Reflections: Evidence-Based Practice and Pilates (Part 1 of 3)

 In Background

This blog started out small and got a bit bigger than I expected, so it’s on offer as three parts. Part one looks at the role of research when it comes to Pilates and Physiotherapy. Part two picks up the thread and looks more in-depth at some of the limitations of research.Part three dives into what ‘Evidence-Based Practice’ means concerning Pilates Therapy practice.

Please jump in and let us know what you think.

 

Reflections on Part one of ISM with Diane Lee and Evidence-Based Practice.  

I attended the first five days of Diane Lee’s ISM series in Chichester February 2019. It’s exciting as it is the first time this course has been held in the UK and I have been waiting since 2015 to learn more from this fantastic physiotherapist. This is the start of what will be a six month long (possibly longer) process of learning new skills and techniques to identify where to focus attention to facilitate changes for my clients. The pre-course online prep was challenging and full of references to evidence based on research done all over the world. This got me thinking about Pilates and evidence. I had a conversation years ago where I freaked out a friend (a biomechanist) when I said something along the lines of “I am interested and read about research related to the ’core’ and Pilates, and then I ignore it…”. Now, this is not 100% true, I don’t ignore all of it, but the sentiment is relatively accurate so hear me out before you judge me.

 

Joseph Pilates (JP) believed he was ahead of his time.

He was known for videoing and photographing himself and his clients, before and after they started practising Pilates. He documented the results, and some of this film footage can be found on the world wide web. He also saw his method as one that science and medicine would one day validate confirming what he believed about the effectiveness of Contrology.  JP was keen on research proving him right. From what I’ve been told by my biomechanist friend, the goal of the research is to invalidate findings or theories.

So researchers come up with a hypothesis then set about proving that it’s wrong and if they fail, then the conclusion is that the hypothesis is accurate. Sounds like fun, personally not my idea of a great time so happy to leave this to the researchers. What this suggests to me is that the evidence that makes its way to us is dependent in part on asking the right questions or coming up with the most accurate/useful hypothesis.

 

We reference what we can.

Since delving into the world of manual therapy and objective screening and creating our Pilates Therapy courses, we do our best to support what we are teaching by referencing anything we can. In fact, evidence was creeping into Pilates back when I first trained with Body Control Pilates. The research they quoted had been done in Australia (I think) and related to the importance of Transversus Abdominis in relation to low back pain (LBP) 

Lederman – The Myth of Core Stability – Download the PDF here

The physiotherapists and others treating individuals with LBP discovered that Pilates Teachers were teaching people to recruit this magic muscle and a love affair began.  We could say it was a match made in heaven, but with heaven, the flip side may be hell. Ok, maybe ‘hell’ is a bit harsh, but there is often a downside.

 

Research informing practice.

The more time I spend in the world of physiotherapy, the more aware I become of the role of research and how it informs, dare I say, sometimes dictates the way they practice with their patients. Having spent five days with some of these lovely physiotherapists, I wonder, how do they feel about this? I also wonder how many Pilates educators and instructors out there pay attention to the latest research and if it informs/influences the way they teach their students/clients?

Over the years I’ve been teaching Pilates, cueing the recruitment of the pelvic floor along with other ‘core’ muscles has gone in and out of fashion. I’ve heard teachers who cue it and also others who don’t. I’ve come across teachers who believe that over-recruitment can cause as many problems as under-recruitment of the pelvic floor. My point is that there are lots of perspectives out there, many based on what their teachers taught them often without ever asking questions or wondering why. I have always been stuck in that toddler phase and annoyingly ask ‘why’ a lot, often there isn’t a clear answer other than ‘that’s the way I was taught’.

The research seeks to ask questions and sometimes comes up with answers, but sometimes it doesn’t.

 

End of Part one…

There are more questions for me than answers so if I haven’t lost you yet come back for part two in the next part of this blog we look at some of the limitations of research when it comes to working with our more complex clients.

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