REHABILITATION

TABLE 1. MOVEMENT DYSFUNCTION COMPONENTS MUSCULOSKELETAL SYSTEMS

Articular system • Joint stiffness • Inflammation of joint

Muscle system

• Muscle inhibition • Muscle weakness/ atrophy

• Joint instability • Reduced muscle endurance

• Muscle/neural

tissue contraction/ tightness

• Muscle imbalance NEURAL SYSTEMS

Motor control and integration • Muscle inhibition

• Alteration in muscle tone • Poor muscle

sequencing/patterning

• Unconscious and conscious control/imbalance • Decreased mental conditioning

• Reduced perceptual skills

specific muscle involved in the selected exercise and the recruitment sequence that is present. The muscle specified relates to the activation of the core areas of (see Figure 1): ■ Trunk ■ Scapular ■ Pelvis

Movement integration

Axial elongation functional strength

Strengthening/ lengthening

Core stability

The recruitment sequence refers to the application of a progression of a loaded threshold contraction of the selected mus- cles in order to improve the motor control. The application of load allows contraction to demand of selected muscles without overloading or recruiting other muscles not selected for that exer- cise. The Pilates method is about applied teaching of form and control, not just a number of difficult and varied exercises. Within the framework of core stability, proprioception needs to be considered in relation to its importance in sport

Proper breathing Postural awareness

Proprioception is the accuracy of joint position sense or the threshold for detect- ing joint movement. Restoring it after injury allows the body to maintain stabil- ity and alignment during dynamic movement. The relevant aspects are static and dynamic senses. ■ Static - provide the conscious orienta- tion of one body part to another.

Figure 4: Diagram of sports Pilates model

scious level unitises the skills of position- al awareness as a starting position and the ability to undertake the movement sequence as required for that particular exercise. An application of this can be seen in thinking through the sequence of movements required in the core areas (pelvis/trunk/scapular/upper arm) in the arm action of throwing a javelin. Postural awareness is dynamic and responsive to the demands of the exercise. The impor- tant element is the form and the integrity of the exercise. It is not about the cre- ation of a rigid state in the trunk where- by the limbs or trunk are moved from or to, to challenge the posture.

Breathing The breathing pattern is an integral part of the sports Pilates exercise method. The biomechanics of breathing is part of the training of the abdominals (both the obliques and transverses), to work in

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co-ordination with the diaphragm. The inspiration phase involves the expansion of the rib cage (lateral breathing). The expiratory phase requires activation of the transverses and pelvic floor musculature to compress the abdomen. This is the first part of abdominal/stability training and is fundamental to the Pilates method and its application.

Core stability Core stability is a term that has been taken on by the fitness industry to mean abdominal exercises with or without an external influence ie. equipment or gym ball. This has previously involved effort with limited care on technique or pattern of contraction in order to build up or train the abdominals, this is shown to lead to the development of core rigidity and mus- cle imbalance, which will lead to injuries. When the term is used in relation to the sports Pilates method, it applies to the

■ Dynamic - neuromuscular feedback relating to rate and direction of move- ment.

This allows the achievement of: ■ Awareness of position or movement (axial elongation, postural awareness, movement integration)

■ Neuromuscular control (ie. detection of afferent stimulus)

■ Conscious voluntary control (enables ability to undertake the exercise)

■ Unconscious (reflex initiated) control, to enable modification of muscle func- tion and initiation of reflexive stabili- sation via muscle receptors, as a back- ground to movement.

Proprioceptive training can improve joint positional sense and hence reduce the occurrence of overuse injuries, by attempting to maximise protection from injury and provide optimal functional restoration.

Stretching/lengthening/flexibility The need for good range or flexibility in

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