Effectiveness of Pilates exercises in sports

Abstract

Participation in sports is spreading all around the world in an attempt of the community to stay active, healthy, prevent health issues and conditions and to ensure quality of life while there is life expectancy and population is getting more and more older. Existing protocols in rehabilitation are sometimes demanding and are addressed in athletes and people with good physical condition while population gets involved in recreational sports activities more and more. Sport injuries are very common not only in athletes but in general population as well. Pilates is a very popular type of exercise and industry around it is flourishing. Although there are indications that it could be used as an alternative in rehabilitation, research is limited in certain fields. The aim of this editorial is to motivate researchers to conduct well-designed studies in sports injuries’ rehabilitation based on the Pilates method, to explore the efficacy of the method as a complementary approach and the optimal integration strategies in diverse sports rehabilitation settings. Last but not least, it is an attempt for the need of the community to establish certification on Clinical Pilates Physiotherapists based on the principles of rehabilitation.

Key Words: Sports injuries; Rehabilitation; Pilates

Core Tip: Pilates "industry" is flourishing while sports injuries are very common. Approaching the issue from two aspects: There is evidence that Pilates is effective but research is based on other conditions than sport related injuries. Moreover, there is evidence based on its principles. Well-conducted trials would contribute to draw safe conclusions, create protocols and thus add an alternative to rehabilitation from specialized Clinical Pilates Physiotherapists.

TO THE EDITOR

Participation in sports, both recreational or competitive, is now gaining ground and amassing widespread appeal throughout the globe. People of all ages, both sexes, from different cultures and with varying needs, appear to be utilizing the inarguable benefits of exercise for the prevention, management, or rehabilitation of a variety of conditions. However, participation in sports is inevitably associated with injury occurrence. Prevalence rates vary between different sports, competition levels and age groups[1]. According to the European Injury Database, 7.6% of visits to emergency departments in Europe are due to sports-related injuries[2]. In the United States, injuries sustained from participation in sports and other related recreational activities increased by 12% in 2022, thus affecting 3.6 million people[3].

BACKGROUND ON REHABILITATION

Rehabilitation in sports injuries is crucial for athletes to fully recover, minimize absence from the field (of action), return to sports activities, and reduce the risk of reinjury. Modern rehabilitation protocols are based on an active management framework that involves the participation and collaboration of specialized scientists in various specialties. Even though the science around rehabilitation is constantly evolving, providing possibilities for rehabilitation, and returning to the field safely, only elite athletes seem to be able to afford such care. Intermediate-level athletes as well as those participating in recreational sports miss out on such opportunities for the most part[4]. Rehabilitation in sports injuries includes rehabilitation of the range of motion, muscle strengthening, improvement of flexibility, enhancement of proprioception and neuromuscular coordination. In the final stages of rehabilitation, functional movements are applied that mimic those of the specific sport[5].

In recent years however, alternative exercise regimens have gained popularity within musculoskeletal and sports rehabilitation. A recent study of a sample of 334 competitive athletes revealed that 69% of them reported using at least one form of complementary medical treatment in the past 12 months[6]. A similar study of professional athletes revealed that alternative exercise practices were selected and used for the purpose of treatment and rehabilitation in individuals with conditions such as spinal pain and several types of sprains, which are quite common in sports[7].

THE “PILATES” CONCEPT

In the above context, Pilates could be applied as an alternative exercise approach that assumes a complete connection between mind and body. Breathing, central stabilization, flexibility, motor control, posture and strength, as well as flow in the execution of movements are the basic principles of Pilates exercises[8].

Pilates has been used mainly as an adjunct to traditional physical therapy[9,10] due to the lack of evidence for its effectiveness in high-quality randomized studies. However, the existing studies provide some preliminary indications regarding its application in the rehabilitation of sports injuries.

Studies in which Pilates exercises were performed showed that they can help increase the strength and flexibility of the core muscles and the strength of the abdominal muscles as well as control pain[11,12]. Other studies in which training protocols using the Pilates method were applied showed positive effects on flexibility[13], which is associated with an increased risk of muscle injuries in athletes[14], while other studies in which Pilates exercises were applied in the rehabilitation of the lower limb concluded that they can be applied at all stages of rehabilitation and can contribute both to complete recovery and prevention of future reinjuries[15,16]. Studies also indicate that Pilates interventions have better results in strength, stability and other functional outcome measures in patients with frequent lower extremity injuries[17].

Biomechanical imbalances modify and maintain incorrect movement patterns, which in turn create predisposing risk factors for injuries. Pilates or Clinical Pilates exercises (wherein the exercises are modified as they are applied to clinical situations) aim to retrain normal movement patterns. This potentially results in a reduced risk of injury and improved functional capacity[18].

At the same time, there is a strong research background regarding the basic principles of Pilates in the prevention and rehabilitation of injuries as well as in the improvement of sports-related skills. In particular, central (core) stabilization training can lead to increased lower-limb strength and improvement in posture, thus contributing to the prevention of musculoskeletal injuries ensuring the quality of life in athletes[19,20]. Simultaneously, core stabilization is related to improved upper-limb skills[21]. Posture, one of the basic principles of Pilates, seems to play a vital role in the prevention and rehabilitation of upper extremity shoulder injuries[22,23] and in increasing muscle performance[24]. A strong research background supports the improving sport-related skills[25,26], while motor control reduces the risk of injury[27]. Finally, studies indicate that respiration training through Pilates exercises plays a significant role in reducing the risk of injuries by increasing the activation of core muscles[28] and better activation of lower-limb muscles during daily activities[29].

CONCLUSION

It appears that Pilates has been investigated mainly for its effectiveness on chronic injuries in the athletic world, with little reference to acute injuries. The evidence displays methodological limitations such as small sample sizes. Nevertheless, this should suffice in establishing a basis for future research. The way Pilates interventions can be applied to numerous sports injuries that also differ in nature, the applied load, the combination with other forms of exercise or even investigating groups of athletes and/or types of injuries that can benefit most from this form of exercise could be paramount issues to consider. Studies on the frequency and application of Pilates in current clinical practice are also useful for investigating the different protocols applied and for investigating protocols based on the characteristics of injuries. This approach could add value to clinical practice since clinical reasoning could be applied to Pilates exercises, which offer an alternative yet effective approach. The future application of Pilates in sports rehabilitation will simultaneously require the creation of evidence-based protocols, as well as valid certification for clinical physical therapists.

ACKNOWLEDGEMENTS

We would like to thank Stasinopoulos D; Georgoudis G and Lamnisos D for their continuous support to our research.