Pilates Exercise Prescription: Knee Injuries

Over the years, in my Physical Therapy and Pilates center,  I have used Pilates exercises and principles to rehabilitate numerous patients with knee injuries. The outcomes have been excellent, and I have always believed that this has something to do with the increased core strength and enhanced mind-body connection these patients achieve.  Although there is still not a lot of published research on Pilates for the lower extremity, it is generally agreed upon that the rationale for use of a Pilates program for lower extremity issues is based on this concept of core strengthening (Wilson J.D. et al. 2005). 

One study by Zuzulak et al (2007) prospectively measured core neuromuscular control properties of active proprioceptive repositioning and trunk displacement in female collegiate athletes, then tracked their injuries for 3 years.  They found that deficient trunk stability was a risk factor for anterior cruciate ligament (ACL) injury. This and other research implies that decreased core stability may predispose one to lower extremity injuries, and suggests that achieving core stability is crucial to establishing a stable base for movement of the extremities.  Pilates then, which has been shown to improve core strength (Emery et al. 2010; Kloubec 2010), is an ideal exercise modality for treatment and prevention of lower extremity injuries.  

A recent study out of Istanbul University (Celik and Turkel 2017) looked specifically at the effects of Pilates on muscle strength, function, and knee instability for patients with a partial ACL tear in which non-surgical treatment was preferred.  Fifty participants between 20 and 45 years of age were randomly assigned to either the Pilates exercise group or the control group. The authors designed a specific program of basic Pilates mat exercises focused on core stability and lower extremity strength and flexibility.  Subjects in the exercise group participated in a 60-minute group class 3 times per week for 12 weeks. The control group did not receive any treatment nor a home exercise program. Functional scores and isokinetic strength were assessed at baseline and at the end of the 12 weeks by a physical therapist. 

Per quadriceps strength testing, the Pilates group experienced significant improvement over that of the control group.  Though both groups showed improvement in knee function, the Pilates group results were of a larger magnitude. According to the responses of the patients in the Pilates group on the Global Rating of Change scale, 88% stated that they felt much better in terms of stability and 12% reported they were slightly better.  The authors believe that the decreased feelings of the knee “giving way” reported by the Pilates group were due to the improved core strength achieved. In the control group, only 23% reported to be slightly better, 38% felt the same and 38% said they had deteriorated slightly. 

This study concluded that participation in Pilates resulted in superior recovery when compared to no exercise participation.   The authors suggest that because Pilates was shown to improve quadriceps strength and subjectively increase both knee stability and function; it provides a good option when choosing a treatment for a partial ACL injury.

References:

Celik, D. and Turkel, N. 2017. The effectiveness of Pilates for partial anterior cruciate ligament injury.  Knee Surg Sports Traumatol Arthrosc 25(8): 2357-2364.

Emery K, De Serres SJ, McMillan A, Cote JN. 2010. The effects of a Pilates training program on arm-trunk posture and movement. Clin Biomech 25:124-130.

Kloubec JA. 2010. Pilates for improvement of muscle endurance, flexibility, balance and posture.  J Strength and Conditioning Research 24(3): 661-7.

Wilson J.D. et al. 2005.  Core stability and its relationship to lower extremity function and injury.  J Am Acad orthop Surg 13:316-25. 

Zazulak B.T, T.E. Hewett, N.P. Reeves, B. Goldberg, and J. Cholewicki. 2007. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med 35(7):1123-30.

Samantha Wood is a licensed physical therapist since 1997, PMA Certified Pilates Instructor, Yoga Alliance certified teacher, and an international educator and Associate Faculty member for BASI Pilates®.