1. Breathing For a correct execution of the Pilates exercises, proper breathing is paramount because with it comes the contraction of the deep muscles. When starting with the method, the patient was instructed to breathe properly, with deep and complete inhalation and exhalation. The directions on how to breathe properly were provided in the first treatment session. The transverse muscle contraction must be the result of forced exhalation, therefore favoring the stability of the entire lumbar spine and pelvis, favoring the relaxation of the inhalation muscles and cervical muscles. The proper breathing can be described by the synchronized motion in the following order: 1. Chest inhalation; 2. Upper chest exhalation; 3. Lower chest exhalation; 4. Abdominal exhalation. Those moments must occur together with the muscle action. 2. Spine Stretch The patient sat on the sit bones, keeping the alignment of the physiological curves of the spine. With knees in extension and the hip in the maximum abduction. The hands were in front of the body, on the floor. The patient inhaled in this posture, followed by a forced exhalation taking the hands ahead of the body. At that moment, the movement started from the cervical vertebrae. The command given to the patient was to "roll up" the vertebrae and later to "roll down," returning to initial posture. 3. The Spine Twist In this exercise, the initial posture is similar to the one of the Spine Stretch. What differs is the positioning of the arms. The arms were in a 90° alignment of flexion and shoulder abduction with the extension of the elbows, keeping proper alignment in order to avoid bending the knees. In this posture, the patient inhaled. Followed by a forced exhalation while taking one of the hands towards the opposite foot, stretching the trunk rotators. 4. The Hundred The patient remained in the supine position, with hip and knees bent, both at 90º; and plantarflexion. The arms were resting alongside the body, with the extension of elbows and palms on the supporting surface. Then, the patient inhaled. Exhalation occurred right after when the patient moved the arms in the air quickly and in sync with the breath, while remaining with a cervical flexion, lifting the scapulae off the floor. 5. The one-leg circle The patient was in the supine position with the lower limbs extended, feet in plantarflexion, with the upper limbs resting alongside the torso and hands on the support surface. The patient performed rotation movements with one of the legs, with the iliac spines facing up all the time. Inhalation was made at the moment of the highest instability of the exercise, that is, during the rotation of one of the legs. 10 repetitions were performed for each side. 6. The Plank This exercise consists of a lateral plank where the patient lies sideways putting the weight on the forearm at a 90º angle. The knees remained in a 90° flexion. The hip in a neutral position and lifted in the air, only supported by the forearm and knee. The opposite arm, the one that does not receive weight, rested alongside the body. The patient performed the isometric exercise for no more than 10 repetitions. Followed by a sequence on the opposite side. 7. Leg Pull Front (Cat or four-support) In this exercise, the patient was positioned in four-supports: the hips in a 90º flexion to the thighs and the thighs in 90º with the legs. The shoulders, elbows and wrists remained similarly in the same direction. After positioning, and with the torso well stabilized, concomitantly, the patient performed the extension of one leg and the extension of the contralateral arm. The alignment of all structures was important to maintain a posture similar to the plank and always preserving the physiological curvature of the spine. The move was performed during exhalation. 8. Swimming To perform this exercise, the patient lay on the stomach, with knees and shoulders extended (arms stretched overhead). Alternately, dissociating the upper and lower limbs, the patient performed a movement similar to swimming. The exercise activates the paravertebral. While raising one of the upper limbs, there was the hyperextension of the contralateral hip. The move was performed during exhalation. The return to the starting position was during inhalation. 9. Rocking The patient was in the prone position, with knees in maximum flexion (stretching the quadriceps muscle). The hands held the feet, keeping elbows in flexion. The patient extended the elbows and the knees. At that time, the patient took a forced exhalation. 10. Swan The patient was in the prone position, with the hands on the floor in the direction or above the shoulders. Then, the patient raised the chest off the supporting surface. The pelvis remained in contact with the floor during the performance. When pushing the floor with the hands, the patient took a forced exhalation. Description of conventional stretching and strengthening exercises These postures were based on Kisner and Colby1717 Kisner C, Colby LA. Exercícios terapêuticos - fundamentos e técnicas, 5ª ed. Barueri: Manole; 2009. and selected according to studies by Macedo and Briganó1818 Macedo CS, Briganó JU. Terapia manual e cinesioterapia na dor, incapacidade e qualidade de vida de indivíduos com lombalgia. Espaç Saúde. 2009;10(2):1-6. and Franco1616 Franco BAS. Avaliação da eficácia de um protocolo de exercícios físicos baseados no método Pilates e nas variáveis dor lombar, flexibilidade e força muscular em profissionais de enfermagem com lombalgia crônica idiopática [tese]. São Paulo: Universidade de São Paulo; 2010.. 1. Strengthening glutes The patient stayed in the supine position with the knees bent and feet in parallel on the floor. The exercise was done with the patient pressing the upper part of the spine against the floor, without lifting the heels. 2. Strengthening ABS The patient stayed in the supine position with knees bent and feet on the floor with the lumbar spine rectified and supported on the same surface. It started with a posterior tilt of the pelvis, raising the head from the floor, which causes a stabilizing contraction of the abdominal muscles. Then, the chest was raised until the shoulder blades were out of the floor. 3. Stretching hamstrings The patient stayed in the supine position with the hip and knee extended and the contralateral leg flexed supported on the floor. Then, the stretched leg was raised towards the chest. 4. Strengthening the torso The patient was on all fours with the hands on the floor. The participant was instructed to perform a pelvic tilt before extending the lower limb. This limb would be stretched to align the hip, and the opposite arm extended overhead simultaneously with the leg extension. While the leg was stretched, the arm raised up to the shoulder. 5. Stretching the anterior torso and strengthening torso extensors The patient was in the prone position, with the hands on the floor in the direction or above the shoulders. After that, the individual raised its chest, keeping the pelvis in contact with the floor. When pushing the floor with the hands, the patient also pushed the shoulder to depress the scapula. 6. Stretching hip adductors With the patient in the supine position, with knees bent and tights in adduction and the feet with the posterior face one against the other. The subject stretched with the arms in shoulder flexion above of the head. 7. Rocking the knees The patient, in the supine position, performed moves from one side to the other with the knees bent and thighs in adduction and bent. 8. Abdominal with partial torso lift and rotation The patient stayed in the supine position with knees bent and feet on the floor with the lumbar spine rectified and supported on the same surface. It started with a posterior tilt of the pelvis, then raising the head off the floor. Then, the chest was raised until the ipsilateral scapula left the floor, rotating the torso towards the opposite knee. 9. Piriformis stretching The patient, in the supine position, crossed one leg over the other with the ankle on the knee, bringing the opposite knee towards the chest to create the stretching. 10. Knee to chest unilateral The patient was in the supine position, with the hip and knee bent unilaterally with the opposite leg extended took the bent limb towards the chest.
|