While at the gym a couple of weeks ago, my friend and I were surprised to see an extended
Dr. Oz TV segment on pelvic prolapse. Dr. Oz was attempting to bring a common cause of incontinence and other abdominal issues, a largely undiscussed topic, into the mainstream. My workout partner found the length and depth of discussion excessive, while I found it refreshing. I had just concluded a lengthy exchange with a client (a nurse) experiencing pelvic prolapse issues. Understandably concerned about pelvic floor stability, she researched the condition on the internet, and asked me questions more appropriate for her doctor. In her research, she found numerous articles recommending Pilates to strengthen pelvic floor stability and manage pelvic prolapse, and one recommending against Pilates for pelvic prolapse. She asked my opinion, based on her specific circumstances. Not being an expert on pelvic prolapse, let alone her situation, I read up on the subject, but couldn't find any data to support the claims of the web site alleging Pilates was detrimental (nor did they cite any research studies). Their concerns seemed contrary to common sense -- a good instructor, observing modifications, would avoid the situations they stressed as unhealthy.
I was uncomfortable with the situation for several reasons. Personal trainers and Pilates instructors are not physicians or nurses. We don't have access to patient medical files, nor do we have the appropriate training or background to make a diagnosis or prescribe treatment. The beauty of Pilates is that it has a set order and exercise design to accommodate the whole body and provide a comprehensive workout for anyone. Instructors should modify exercises for the safety of individuals and to help clients succeed, but should continue to progress and refine as much as clients are able.
Still, after all the recent discussion about pelvic prolapse, I was happy to see in
Nov-Dec 2010 IDEA Fitness Journal, that researchers have found a 12 week Pilates progam can improve muscle strength in the pelvic floor as effectively as 12 weeks of pelvic floor training. Study results were published in the
International Urogynecology Journal (2010; 21[4], 401-408).
Researchers from
Atlantic Health Division of Urogynecology in Morristown, NJ wanted to determine whether a Pilates program and a Pelvic Floor Muscle Training (PFMT) were equally effective in developing pelvic muscle strength. They randomly assigned 62 women with little or no pelvic-floor dysfunction to either Pilates or PFMT training twice a week, for one hour. Data analysis showed all participants improved pelvic floor muscle strength.
Patrick Culligan, MD, director of urogynecology at Atlantic Health and lead study author, said, "The Pilates group received all the pelvic-floor benefits enjoyed by the PFMT group, but they also received [the] full-body benefits of Pilates as well. Therefore, the Pilates program was the clear winner. All of the benefits enjoyed by the PFMT group were rather 'private,' whereas the Pilates group received those benefits PLUS better overall strength, flexibility, posture and confidence. The drawback of PFMT treatments is that they were 'medicalized': in other words, the patients had to go to a medical office and get undressed. On the other hand, the Pilates group received their instruction in a comfortable studio, fully clothed."
What about my client? In desperation, I requested a medical release from her doctor to continue Pilates, as a means of forcing her to have an in-depth discussion about her situation and her internet research with her doctor. She hasn't been back, so I assume she hasn't had that conversation. Thank goodness Dr. Oz is taking the discussion mainstream. The even better news is that research supports Pilates as a means of strengthening the pelvic floor while providing a comprehensive workout.
