PILATES FOR MS:
An Expert Weighs In
Pilates is a physical fitness program developed by Joseph Pilates in the early 20th century. In recent years it has become a mainstay class at gyms and studios specializing in the practice—most featuring the reformer—can be found worldwide. Because Pilates can be done primarily on a mat, it is a popular fitness routine for people with multiple sclerosis as it can assist with balance, body awareness, stress reduction, flexibility, and strength. Here is an overview with insightful input from nationally certified Pilates instructor Leah Jones.
One of the most popular exercise buzzwords over the past decade or two has to be Pilates. The now popular exercise program started in the early 1900s, when a young man named Joseph Pilates rigged up springs to hospital beds to help bedridden patients exercise. His rehabilitation program evolved over the years, helping everyone from professional athletes to the disabled. Today more than 10 million people practice Pilates, including a number of MSers.
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IMPORTANT: Consult with your doctor and/or neurologist before starting any exercise program.
WHY PILATES FOR MS?
What makes Pilates so popular in the MS community? Pilates focuses on core muscles—muscles in the center of the body like deep abdominals and muscles around the spine—that are important for overall stability and balance, common problem areas in multiple sclerosis.
“I often refer to this as the “spine sandwich” when I teach,” says Leah Jones, a nationally certified Pilates instructor. “We have to strength our whole core, not just the pretty 6-pack muscle, the rectus abdominals, to have true core strength and fully support our spinal columns. Pilates allows us to address imbalances and one-sided weakness by working fundamental movements to increase core strength and spinal mobility. Improved core support leads to better alignment and posture, which takes stress off of other parts of our body that compensate for weakness or alignment issues. Because lengthening and stretching are such fundamental parts of Pilates, the strength and toning comes without sacrificing flexibility. Instead, there is usually an increase in functional flexibility in addition to muscle development.”
Pilates also builds strength (without bulk), teaches body awareness (great for those MSers with numbness), promotes good posture, and improves muscle elasticity and joint mobility (spasticity stiffness anyone?).
“One of my favorite quotes from Joseph Pilates is ‘change happens through movement, and movement heals,’” says Leah. “That certainly doesn’t mean Pilates will turn anyone into Arnold Schwarzenegger circa Pumping Iron or that anyone should even aspire to look like that. This has always meant to me that Pilates has the power to improve our body in meaningful and useful ways. The best feeling as a Pilates instructor is when a client says their back doesn’t hurt anymore, they can put their shoes on easier, or it’s easier to lift their children or grandchildren. Sometimes the victories are unglamorous but hugely important like when a client says their pelvic floor strength has improved enough that they no longer suffer from incontinence or have fewer issues. These are little victories in healing that don’t necessarily make them look better at the beach but make their everyday lives better, and that’s what our real goal is in a Pilates practice.”
One of the more overlooked benefits of Pilates is that it emphasizes proper breathing and smooth, flowing movements—both natural stress relievers. As you are probably aware, combining stress and multiple sclerosis is like putting pundits from Fox News in the same room with commentators from MSNBC. Not good. “Breathing is a Pilates principle and one of the most important aspects of a Pilates practice, explains Leah. “Joseph Pilates wrote in Return to Life, ‘Before any real benefit can be derived from physical exercises, one must first learn how to breathe properly. Our very life depends on it.’”
Like yoga, there is a good deal of mat work in Pilates; you are often in a reclined or seated position (handy if you are unsteady on your feet). Aside from a few exercises, it tends to not be aerobic—reducing the risk of overheating. Using low-impact, partial weight-bearing techniques, with an emphasis on economy of motion, it’s a safe workout for MSers of any age.
Many fitness centers offer Pilates classes, while dedicated studios abound. Another resource is the internet and various video streaming services, where you will find thousands of virtual classes to follow. ActiveMSers also recommends checking our Connect forum for potentially free or discounted classes for people with disabilities in your area. But where to begin? Leah has some pointed advice.
“If it’s in your budget, I recommend every single client begin with a private/individual session. An introductory session or sessions with a qualified Pilates instructor will introduce you to the equipment, the repertoire, and the breathing. It will also give you ample time to discuss your individual needs, like studio temperature, props for support, or any modifications that make the practice accessible and beneficial. Knowing these modifications and guiding principles creates a good foundation of knowledge that will help you feel comfortable attending classes with different instructors, on new pieces of equipment, or at different studios.”
A few words of warning. Finding a good Pilates instructor who’s a good fit can be challenging, so don’t give up if you don’t particularly enjoy your first experience. We at ActiveMSers have experienced a half dozen instructors: one great, two decent, two poor, and one atrocious (think LOUD dance music with an instructor screaming into a mic to pump it up).
It pays to shop around! Leah seconds that advice.
“Instructor qualifications range from physical therapists to people who took an online course one weekend. Read the bios of the instructors at a studio you’re interested in. They usually include their training background. If you’re unsure where to start, you can find Nationally Certified Pilates Instructors, instructors who have completed a 500hr training AND the Pilates Method Alliance certifying exam, by going to the NCPT website. Well-respected education programs like BASI, Balanced Body, Polestar, Peak, and many others maintain a list of instructors who have completed their programs. These are usually searchable and publicly available to those looking for instructors in their area.”
The price of instruction is also a factor. Leah has some recommendations on that front.
“If cost is a consideration, look for Pilates training facilities that employ apprentices. A comprehensive Pilates training is 500 hours usually performed over 12-18 months. The Air Force let my husband fly a plane by himself in fewer hours than it took me to complete my apprenticeship. Good training schools take this seriously! This is a long-winded way of saying apprentices aren’t bad or low quality. They are just people somewhere in their 500-hour journey, of which, about 250 are teaching hours. They are also often under the supervision of a Master Instructor who may help them plan a session or may jump in to offer their expertise (so you get a Master Instructor at the apprentice rate—woohoo!).”
Also, Pilates tends to be more aerobic than tai chi or yoga, so heat and fatigue could be issues (especially if they don’t keep the room cool enough!). If you are doing a reformer class (a custom Pilates machine), it can be more challenging on balance, so the instructor to participant ratio should be high. Lastly, some postures can fire up our Lhermittes (the spine buzzing sensation MSers often experience when bending the head down toward the chest).
CHOOSING YOUR STUDIO
We have a few tips to keep in mind when you start your Pilates program in order for you to have a pleasant experience.
Talk to your doc. I know, I know, you hear this all the time, but it’s smart to first talk to your primary care physician and/or your neurologist.
Experiment. Try out a class at your local gym or Pilates studio. Then try another class with a different instructor. And then try one more class with a different instructor still. Go back to the one you like best and who best fits your exercise style and needs. Some instructors have ungodly challenging classes while others are so effortless that you might as well be taking a nap.
Temperature matters. Pay attention to your workout room and class times. If heat gives you problems, choose a gym that keeps their rooms on the cool side and aim for morning sessions when these areas tend be cooler. Additionally, classes during off times are less crowded meaning fewer bodies to generate heat. But really, a professionally certified instructor with 500 hours of training should have your back. Leah: “They should know to change the AC for clients with MS just as they should know not to distally load a post-op ACL repair client or that someone without an anterior approach hip replacement cannot perform external rotation for 6 weeks/until cleared by their doctor. That’s how fundamental it should be. Special populations and contraindications are a huge part of training and testing. However, this is always something worth discussing with the instructor before a group session or during your first private session. If you have any concerns about their ability to work with you, find another instructor.”
TYPES OF CLASSES/EQUIPMENT
Reformer. This custom piece of Pilates equipment might look like a funky torture device, but really it’s a helpful device to get you into positions to maximize strength-building. I personally have limited experience on the reformer, but it is standard in many studios. Do not use it on your own without proper instruction.
Other apparatuses. “Joseph Pilates invented several pieces of equipment,” says Leah. “While the Reformer is the most common in studios, there is also the Trapeze Table/Cadillac, the Chair, the Magic Circle, the ladder barrel, and the spine corrector. At a classical studio, you might also see some of the more obscure equipment like the high chair, the baby chair, the guillotine, the ped-o-pull, or the foot corrector. We also have more modern adaptations like the arc and the springboard. Any and all of these things can be used in a class or private session and can be modified for use by anyone.”
Mat classes. Don’t overlook them in favor of classes that use the reformer. “It’s usually less expensive and it’s just as effective,” says Leah. “Joseph Pilates creates the mat repertoire first and then his equipment to assist in doing those same exercises correctly. I see a lot of clients who believe a class is better because there is equipment, and that’s not the case. Both are equally effective. Mat can actually be more challenging because participants rely on their own bodyweight and core strength to perform the movements, not the assistance or resistance from the springs. The main consideration here is getting on and off the floor. In a private session, mat work can be done on the Cadillac, which is 12-24” off the ground. A clinical height Cadillac is 24” and what you’ll typically find in a PT clinic, and it’s the most comfortable height for getting on/off.”
Pace yourself. Go at your own pace. If a certain exercise bothers you—your Lhermittes gets fired up, you get too hot, whatever—take a break. Your Pilates instructor can likely suggest alternative positions that would work better for you. By the same token, if you feel you are not challenged enough, ask the instructor to show you a more difficult technique.
Home advice. For those on tight budgets, limited free time, or with transportation issues, you can practice Pilates at home once you are comfortable with traditional Pilates movements learned at your classes. We recommend getting a few lessons under your belt to ensure proper form. It also helps to have a yoga/Pilates mat (two popular ones here and here).
Reading suggestions. To build on your Pilates experience, reading and reviewing the fitness practice is essential. Leah’s recommendations on that front: “I recommend Return to Life Through Contrology by Joseph Pilates for anyone looking to seriously understand Pilates and its purpose. I also like Pilates for Dummies. It gives a great breakdown of the exercises in more detail than Return to Life and incorporates a lot of anatomy information. It’s written by Ellie Herman, who invented the Springboard, a hugely popular modern adaptation of the Tower.” I don’t understand that last sentence, but I do own Pilates for Dummies (the title suited me perfectly) and I can attest it is a great, helpful guide.
Pilates Virtually. “It doesn’t matter where you live—you can take class in New York or London or Hawaii from the comfort of your home,” says Leah. “Prices are also generally more budget-friendly this way. As an instructor who has taught online for about a year and a half, I don’t think the quality suffers. That was my main concern going in, but a well-positioned camera and a good internet connection makes watching form and alignment and providing feedback just as easy as it is in the studio. We lose tactile cues, but that just forces the instructor to get creative and to find new ways to explain the exercise or movement.” Leah recommends Pilates Anytime, which is $18/month and has classes suitable for all levels and abilities with plenty of modifications. “There’s also a nice discussion with Mari Winsor that can be viewed without a subscription and don’t miss her 15 Min Mat class with Mari. Mariska Breland is another great resource. She has MS and is a Pilates Instructor. She has a workshop on Neuroscience and Exercise (cost is $69).”
Social Media Classes. There are classes going on through Facebook and Instagram live as well. “The instructor can’t see the participants in these types of classes, so my rule of thumb is do what you can, modify when you need, and respect your body enough to know when not to push any harder,” says Leah. “Pilates is not a ‘more is better’ modality, so do what feels right. Make the exercise harder by paying more attention to your form rather than holding an exercise longer or doing more reps, even if the instructor calls out more reps! Like Joseph Pilates said, ‘A few well-designed movements, properly performed in a balanced sequence, are worth hours of doing sloppy calisthenics or forced contortion.’”
You can do this! Leah cannot emphasize this enough. “Even people who cannot ‘move’ and toddlers can do Pilates. Theo St. Francis is a quadriplegic who has been a huge advocate for Pilates. He and Stephanie Behrendt, a Pilates instructor, are doing really interesting research and work studying neurological reconnection. And Joakim Valsinger does Pilates with his toddler who has Prader Willi Syndrome to help with his poor muscle tone and coordination issues. Plus, a toddler doing Pilates is just really stinking cute.”
Pilates has the potential to help those with multiple sclerosis in many common problem areas: balance, body awareness, stress, spasticity, and strength to name just a few. As a refreshing mind/body workout, it’s a great alternative—or accompaniment—to tai chi and yoga. Physical therapists often recommend Pilates to help rehabilitate injuries since it incorporates low-impact movements in a gentle, graceful manner. But it is far more than that.
And your MS will thank you.