Vestibular Rehab with a Pilates Spin
by Brett Lezamiz, PT, DPT, OCS
(Presented to Seattle Dizzy Group 5/11/13)Pilates isn’t just about core strength or cranking out The Hundred. It is a discipline with six core tenets: centering, concentration, control, precision (quality vs. quantity), breath, and flow that can add depth and variety as well as improved balance and stability to a vestibular rehabilitation program.
Core Principles of Pilates
The main focus of Pilates is to center the body, “The Powerhouse.”
All movement begins and is sustained through this center.
Joseph Pilates believed that “it is the mind that guides the body.”
We center the mind with the body in actions to bring the 5 aspects of the mind into the workout: Intelligence, Intuition, Imagination, Will, and Memory.
Joseph Pilates didn’t call it Pilates, he called it the “Art of Controlology.”
When working from the center and with full concentration, we are able to maintain control of every movement, not allowing bad habits or gravity to take over.
“The benefits of Pilates depend solely on your performing the exercises exactly according to the instructions,” Joseph Pilates.
Work with Quality instead of Quantity.
The full workout is a flowing succession of exercises performed with vigorous dynamics.
Principles of Vestibular Rehabilitation
- Small increase in symptoms
- Slow progression
- Step forward, step back
- Worse before better
- Must produce an “error signal”
- Movements and exposure to stimuli that challenge the vestibular system
- Reduce symptoms
- Improve quality of life
- Increase postural/gait stability
- Improve visual acuity
What techniques as clinicians do we use in vestibular rehabilitation to achieve these goals?
1. Compensation: when there is damage to the vestibular system
2. Habituation: with repeated exposure, builds tolerance to the stimulus
3. Adaptation: long-term changes of the vestibular system that occur in response to the stimulus
4. Substitution: use of alternative strategies to replace lost or compromised function
Sample exercise progression:
1. Standing Wall Exercises
A. Quiet standing in Pilates stance
B. Target practice, smooth pursuit or x1 viewing exercise standing against wall in Pilates stance
C. Coordination exercise (breathing with head movement)
D. Arm circles 5x each way – no head movement
E. ¼ squat with target practice or x1 viewing
F. What other variables could you change? (move away from wall!)
2. Sitting Postural Exercises (TV exercises)
A. Quiet sitting with Powerhouse engaged
B. Quiet sitting with target practice, x1 viewing smooth pursuit, etc.
C. Sitting with arms folded at shoulder level
D. Just arms with target practice or x1 viewing
E. No arms with alternating knee bending, straightening
F. Arms with alt. knee bending straightening
G. No arms with alternating leg lifting, lowering
H. Arms with alt leg lifting, lowering
Other Pre-Pilates Exercises:
Look over shoulder
Lift up on toes
Press up on arms
Leg lifts Iying down
***Any time we combine vestibular exercises with any other exercises (whether Pilates or just walking) the exercise becomes exceptionally HARDER!!!
YOU WILL GET TIRED FASTER
YOU MAY BE MORE SYMPTOMATIC
BUT, it’s more like real life so you’ll get BETTER, FASTER!!!***
The Pilates Body: the ultimate at-home guide to strengthening, lengthening, and toning your body – without machines, Brooke Siler 2000; 1st edition
Vestibular Rehabilitation: A Competency Based Course. Lectures from May 2010
Brett Lezamiz, PT, DPT, OCS
Brett Lezamiz is a manually trained therapist delivering individualized, hands-on treatment to her patients. She is a certified Orthopedic Clinical Specialist (OCS) and has taken over a dozen continuing education courses to augment her knowledge and clinical skills. She continues to take courses and she joined Pilates Seattle International in order to become a certified Pilates instructor to further satisfy her desire to provide the best care.
Through her years of practice, Brett has developed a treatment style that uses her manual skills to improve soft tissue, fascial and joint mobility. She strongly believes one must compliment manual/hands-on work with patient-specific movement reeducation, strengthening and stabilization exercises. This step is crucial or patients cannot return to their prior activities, or when they do, they get reinjured.
In 2010, Brett successfully completed the highest physical therapy certification for vestibular rehabilitation at Emory University (Susan Herdman course). Since that time, she has been effectively treating patients with dizziness and/or loss of balance due to vestibular, or inner ear, conditions.
Brett attended the University of Southern California for her graduate work in physical therapy where she earned a doctorate of Physical Therapy (DPT) in 2004. She moved back to the Pacific Northwest during her final clinical residency and has resided here and worked in several outpatient clinical settings since. Brett is active enjoying running, biking, hiking, and skiing and anything with her Golden Retriever.
For more information about Vestibular Rehabilitation Therapy (VRT): http://vestibular.org/understanding-vestibular-disorder/treatment/treatment-detail-page