Download Application of Pilates principles increases paraspinal

Journal of Bodywork & Movement Therapies (2015) 19, 62e66
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EXERCISE PHYSIOLOGY
Application of Pilates principles increases
paraspinal muscle activation
Letı́cia Souza Andrade, PT a,*, Luı́s Mochizuki, PhD b,
Flávio Oliveira Pires, PhD b, Renato André Sousa da Silva, MsC c,
Yomara Lima Mota, PhD a
a
Department of Physical Education and Physiotherapy, Catholic University of Brasilia, Brazil
School of Arts, Sciences and Humanities, University of São Paulo, Brazil
c
Department of Physical Education, Catholic University of Brasilia, Brazil
b
Received 22 June 2014; received in revised form 20 October 2014; accepted 11 November 2014
Summary Objective: To analyze the effect of Pilates principles on the EMG activity of
abdominal and paraspinal muscles on stable and unstable surfaces.
Methods: Surface EMG data about the rectus abdominis (RA), iliocostalis (IL) and lumbar multifidus (MU) of 19 participants were collected while performing three repetitions of a crunch exercise in the following conditions: 1) with no Pilates technique and stable surface (nP þ S); 2)
with no Pilates technique and unstable surface (nP þ U); 3) with Pilates technique and stable
surface (P þ S); 4) with Pilates and unstable surface (P þ U). The EMG Fanalysis was conducted
using a custom-made Matlab 10.
Results: There was no condition effect in the RA iEMG with stable and unstable surfaces
(F(1,290) Z 0 p Z 0.98) and with and without principles (F(1,290) Z 1.2 p Z 0.27). IL iEMG
was higher for the stable surface condition (F(1,290) Z 32.3 p < 0.001) with Pilates principles
(F(1,290) Z 21.9 p < 0.001). The MU iEMG was higher for the stable surface condition with
and without Pilates principles (F(1,290) Z 84.9 p < 0.001).
ª 2014 Elsevier Ltd. All rights reserved.
Introduction
* Corresponding author. Catholic University of Brasilia, Q.S. 07 e
Lote 01 e EPCT, Águas Claras, Taguatinga (DF), Brazil. Tel.: þ55
06184628560.
E-mail address: [email protected] (L.S. Andrade).
http://dx.doi.org/10.1016/j.jbmt.2014.11.011
1360-8592/ª 2014 Elsevier Ltd. All rights reserved.
In 1920, Joseph Pilates (1880e1967) created a specific exercise method that was intended for rehabilitating soldiers
injured during World War I. This exercise technique, the
Pilates method, was based on a continuing focus on body
awareness so that the self-perception of the body and
kinesthesia would be improved during exercise. It has been
suggested that this kind of approach during exercise might
Application of Pilates principles increases paraspinal muscle activation
lead to a self-body awareness that would connect mind and
body (Wells and Kolt, 2012; Latey, 2001).
Pilates-based exercises have been used for low back pain
prevention or rehabilitation as this kind of conditioning
exercise may activate the deep trunk muscles, providing
greater spine stability (Muscolino and Cipriani, 2004). The
current literature supports the notion that reductions in
chronic low back pain after a bout of Pilates-based exercises may be obtained through improvements in postural
control due to an increased muscular endurance strength
and flexibility (Rydeard et al., 2006; Lim et al., 2011;
Newell et al., 2012; Sekendiz et al., 2007; Kaesler et al.,
2007).
Pilates practitioners believe that such an increased
muscular endurance strength and flexibility and improved
postural control may be a consequence of principles that
include mental concentration, control, centering, flow,
precision and breathing (Latey, 2001; Muscolino and
Cipriani, 2004). For example, while centering increases
spinal stability promoted by the co-contraction of antagonist muscles (Marques et al., 2012), controlling the forced
expiration during the movement may recruit abdominal
muscles (Neumann and Gill, 2002) and increase the activity
of the lumbar-pelvic stabilizer muscles (Santos et al.,
2010). Furthermore, combining self-control and centering
may increase the biceps brachial activity and the electromyography (EMG) of co-activated muscles such as the
multifidus, iliocostalis lumborum, rectus abdominis and
internal oblique muscles (Rossi et al., 2013; Barbosa et al.,
2013).
However, an important methodological aspect regarding
Pilates studies (Marques et al., 2012; Neumann and Gill,
2002; Santos et al., 2010; Rossi et al., 2013; Barbosa
et al., 2013) precludes a consistent understanding of the
Pilates principles, as most studies have not included all the
principles together when investigating Pilates-based exercises. Therefore, it is not possible to know whether positive
effects on rehabilitation and physical fitness after a Pilatesbased exercises program could be obtained without the
application of the principles. In theory, it is necessary to
include mental concentration, control, centering, flow,
precision and breathing when evaluating the Pilates
method’s effectiveness (Di Lorenzo, 2011).
In contrast, a concurrent Pilates-based method suggested for rehabilitation purposes is the proprioceptive
method. This method uses unstable surfaces such as a foam
roller or gym ball to improve proprioceptive mechanisms,
which are believed to be important for the effectiveness of
rehabilitation during the Pilates program. For example,
studies have suggested the effectiveness of using unstable
surfaces and reported increases in the activation of
abdominal and paravertebral muscles during crunch,
pushup and single-legged hold exercises (Vera-Garcia et al.,
2000; Kim et al., 2011; Marshall and Murphy, 2005;
Escamilla et al., 2010; Sternlicht et al., 2007).
Therefore, the aim of this study was to investigate the
effects of using Pilates principles on the electromyography
activity of abdominal and paraspinal muscles during a
crunch exercise on to the ground and using the foam roller.
Due to controversial results, two hypotheses were formulated: There is a difference in the EMG activity of the rectus
abdominis, iliocostalis and lumbar multifidus between the
63
use and nonuse of Pilates principles during a crunch exercise; and there is a difference in the EMG activity of the
rectus abdominis, iliocostalis and lumbar multifidus when
the crunch exercise is done under a stable condition
compared to when it is done under an unstable condition.
Materials and methods
Participants
Nineteen healthy women (25.6 5 years old, body mass of
52 6 kg, height of 162 0.1 cm, and body mass index of
19.7 2 kg/cm2), not experienced with Pilates exercise,
volunteered to take part in this crossover study. They were
recruited from the university campus according to the
following inclusion criteria: 1) absence of acute or chronic
low back injury or prolonged back pain; 2) negative diagnosis of orthopedic, rheumatologic, neurologic and respiratory disorders; 3) absence of congenital or acquired
anomalies in upper and lower limbs. After explaining the
risks and benefits of the experimental procedures, participants signed a written informed consent. All the procedures
were previously approved by the local Ethics Committee
(15212313.3.0000.0029) and conducted in accordance with
the Helsinki declaration.
Procedures and instruments
A 16-bit, four-channel surface electromyography system
(EMGSystem, 630C Brazil) measured the muscle activity at
a sampling rate of 1 kHz, while the EMG signal was recorded
by a specific software (EMGlab, EMGSystem, Brazil). After
skin exfoliation and cleaning (70% isoprolic alcohol), bipolar
surface Ag/AgCl electrodes (Kendall-Meditrace 200) were
placed over the rectus abdominis (RA), iliocostalis (IL) and
lumbar multifidus (MU) muscles, following the probable
muscle fiber orientation. Electrodes were placed within a
4 cm inter-electrode distance and fixed by adhesive tape
parallel to the muscle fibers. In order to ensure a reliable
localization, the electrodes were placed according to the
SENIAM (surface electromyography for the noninvasive
assessment of muscles) according to the following
description (Hermens et al., 2000): IL muscle, 6 cm lateral
to the intervertebral space L2eL3; MU muscle, 2 cm lateral
to the midline of the interspinous space L4eL5; and the
principal muscle responsible for flexion of the trunk, the RA
muscle, 2 cm lateral to the umbilicus.
Exercise protocol
Three repetitions of a crunch exercise were performed in
four different conditions: 1) no Pilates technique and stable
surface (nP þ S); 2) no Pilates technique and unstable
surface (nP þ U); 3) Pilates technique and stable surface
(P þ S); 4) Pilates technique and unstable surface (P þ U). A
foam roller was used as an unstable surface and the exercises were performed in sequential order to avoid any influence from prior knowledge of the Pilates principles. The
participants were familiarized with the crunch exercise
execution according to the Pilates principles (mental
64
concentration, self-control and centering, flow, precision
and breathing). Before the familiarization they were
informed about the Pilates-based exercises regarding the
pelvic position (neutral), thoracic cage position, breathing,
movement and stabilization of the shoulder girdle, head
and cervical spine position and pelvic floor activation.
These techniques, referring to the modern Pilates principles, have been used to improve posture and control of
movement.
During the movement execution, participants were
instructed to maintain the pelvis in a neutral position. A
pressure biofeedback cuff unit (Stabilizer) was used to
assist them in maintaining a neutral position with a neutral
pelvis during the exercise. The pressure cuff unit was
placed under their lumbar spine and inflated up to 20 and
40 mmHg. The participants were instructed to maintain the
neutral position by maintaining a target pressure, visually
controlled on an analog pressure gauge during the trunk
flexion. In all situations it was emphasized that volunteers
should maintain a neutral lumbar spine to avoid pressure on
the electrodes from the paraspinal muscles. The execution
of the crunch exercise using the foam roller promoted
greater pressure in the cuff unit due to the smaller contact
area compared to the ground.
Regarding the crunch exercises without applying all the
Pilates principles, participants were instructed to keep
their arms straight along the body while flexing the knees
and maintaining the feet in a flat position, on stable and
unstable surfaces. In contrast, crunch exercises while
applying Pilates principles were performed on stable and
unstable surfaces while participants kept neutral spine and
pelvis positions, feet flat on the floor, and legs abducted at
the hip line. Furthermore, they were recommended to keep
the neck stretched to create a cranial-vertebral flexion
during the inspiration phase. In addition, they were recommended to use pursed-lip breathing and contract the
abdominal muscles during the expiration (Fig. 1).
Two footswitches connected to the EMG system were
used to monitor the start and the end of the trunk flexion
during the exercise (at the occipital region and at the
vertebral spinous process at T7). The first footswitch indicated the start of the movement and the second footswitch
indicated the end of trunk flexion.
Data analysis and statistics
The EMG analysis was conducted using a custom-made
Matlab 10. The raw EMG signal was low-pass filtered
L.S. Andrade et al.
Figure 2 Mean iEMG of rectus abdominis (RA), iliocostalis (IL)
and lumbar multifidus (MU) muscles in the four different situations: stable (S), unstable (U), without principles (nP), with
principles (P). þ Comparison S and U, without P and P
(p < 0.001) þþ Comparison S and U (p < 0.001).
(Butterworth 4th order, 200 Hz), demeaned and full-wave
rectified to calculate the area under the EMG curve (iEMG)
of the RA, IL and MU muscle activity. The iEMG was calculated at a time window of 200 ms in the middle of the
crunch movement. Thus, the EMG data were normalized by
the peak activation obtained during the crunch exercise.
Data were reported as mean and standard deviation
(SD). The two-way analysis of variance (ANOVA) and the
post hoc Tukey test were carried out to evaluate the effect
of the Pilates principles (with x without) and the variable
surface (stable x unstable). The statistical significance was
set when p < 0.05.
Results
Values of the RA, IL and MU muscle iEMG during exercise
while using Pilates principles (with x without) and the
variable surface (stable x unstable) are presented in Fig. 2.
No variable surface effect was observed in the RA iEMG,
comparing stable and unstable surface (F(1,290) Z 0
p Z 0.98). Similarly, the conditions with and without
Pilates principles did not affect the RA iEMG (F(1,290) Z 1.2
p Z 0.27).
In contrast, IL muscle iEMG was affected by variable
surface; an unstable surface produced lower iEMG than a
stable one (F(1,290) Z 32.3 p < 0.001). Furthermore, the
Pilates principles produced greater iEMG than in condition
Figure 1 Concentric phase of the abdominal exercise with pressure biofeedback cuff unit under lumbar spine: A) stable surface
(S) and B) unstable surface (U).
Application of Pilates principles increases paraspinal muscle activation
without Pilates principles (F(1,290) Z 21.9 p < 0.001). A
surface interaction effect in line with Pilates principles was
observed so that the IL muscle iEMG was higher when the
crunch exercise was performed on a stable surface while
using the principles.
The MU muscle iEMG was further affected by the variable surface: the MU iEMG was higher on a stable surface
than on an unstable surface (F(1,290) Z 84.9 p < 0.001).
Fig. 2 shows these results.
Discussion
The aim of this study was to analyze whether the Pilates
principles and the variable surfaces (stable and unstable)
might affect abdominal and paraspinal muscle activation
when a crunch exercise was performed. It was found that the
Pilates principles did not maximize the EMG amplitude of the
rectus abdominal muscles during the crunch exercise.
The results of the present study showed that activation
of the RA muscle was not influenced either by trunk instability or the Pilates principles. Thus the application of the
Pilates principles, such as centering, breathing and neutral
pelvis, were not able to increase the RA muscle activation
while performing a crunch exercise. Some authors have
documented the potential of Pilates principles for specific
muscular recruitment patterns. For example, Santos et al.
(2010) observed different muscle activation patterns
related to breathing technique in Pilates exercises, so that
a greater RA and external oblique muscle activation
occurred while performing a roll-up exercise (Kloubec,
2011; Suzuki et al., 1995). Importantly, instead of investigating the combination of all Pilates principles, those authors investigated only the breathing principle.
In the present study, the use of a round foam roller did
not change the abdominal muscle activation. Perhaps the
legs and feet positions may not have allowed the foam
roller movement as studies have shown that the performance of an abdominal exercise on an unstable surface,
such as on a roller or a ball, increases the muscle activation
due to a smaller contact area, which impairs the balance
and trunk stability (Vera-Garcia et al., 2000; Kim et al.,
2011; Marshall and Murphy, 2005). In this study, all volunteers were placed in the same position.
The highest MU iEMG was found when the trunk was
stable, regardless of the Pilates principles. Escamilla et al.
(2010) observed lower activation of the lumbar paraspinal
muscle during abdominal exercises on a ball. Those authors
emphasized that the low activation using a ball may have
also developed muscle resistance. The highest MU activity
observed in our study can provide mechanical stability to
the lumbar spine, as the trunk flexor and extensor muscles
are activated during the crunch exercise. Thus, a stable
position is ensured with a balanced co-contraction
(abdominal and paravertebral) providing stability of the
lumbar spine and decreasing the load on the spine
(Ebenbichler et al., 2001; Hodges and Richardson, 1996;
Cholewicki et al., 1997).
Our results also suggest that the Pilates principles may
be used to increase the IL contraction necessary to stabilize
the lower back, suggesting its use for therapeutic proposals. Perhaps the neutral pelvis during the exercise
65
influenced the IL activation. As a result, for the maintenance of a neutral pelvis the shear forces on the spine may
have been reduced, leading to a reduced flexion position.
The posterior pelvic tilt changes and high levels of lumbar
flexion have been associated with increased load on the
annulus and posterior ligaments of the spine (Gallagher
et al., 2005; Mawston and Boocock, 2012). Accordingly,
maintaining a neutral pelvis has been recommended during
Pilates exercises.
Treatments for low back pain routinely include different
types of “back exercise” such as spinal flexion exercises
with differentiated postures. However, which type of exercise will provide a safe and effective treatment remains
contradictory. For example, in treating patients with
chronic mechanical low back pain, Elnaggar et al. (1991)
compared the effects of spinal flexion and extension exercises on the severity of the low back pain and thoracolumbar spinal mobility. The results did not indicate
whether a specific type of exercise may be more worthwhile than others in increasing the coronal and transverse
mobility of the thoracolumbar spine. Thus, it may be suggested that either spinal flexion or extension exercises
could be used to reduce the severity of chronic mechanical
low back pain. Similarly, Dettori et al. (1995) compared two
types of exercise and observed that flexion or extension
exercises were more effective for treating patients with
acute low back pain. Thus, together with previous results,
the present study may suggest the effectiveness of crunch
exercises with and without Pilates principles, regardless of
the stability of the lumbar spine.
Some limitations of the present study should be highlighted. The RA, IL and MU muscles were analyzed unilaterally, and eventual lateral differences in electrical
activation were ignored. Moreover, our results should be
related only to the mat Pilates exercises. The present study
acknowledges that future studies are required to enable
better understanding of the effects of the Pilates principles
among different exercises, populations and ages.
Conclusions
The RA muscle EMG was not affected by either the Pilates
method or the use of a foam roller. The IL muscle EMG was
higher on the stable surface and for the Pilates principle
condition. The MU muscle EMG showed the highest activation in the stable surface condition. The therapeutic use of
crunch exercises with Pilates principles should be chosen to
achieve greater IL co-contraction to stabilize the lower
back. Based on the results, it can be recommended that
exercises are performed on a stable surface to maximize
paraspinal activation.
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