Should we be left to our own devices? The beneficial effects of Pilates & Physiotherapy working together following post operative surgery.

Guest Blog written by Gordon Ellis www.info-physio.com

As an established Chartered and State Registered Physiotherapist (www.info-physio.com). I would like nothing better than to state how good the NHS is regarding postoperative rehabilitation.

I have never been in any doubt that I am fortunate to live in a country where I can receive a healthcare service that is provided 24/7, and in many instances this is delivered to a high standard. It's also not my purpose to discuss the quality of that service as a whole, qualifications, experience and knowledge base that the NHS as a service provider delivers.

The concerns and issues (which are of my opinion) are directed towards the following - post surgery variables that restrict or hinder patients from full recovery.

These being;

• The limited time availability health care professionals are given to administer therapies
• Poor systems in place
• Poor verbal and administrative communication
• The increasing volume of population attending hospital
• People living longer and associated age related conditions
• The dictation of finance creating what seems a bigger priority than health
• The lack of programs and systems that give patients clear detailed guidelines on the do's & don’ts that they need to follow postoperative surgery
• Clear detailed exercise regime that they can follow, which has been clearly demonstrated and explained, and more importantly, fitted around their surgery and them as an individual.

I often hear the phrase 'best practice', surely this means best practice at this moment in time or as far as we know? It’s of my opinion related to many the above reasons, and from speaking to numerous patients who are dissatisfied with their postoperative rehabilitation package, or should I say the lack of one, the quality of aftercare suffers.  In fact, on many occasions has ceased to exist, and I wonder have we now got a ‘health’ service or a 'medication prescribing service’, when surely the answer is activity, correct movement and motivation.

When a person leaves hospital after a surgical procedure the post-operative care, in my opinion, should address the full biopyschosocial aspect of recovery. To have the patients’ full body and systems fully functioning to as close to what normal is for them. To discuss this in depth would take far too long, so I want to focus on one aspect, "the beneficial effects of Pilates working alongside physiotherapy in the functional rehabilitative phase".

May I point out that I'm not a Pilates teacher, nor do I practice it myself, however, I do see the significant beneficial effects that Pilates gives to enhance patient recovery, when delivered in conjunction with physiotherapy.

As an experienced healthcare professional in sport, working as 1st Team Physiotherapist in the Premiership for many years, and with sports teams abroad. I also have extensive experience in setting up and running courses and programs for patients with MS, spinal injuries, stroke recovery patients and cancer patients. You not only see injuries/illness from onset you also see the condition tested in their active daily living, or witness them being tested at a very high level on a continuous basis in sport, demonstrating the sustainability needed of the body part in question to cope with demands.

If we were just to look at the knee and hip joints on their own, so many times we witness a reoccurrence of problem or the patient reporting reduced functionality, or more so, another part of the body breaking down due to overwork, in particular the stress placed on the lumbar spine. Therefore the early intervention of Pilates exercises, working alongside the advice and rehabilitation plan of a Chartered Physiotherapist, makes sense.

Once the patient had been confirmed clear of the risk of any post operative infection or contraindications, and under the guidelines of the patients’ consultant/GP, we can then work through the phases of non, partial and full weight bearing exercise.

The main areas to be focused on being to; 

• Establish full active and passive range of movement to the joint affected, 
• Decreased inflammation and any post operative pain, I
• Increased elasticisticity of the musculature that is in contracture or spasm, 
• Increased dynamic stability of the musculature around the operative joint, 
• Increased neural pathways to the musculature that supports the joint, 
• Increased patients functional movement, increase balance, coordination and proprioception, 
• Recognition of atrophy (muscle wastage) to the specific muscles surrounding the post operative joint also the muscles working in synergy to work the joint or work as fixators to work the joint. 

All health care professionals will realise that the above is not a full list but a good framework to build on.

We must remember the importance of re-evaluating the patient on every appointment or class, it shouldn’t be set in stone nor taken for granted, that a patients progress will go in a linear direction, and allowances should be made for the different and changing pathology as time progresses. We need to keep an awareness that patients need guidance, some will not have the motivation or the understanding that the exercise regime is a vital requirement, others through ignorance, may do too much.  It should also be noted that along with, the consultant, doctor and Pilates teacher, they all work alongside the Physiotherapist to inform and educate the patient on what their trauma was, what was done and how they need to take on board responsibility for their future.

We need to remember the importance of good blood flow to the area, which brings oxygen to the tissue, the beneficial effects of hydration and nutrition, also body weight management and control, the psychological motivation and guidance the patient requires, hydrotherapy where possible, hence the need for a structured plan which has a full body measured assessment at the start, a goal to achieve at the end and structured measureable benchmarks along the way; to keep the patient, physiotherapist and Pilates

I firmly believe, having worked with good Pilates teachers over many years, and researched the method in depth, that Pilates working with Physiotherapy can and does play a major role in a patients quicker, safer recovery with less chance of reoccurrence of re-injury.

Working with a Pilates teacher I would expect them to advise, educate and where needed, correct patients with their breathing techniques, body alignment, improved posture and control, to create a stronger framework and foundation.  As well as instilling confidence, a better sense of well being, improving self-esteem, working towards reducing stress, anxiety and depression within the sessions as a result of increased activity.  However, always remembering, as we all should, never to step beyond the level of their qualifications and experience, seeking the correct advice where applicable. The patient should as a result through participation, reduce isolation issues, and feel improved confidence physically and mentally. The Pilates teacher working with the patient within a supportive class setting or one to one, in a session that is structured and safe - where the patient feels listen to with care and empathy.

The Pilates teacher constantly creating an environment that motivates the patient, creating clear meaningful but objective plans, goals that are constantly being reinforced through demonstration, explanation and correction where needed.

As with all our articles, we must stress the importance of keeping close contact with the patients consultant or GP, so that nothing is left to risk and everyone is kept well informed. Once the program is completed always contact the patient 3-6 months following completion to establish how beneficial the service was, to gain vital information to help inform and enhance the ongoing program.

If you would be interested in finding out more about our Pilates and Physio post-op programs, please contact us.

Why movement is medicine, and THE best exercise for your body.

Hi All

As a Pilates and movement instructor I see lots of people who have got problems with their joints or muscles and need help.  I work with physiotherapists and between us we can usually get people moving pain free again.  When you go to the doctor and you say have a kidney problem, the doctor will likely give you pills with strict guidelines on when to take them, how many to take etc., but when the doctor prescribes movement they will probably just give some vague - 'you need to do Pilates' or 'take up a sport' prescription.  

Well we need, as a society, to take movement as a medicine seriously.  It is one of the best pain killers that there is, movement will also lower your blood pressure, increase your circulation to certain areas, increase your metabolism, lower your body mass and lower your stress levels (along with many other things), so why don't we do it more?  We also need to understand (just as in medicine), not all movement is good for the joints or certain conditions, and not all movement is the same - just as in pharmaceuticals certain movements will make you better and certain movements will make you worse.  So a scatter gun approach to movement, especially when you have an existing issue, might not be beneficial at all.  I get a lot of people coming to me with injuries because of the exercise that they were doing, on top of an existing condition.

In today's society movement has become synonymous with exercise and fitness, this should not be the case at all.  'Exercise' is what we started to do because as a society we weren't moving enough, if you move there is no need to 'exercise'.  Often 'exercise', and I'm talking accelerated heart rates, short bouts in a gym type exercise, can be detrimental to health in the long-term particularly for the health of the joints and the long-term function of the adrenal glands.

So what should I do then?  In her book 'Alignment Matters' Katy Bowman, who is a bio mechanist, states that, 'if you want to see dramatic improvements to chronic conditions such as fibromyalgia, cardiovascular disease, osteoarthritis, and Type 2 diabetes, then you should be stretching for twenty to sixty minutes every day, then follow up the stretching with a light, easygoing fifteen minute walk, two to three times a week.'

What movements you should/not be doing;

1. Walking - us humans really are designed for walking, and when I say walking, I'm not saying a gentle stroll around the block, I'm talking about long walks 10 miles at least at a medium pace.  Obviously this is probably not achievable in modern life - so just as much walking as you can fit into your day, and at a brisk pace.  
Also I don't count walking on a treadmill as proper walking - your body needs correct traction, and the push back from the hip/glute's - the moving belt on a treadmill replaces this action.  
You need to be walking everyday, yes everyday, for at least 20 minutes at a brisk pace.
So get outside!!

2. Anyone with degenerative changes in the knees, hips and spine should not be running, jogging or jumping!  These activities will increase the rate of degeneration in the tissues and will lead to greater risk of disk damage, osteoarthritis etc.

3. Most 'exercise' is fad driven!  Find yourself a good instructor who knows the science behind the movement, and can 'prescribe' you exercises that are good for your condition and will help improve it.

4. Research has shown that consistent, lower intensity movements (walking, Pilates, Yoga) demonstrate greater long term decreases in body fat than high intensity and joint-damaging high-impact exercise sessions.

So there you go, 'Dr Jill' can prescribe exercises to you!  
So dig out your walking boots and get out, it's a beautiful world outside. Enjoy!

Jill x


If you would like to book a session with Jill she can do 1-2-1 sessions, if you have any pain which restricts you from walking then contact her and she will advise the best way forward. www.organicpilates.co.uk

The link between Physiotherapy and Pilates when addressing Spinal Injury.

Today we have guest blog from Gordon Ellis from www.info-physio.com; Gordon spent 12 years a 1st Team Physio at Sunderland AFC, and he also was physiotherapist to His Highness the Crown Prince of Dubai - to name but a few of his roles!  He now has his own practice in County Durham, and I work closely with him as a Pilates instructor to ensure the best outcomes for our patients.  Find out more at his website at the link above.

Here is my personal view, explanation and in-ways education, to patients/clients who suffer with spinal (back) trauma or spinal injuries. 

Patients are usually referred for a course of Pilates as they are at that stage of functional rehabilitation recovery that the musculature surrounding the injured area, or the damaged muscle/tissue, requires further intervention by way of dynamic stability, to promote postural stability and improved function. In many cases the patient will self refer as they feel they need what Pilates offers.

Around our body there is an ongoing equation taking place between mobility and stability of joints; with the joint stating it requires range of movement and the musculature stating it needs to create stability and fixation for its movements, and postural support. One of the many systems working alongside this is our nervous system, with reciprocal innovation taking place (the interplay of muscles being stimulated or relaxed, for our posture and support). For good joint function there has to be balance between them all. It's well documented that the more functional a joint is through increased range of movement, stronger stable musculature, increased neuromuscular communication, the more chance it will have to repair. 

There are also associated problems that come with spinal trauma such as referred symptoms into the limbs, compensatory effects, atrophy (wastage) of associated muscles that work in synergy with the spine, decreased cardiovascular/respiratory function - as a result of inactivity throughout the pain and decreased functional capability period; and without question decreased communication of the nerves or nerve trauma, not to mention the psychological and social demands these injuries create. 

It has to be stated that Pilates is neither a replacement for treatment or a resolve from the spinal conditions. In many cases the trauma still exists even following post operative surgery where through time, scar tissue, adhesions and degeneration take place.

An experienced Pilates teacher will discuss a patients case history with the Physiotherapist, and where possible, the patients GP or consultant, establishing the contraindications (what not to do, or is dangerous to do) whilst working alongside each other in their fields of expertise to:

1) Preserve the rest of the body's functions.
2) Prevent the clients condition deteriorating.
3) Promote to full recovery without reoccurrence where possible.
4) Create an on going management plan with the Physiotherapist and Client. 

5) Educate the Client as part of a multidisciplinary approach to the nature of their condition in tandem with a home exercise program, that seeks to support through a bespoke set of exercises that are visually demonstrated and verbally explained, to obtain the correct technique, administering the intensity through reps, sets, time, duration etc.. that's at the clients correct stage of recovery.
6) Keep the Patients GP updated & work with their advice.

Both Therapist and Pilates teacher should periodically review the patients progress but also obtain regular feedback from the individual to ascertain if the program of treatment, therapy, exercises are achieving what there purpose is. It also gives valuable information for all parties for future patients. 

In summary it is important that the Physiotherapist/Patient acknowledges and understands the value of Pilates though its ability to retrain and develop musculature in a controlled safe environment, with the added benefits to bring awareness of correct breathing techniques, postural control, relaxation and create strong muscular foundations to the rest of the body, to say but a few. 

The Pilates teacher/Client must also acknowledge and understand the value of periodical and on going reviews/ treatment/rehabilitation from the Physiothetapist to identify any new problems and catch them early or maintain the ongoing cellular pathology related to the condition.

Without the above being put in place and kept to we run the risk of not only reoccurance, but more complicated spinal trauma emerging".
Gordon Ellis ( September 2016)