Pilates Principles

A primary goal of the Pilates Method is to create a connection between the mind and the body so that without thinking, one would be able to stand, move and carry out daily activities with control and ease.

In the Pilates Method work, there are six basic principles.1,2 The way in which the Pilates exercises are performed is based on these principles. Following these principles while performing the exercises will train the mind and body to connect, producing an attention-free movement. The way the exercises are performed is more important than the exercises themselves.

Concentration

To perform the exercises correctly, one needs to concentrate on the details of the positioning and placement of the whole body. The correct placement of the limbs will allow for a connection of the limbs into the core. In the Pilates Method, every position and movement of the body is interrelated and important.

Control

All exercises in the Pilates Method need to be performed with control. This is why one needs to concentrate on the details of every movement. There needs to be control not just of the large movements of the limbs but of the small movements as well. One needs to control the positions of the fingers and toes, rotation of the wrists and the curve of the spine. The awareness and control of these details will connect the mind and the body.

Centering

The center of the body is the focal point of the Pilates Method. This is often referred to as the “Powerhouse.” It is the area that wraps around the entire torso from the bottom of the ribcage to the top of the hip bones. The goal while performing the Pilates exercises is to connect into the core muscles or the “Powerhouse.”

Flow of Movement

The movement of each exercise should flow evenly and smoothly, Not too fast or too slow, Not too rigid or too loose. To keep the flow of the movement requires concentration and control from the center.

Precision

The whole focus is to do each movement with precision. It is better to do one repetition perfectly than it is to do many repetitions poorly.

Breathing

According to the Pilates Method, correct breathing is a vital part of the exercise program. Joseph Pilates, the founder of Pilates, wanted full inhalations and complete exhalations while performing the exercises. He felt this was a way of cleansing the body and getting rid of wastes. The inhalation should be on the point of effort and the exhalation should be on the return or relaxation. This will allow for a deeper abdominal connection. The breath is coordinated with the movements.

Application to Hand Therapy

A primary goal of Pilates is to achieve uniform development throughout the entire body obtaining a balanced muscular system. As we know, poor posture can have a significant impact on the upper extremity (UE), causing many UE dysfunctions. These muscular imbalances can increase the risk for nerve entrapment, fascial tightening, loss of musculotendinous length, and altered biomechanics of the UE. Posture plays a contributing role in many of the common diagnoses treated by hand therapists, including tendinopathies, overuse syndromes, and nerve entrapments, such as carpal tunnel syndrome. Poor posture may cause or contribute to the UE problem, or it may be caused by the impact of an UE injury, as is the case when a patient “carries” an injured arm by assuming a position of shoulder internal rotation and elbow flexion.

This protective position compromises shoulder mobility and scapular stability and promotes thoracic tightness. Whether the poor posture is the cause of the injury or is secondary to the injury, both dysfunctions need to be addressed from a whole body standpoint.

Where Does Proximal Stability Originate From?

Drawing on Joseph Pilates’ classical school of thought, this section encourages hand therapists to rethink how to connect the UE into the body to allow the UE to function freely as an integrated part of the whole system. The idea that proximal stability facilitates distal function is a traditional concept in rehabilitation. Working from this concept, patients would first “correct” their posture and then work on their distal exercises or activities. We believe that stabilizing proximally in order to treat distally can often create an artificial stabilization, which is a held or locked down position not allowing free movement throughout the system.

An alternate way of creating UE stability is to engage from the hand distally to facilitate a proximal stability. This concept of engaging the hand first elicits recruitment of the muscles distally to proximally, allowing the UE to move freely in a way that is connecting to the whole body. This is a natural stabilization. We propose that natural stabilization promotes a freedom of movement which improves range of motion (ROM) and enhances neuromuscular responses of the UE in hand therapy. In other words, we (the authors) recommend trying to connect distally from the palm through the arm into the whole body, and then proceeding with hand therapy interventions while sustaining the whole body connectedness. To better visualize this concept, think of a feedback-feedforward loop. Input from the hand connecting proximally (feedback loop) stimulates and elicits improved quality of motion distally (feedforward loop).