Progressing beyond injury management to higher level function with APPI matwork Pilates
Progressing beyond injury management to higher level function with APPI matwork Pilates. By Sophie Contreras (APPI Presenter, Physiotherapist, UHM Education Manager)
Physios and other rehabilitation professionals are experts in injury management and therapeutic exercise prescription, so incorporating some of the modified, lower level Pilates exercises into treatment plans makes a lot of sense and is something clinicians generally feel quite comfortable with. We know though, to get our clients able to cope with everyday activities, exercise, sport or manual work following an injury, we need to challenge them with appropriate exercise to get them strong and take them beyond the initial injury and pain management phase.
Much of the repertoire in Matwork level 1 looks at re-training motor control. Exercises tend to focus on lumbo-pelvic stabilisation, movement dissociation and training postural awareness and endurance, all vital components of rehabilitation. However; in order to have functional carryover we need to start to incorporate a wider variety of movements and start to increase the load clients are exposed to, in a progressive manner. Once good control has been achieved, and proprioception and coordination have improved, advancing the APPI Pilates exercises beyond the beginner level, is a great way of further challenging clients to prepare them to better deal with their activities of daily living, sports, or whatever activity it is they want to return to.
For example, if we take a look at a progressing scapular control with an end goal of being able to return comfortably to a regular strong yoga practice, we need to train our clients with weightbearing exercises that more closely relate to what is required of them during their yoga practice. In matwork one we teach movements such as swan dive level 1 and breast stroke preparations level 1 - great exercises to educate our clients about deep neck flexor activation, scapular placement and postural awareness - a vital foundation to develop, however; could only be considered a starting point for preparing someone to return to this type of activity. Retraining weight-bearing control of the upper limb must be addressed to get the best outcome in this scenario. Teaching some of the APPI controlled strength movements would be very appropriate once the base foundation had been achieved with the beginner exercises. Exercises such as leg pull in prone preparation and leg pull in prone, and variations would be ideal to progressively re-train the higher level weight-bearing control required to return to this activity. The photos below demonstrate a few higher level movements and variations that could be useful for this type of scenario.
Ultimately we have a responsibility to provide our clients with the education and tools to advance them beyond injury and pain management to higher level function and fitness, so they can return to work, life and to what they love without the fear of re-injury.
