So I am here to give to you, the trainers in the trenches, just what you need to have in your armory when engaging with one of these navel pullers of the New Age. Rather than smacking them upside the head with the rolled-up weekend edition of your local newspaper, as I usually do, you can now roll up a copy of this article and stuff it deep into their incredulous, slack-jawed mouths.

To begin de-programming a Pilates cult member, I suggest you take a leaf from A Clockwork Orange and strap the brainwashed subject into a barber’s chair, fix back their eyelids, and show them these MRI scans. If a picture says a thousand words, these pictures say a hell of a lot more:

Left: Pilates result; Right: Functional strength rehab result

The two MRI scans you see here are clear, undeniable proof of the failure of long-term Pilates training and the success of functional strength rehabilitation methods to cure low back pain.

The MRI on the left is from a person who came to see me about her years of unresolved low back pain. She had been doing “clinical Pilates” three to four times per week for the last four years, and was still having low back pain. What you see in her scan is atrophic multifidus muscle in the lumbar spine. This is after four years of so-called rehabilitation. Her spinal musculature is lacking stabilizing muscle and is fat infiltrated. Her scan is otherwise clear of any problems. There is no disc injury, just poor musculature, and she was doing Pilates at one of the most respected Pilates teaching and rehabilitation centers in the country. And yes, she could perform an isolated transverse abdominis contraction.

The scan on the right is a guy who came to see me who had experienced a huge disc injury, including nerve involvement. Did that worry me? No. I’ve treated over 10,000 patients in the last twenty years and I began weight training as an athlete before I was a physical therapist. I assessed him and began him on functional strength rehabilitation. What you see in his scan is the result of his rehab. Massive paraspinal musculature and maximum multifidus hypertrophy.

What did he do for rehab? He did exactly what I prescribe – a progressive protocol that included deadlifting (he knew how to do it) in the early stage and culminated with double kettlebell swings and kettlebell Sots pressing at the end stage of rehab. The exact protocol I prescribe varies upon the patient’s presentation, but the paradigm is clear – progressive overload and functional movement loading. This athlete continued in his training, even with a bulge (I taught him the skills to manage the problem in training, I’ll teach you that in another article) and competed successfully at an international level weeks after the scan was taken.

Let’s take a closer look at the scans now so you can really sink your teeth into the Pilates jugular. I’ll start with what resulted from four years of clinical Pilates and transverse abdominis isolation rehabilitation protocols.

You don’t need a degree in radiology to understand these MRI scans, but I’ve helped to define the points I think are best. I’m not a graphic artist, just a genius, so put up with my efforts – it’s worth it.

In this scan, the area where the fat is sitting is where the deeper layers of the multifidus muscle should be. It is not there. Fat is, and fat is not a very functional tissue to have next to your spine. The muscle you see is the dark tissues as indicated and the bone has been outlined for clarification. What you see is the result of non-functional transverse abdominis focused “core” training. Though they used the term “functional core,” it failed that requirement spectacularly. Why have these methods failed this person, and why has it been failing athletes as a method of low back rehabilitation? Move over and let me drive, I understand these streets.

First, let’s begin by enjoying the fruits of our intellectual labors, and revel in the results of functional strength rehabilitation.

Muscle, muscle everywhere! Look at this scan it could come from a damn rodeo bull! Everything that should be hypertrophied is. This was after just four months of functional strength rehab. There is no mystery as to why functional strength rehabilitation protocols work and why core stability and Pilates methods fail. It is all in the science of anatomy and movement.

I have been studying science, injury, rehabilitation and strength for about 25 years. This involved thousands of patients and a lot of post-graduate study. I cannot show you, today, the exact methods I use to assess and rehab in this short article. This article is about results and the obvious science of successful rehabilitation principles. Principles you already know. I’m going to now put in place some of the foundation stones of successful rehabilitation, and highlight how the Pilates and core approach fails those basic human physiological principles.

Key points to be addressed in the low back rehabilitation:

• Consequent to low pain injury the multifidus muscle of the spine atrophies.
• People with low back injury have altered movement patterns after injury.
• Over 90% of people who injure their low back will have more episodes of injury.

So let us look at the facts of functional strength rehabilitation:

SAID = Specific Adaptation to Imposed Demand.

Yes, you all knew that. But why has it not been applied in the field of lumbar spine rehabilitation?

You must produce hypertrophy of the lumbar multifidus muscle. How does “pulling your bellybutton in towards your spine” while lying upon a reformer bed waving your arms and legs about like a dying turtle on its back in the midday sun produce a hypertrophic adaptation? Uh, it doesn’t, Beavis. The Pilates methods fail to impose significant enough overload to the musculature to produce functional hypertrophy. There is no overload to produce muscular hypertrophy that will translate to athletic demands. The specific adaptation you learn from Pilates is specific only to Pilates.

Functional rehabilitation requires movement specific overload, e.g. deadlift, kettlebell swing. Spectacularly, the research parroted by these transverse abdominis advocates is a study by Hoffer and Andreasson that contends contractions as low as 25% maximum voluntary contraction are able to provide maximal joint stiffness. This reference was a study of the soleus muscle of a cat that had been decerebrated (removed the cerebral brain function from). Do you think the study of a soleus muscle in a cat (quadruped), which had been brain injured, is reasonable support, or applicable to human beings (biped without brain injury)? But these numbers are often quoted by supporters of Pilates. 25% of a maximum contraction of transverse abdominis will not result in overload and hypertrophy of the multifidus, which is required for rehab. Also, transverse abdominis is not a lumbar stabilizing co-contractor with multifidus. No, it is not. Never was, and never will be.

Altered movement patterns are noted consequent to low back injury. Yes, transverse abdominis is supposed to be the first muscle to contract in human movement, but what is the best way to restore normal movement patterns (including restoring transverse abdominis patterning)? It’s not by lying on your back or being on your hands and knees. Restore normal movement patterns by learning normal movement patterns, not abnormal ones.

So teaching a person to move correctly and to control a lumbar lordosis under load produces the single most effective method of overload, movement specific function, and pain-free low back restoration. You begin deadlifting and kettlebell swinging early. This keys into why back pain is recurrent. People are not addressing functional movement patterns. By functional movement pattern I do not mean that confounding, stupid fitball exercise involving some sort of damn cable machine and a delirious rapturous grin from a personal trainer. The rule of thumb these people seem to use is, “If it looks dangerous or stupid, tell the client it is for their functional core.” In science functional means functional, not fucking stupid.

Now, there are important protocols, assessments and progressions within functional strength rehabilitation to produce the outcome I have demonstrated. This article is not here to show you what they are. Those articles come later. This article is specifically focused to show the superiority of progressive overload and applied strength science to the superstition and blind belief systems that now dominate low back rehab in the minds many health professionals. It is time for professional trainers to take back the rehabilitation work that is really theirs in the first place. It might mean a lot more study for you, but I’ll also be the first to tell you – being smart feels good.

Okay, now I’m off to write a book on the science and methods of successful strength rehabilitation. Now let’s see, how will I begin? I know I’ll begin with, “Call me Ishmael.”

References:

1. Hoffer J Andreasson S 1981 Regulation of soleus muscle stiffness in premammillary cats. Journal of Neurophysiology 45: 267-285

MRI scans property of Andrew Lock.

Cat photo courtesy of Shutterstock.

The post Proof That Functional Strength Training Cures Low Back Problems and Pilates Won’t appeared first on Breaking Muscle.

I have never read an explanation about of how to dismantle the theory that transverse abdominis (TrA) and multifidus were the co-contraction couple that provided stability for the lumbar spine. So I’ll take the lead, it is time to pay attention to that man behind the curtain and examine what really is going on in the land of Pilates Oz.

There was a time last century when a paper was published called Muscle control–pain control. What exercises would you prescribe? In it the authors, Richardson and Jull of the University of Queensland, proposed evidence showing that TrA and multifidus were the two most important muscles involved in the resolution and rehabilitation of low back pain. They stated that these two muscles worked as a “force couple” providing the muscular stability for the joints of the lumbar spine.

I don’t know why, but the health professions followed like lemmings off a cliff, and their proposal became sacred law. I don’t know why anatomists didn’t do a collective WTF! But somehow it just sneaked past almost everyone. It is now time to put this beast out of it misery once and for all, so here is my collection of wooden stakes. Gather round and grab some, because we are going hunting!

What I am going to do is list some of the concepts and references used by Richardson and Jull, and show you how that research either does not apply or even, in some cases, proves them wrong:

1. Co-Contraction Provides Joint Stability

One method of increasing joint stability is through enhanced muscle stiffness by the co-contraction of agonist and antagonist muscles that lie on each side of a joint. This applies to unidirectional peripheral joints such as knees, elbows, and fingers. The problem is that the spinal segment is multidirectional, and does not have agonist and antagonist muscles directly attaching on each side of its joints.

Read this: there are no muscles attaching in front of the spinal joints. Spines are not similar to the unidirectional peripheral joints. The multifidus muscle (shaded dark red in illustration to the right) of the spine opposes the flexion moment of the oblique and rectus abdominis muscles, not the contraction of transverse abdominis, because TrA does not have a flexion moment. So, the only muscles that may be considered to be “force couples” are the oblique and rectus abdominals and the spinal erector muscles as a group.

2. Local and Global Muscle Definitions

Following from this, to support their theory, Richardson and Jull state that they define TrA and multifidus as local muscles, because in the standard unidirectional joint only local muscle can stabilize the joint. Then they use a study that clearly shows their definition is wrong, but they state that study supports their definition. It makes astounding reading, here it is: Bergmark differentiates betwen local and global muscles.

Richardson and Jull propose that they are supported in their definition that TrA is a local muscle by this study of lumbar spine stability. Bergmark proposed a difference between local and global muscles in that global muscles are those that provide general trunk stabilization. Richardson and Jull also state, “Such muscles (global) balance external loads and in that way help minimize the resulting forces on the spine. Local muscles refer to those attaching directly to the lumbar vertebrae. These muscles are considered to be responsible for segmental stability as well as controlling the positions of the lumbar segments.”

Okay, here is the truth, and read it carefully:

Transverse abdominis does not attach directly to the lumbar spine.

TrA attaches to the middle lumbar fascia. It is not the only muscle that attaches to the fascia, and additionally and majorly, the TrA does not control the position of the lumbar spine joint. It can only be described as a “global muscle.” TrA contraction increases intra-abdominal pressure; it balances and creates general trunk stabilization only. By Richardson and Jull’s own definition TrA is a global muscle. Bergmark further states, “The global erector spinae muscles are by far the most important back muscles both in regards to equilibrium and stability of the spine.” Not the TrA and multifidus that Richardson and Jull propose.

Yes, I drew this.

Further to this, the Bergmark study referenced states that the global and local differentiation was only used to create a mechanical modelling system for the study. This is not an anatomical fact of differentiation, but a modelling tool, and Bergmark states on page 48, “In the model only back muscles and no abdominal muscles are included.”

Bergmark ascribed muscles to these groups according to their main function. TrA’s main function is the creation of intra-abdominal pressure. Bergmark states, “The main role of the global system appears to be to balance the outer load so that the resulting force transferred to the lumbar spine can be handled by the local system.” He also states that the “local muscle system” is defined by all muscles that have their origin or insertion on the vertebrae, with the exception of the psoas because it is a hip flexor. (Bergmark did not appear to understand the role of psoas, with its direct spinal attachment upon the vertebral bodies (not joints), counteracting the action of iliacus upon the pelvis, and the psoas’s role in producing intra-discal pressure when contracting.)

3. The Cresswell Study

Richardson and Jull then state, “A muscle that could be described as part of the local system, and which has not been studied extensively to date, is the transversus abdominis. Its importance in lumbar stabilization was first addressed by Cresswell et al (1992).” Well, I read the Cresswell study and here it what it says: “It appears that transversus abdominis is the abdominal muscle whose activity is most consistently related to changes in intra-abdominal pressure.” So Cresswell, whom they reference, gives his determination of TrA’s role in lumbar stability as that of a global muscle producing intra-abdominal pressure.

Richardson and Jull continue, “These researchers studied the muscles of the back.” No, they did not actually. No back muscles were studied! The study is titled, Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Why did Richardson and Jull state this study included back muscles? Cresswell’s study demonstrated that the TrA had direct links with the development of intra-abdominal pressure. Furthermore, it demonstrated that this muscle contracted with all trunk movements regardless of the primary direction of movement. The study totally disproves the concept that defines transverse abdominis as a “local muscle.”

As I was searching for a reference given by Richardson and Jull, I was able to find another paper of interest published in the journal Physical Therapy – Hodges and Richardson’s Contraction of the abdominal muscles associated with movement of the lower limb. Interestingly it involves one of the authors of the paper we are dissecting.

In the results of this study it states, “Although reaction time for the TrA muscle was consistent across movement directions, reaction time for the rectus abdominis and multifidus muscles varied with the direction of movement.” You will note that this statement conflicts with the co-contraction theory proposed in Muscle control–pain control. Reading this study it was clear that TrA and multifidus are not co-contracting, are contracting separately, and multifidus is contracting in response to the direction of limb movement. Stated – TrA is not direction specific, and multifidus activity is direction specific. So, Richardson and Jull have a study by Richardson that conflicts with their co-contraction reasoning, yet that conflict is not raised in Muscle control–pain control.

So, here is a quick summary. Transverse abdominis and multifidus are not a co-contraction force couple that stabilizes lumbar joints. Transverse abdominis is a global muscle whose action is non-specific to spinal joints. Multifidus is a local muscle whose action is specific to spinal joints. Multifidus is direction specific and contracts to oppose the flexion moment produced by contraction of the oblique abdominal muscles in particular. Exercise to isolate transverse abdominus in fact will likely produce a destabilizing effect by excluding the oblique abdominals action. This is non-functional, and should not be used in the rehabilitation of athletes with low back problems.

References:

1. Bergmark A 1989 Stability of the Lumbar Spine. A study in mechanical engineering. Acta Orthopaediea Scandinavica Supplimentua 230(60):20-24

2. Cresswell AG, Grundstrom A, Thorstensson A 1992 Observations on intra-abdominal pressure and patterns of abdominal intramuscular activity in man. Acta Physiologica Scandinavica 144: 409-418

3. Hodges PW Richardson CA 1997 Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy Vol 77 No. 2 Feb

4. Richardson CA, Jull GA 1995 Muscle control-pain control. What exercises would you prescribe? Manual Therapy 1, 2-10

Illustrations 3&4 by Uwe Gille (modified from Gray) [Public domain or Public domain], via Wikimedia Commons.

The post Santa Claus, Fairies, and Why the Transverse Abdominis/Multifidus Co-Contraction Theory Belongs in the Fiction Section appeared first on Breaking Muscle.

I decided to use this article as an opportunity to help others apply critical analysis to this kind of material. To best explain the issues that arose for me and help you analyze future articles you encounter on fitness methodologies, I’m going to share some excerpts from it (in italics) and follow each with my thoughts.

“The workouts are based on the teachings of the late Joseph Pilates, whose fitness method focuses attention on strengthening core posture muscles and deep breathing.”

Pilates is core posture muscle strengthening and deep breathing. What are the “core” posture muscles and the rationale for the deep-breathing focus? A solid presentation would offer the physiological details, or at least a general goal of them.

“If the workout is a good one, then all of the exercises are based on the fundamental principles of Pilates, which are centering, control, breathing, fluid movement, form, concentration.”

Pilates now incorporates more than just core posture and deep breathing? Is it some type of relaxation technique due to the emphasis on “centering” and “control?” Centering what? Controlling what? What are fluid movement, form, and concentration?

“If you do the workouts about three times a week for an hour each time, your waistline will probably be trimmer because there is a lot of abdominal work.”

This implies doing abdominal work reduces body fat. Spot reduction is impossible and we’ve known that for years. An hour per workout, three times per week, focusing on core/posture muscles? This is unnecessary. An hour (or less) devoted to higher-calorie burning activities (i.e., interval or circuit training) and addressing the “core” with basic strength training exercises would be more productive. To decrease body fat, a calorie deficit must be created. The addition of high-calorie burning exercise (which Pilates is not) is a better option for probably becoming trimmer.

“Pilates also focuses on the muscles around your joints – especially hips and shoulders, where you work to refine smaller muscles in those areas.”

Are shoulders now considered part of the “core?” Where do you draw the line for the “core” muscles? What specific joints and muscles are targeted in Pilates? I am left curious how a Pilates’ routine trumps a conventional resistance training routine that addresses joint strength and stability, augments flexibility, and burns more calories than Pilates.

“It balances the muscle system so that no one muscle group is stronger than the other. You prevent injury because there is nothing pulling adversely on the skeletal frame because of muscular imbalance.”

A balance of joint strength and stability (agonist/antagonist) is also the goal of any properly designed strength training program. Working joint flexion and extension, adduction and abduction, inward rotation and outward rotation – all of this contributes to joint stability and balanced strength. This can be accomplished using conventional strength training exercises that activate more muscle through a variety of safe ranges of motions.

“The workouts should help you do many activities with more energy and efficiency – playing golf, running, cycling, walking, or sitting at your desk.”

How is Pilates specific to those activities? Motor learning principles clearly state that no transfer occurs between dissimilar activities. Exact replication or movement practice (specificity of motor skill work) is needed for positive results to occur.

Regarding energy – how does Pilates increase more energy? Involving larger muscles (i.e., running or on-your-feet exercises) is more demanding on the body. This uses more energy and can better create a cardiovascular overload that ultimately leads to better conditioning, and thus one possessing more energy.

“Pilates creates an immense amount of body awareness, which is beneficial whether you’re sitting at your desk all day or you’re a serious athlete.”

Awareness in terms of what: standing, sitting, moving a specific way, where my left arm is, or where my right ear lobe is? I am missing an explanation of the science here. How does this help a serious athlete who is already focused on their sport-skill work, strategy development, strength training, energy-specific conditioning training, and attention to proper nutritional intake?

“It’s exactly what people who are tighter should be doing because it will help elongate their muscles.”

Simply extending any joint to its complete range of motion will “elongate” the muscle(s) acting at that joint. Any further “elongation” will require surgical intervention to alter muscle and/or tendon insertions and origins. You cannot alter your genetic endowment. Conventional static-stretching exercises will also help people within the confines of their inherent skeletal structure.

“Doing movements incorporating Pilates principles will give you a supple, youthful spine, and long, lean muscles.”

Regarding “long, lean muscles,” taller, longer-limbed humans (ectomorphs) have longer limbs and longer muscles as compared to shorter-limbed humans (mesomorphs) who have naturally shorter muscle bellies. One cannot change that.

“If you are doing an exercise without activating the correct muscles, you could injure yourself or end up not getting the results you want – a great toned body.”

It is implied that Pilates gives you a “great toned body” provided one activates the correct muscles. I wish it were that simple. Obviously, one’s given (and unalterable) body type, energy expenditure, exercise habits, and nutritional intake play a huge factor in obtaining a “toned” body as opposed to simply using Pilates techniques.

On the subject of “tone,” it is mainly a marketing term with little scientific merit. In reality, one cannot tone his/her body. One can alter body composition in terms of fat and muscle composition to enhance muscle visibility. However, to suggest that doing Pilates three times per week for one hour will give one a “great toned body” – and not considering body type, energy expenditure, exercise regimen, and nutritional habits – is totally irresponsible.

After reading this entire article with an analytical mindset, here is my summary. Pilates may serve a purpose in strengthening abdominal, lumbar, and associated muscle groups, but it is a poor choice for those attempting to maximally burn body fat and become more muscular. Fat spot reduction is impossible and Pilates by itself is not an efficient means of burning calories and building muscle. If these are in fact your goals, your time would be better spent performing total body strength training (including abs and low-back) and high-calorie burning exercise such as interval training or high intensity circuit workouts.

Next time you see an article promoting any particular fitness trend or methodology, take a moment to read it critically. Let your mind question the material and see where it leads you.

Photos courtesy of Shutterstock.

The post How to Read and Analyze an Article About Pilates appeared first on Breaking Muscle.

If you’re a Pilates purist, I feel confident in saying you will enjoy Alisa Wyatt’s Pilates workouts. I’ve tried the Intermediate and Advanced level workouts, and both were excellent. The Advanced workout in particular is a work of athletic art. Alisa is so skilled in Pilates, and it’s amazing and inspiring just to watch her do the exercises. My four-year-old daughter is transfixed every time I turn it on and lets me do the whole thing undisturbed.

Alisa is a self-proclaimed Pilates purist, with an impressive training background. She was a student of Romana Kryzanowska, one Joseph Pilates’ students, and has been teaching Pilates for more than a decade. She has trained several professional athletes and also runs a website called Pilatesology, which is dedicated to teaching people about classical Pilates.

On her website, Alisa notes:

The purest form of Pilates is the mat work. It was the first thing that Joe Pilates created and all of his apparatus was invented as a way to get people to do the mat better. The mat is what Joe taught you first when you visited his studio and you were expected to do it on your own every day.

In that spirit, both of these DVDs are mat-based, and don’t require any additional equipment, except for a good mat. You really do want to have plenty of padding for your spine, especially if you’re like me and your spine sticks out like a dinosaur. The format for both DVDs is very simple: Alisa has a brief introduction providing some Pilates basics, followed by a 40 minute workout. The exercises flow into each other at a fast pace, and I found the workout actually went by pretty quickly.

The Intermediate DVD is ideal for those who have experience with Pilates and a solid core foundation. If you haven’t taken Pilates before, or if you have any lower back problems or core issues that would compromise core strength, I would not recommend it. For example, I would not have been able to do this workout nine months ago because I was still recovering from a c-section. I got through the whole workout without making any modifications, but it was definitely a challenge. Alisa also has a beginner DVD if you haven’t taken a Pilates class before.

The flow is fast-paced, but she does provide just enough recovery time after the intense exercises. I like the way that Alisa cues throughout the workouts. The narration is constant, just like in a regular Pilates class, which might be annoying for your husband sitting in the other room trying to read. However, since you are lying on the ground for many exercises and can’t see the screen, the verbal cueing is absolutely necessary and helpful.

The Advanced workout is definitely advanced. I couldn’t do some of the exercises for the entire duration. I would recommend the advanced workout for Pilates students with a lot of previous experience and even instructors who need a good at home or travel workout. If you are a yoga enthusiast or dancer, you might also benefit from this DVD. The sequence of exercises is almost identical to the intermediate DVD (it follows the classic sequence from Joseph Pilates), but with more challenging modifications.

These DVDs are not flashy – there isn’t even any background music – and you won’t find Hollywood instructors and frilly sets. But they don’t need to be, because the workouts are solid and the emphasis is on proper execution of movement. What you will find is top-notch instruction in the fundamentals of Pilates, as well as cuing from an experienced Pilates trainer. If you’re a Pilates enthusiast looking for a classic workout that will challenge you, don’t pass up these workouts.

Photos provided by Jack Coble/Pilatesology.

The post DVD Review: Alisa Wyatt Intermediate and Advanced Pilates Mat Workouts appeared first on Breaking Muscle.