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1.  A Comparison of 12 Weeks of Pilates and Aquatic Training on the Dynamic Balance of Women with Mulitple Sclerosis 
International Journal of Preventive Medicine  2013;4(Suppl 1):S110-S117.
Multiple Sclerosis (MS) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated. The objective of this study is to understand the effect of Pilates exercises and aquatic training for a 12 week period on the dynamic balance of MS patients.
The research method is semi-experimental. As a result, among the female patients visiting the MS clinic of Kashani hospital in Esfahan, 57 patients with disease intensity levels between 0 and 4.5 were taken as samples. The average length of the disease was 8 ± 2 years, 20;40 years old, and they were randomly divided into three groups of Pilates exercise group, aquatic training group, and the control group. The exercise schedule for the experiment groups consisted of 12 weeks, three sessions per week, and 1 hour for each session. The dynamic balance of the patients, before and after the exercises was measured by Six Spot Step Test.
The adjusted mean differences of Timed Up and Go Test (TUGT) scores of the experimental groups are significantly different (P<0.05). Therefore, it can be said that Pilates exercise interventions and aquatic training can significantly increase the dynamic balance of the examinees in the post-experiment stage.
Performing the Pilate exercises and aquatic training increases dynamic balance of the MS patients. Considering the role of dynamic balance on physical fitness and enabling the person in doing is daily chores and routines, and its direct effect on the quality of life, it leads the specialists in applying these exercises as a supplementary treatment along with the medicinal treatments for MS patients.
PMCID: PMC3665016  PMID: 23717760
Aquatic training; dynamic balance; multiple sclerosis; pilates
2.  Effects of a mat pilates program on cardiometabolic parameters in elderly women 
Objective: This study aimed to determine the effects of mat Pilates on resting heart rate, resting blood pressure and fasting blood glucose, cholesterol and triglycerides in elderly women.
Methodology: Fifty sedentary, apparently healthy females aged 60 and older were randomly assigned into a control (CG, n = 25) or an intervention (IG, n = 25) group. The IG took part in an eight-week progressive mat Pilates exercise program, three times weekly while the CG did not take part in any structured exercises throughout the eight-week period. All subjects underwent pre- and post-tests in which cardiometabolic parameters were assessed.
Results: In the eight-week mat Pilates program, the IG only demonstrated a significant (p ≤ 0.05) decrease in systolic BP (p = 0.040) from 135.84 ± 14.66mmHg to 128.80 ± 16.36mmHg and a significant increase in blood glucose (p = 0.000) from 5.07 ± 0.46mmol.L-1 to 5.83 ± 0.57mmol.L-1, whereas resting HR (p = 0.148) (from 68.80 ± 12.58beats.min-1 to 73.20 ± 11.46beats.min-1), resting diastolic BP (p = 0.342) (from 75.64 ± 10.10mmHg to 77.44 ± 9.32mmHg), blood TC (p = 0.073) (from 5.37 ± 0.99mmol.L-1 to 5.67 ± 1.04mmol.L-1) and blood TG (p = 0.384) (from 1.77 ± 0.88mmol.L-1 to 1.92 ± 0.87mmol.L-1) did not produce any significant changes.
Conclusion: Due to the contradictory nature of the cardiometabolic variables (except systolic BP) with the findings of previous studies, it is difficult to establish a case for using Pilates as a substitute for more conventional forms of exercising when exclusively attempting to favourably alter cardiometabolic parameters at least among the elderly women in our sample.
PMCID: PMC3809231  PMID: 24353564
Pilates program; Resting heart rate; Resting blood pressure; Fasting blood glucose; Cholesterol; Triglycerides; Elderly women
3.  The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review 
PLoS ONE  2014;9(7):e100402.
To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs).
Data Sources
A search for RCTs was undertaken using Medical Search Terms and synonyms for “Pilates” and “low back pain” within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science.
Study Selection
Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included.
Data Extraction
Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted.
Data Synthesis
The methodological quality of RCTs ranged from “poor” to “excellent”. A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period.
Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than others.
PMCID: PMC4077575  PMID: 24984069
4.  Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial 
BMC Neurology  2012;12:19.
People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.
This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of:
1 Establishing the effectiveness of core stability training
2 Comparing core stability training with standardised physiotherapy exercise
3 Exploring underlying mechanisms of change associated with this intervention
This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before and after intervention to assess changes in abdominal musculature at one of the four centres (Plymouth).
This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory.
Trial registration NCT01414725
PMCID: PMC3364845  PMID: 22480437
Multiple sclerosis; Mobility; Balance; Exercise; Physiotherapy; Core stability
5.  The Effect of Pilates Exercise on Trunk and Postural Stability and Throwing Velocity in College Baseball Pitchers: Single Subject Design 
Baseball pitchers need trunk strength to maximize performance. The Pilates method of exercise is gaining popularity throughout the country as a fitness and rehabilitation method of exercise. However, very few studies exist that examine the effects of the Pilates method of exercise on trunk strength or performance.
Using a single subject, multiple baseline across subjects design, this study examines the effects of the Pilates method of exercise on performance of double leg lowering, star excursion balance test, and throwing velocity in college-aged baseball pitchers.
A convenience sample of three college baseball pitchers served as the subjects for this single subject design study. For each subject, double leg lowering, star excursion balance test, and throwing speed were measured prior to the introduction of the intervention. When baseline test values showed consistent performance, the intervention was introduced to one subject at a time. Intervention was introduced to the other subjects over a period of 4 weeks as they also demonstrated consistent performance on the baseline tests. Intervention was continued with periodic tests for the remainder of the 10 week trial.
Each subject improved in performance on double leg lowering (increased 24.43-32.7%) and star excursion balance test (increased 4.63-17.84%) after introduction of the intervention. Throwing speed improved in two of the three subjects (up to 5.61%).
Discussion and Conclusions
The Pilates method of exercise may contribute to improved performance in double leg lowering, star excursion balance tests, and throwing speed in college baseball pitchers.
PMCID: PMC2953286  PMID: 21522199
trunk strength; throwing speed; core stability
6.  The Effects of Pilates Mat Exercise on the Balance Ability of Elderly Females 
[Purpose] The purpose of this study was to examine the effects of Pilates exercise on a mat and balance exercise on an unstable base of support for trunk stability on the balance ability of elderly females. [Subjects and Methods] Forty elderly women aged 65 or older were equally assigned to a Pilates mat exercise (PME) group and an unstable support surface exercise (USSE) group. They conducted exercise three times per week for 12 weeks for 40 minutes each time. In order to examine balance, sway length and the speed of the center of foot pressure were measured for one minute, and in order to examine dynamic balance, the Timed Up and Go (TUG) test was conducted. [Results] After the intervention, sway length, sway speed, and TUG significantly decreased in both groups. A comparison of sway speed after the intervention between the two groups revealed that the PME group showed larger decreases than the USSE group. [Conclusion] PME and USSE elicited significant effects on the static and dynamic balance of elderly female subjects, suggesting that those exercises are effective at enhancing the balance ability of this group of subjects. However, the Pilates mat exercise is regarded as being safer than exercise on an unstable base of support.
PMCID: PMC3944308  PMID: 24648651
Pilates mat exercise; Unstable support surface exercise; Elderly females
7.  Integrating Pilates Exercise into an Exercise Program for 65+ Year-Old Women to Reduce Falls 
The purpose of this study was to determine if Pilates exercise could improve dynamic balance, flexibility, reaction time and muscle strength in order to reduce the number of falls among older women. 60 female volunteers over the age of 65 from a residential home in Ankara participated in this study. Participants joined a 12-week series of 1-hour Pilates sessions three times per week. Dynamic balance, flexibility, reaction time and muscle strength were measured before and after the program. The number of falls before and during the 12-week period was also recorded. Dynamic balance, flexibility, reaction time and muscle strength improved (p < 0. 05) in the exercise group when compared to the non-exercise group. In conclusion, Pilates exercises are effective in improving dynamic balance, flexibility, reaction time, and muscle strength as well as decreasing the propensity to fall in older women.
Key pointsPilates-based exercises improve dynamic balance, reaction time and muscle strength in the elderly.Pilates exercise may reduce the number of falls in elderly women by increasing these fitness parameters.
PMCID: PMC3737905  PMID: 24149302
Pilates; elderly women; balance; reaction time; muscle strength
8.  Pilates: how does it work and who needs it? 
Pilates uses a combination of approximately 50 simple, repetitive exercises to create muscular exertion. Advocates of this system of exercise claim that exercises can be adapted to provide either gentle strength training for rehabilitation or a strenuous workout vigorous enough to challenge skilled athletes. The exercises are designed to increase muscle strength and endurance, as well as flexibility and to improve posture and balance. There is cautious support for the effectiveness of Pilates in improving flexibility, abdominal and lumbo-pelvic stability and muscular activity. Stronger support cannot be given at this point in time primarily due to the limited number of studies and the lack of sound methodology in the published research. However, current research does indicate that there may be applications for this type of intervention in certain clinical populations that are worthy of continued investigation.
PMCID: PMC3666467  PMID: 23738249
pilates; muscles exercises
9.  Influence of Pilates Mat and Apparatus Exercises on Pain and Balance of Businesswomen with Chronic Low Back Pain 
[Purpose] The purpose of this study was to examine the influence of mat Pilates and apparatus Pilates on pain and static balance of businesswomen with chronic back pain. [Subjects and Methods] Participants were randomly allocated to Pilates mat exercises (PME) or Pilates apparatus exercise (PAE), and performed the appropriate Pilates exercises 3 days per week for 8 weeks. In order to measure the improvement in the participants’ static balance ability as a result of the exercise, the sway length and sway velocity of the subjects were measured before and after the experiment while the subjects stood on a Balance Performance Monitor (BPM) facing the front wall for 30 seconds with their eyes open. The visual analogue scale (VAS) was used to measure the degree of pain. [Results] The VAS score, sway length, and sway velocity of both groups decreased significantly after the experiment, but the PME group showed a greater decrease than the PAE group. [Conclusion] PME showed greater improvement in pain level and balance compared with PAE in this research. Since the subjects of this study were patients with low back pain, PME is assumed to have been more suitable and effective because it uses body weight to strengthen core muscles rather than heavier apparatuses as in PAE.
PMCID: PMC3996402  PMID: 24764614
Pilates mat exercise; Pilates apparatus exercises; LBP
10.  Effectiveness of mat Pilates or equipment-based Pilates in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial 
Chronic low back pain is an expensive and difficult condition to treat. One of the interventions widely used by physiotherapists in the treatment of chronic non-specific low back pain is exercise therapy based upon the Pilates principles. Pilates exercises can be performed with or without specific equipment. These two types of Pilates exercises have never been compared on a high-quality randomised controlled trial.
This randomised controlled trial with a blinded assessor will evaluate eighty six patients of both genders with chronic low back pain, aged between 18 and 60 years, from one Brazilian private physiotherapy clinic. The patients will be randomly allocated into two groups: Mat Group will perform the exercises on the ground while the Equipment-based Group will perform the Pilates method exercises on the following equipment: Cadillac, Reformer, Ladder Barrel, and Step Chair. The general and specific disability of the patient, kinesiophobia, pain intensity and global perceived effect will be evaluated by a blinded assessor before randomisation and at six weeks and six months after randomisation. In addition, the expectation of the participants and their confidence with the treatment will be evaluated before randomisation and after the first treatment session, respectively.
This will be the first study aiming to compare the effectiveness of Mat and Equipment-based Pilates exercises in patients with chronic non-specific low back pain. The results may help health-care professionals in clinical decision-making and could potentially reduce the treatment costs of this condition.
Trial registration
Brazilian Registry of Clinical Trials RBR-7tyg5j
PMCID: PMC3544561  PMID: 23298183
Pilates-based exercises; Low back pain; Disability
11.  The efficacy of the addition of the Pilates method over a minimal intervention in the treatment of chronic nonspecific low back pain: a study protocol of a randomized controlled trial☆ 
Journal of Chiropractic Medicine  2011;10(4):248-254.
There is little high-quality evidence on the efficacy of the Pilates-based exercises for the treatment of chronic nonspecific low back pain. Therefore, the objective of this paper is to present a study protocol to investigate the efficacy of adding Pilates-based exercises to a minimum intervention in patients with chronic non-specific low back pain.
This randomized controlled trial will recruit 86 patients of both sexes, aged between 18 and 60 years, with chronic non-specific low back pain. The participants will be randomly allocated into 2 treatment groups: the Booklet Group, which will receive a booklet with postural orientations, and the Pilates Group, which will receive the same booklet in addition to a Pilates-based exercises program. The general and specific functional capacities of the patient, kinesiophobia, pain intensity, and the global perceived effect will be evaluated by a blinded assessor before randomization and at 6 weeks and 6 months after randomization. In addition, the expectations of the participants and their confidence in the treatment will be evaluated before the randomization and after the first treatment session, respectively.
It is hoped that the results of this study will provide high-quality evidence on the usefulness of Pilates-based exercises in the treatment of chronic non-specific low back pain.
PMCID: PMC3315867  PMID: 22654682
Randomized controlled trial; Exercise movement techniques; Low back pain; Patient education as topic; Disability evaluation
12.  24-weeks Pilates-aerobic and educative training to improve body fat mass in elderly Serbian women 
The purpose of this study was to examine the differences in anthropometric measurements using an aerobic and Pilates exercise program which lasted 24 weeks.
This was a clinical intervention study of 303 women over the age of 60 living in Novi Sad, Serbia. Changes in body mass index and skinfold thickness were estimated through height, weight, and anthropometric measurements. The program comprised Pilates exercises for upper- and lower-body strength, agility, and aerobic capacity.
Fat mass (FM) improved significantly (pre-test, 32.89%, 8.65; post-test, 28.25%, 6.58; P<0.01). Bone diameters and muscle perimeters showed no significant changes pre- and post-test (P>0.05), but there was a higher correlation between FM (%) and waist–hip ratio (rho, 0.80; P<0.01).
A mixed program of aerobics and Pilates, controls and improves baseline muscle mass and decreases FM values, without causing deterioration during practice and follow-up exercises.
PMCID: PMC3916634  PMID: 24516331
lean body mass; anthropometric measures; educative program
13.  The effects of rehabilitation on the muscles of the trunk following prolonged bed rest 
European Spine Journal  2010;20(5):808-818.
Microgravity and inactivity due to prolonged bed rest have been shown to result in atrophy of spinal extensor muscles such as the multifidus, and either no atrophy or hypertrophy of flexor muscles such as the abdominal group and psoas muscle. These effects are long-lasting after bed rest and the potential effects of rehabilitation are unknown. This two-group intervention study aimed to investigate the effects of two rehabilitation programs on the recovery of lumbo-pelvic musculature following prolonged bed rest. 24 subjects underwent 60 days of head down tilt bed rest as part of the 2nd Berlin BedRest Study (BBR2-2). After bed rest, they underwent one of two exercise programs, trunk flexor and general strength (TFS) training or specific motor control (SMC) training. Magnetic resonance imaging of the lumbo-pelvic region was conducted at the start and end of bed rest and during the recovery period (14 and 90 days after re-ambulation). Cross-sectional areas (CSAs) of the multifidus, psoas, lumbar erector spinae and quadratus lumborum muscles were measured from L1 to L5. Morphological changes including disc volume, spinal length, lordosis angle and disc height were also measured. Both exercise programs restored the multifidus muscle to pre-bed-rest size, but further increases in psoas muscle size were seen in the TFS group up to 14 days after bed rest. There was no significant difference in the number of low back pain reports for the two rehabilitation groups (p = .59). The TFS program resulted in greater decreases in disc volume and anterior disc height. The SMC training program may be preferable to TFS training after bed rest as it restored the CSA of the multifidus muscle without generating potentially harmful compressive forces through the spine.
PMCID: PMC3082685  PMID: 20593204
Bed rest; Magnetic resonance imaging; Gravity; Multifidus muscle; Psoas muscle; Rehabilitation
14.  Pilates 
Sports Health  2011;3(4):352-361.
The interest and popularity of Pilates is increasing worldwide. In addition to being used in fitness programs, it is being used in some rehabilitation programs.
Evidence Acquisition:
This review summarizes level III evidence from 1995 to 2009 obtained from PubMed (MEDLINE), CINAHL, and the Internet. Meta-analyses, systematic reviews, randomized controlled trials, and controlled trials published in peer-reviewed journals were retrieved for appraisal. The keywords searched were Pilates and core stabilization.
Ninety articles were identified in MEDLINE and CINAHL; 9 articles satisfied the inclusion criteria for level III evidence.
There is a scientific basis for the effectiveness of Pilates exercise, with limited evidence to support it as a rehabilitative intervention.
PMCID: PMC3445206  PMID: 23016028
Pilates; rehabilitation; core strengthening
15.  Neck pain 
Clinical Evidence  2008;2008:1103.
Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy, physical treatments, postural techniques (yoga, pilates, Alexander technique), pulsed electromagnetic field (PEMF) treatment, soft collars and special pillows, spray and stretch, surgery, traction, and transcutaneous electrical nerve stimulation (TENS).
Key Points
Non-specific neck pain has a postural or mechanical basis, and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but becomes chronic in about 10% of people.Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident.
The evidence about the effects of individual interventions for neck pain is often contradictory because of poor quality RCTs, the tendency for interventions to be given in combination, and for RCTs to be conducted in diverse groups. This lack of consistency in study design makes it difficult to isolate which intervention may be of use in which type of neck pain.
Stretching and strengthening exercise reduces chronic neck pain compared with usual care, either alone or in combination with manipulation, mobilisation, or infrared. Manipulation and mobilisation may reduce chronic pain more than usual care or less-active exercise. They seem likely to be as effective as each other or as exercise, and more effective than pulsed electromagnetic field (PEMF) treatment, or than heat treatment. Acupuncture may be more effective than some types of sham or inactive treatment at improving pain relief and quality of life at the end of treatment or in the short term.
Analgesics, NSAIDs, antidepressants, and muscle relaxants are widely used to treat chronic neck pain, but we don't know whether they are effective.
We don't know whether traction, PEMF treatment, TENS, heat or cold, biofeedback, spray and stretch, multimodal treatment, patient education, soft collars, or special pillows are better or worse than other treatments at reducing chronic neck pain.
Early mobilisation may reduce pain in people with acute whiplash injury compared with immobilisation or rest with a collar. We don't know whether exercise, early return tonormal activity, PEMF treatment, multimodal treatment, or drug treatment can reduce pain in people with acute whiplash injury.
We don't know whether percutaneous radiofrequency neurotomy, multimodal treatment, or physical treatment reduce pain in people with chronic whiplash injury.
We don't know whether surgery, analgesics, NSAIDs, muscle relaxants, or cervical epidural steroid injections reduce pain in people with neck pain plus radiculopathy.
PMCID: PMC2907992  PMID: 19445809
16.  A novel “pelvic ring augmentation construct” for lumbo-pelvic reconstruction in tumour surgery 
European Spine Journal  2012;21(9):1797-1803.
Reconstructing or augmenting the lumbo-pelvic junction after resection of L5 and part of the sacrum is challenging. Numerous lumbo-pelvic reconstruction methods based on posterior construct and anterior cages have been proposed for cases involving total sacrectomy and lumbar vertebrectomy. These constructs create long lever arms and generate high cantilever forces across the lumbo-sacral junction, resulting in implant failure or breakage. Biomechanical studies have shown that placing implants anterior to lumbo-sacral pivot point provides a more effective moment arm to resist flexion force and improves the ultimate strength of the construct. We present here a novel method to augment a lumbo-pelvic construction using a pelvic ring construct.
A 69-year-old lady presented with implant failure of her two previous posterior lumbo-pelvic reconstructions performed by the authors. She initially presented, two and a half years previously with 6 months history of back pain with normal neurological function. MRI scans of her whole spine showed isolated secondaries in the lumbar spine (L4, L5) and sacrum (S1). An abdominal CT scan revealed a primary tumour in her right kidney. Briefly, the first surgery involved a single-stage removal of posterior elements of L4 and L5 and posterior stabilisation from L2 to pelvis, anterior resection of L4 and L5 and partially S1 with implantation of an expandable Synex II cage. The cage was replaced with an anterior rod construct from L2 and L3 to a trans-sacral screw a week later as it had dislodged. The second revision, 9 months later, involved removal of two posterior broken rods which were replaced and converted into a modified four-rod construct. While monitoring her progress, it was subsequently noted that the trans-sacral rod had broken. Therefore, it was decided to augment her lumbo-pelvic construct to prevent eventual catastrophic posterior construct failure. From a posterior approach, contoured rods were passed bilaterally along the inner table of the pelvis under the iliacus muscle up to the anterior border of the pelvis. Using T-connectors, the rods were connected to the posterior lumbo-pelvic construct. Thereafter, two anterior supra-acetabular pelvic screws were connected to a subcutaneously placed rod matched to the shape of the anterior abdominal wall. The pelvic ring construct was completed on connecting this rod with T-connectors to the free ends of the contoured iliac rods.
Results and conclusion
There were no intra-operative complications. At the end of 12 months, she was mobilising with a frame, with no radiological evidence of failure of the construct. However, she died due to disease progression at the end of 15 months. Experience from one clinical case shows that such a construct is feasible and adds a technical option to the difficult reconstruction of lumbo-pelvic junction after tumour surgery.
PMCID: PMC3459110  PMID: 22476632
Lumbo-pelvic instrumentation; Pelvic ring construct; Spinal metastasis; Revision construct
17.  The Feasibility of performing resistance exercise with acutely ill hospitalized older adults 
BMC Geriatrics  2003;3:3.
For older adults, hospitalization frequently results in deterioration of mobility and function. Nevertheless, there are little data about how older adults exercise in the hospital and definitive studies are not yet available to determine what type of physical activity will prevent hospital related decline. Strengthening exercise may prevent deconditioning and Pilates exercise, which focuses on proper body mechanics and posture, may promote safety.
A hospital-based resistance exercise program, which incorporates principles of resistance training and Pilates exercise, was developed and administered to intervention subjects to determine whether acutely-ill older patients can perform resistance exercise while in the hospital. Exercises were designed to be reproducible and easily performed in bed. The primary outcome measures were adherence and participation.
Thirty-nine ill patients, recently admitted to an acute care hospital, who were over age 70 [mean age of 82.0 (SD= 7.3)] and ambulatory prior to admission, were randomized to the resistance exercise group (19) or passive range of motion (ROM) group (20). For the resistance exercise group, participation was 71% (p = 0.004) and adherence was 63% (p = 0.020). Participation and adherence for ROM exercises was 96% and 95%, respectively.
Using a standardized and simple exercise regimen, selected, ill, older adults in the hospital are able to comply with resistance exercise. Further studies are needed to determine if resistance exercise can prevent or treat hospital-related deterioration in mobility and function.
PMCID: PMC270049  PMID: 14531932
exercise; resistance; strengthening; deconditioning; geriatrics
18.  Short term modulation of trunk neuromuscular responses following spinal manipulation: a control group study 
Low back pain (LBP) is one of the most frequent musculoskeletal conditions in industrialized countries and its economic impact is important. Spinal manipulation therapy (SMT) is believed to be a valid approach in the treatment of both acute and chronic LBP. It has also been shown that SMT can modulate the electromyographic (EMG) activity of the paraspinal muscle. The purpose of this study was to investigate, in a group of patients with low back pain, the persistence of changes observed in trunk neuromuscular responses after a spinal manipulation (SMT).
Sixty adult participants with LBP performed a block of 5 flexion-extension movements. Participants in the experimental group (n=30) received lumbar SMT whereas participants in the control group (n=30) were positioned similarly for the treatment but did not receive SMT. Blocks of flexion-extension movements were repeated immediately after the manipulation as well as 5 and 30 minutes after SMT (or control position). EMG activity of paraspinal muscles was recorded at L2 and L5 level and kinematic data were collected to evaluate the lumbo-pelvic kinematics. Pain intensity was noted after each block. Normalized EMG, pain intensity and lumbo-pelvic kinematics were compared across experimental conditions.
Participants from the control group showed a significant increase in EMG activity during the last block (30 min) of flexion-extension trials in both flexion and full-flexion phases at L2. Increase in VAS scores was also observed in the last 2 blocks (5 min and 30 min) in the control group. No significant group x time interaction was seen at L5. No significant difference was observed in the lumbo-pelvic kinematics.
Changes in trunk neuromuscular control following HVLA spinal manipulation may reduce sensitization or muscle fatigue effects related to repetitive movement. Future studies should investigate short term changes in neuromuscular components, tissue properties and clinical outcomes.
PMCID: PMC3602072  PMID: 23496876
Spinal manipulation; Electromyography; Kinematics; Flexion-relaxation phenomenon
19.  The Association of Flexibility, Balance, and Lumbar Strength with Balance Ability: Risk of Falls in Older Adults 
The purpose of the present study was to determine the effects of a proprioceptive training program on older adults, as well as to analyze the association between flexibility, balance and lumbar strength (physical fitness test) with balance ability and fall risk (functional balance tests). This study was a controlled, longitudinal trial with a 12-week follow-up period. Subjects from a population of older adults were allocated to the intervention group (n = 28) or to the usual care (control) group (n = 26). Subjects performed proprioceptive training twice weekly (6 specific exercises with Swiss ball and BOSU). Each session included 50 minutes (10 minutes of warm-up with slow walk, 10 minutes of mobility and stretching exercises, 30 minutes of proprioceptive exercises). The outcome variables were physical fitness (lower-body flexibility, hip-joint mobility, dynamic balance, static balance, and lumbar strength) and functional balance (Berg scale and Tinetti test). The experimental group obtained significantly higher values than the control group in lower-body flexibility, dynamic balance, and lumbar strength (p = 0.019, p < 0.001, and p = 0.034 respectively). Hip-joint mobility, dynamic balance, and lumbar strength were positively associated with balance ability (p < 0.001, p < 0.001, and p = 0.014, respectively) and the prevention of falls (p = 0.001, p < 0.001, and p = 0.017 respectively). These findings suggest that a 12-week proprioception program intervention (twice a week) significantly improves flexibility, balance, and lumbar strength in older adults. Hip-joint mobility, dynamic balance and lumbar strength are positively associated to balance ability and the risk of falls in older adults. This proprioceptive training does not show a significant improvement in hip-joint mobility or static balance.
Key pointsA 12-week proprioceptive intervention program (two times per week) significantly improves flexibility, balance, and lumbar strength in older adults.The risk of falls and balance ability are significantly improved after a training program with Bosu and Swiss ball in older adults.An improvement in joint mobility, dynamic balance and lumbar strength is positively associated with balance ability and improved fall risk in older adults.A 12-week proprioceptive intervention program (two times per week) does not show a significant improvement in hip-joint mobility and static balance.
PMCID: PMC3990889  PMID: 24790489
Proprioception; physical condition; training; physical qualities; swiss ball
20.  An Analysis of Muscle Activities of Healthy Women during Pilates Exercises in a Prone Position 
[Purpose] This study analyzed the activities of the back and hip muscles during Pilates exercises conducted in a prone position. [Subjects] The subjects were 18 healthy women volunteers who had practiced at a Pilates center for more than three months. [Methods] The subjects performed three Pilates exercises. To examine muscle activity during the exercises, 8-channel surface electromyography (Noraxon USA, Inc., Scottsdale, AZ) was used. The surface electrodes were attached to the bilateral latissimus dorsi muscle, multifidus muscle, gluteus maximus, and semitendinous muscle. Three Pilates back exercises were compared: (1) double leg kick (DLK), (2) swimming (SW), and (3) leg beat (LB). Electrical muscle activation was normalized to maximal voluntary isometric contraction. Repeated measures analysis of variance was performed to assess the differences in activation levels among the exercises. [Results] The activity of the multifidus muscle was significantly high for the SW (52.3±11.0, 50.9±9.8) and LB exercises(51.8±12.8, 48.3±13.9) and the activity of the semitendinosus muscle was higher for the LB exercise (49.2±8.7, 52.9±9.3) than for the DLK and SW exercises. [Conclusion] These results may provide basic material for when Pilates exercises are performed in a prone position and may be useful information on clinical Pilates for rehabilitation programs.
PMCID: PMC3927047  PMID: 24567680
Back and hip muscles; Electromyography; Pilates
21.  Randomized Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-type Constipation 
Diseases of the colon and rectum  2009;52(10):10.1007/DCR.0b013e3181b55455.
To determine whether biofeedback is more effective than diazepam or placebo in a randomized controlled trial for patients with pelvic floor dyssynergia-type constipation, and whether instrumented biofeedback is necessary for successful training.
One hundred seventeen patients participated in a 4-week run-in (education and medical management). The 84 who remained constipated were randomized to Biofeedback (n=30); Diazepam (n=30); or Placebo (n=24). All patients were trained to do pelvic floor muscle exercises to correct pelvic floor dyssynergia during 6 biweekly 1-hour sessions, but only Biofeedback patients received electromyography feedback. All other patients received pills 1-2 hours before attempting defecation. Diary data on cathartic use, straining, incomplete bowel movements, Bristol stool scores, and compliance with homework were reviewed biweekly.
Before treatment, the groups did not differ on demographic (average age 50, 85 percent females), physiologic or psychologic characteristics, severity of constipation, or expectation of benefit. Biofeedback was superior to diazepam by intention to treat analysis (70 percent vs. 23 percent reported adequate relief of constipation 3 months after treatment, χ2 = 13.1, p < 0.001), and also superior to placebo (38 percent successful, χ2 = 5.7, p = 0.017). Biofeedback patients had significantly more unassisted bowel movements at follow-up compared to Placebo (p = .005), with a trend favoring biofeedback over diazepam (p = .067). Biofeedback patients reduced pelvic floor electromyography during straining significantly more than diazepam patients (p < 0.001).
This investigation provides definitive support for the efficacy of biofeedback for pelvic floor dyssynergia and shows that instrumented biofeedback is essential to successful treatment.
PMCID: PMC3855426  PMID: 19966605
biofeedback; constipation; dyssynergia; dyssynergic defecation; electromyography
22.  Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: Study protocol of a randomized clinical trial [NCT00257998] 
Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR.
Consecutive patients with LBP referred to physical therapy clinics in one of four geographical locations who satisfy the CPR will be invited to participate in this randomized clinical trial. Subjects who agree to participate will undergo a standard evaluation and complete a number of patient self-report questionnaires including the Oswestry Disability Index (OSW), which will serve as the primary outcome measure. Following the baseline examination patients will be randomly assigned to receive the lumbopelvic manipulation used in the development of the CPR, an alternative lumbar manipulation technique, or non-thrust lumbar mobilization technique for the first 2 visits. Beginning on visit 3, all 3 groups will receive an identical standard exercise program for 3 visits (visits 3,4,5). Outcomes of interest will be captured by a therapist blind to group assignment at 1 week (3rd visit), 4 weeks (6th visit) and at a 6-month follow-up. The primary aim of the study will be tested with analysis of variance (ANOVA) using the change in OSW score from baseline to 4-weeks (OSWBaseline – OSW4-weeks) as the dependent variable. The independent variable will be treatment with three levels (lumbo-pelvic manipulation, alternative lumbar manipulation, lumbar mobilization).
This trial will be the first to investigate the effectiveness of various manual therapy techniques for patients with LBP who satisfy a CPR.
PMCID: PMC1421401  PMID: 16472379
23.  Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain 
European Spine Journal  2008;18(3):410-418.
An important aspect of neuromuscular control at the lumbo-pelvic region is stabilization. Subjects with low back pain (LBP) have been shown to exhibit impairments in motor control of key muscles which contribute to stabilization of the lumbo-pelvic region. However, a test of automatic recruitment that relates to function has been lacking. A previous study used ultrasound imaging to show that healthy subjects automatically recruited the transversus abdominis (TrA) and internal oblique (IO) muscles in response to a simulated weight-bearing task. This task has not been investigated in subjects with LBP. The aim of this study was to compare the automatic recruitment of the abdominal muscles among subjects with and without LBP in response to the simulated weight-bearing task. Twenty subjects with and without LBP were tested. Real-time ultrasound imaging was used to assess changes in thickness of the TrA and internal oblique IO muscles as well as lateral movement (“slide”) of the anterior fascial insertion of the TrA muscle. Results showed that subjects with LBP showed significantly less shortening of the TrA muscle (P < 0.0001) and greater increases in thickness of the IO muscle (P = 0.002) with the simulated weight-bearing task. There was no significant difference between groups for changes in TrA muscle thickness (P = 0.055). This study provides evidence of changes in motor control of the abdominal muscles in subjects with LBP. This test may provide a functionally relevant and non-invasive method to investigate the automatic recruitment of the abdominal muscles in people with and without LBP.
PMCID: PMC2899422  PMID: 19015895
Low back pain; Ultrasound imaging; Motor control; Weight-bearing; Functional testing; Transversus abdominis muscle
24.  Effect of Pilates Training on Alpha Rhythm 
In this study, the effect of Pilates training on the brain function was investigated through five case studies. Alpha rhythm changes during the Pilates training over the different regions and the whole brain were mainly analyzed, including power spectral density and global synchronization index (GSI). It was found that the neural network of the brain was more active, and the synchronization strength reduced in the frontal and temporal regions due to the Pilates training. These results supported that the Pilates training is very beneficial for improving brain function or intelligence. These findings maybe give us some line evidence to suggest that the Pilates training is very helpful for the intervention of brain degenerative diseases and cogitative dysfunction rehabilitation.
PMCID: PMC3703805  PMID: 23861723
25.  Effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia – a multi-centre randomised controlled trial 
BMC Psychiatry  2013;13:26.
Negative symptoms of schizophrenia are frequently associated with poor long term outcomes. Established interventions have little, if any, positive effects on negative symptoms. Arts Therapies such as Body Psychotherapy (BPT) have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control.
In a randomised controlled trial, 256 schizophrenic outpatients with negative symptoms will be randomly allocated either to BPT or Pilates groups. In both conditions, patients will be offered two 90 minutes sessions per week in groups of about 8 patients over a period of 10 weeks. Outcomes are assessed at the end of treatment and at six months follow-up. The primary outcome is severity of negative symptoms, as measured by the Positive and Negative Symptom Scale (PANSS), whilst a range of secondary outcome measures include general psychopathology, social contacts, and quality of life. We will also assess the cost-effectiveness of the intervention.
The study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat. If the trial is successful, it will add a new and effective option in the treatment of negative symptoms. Group BPT is manualised, might be attractive to many patients because of its unusual approach, and could potentially be rolled out to services at relatively little additional cost.
Trial registration
Current Controlled Trials ISRCTN84216587
PMCID: PMC3556155  PMID: 23317474

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