Pilates and Parkinson’s

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Pilates and Parkinson’s

Article By Sarah Sessa, BSc, MCSP, MHCPC & Karen Pearce | Featured on Pilates.com

There has been increasing scientific evidence to show that exercise can be of benefit for people with Parkinson’s, with regimes that involve complex motor sequencing (Keus et al 2014), the process by which movements are broken down into separate components and practiced in order to internalise the pattern (Di Lorenzo 2011). Anecdotal evidence also supports the use of posture-rich regimes such as Pilates (Parkinson’s UK 2013). Pilates instructors are updating their qualifications and specialising in rehabilitation, including Parkinson’s, as this exciting evidence emerges (Hudson 2013).

Over the last few years we have seen a number of clients with Parkinson’s in our studio who have made Pilates a part of their life. They report greater strength and flexibility, increased mobility and function, and most importantly they feel happier and more in control of their condition. We use the Reformer, Trapeze and CoreAlign along with matwork to offer tailor-made programmes for the client’s individual needs as well as addressing difficulties commonly seen with Parkinson’s. These clients are invited to have regular neuro-physiotherapy assessments to check progress and utilise validated physiotherapy outcome measures to monitor changes in balance, function and physical capacity. All our instructors are affiliated to Alan Herdman and are highly trained in offering Pilates for rehabilitation.

This article briefly reviews Parkinson’s and discusses the potential role of Pilates in the management of this condition, finishing with a few exercises that we have found particularly effective.

Parkinson’s is a degenerative neurological condition affecting 1 in 500 people in the UK with usual age of onset being after 50 although earlier diagnosis can occur (Parkinson’s UK 2013). A person with Parkinson’s can experience motor symptoms such as tremor, bradykinesia (or slowness of movement), and muscle rigidity. Non-motor symptoms can also occur. For example, sensory disturbance, problems with mood, sleep and emotional response and difficulties with face or name recognitions. It is important to be aware of these non-motor symptoms during sessions (Aragon et al 2007). Functionally, a client can experience difficulty with walking, balance, and fine motor activities such as fastening buttons. Their posture can become tight and flexed with decreased rotation of the spine. During walking, we can see the base of support becoming narrow, the client takes small, shuffling steps and decreased arm swing (Keus S et al 2014). People with Parkinson’s can become increasingly sedentary which presents them with a greater risk of secondary problems such as osteoporosis and cardiovascular insufficiency (Speelman A et al 2011).

How Can Pilates Help
Pilates can improve strength, flexibility, balance, relaxation and breathing control, but can also work on the specific problems encountered with Parkinson’s. Royer and Waldmann (2007) suggest a programme should work on:

  • Spine mobility, especially through lateral flexion and rotation
  • Scapular patterning prior to arm movement, then integrate this into spinal mobility
  • Hip mobility, particularly through extension, rotation, adduction and abduction
  • Integration with gait re-education and every day functional activity

Pilates can also incorporate cueing which has been shown to improve function and motor output in people with Parkinson’s (Masterson 2015). Examples of cues could be visual imagery, mental rehearsal of the movement before performing it, or auditory/verbal cues from the instructor.

Within rehabilitation, Pilates can be considered as a task-specific, goal-orientated motor learning regime, whereby function is improved through the process of complex motor sequencing (Anderson and Spector 2005). Repetitions, intensity and complexity of movements can be modulated in Pilates, which can improve motor control and potentially enhance neuroplasticity (Petzinger et al 2013).

Pilates equipment allows us to provide increased support when working on components of movements that might be difficult, plus proprioceptive input can be enhanced (Anderson and Spector 2005). For example, components of gait can be broken down and worked on during footwork exercises on the Reformer using the foot bar or jump board. The trunk is fully supported and not working against gravity, so the lower limbs can really be the main focus. As the movement becomes easier to perform, the client can be brought up into standing, perhaps using the CoreAlign.

Here are a few examples of exercises we use in our studio for people with Parkinson’s.

Suggested Pilates for Parkinson’s Exercises

To start: Rest position

Lie on your back with yours knees bent and hip width apart.
Feel that you have a natural curve in the spine (neutral spine) and that the two hip bones are on the same horizontal plane as your pubic bone.
Shoulders and ribcage should be relaxed with a feeling that your shoulder blades are sliding down your back with your arms down by your side.

  1. Leg slides and dying bugs
    Great for stretching out the hamstrings and hip flexors as well as working on general joint mobility, core strength and co-ordination.

Start in the rest position.
Breathe in and take one arm up to ceiling.
Breathe out and take the arm behind your head towards the floor as the opposite foot slides along the mat until the leg is fully stretched out.
Inhale and return the leg to the starting position and arm up to ceiling.

  • Reach to the end of your finger tips but only take the arm as far as possible without lifting your ribcage or arching your back.
  • Make sure your pelvis remains still when bringing the straight leg back to the starting position.
  • Repeat on the opposite side.
  • You can leave the arms out of the exercises to begin with, just stretching the legs out one at a time (leg slides).
  • Repeat 8-10 times each side.

Imagine that your deep abdominal muscles are the control centre for your limbs.

  1. Swimming prone
    This (and many other exercises lying on the tummy) can be great for inhibiting flexion that can be encounter with Parkinson’s and is also good for improving co-ordination.

    Avoid this exercise with spondylolisthesis (slipping of vertebra).

Lie face down with your legs straight and your arms stretched up by your ears.
Place a soft book or towel under your forehead.
Breathe in to prepare, then breathe out as you draw in with the deep abdominal muscles and lift your right arm and left leg slightly off the floor.
Breathe in to return to starting position.
Breathe out and repeat on other side.
Repeat 8-10 times each side.

  • Place a pillow under your tummy if you feel discomfort in your lower back.
  • Don’t expect to lift the arm or leg very high off the ground.
  • Try to keep the shoulders drawn down your back.
  • Try not to lift the hip of the working leg.

Lengthen the limbs at the start of the exercise then just lift them up away from the floor.

  1. Cossack Arms
    This exercise is great for working on rotation of the spine that maybe decreased with Parkinson’s.

    Avoid this exercise with osteoporosis.

Avoid this exercise with osteoporosis.
Start seated on a chair or balance ball with knees aligned and level with hips (place a book under feet if necessary).
Place a cushion between your knees and gently squeeze.
Place one hand on top of other in front of the chest with elbows held out to side.
Breathe in to prepare, breathe out as you draw the abdominal muscles in and rotate the upper body to one side.
Breathe in to return to centre.
Breathe out and repeat to other side.
Repeat 8-10 times each side.

  • Try to keep the shoulders down and hands in middle of chest bone
  • Try to keep the pelvis still and knees facing forward.

Imagine your spine is a straight rod and your torso a square box rotating around it. Your knees have headlights on them that need to keep facing forwards

  1. Bow and Arrow
    This exercise improves balance, spinal rotation and muscle strength.

With osteoporosis, avoid the rotation segment.

Trapeze table – 2 long yellow springs with handles.
Stand at end of Trapeze facing the poles with the long yellow springs attached to top hooks and hold handles.
Exhale as you pull one arm back bending the elbow whilst rotating to that side and allow the other arm to lengthen in front.
Return to the starting position.
Repeat to other side.
Repeat 8-10 times each side.

  • Keep the shoulders down throughout the exercise.
  • Try to rotate from waist only.
  • Stand far enough away from the machine to create resistance with the springs.
  • Think of a bow and arrow and the long reach needed to fire the arrow.

This exercise can also be done holding an exercise band hooped around a pole.

  1. Punch with Rotation
    As for Bow and Arrow. This exercise works on standing balance, muscle strength and rotation.

As for Bow and Arrow. This exercise works on standing balance, muscle strength and rotation.

With osteoporosis, avoid the rotation segment.
Stand facing away from the trapeze table with 2 long yellow springs attached at shoulder height and holding the handles.
Feet are hip width apart and elbows bent slightly behind your torso.
Exhale and punch with your right arm diagonally across your body towards the left, allowing a slight rotation of the upper body.
Inhale and return to centre.
Repeat with other arm in the opposite direction.
Repeat 8-10 times each side.

  • Stand far enough away from the machine to create resistance with the springs.
  • Make sure you activate the scapular stabilisers as you punch each arm.
  • Engage the abdominals and try to keep the pelvis stabilised as you rotate the upper body.

This exercise can be performed with a resistance band wrapped around a stable piece of furniture.

  1. Single leg hip Circles
    These exercises work on hip mobility and strength as well as encouraging lengthening of the hamstrings.

Start lying semi-supine on the Trapeze table. Support the head with a cushion if needed.
Place one foot in the loop of the long purple spring (choose suitable height of resistance) and start with the leg straight and at a 45 degree angle.
Exhale and circle the leg down and around the 45 degree angle 5 times, then reverse and go up and around 5 times.
Repeat with other leg

  • Keep the pelvis stabilised throughout – the movement comes from the hip joint only.
  • Don’t cross the midline on the circles.
  • Lead with the toes – not the heel.
  • Keep the breathing regulated.

These hip circles can also be done lying semi supine and using a resistance band looped around the arch of the foot and held with the hands.

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