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Dr. D. Y. Patil Vidyapeeth, Pune
(Deemed to be University)
Dr. D. Y. Patil College of Physiotherapy
Sant Tukaram Nagar, Pimpri, Pune-411018

Pilates in Arthritis

Pilates in Arthritis

Discover the Power of Pilates for Arthritis Management and Wellness - Improve Strength, Flexibility, and Mobility!

Dr. Amita Aggarwal
September, 13 2023

Arthritis has been derived from Greek terminology, meaning “Disease of the joints.” There are different types of arthritis with different causal factors and presentation symptoms. Broadly, it can be categorized as inflammatory and non-inflammatory arthritis.

Rheumatoid arthritis (inflammatory non-infectious subtype) is caused by an autoimmune disease with bilateral involvement of joints, early morning stiffness, nodules, and small joint involvement.

Ankylosing spondylitis (inflammatory non-infectious subtype) is another type of arthritis with autoimmune etiology and involvement of bamboo spine with breathing difficulties.

Though a variety of types of arthritis exist, osteoarthritis being the most common. It is a non-inflammatory type of arthritis with insidious onset and involvement of mostly weight-bearing joints. With a high prevalence in hip and knee joints, it causes functional limitations along with pain and joint stiffness. The most common risk factors are age, female gender, obesity, and any previous injury or intraarticular fractures. Chronic cases with higher disabilities and restriction of daily activities are major candidates for surgical management or pharmacological management.

Early management of the condition will not only prevent the deterioration of joint structure (deformities) but also a healthy outlook on associated comorbidities. Non-pharmacological management can include static and dynamic exercises with or without electrotherapy modalities based on patient assessment. Most of these patients are advised low-intensity, high-repetition exercises that can be given in either weight-bearing or non-weight-bearing positions.

Pilates was first explained by Joseph Pilates. It is a form of exercise that offers a gentle but strong approach to attain strength, flexibility, and stamina. It is not only for fitness but also a rehabilitation tool for specific conditions. It helps in training the core group of muscles. It refers to abdominal and back muscles with gradual involvement of the body as a whole. The client is initially guided for good activation of central core muscles followed by training of the peripheral muscles. Good core recruitment is an essential aspect before beginning the activation of the peripheral muscles as it forms the powerhouse of the body.

Principles to be followed are:

  1. Relaxation - Before starting the exercise, make sure to learn relaxation of muscles by letting go of all your stress to attain a correct starting position and perform the movement efficiently.
  2. Concentration - Be aware of joint positions on one’s whole body. A focused concentration is required as it is the mind that will guide the body.
  3. Breathing - It is the first and the last act of life. Exercises have to be followed with full rhythmic breathing. Have full exhalation to have a full inhalation.
  4. Centering - Core is the center house where all the energy begins and gets radiated to the peripheral extremities. With better trunk stability, more accurate movement at mobility segment can be seen.
  5. Coordination – Coordination of the breathing and central recruitment with the peripheral movement is required to achieve the correct position or movement.
  6. Alignment - One has to learn to start from a neutral alignment at pelvis, spine, and scapulae. The body weight is slightly forward on the balls of the feet.
  7. Fluidity - Pilates should permit the flow of movement and energy from one body part to another graciously to achieve purposeful movement.
  8. Stamina - As one becomes proficient at the exercises, more efficient movements are achieved with the gradual buildup of endurance and stamina.

It includes a series of sequential movements with a steady flow of energy. Its progression is achieved by altering the base of support, center of mass, and length of the body levers. Pilates, if advocated properly, helps to attain toned muscles, improved posture, strength, and balance along with flexibility. This will have an added benefit with bone density remaining steady, which helps to decrease the risk of osteoporosis. Standing Pilates can help to train functionally. Many people favor one-leg standing with unequal weight distribution between both feet. They stand with an exaggerated curve and protruding abdomen. This creates back and knee pain. As a thumb rule while doing Pilates, the movement is initiated from the core, representing your powerhouse with the mental awareness of maintenance of good posture.

Exercises suggested include:

  • Hip flexors kneel position stretch.
  • Spine stretch - Opposing squat stretch and lengthening side stretch

With abdominal hollowing

  • Standing ankle circles
  • Single leg circles
  • Squatting with arms behind back followed by arms falling towards knees to raise arms at shoulder level.
  • Lunge followed by side lunge and then thigh lunge.

With wall support

  • Triangle
  • One-legged biceps curl
  • Outer thigh blaster

Breathing exercises and stretch as a cool down.

The protocol includes a beginner start and can be further tailored based on individual requirements. Depending on the client's status, these exercises can further be progressed to include mat and ball Pilates. When followed, it is a powerful antidote not only to arthritis but other health issues as well.

Pilates can offer to train everyone, whatever your age or fitness level may be.