Pilates and the Compromised Spinal Cord

By Allison Cabot, PT; Dawn-Marie Ickes, MPT; and Gabrielle Shier, MPT
As seen in the Summer 2008 Balanced Body Pilates COREterly
When an individual is afflicted with a spinal cord injury, there generally will be a loss of motor function and/or sensation at and below the level of injury. Where along the spine and how the injury took place will dictate the severity of the loss. The most common spinal cord injuries occur from motor vehicle accidents, gunshot wounds, and sports related accidents or falls. Non-traumatic occurrences are classified as spinal cord dysfunction.
Establishing a wellness program is extremely beneficial for maintaining and improving functional abilities and emotional well-being for patients with spinal cord injuries or dysfunction. A well-rounded program should include elements which enhance functional independence in addition to promoting fitness, balance, core strength and spinal stability.
Staying well despite injury or dysfunction involves commitment to a healthy lifestyle. Exercise is one step which, if properly executed, can enhance the functional ability of an individual afflicted with a spinal cord dysfunction. It also promotes general well-being and improved self-esteem. But with any exercise programming, precautions must be adhered to. Prior to initiating any exercise, you must learn the indications and contraindications of this population. It is imperative to consult with a trained health care professional who specializes in spinal cord injury/dysfunction.
Pilates when used in a rehabilitative capacity is an excellent choice of exercise for those individuals with a neurological impairment of the spine. It incorporates modern biomechanical principles focusing on posture, body alignment and proper muscle recruitment. It challenges the proprioceptive system so that in a spinal cord injury client – you can strengthen the nerve to muscle message, so that even if the muscle cannot be further strengthened, you can maintain or even strengthen the nerve message from the central nervous system. In addition, it facilitates the mind-body connection and breath for overall relaxation and one’s own awareness of body and self.
Pilates is ideal for persons with disabilities, because the repertoire is all encompassing with over 500 exercises. In addition, every exercise can be modified according to the mobility and ability of the participant. Because Pilates uses spring resistance instead of weight bearing exercises, spinal cord injury patients who have partial involvement can effectively strengthen the legs. Each exercise focuses on concentration, control, precision, and the fluidity of the movement. In addition, breath and core stability are key components to each exercise. It also is different from conventional weight training in that its focus is on facilitating the smaller stabilizing muscles and core musculature. These muscles are imperative in order to maximize normal function and restore trunk control.
The benefits of Pilates for a spinal cord client include, but are not limited to, improved stability, flexibility, core strength, shoulder, spinal and pelvic stability, a more balanced musculature, improved motivation and self-confidence/esteem. Postural integrity is found and maintained. Best of all it is safe and effective.


Case Study – Patient with spina bifida – incomplete
Mark* was ambulatory and functional, but was unable to run and walked with a limp, one leg being much weaker than the other. He was highly motivated to strengthen “what he had” by doing lower body strengthening exercises at the gym. However, he experienced chronic knee and lower back pain. During the first year of his physical therapy, which included Pilates, his pain decreased by 90%! He showed remarkable improvements in strength and function. Now after 2 years, Mark has shown signs of increased strength in both legs, particularly in his weaker leg. Now his knees are pain-free and his limp has disappeared. However, when he attempts to strength train on his own at the gym, the pain returns. Not only is Mark an example of how Pilates can change the way a person moves, it illustrates how one must continue the practice to get the full benefit Pilates can offer. 20150703_132532
The inherit nature of the equipment which includes the Reformer, Cadillac, and Wunda chair encompasses versatility and improves effectiveness of exercises because of the springs. The springs come in various tensions and therefore can be utilized to produce different levels of tension. Utilization of the Pilates equipment should be performed only by those individuals who have been adequately trained. A trained instructor should be spotting their client at all times and if working with this population type should have adequate knowledge of how to work with a neurological client.
For more information on spinal cord injury and dysfunction please refer to NCPAD’s fact sheet on Spinal Cord Injury.
Allyson Cabot, PT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Kinesiology from UCLA and graduated from CSULB in 1991 in Physical Therapy. She is certified in Pilates and Gyrotonic®.
Dawn-Marie Ickes, MPT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Biology from Loyola Marymount University and graduated with a Masters in Physical Therapy from Mount Saint Mary’s College in 1996. She sits on the national Board of Directors for the Pilates Method Alliance. She is certified in Pilates.
Gabrielle Shrier, MPT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Kinesiology from UCLA and graduated with a Masters in Physical Therapy from USC in 1994. She is certified in Pilates and Gyrotonic®.


IMPROVE MY GAME How To Improve Rotation While Protecting Your Lower Back

Tue Jun 2, 2015 by Mike Boyle

The thoracic spine is often a neglected section of twelve vertebrae stuck between the much more talked about lumbar spine and the forever-painful cervical spine. 

 Thoracic Spine

By definition, the thoracic spine is the twelve vertebrae that connect with the rib cage and is located between the lumbar spine and the cervical spine. Because we rarely get thoracic pain we tend to overlook this critical area. Neck and low back pain are rampant so the thoracic spine is often completely overlooked. Unfortunately a big key to avoiding both lower back pain and neck pain may lie in the mobility of your thoracic spine.

In the simplest terms, the body does what is easy, not what is best. As we age the thoracic spine stiffens. As a result we tend to turn the head at the neck (cervical spine) or rotate at the lower back (lumbar spine). A mobile thoracic spine can help to avoid or relieve both low back and neck pain by allowing rotation in this key area.

In the simplest terms, the body does what is easy, not what is best.

For years we have been warming up the wrong area with the wrong exercises. Lots of “experts” recommended exercises like hip crossovers and scorpions to “warm-up” the low back.

Here’s a video I put together for Golf Digest discussing common “rotational” exercises that are probably doing more harm than good.


The video was essentially a spin-off of an article I wrote a few years ago titled “Is Rotation Training Hurting Your Performance?”  In the article I recommended that athletes, particularly golfers, avoid most exercises that rotate the lumbar spine and instead focus on developing motion at the hips and thoracic spine.  The truth is that good motion in golf comes from turning the hips and the shoulders not from rotating the lumbar spine. In her book, The Diagnosis and Treatment of Movement Impairment Syndromes, author Shirley Sahrmann notes a key fact that I believe has been overlooked in the performance field: 

“The overall range of lumbar rotation is …approx 13 degrees. The rotation between each segment from T10 to L5 is 2 degrees. The greatest rotational range is between L5 and S1, which is 5 degrees…The thoracic spine, not the lumbar spine should be the site of greatest amount of rotation of the trunk… when an individual practices rotational exercises, he or she should be instructed to “think about the motion occurring in the area of the chest”
(Sahrmann, p61-62)

Therefore, a way to get good hip motion and good shoulder turn is to focus on the hips and thoracic spine, not the low back. Bottom line, bad golfers turn at the low back. Good golfers turn at the hips and shoulders.

Additionally, the ability to resist or to prevent rotation may in fact be more important than the ability to create it. Clients or athletes must be able to prevent rotation before we should allow them to produce it.

As I mentioned in the video above, golfers should seek to improve internal and external rotation of the hips.  Exercises like the Comerford Hip Complex, a progression developed by Australian physio Mark Comerford, strengthens the rotators of the hips and improves lateral stability in your golf swing.

Comerford Hip Complex

Comerford Hip Complex – Video

Mobility at the thoracic spine is actually simpler to develop than you think. It doesn’t even involve rotation. What you are going to do to mobilize the thoracic spine is to perform a series of simple crunch type exercises while lying on two tennis balls taped together with masking tape or your can even put them in a sock.  It’s a simple exercise that you can do at the gym or even in front of the TV.  Dr. Rose demonstrates in the following video:

Tennis Ball Thoracic Spine Mobility

Tennis Ball Thoracic Spine Mobility – Video Link

Place the tennis balls under your back with one ball on either side of the spine. Begin at just above bellybutton level. With the balls in position do five crunches. You should feel the balls pushing into your spinal erectors (the big muscles on either side of the spine). The balls are actually pushing the vertebrae slightly forward, in effect creating motion (mobility) at the level of that segment. A series of these crunches can be done all the way to the top of the shoulder blades. The end result is often a large increase in shoulder turn. Another possibility is to foam roll the thoracic spine. Make sure the elbows are together to separate the shoulder blades and get pressure on the thoracic spine.

If you are bothered by low back pain, neck pain or want more shoulder turn try the attached mobility exercises. Just remember, it’s not always where it hurts that needs the attention. Often times it’s the joint above or below.


Do you have a Pelvic Tilt?

Have a look at your posture in the mirror. What do you see?
Do you have a pronounced lower back arch? Do your tummy and bottom stick out a little bit? This posture indicates an anterior pelvic tilt, meaning your pelvis tips forward more than it should.
As in the above picture, everybody’s pelvis will naturally tilt slightly forward, but when the angle of the pelvis tips sharply forward, it is out of position.
To give yourself a better idea of the depth of your pelvic tilt, find the pointy bone at the front of your hip, and the corresponding pointy bone on your back.

Look side-on in the mirror. If you have an anterior pelvic tilt, the front bone will be significantly lower than the back.
So why is this a problem?
Well, if your pelvis is in the wrong position, it can put everything else out of position too! As well as your lower back and hips, it can cause pain and tightness in your upper back, neck and throughout the rest of your body.

An anterior pelvic tilt is often the result of sitting too much, sitting incorrectly, or most often from a combination of the two.
Excessive sitting causes an imbalance in the muscles controlling the pelvis. While some of these muscles become weak and inhibited, others become tight and overactive.
To fix an anterior pelvic tilt, you will need to stretch the tight/overactive muscles (hip flexors, tensor fascia lata, quadriceps, lower back erectors and thoracolumbar fascia), and strengthen and activate the weak/inhibited muscles (gluteal group, hamstring, abdominals and oblique’s).