Seattle Dizzy Group

Vestibular Rehab with a Pilates Spin

by Brett Lezamiz, PT, DPT, OCS

(Presented to Seattle Dizzy Group 5/11/13)

Core Principles of Pilates

Centering

The main focus of Pilates is to center the body, “The Powerhouse.”

All movement begins and is sustained through this center.

Concentration

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.

Control

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.

Precision

“The benefits of Pilates depend solely on your performing the exercises exactly according to the instructions,” Joseph Pilates.

Work with Quality instead of Quantity.

Flow

The full workout is a flowing succession of exercises performed with vigorous dynamics.

Principles of Vestibular Rehabilitation

Principles:

– 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

Goals:

– 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

Look up/down

Shoulder circles

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!!!***

References:

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.