When Joseph Pilates developed his exercise method in the early 20th century, it is unlikely that he imagined how popular it would become. As a child, he suffered from illnesses including asthma, rickets and rheumatic fever. Dedicated to improving his physical fitness, Pilates believed that postural dysfunction and inefficient breathing techniques contributed to poor health.
He refined his method, originally called Contrology, while interned in a camp with other German nationalists in England during World War I. While there, Pilates worked with injured and ill detainees, using hospital bedsprings to provide assistance and resistance for rehabilitation from illness and injury.
Although he was trained as a boxer and gymnast, and enjoyed skiing and diving, when Pilates immigrated to NYC in the 1920s, he developed a following in the dance community.
His method was soon adopted as an integral part of training and rehabilitation for dancers and, as it has evolved, is now commonly found in fitness centers and physical therapy clinics.
With a focus on developing dynamic core stability, Pilates is an effective exercise modality for runners. Research shows that an exercise program focusing on the hip, pelvis and trunk musculature can be useful in the treatment and prevention of common running injuries.1
Pilates helps physical therapists identify faulty movement patterns, correct form, and use equipment to regress or progress an activity. Pilates allows the specific demands of running to be replicated for use during injury rehabilitation, or as part of a runner’s program for strengthening and stabilization to prevent injury.
Two Fitness Trends
Just as Pilates emerged as a popular exercise method, the past decade has also witnessed a tremendous surge in the participation in recreational running. Since 2000 the number of half-marathon finishers has tripled, growing 24 percent from 2009 to 2010, and has become the fastest growing road race distance in the United States.2
Due to the rise in popularity of running, recent trends in minimalist footwear, and programs promoting specific training philosophies, the number of running-related continuing education courses for physical therapists has also significantly increased.
As more individuals integrate running into their fitness routines, physical therapists will be an essential part of the rehabilitation and prevention of running-related injuries. Runners often develop muscular imbalances and faulty movement patterns, or have poor training strategies predisposing them to injury.
Physical therapists must be able to evaluate dysfunction and the mechanics that contribute to injury.
Dr. Stuart McGill, a researcher of spine biomechanics, proposes that progression of a stability program should include identification and correction of faulty movement patterns, with emphasis on teaching hip motion separate from lumbar motion; development of spine stability followed by whole body stability through exercises specific to a patient’s functional tasks; and development of endurance.3
Pilates can be used as a tool for assessing and retraining movement patterns, and to improve strength and stability to meet the demands of running.
The Single Leg Squat
A thorough evaluation of the injured runner must include observation of movements specific to running. The Single Leg Squat is a coordinated, multi-joint movement that requires integration of the entire body for correct performance.
Though challenging, The Single Leg Squat is a foundational movement of running and an excellent predictor of run mechanics. Clinically, The Single Leg Squat Test is used to identify faulty movement patterns including pelvic drop, femoral adduction or internal rotation and excessive pronation.
The Single Leg Squat Test may be replicated on the Reformer to make the movement less challenging, while still providing an opportunity to assess alignment and retrain faulty movement patterns.
For the Single Leg Press, the runner lies supine on the Reformer with one foot on the footbar and the other held in a tabletop position.
Pushing against the footbar, the leg extends against resistance. Although the Reformer provides trunk support, a runner with weak gluteals may still demonstrate femoral adduction during the movement.
Pelvic position should be evaluated for pelvic tilt and lower abdominal recruitment. Foot placement will provide additional information about a runner’s mechanics.
Once positional faults are identified, the therapist can teach the runner correct alignment using verbal or tactile cuing. After the correct movement is learned, the Single Leg Press can be progressed by adding springs while requiring the runner to maintain correct alignment.
The Step Up on the Chair, a progression from the Reformer, provides valuable information about a runner’s ability to integrate trunk stability with lower extremity movement in the absence of trunk support. Standing facing the Chair, with one foot on top and the other on the pedal, the runner steps onto the chair, using springs to assist the movement.
During the exercise, positional faults at the lumbar spine, pelvis, continuing down the kinetic chain may be seen. The number of springs used depends on the amount of assistance required and should be documented as an objective measure of progress, with fewer springs used as the runner gains strength and stability.
The Jumpboard is an accessory attached to the Reformer used to introduce absorption to a runner following injury, or for the development of power to enhance run performance. Once a runner is able to demonstrate correct lower extremity alignment during the Single Leg Press, absorption activities may be added.
The Stable Trunk
The ability to move the legs reciprocally while maintaining a stable trunk is an essential component of running. However, excessive pelvic motion is often observed and can be a contributing factor to many common running injuries. Matwork reveals a runner’s ability to integrate trunk stability with lower-extremity movement.
The Side Kick Series is a group of exercises focusing on hip strengthening and trunk stabilization. While propped on elbow in sidelying, the runner lifts the top leg to hip height and completes forward and back swings, lifts and circles while attempting to stabilize the trunk.
Single Leg Circles are practiced in supine with the working leg held straight in the air. The runner stabilizes the pelvis while circumducting the leg. Depending on the stability of the runner, the exercise may be regressed.
Runners with short hamstrings or hip flexors may be unable to assume the traditional position of hip extension for the resting leg and should start in a hooklying position. A resistance band placed over the foot of the working leg and held in the opposite hand may be incorporated to provide kinesthetic feedback, leading to a more controlled movement.
During each exercise the therapist should look for pelvic instability. Once the runner is able to stabilize the pelvis during matwork, the exercises can be progressed to standing.
The main focus of the exercises chosen is on the development of lower-body strength and mobility with trunk stability; however, running is a full-body sport and a thorough program must include trunk mobility and upper-extremity strengthening exercises.
While no specific routine is appropriate for everyone, the following exercises have components that are beneficial to most runners.
The Single Leg Stretch improves breath control, increases core stability and develops endurance during reciprocal lower-extremity movement. The runner lies supine in a partial curl position with one leg extended at a 45-degree angle.
The other hip is flexed to a 90-degree angle with the hands positioned on either side of the knee to encourage correct alignment in the frontal plane. The runner switches legs, coordinating the movement with his breathing, while maintaining a stable trunk.
Standing Hip Abduction on the Reformer has been shown to decrease knee pain, increase strength and improve alignment during a step-down, a biomechanically similar maneuver during initial contact to mid-stance in running.1 While standing with one foot on the carriage of the Reformer, the runner performs bilateral hip abduction while maintaining neutral lower-extremity alignment.
Bridge with Extension is used to develop eccentric hamstring strength, essential during running to slow the swing leg in preparation for footstrike. Lying supine on the Reformer with feet on the footbar, the runner performs a bridge against light resistance while preventing carriage movement.
Once in the bridge position, the hips and knees extend to move the carriage back, then flex to pull the carriage in to the bumper.
By understanding the mechanics of running and identifying movement faults that place a runner at risk of injury, the trained therapist can develop an exercise program using matwork or Pilates apparatus to help runners of all levels hit their stride.