February 2010

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Pilates as Sports Injury Rehabilitation

by Colleen Glenn 

Rehabilitation scenario: I just started working with a college football player with a fractured right tibia/fibula that was repaired with rod and pins. Unfortunately, prior to the repair he suffered from compartment syndrome and the result was nerve damage that left him with numbness from his mid shin down to his foot, causing foot drop. He did mat Pilates while playing football and wants to resume Pilates now that he is in physical therapy. He can return to light weight bearing on his leg in two weeks and I would like some input on exercises to do with him.

How to incorporate Pilates: I would suggest getting him back into his mat work routine because he is most familiar and comfortable with it. Initially, this will help to build his confidence and lift his spirits. Suffering such an injury accompanied by the nerve damage is a very difficult situation mentally and emotionally, as well as physically. After 35-40 minutes of mat work, begin to work on the apparatus to support lower leg and foot exercises and reprogramming of overall alignment. Generally, I would suggest working on the reformer doing foot work variations with different spring loads, which wouldn’t necessarily be a poor choice. However, in this case it’s important that he see his lower leg position and focus his mind on his problem areas during movements. In this way he can internalize what good and poor mechanics feels like, with your direction, and transfer that sensation to other exercises where he can’t see his feet, like reformer foot work. Monkey and foot work with the push through bar may be an excellent option. The downward spring tension gives something to press up against to build strength, opposition and to assist in holding good positions. These exercises allow for correcting knee, ankle and foot alignment from the visual perspective. One leg Monkey is a natural progression. Focus first on the injured leg, then the uninjured leg and back again to the injured leg. You may need to use arm springs for less tension.

On the contrary, an exercise like Push Through with the feet would not be a good choice because it does not provide enough support and may compromise the knee. It could be added much later when control and strength are achieved. Push Through with the feet is when the arches of the feet are on the Push Through Bar, the knees bend and then the legs straightened. The pelvis lifts up into a bridge position and one leg lifts off the Push Through bar several times or with alternate lifting. If it’s done too soon without control it will cause overcompensation and problems.  

Other exercises I would focus on include Pumping on the High Chair, Achilles Stretch, and One Leg Pumping. Using mirrors to see positioning and movement is crucial for these exercises. In fact, using the mirror in general may be an important aspect of training a rehabilitation client. All exercises mentioned are weight bearing, less stressful to the joints and help strengthen the center, which is important. Continue to think of exercises that support and provide positive resistance but not too much tension initially. Leg Springs would be an excellent choice, for example. Chair exercises, Achilles Stretch, Tendon Stretch and foot work are also good choices.

Reformer work should be foot focused with various foot positioning and spring tensions. You can start reformer foot work on light springs and build up to adding more springs. It is important to not allow the foot to work with heavy tension in the foot drop position which would cause more problems. Another option may be to use the Jump Board so the entire foot makes contact with a surface. This is good for awareness; add some cushion under the drop foot to lift the arch. This could help activate those muscles which are not being activated due to the dropped arch.  Using props for squeezing the knees and ankles is helpful for alignment, muscle activation and awareness. Hold the foot and ankle in position as another option. If the student comes two to three times a week you should see progress. If you haven’t used documentation prior to this client, then now is the time. Progress will be measurable and documenting it will be insightful for both you and the student. It is important to remember that he can get better and that nerves do regenerate. Each time do a bit less mat and more apparatus and see what happens. Remember, exercise and a positive outlook go a long way.

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