her general well-being including

her mobility is slowly but constantly declining.

Today she has multiple problems related to her disease: she remains weak and numb

on the right side of her lower limb making walking very difficult. She has impaired

urinary bladder functions and persistent balance problems with some sensation of

lack of control. Also, extreme fatigue is determining her daily life. In her day to day

life she works full time and tries to stay as active as possible. The client has been

recommended to undertake weekly physical training including Pilates exercises to

assist with muscle strengthening, joint mobility, stretching, coordination and

correct muscle activation with the focus of her lower limbs. She needs support to

walk, most of the times she takes a scooter to move around. She can also walk slowly

with the use of crutches.

The following symptoms and problems have been identified in this case study:

1. Weak core muscles such as rectus abdominis, transverse abdominals,

internal and external 0blique, pelvic floor, multifidus, erector spinae

(sacrospinalis), longissimus thoracis and the diaphragm. The client

complains about instability and imbalance especially during walking. She has

problems with muscle weakness and co-ordination.

2. Motor control symptoms in the left lower limb. General dysfunctionality of

her right leg and hip

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What can and needs to be done?

• Strengthening the core muscles in general but also in particular the pelvic

floor and transverse abdominals to gain more bladder control and strength.

• Strengthening all main muscles groups with the focus on lower limbs to

improve overall mobility.

• Practicing and improving the coordination of movements and the mind-body

connection.

• Exercising breathing to work the diaphragm.

• Increasing flexibility through regular stretching exercises.

EXERCISE SELECTION:

To meet the client’s needs the exercises should be a challenge but never a struggle

and it is put into consideration that there are good days and bad days relating to the

unpredictable disease runs of MS. Therefore, the whole program has been designed

to address the client’s goals, namely to overcome the limitations in mobility and to

take into consideration the need to adapt and assist wherever the unpredictable

development of MS symptoms makes it necessary. The program is following along

the Principles of Pilates and the BASI Block system promoting a full body work-out

with the goals of improving muscle strength, increasing mobility and flexibility and

achieving an overall feeling of well-being and satisfaction.

Hip Work: Single Leg Work is included in this program although most of the times

it could not be practiced due to Anke’s physical limitations. Furthermore, it was

necessary on certain days to reduce resistance and even skip exercises to complete

the program. In general, the resistance needs to be light.

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BASI BLOCK PROGRAM

Block Exercise Muscle Focus

Objectives Adaption/Assist

Warm-up (Beginner)

Mat - Pelvic Curl - Spine Twist Supine - Chest lift - Chest lift with rotation

Abdominals Hamstring Obliques

Warm up

- Pelvic stability - Abdominals

strength - Spinal Rotation

Small ball is placed between knees as Anke has difficulties with holding legs in a stabilised position during movement. The ball allows her to grip her knees against it to maintain hip distance during both Pelvic curl & chest lift exercises.

Foot Work Reformer Parallel Heels Parallel Toes V Position Heels V Position Toes Open V Position Heels Open V Position Toes Calf Raises Prances Prehensile Single Leg Heel Single Leg Toe

Hamstrings Quadriceps Ankle Plantar Flexors Hamstring Quadriceps

Warm up

- Hip Extensor Strength

- Knee Extensor Strength

- Plantar Flexor Strength

- Hip Extensor

Strength - Knee Extensor

Strength - Ankle Plantar

Strength

Small ball is placed between knees for stability. Anke sometimes needs to use her hands as an assist for keeping the position especially during Open V Position and Single Leg exercises.

Abdominal Work

Reformer Hundred Prep

Abdominals

- Abdomnial Strength

- Shoulder extensor control

Anke needs to put down her feet on foot rest since she is sometimes not able to keep both legs in table top position during the whole exercise

Hip Work Reformer

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Frog Circles (Down/Up) Openings

Hip Adductors Hamstring

- Hip Adductor Strength

- Knee Extensor Control

- Pelvic Lumbar Stability

Anke needs to place the straps over her knees instead of on her feet. She is then able to complete the exercises because of a better leg support.

Spinal Articulation*

Reformer Bottom lift Bottom lift with extension* *first set of this exercise was introduced after the 10th session

Abdominals Hamstrings

- Spinal Articulation

- Hip extensor control

Anke needs to lower her legs on the foot rest like it is done on the mat (Pelvic Curl). A small ball assists during the exercise

Stretches Reformer Kneeling Lunge

Hip Flexors Hamstring

- Hip Flexor Strength

- Hamstring Strength

Resistance differs from left to right leg. Adjustment needs to be done due to the weakness of the right leg (Hamstring)

Full Body Integration I*

Reformer Knee Stretch Series Scooter Round Back Flat Back

Abdominals

- Trunk and shoulder stabilization

- Hip and Knee extensor control/strength

During Scooter Anke has problems to maintain pelvic lumbar stabilization therefore the movement becomes on her weak side smaller with no or low resistance

Arm Work Reformer Arms Supine Series: Extension Adduction

Latissimus Dorsi

- Scapular Stability

One and sometimes both legs need a rest on the foot rest during the exercise

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Up Circles Down Circles Triceps

Triceps

- Shoulder Adductor Strength

- Shoulder Mobility

- Shoulder Extensor Strength

to concentrate on arm work.

Leg Work Reformer Single Leg Skating

Gluteus Medius

- Hip Abductor Strength

- Pelvic Lumbar Stability

- Knee extensor strength

Few repetitions and more rests in between are necessary. She holds gently onto me as a supported to further assist her to keep balance during the exercise

Lateral Flexion and Rotation

Mat Side Lifts

Abdominal Obliques

- Lateral Flexion Strength

- Trunk Stability

Back Extension

Reformer Breaststroke Prep

Back extensors

- Back Extensor Strength

- Elbow Extensor Strength

* Spinal Articulation and Full Body Integration I has only been introduced to the Workout plan after session 10

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CONCLUSION

In this controlled study with my client Anke the effects of Pilates on body control,

balance and muscle strength were investigated. The effects of Anke’s MS symptoms

are obvious and the disease influences, inhibits and interferes with her daily life. The

most profound aspect of the disease is her increasing immobility which hinders her

from being as active as she would like to be. With no known cure so far, her

aspiration is to maintain and even improve constantly her mobility, flexibility and

general fitness.

Through the BASI Program Anke was able to gain a mind-body awareness which

helped her to feel better insight out. She was able to improve her joint mobility and

posture and through special core exercises she even felt more stable and stronger.

She has been working constantly and diligently over a period of 16 weeks

strengthening, stretching her body not only to improve her required area of the

lower limbs, but also getting a full body workout, creating a sense of

accomplishment. Especially the work with the reformer has helped Anke to

strengthen und elongate her spine because adjustments of the tension to the exact

level of challenge is possible.

Anke has learnt through the BASI Block System to confront her challenges and

overcome certain weaknesses and fears that had been manifested in her brain. She

gained more and more confidence in what she can do and noticed tremendous

improvements in her posture and alignment.

“Love your body, know your limitations, push to learn and have gratitude for your

personal commitment to fitness.”

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BIBLIOGRAPHY:

Books

Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California,

USA: Body Arts and Science International, 2000 - 2012

Isacowitz, Rael. Reformer Movement Analysis Workbook. Costa Mesa,

California, USA: Body Arts and Science International, 2000 - 2012

Isacowitz, Rael. Mat Movement Analysis Workbook. Costa Mesa, California,

USA: Body Arts and Science International, 2000 – 2012

Hooper, K. Managing Progressive MS. New York, NY; National Multiple Sclerosis Society; 2011 Isacowitz, Rael., Karen Clippinger: Pilates Anatomy, 2011 Blandine Calais-Germain, Anatomy of Movement, Seattle, WA 2014

Websites

“What is MS?”, Diagnosis, www.mssociety.ca

“Exercise for MS symptoms”, www.mssoiciaty.org,uk

“What is primary-progressive MS”, www.healthline.com

“Epidemiology of MS”, www.nationalmssociety.org

“Working with MS on the Pilates Reformer”, by Mary Kay Hausladen, PT,

GCFP, www.pilates-pro.com/pilates-pro/2009

“Cruz-Ferreira A, Fernandes J, Larjano L, et al : A systematic review of the

effects of pilates method of exercise in healthy people. Arch Phys Med Rehabil,

2011, 92: 2071-2081, www.ncbi.nlm.nih.gov

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“Facts about MS”, https://www.mstrust.org.uk

www.everydayhealth.com/multiple-sclerosis