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Effect of Pilates Mat Exercises on Neuromuscular Efficiency of the Multifidus and Internal Oblique Muscles in a Healthy Ballerina.

Ballet dancers have been shown to require physical training to strengthen their trunk muscles, improve performance, and avoid injuries, especially those in the lower back. (1-5) Such injuries are estimated to affect 95% of professional ballet dancers, (6)- (9) who therefore could benefit from exercises developed by Joseph Pilates that are aimed at increasing flexibility and endurance of the "core muscles." (10)- (12) The core is composed of 29 pairs of muscles that support the hip-pelvis-lumbar spine complex. (13) Core stability has been defined as the ability to control the positioning and movement of the trunk over the pelvis and to transfer strength to the upper and lower limbs. (14)- (20)

Pilates exercises have been shown to increase torque (21) and decrease lumbar pain in adult women. (22)- (28) This occurs because those exercises recruit the deep abdominal muscles that stabilize the vertebral segments. (29) To decrease impact on the body's joints, most Pilates exercises are done in the supine position on a mat or on specialized apparatus, such as the reformer, the cadillac, the ladder barrel, and the high chair. (21)

Pilates exercise may improve neuromuscular efficiency (NME), (30) which is commonly measured clinically or during sports activities, and defined as the relationship between the electrical activity and force of the muscles. (31) NME may vary according to gender, pathology, and training, conditions that can affect an individual's neuromuscular adaptation. (32)- (37)

The multifidus (MU) and internal oblique (IO) muscles, acting in co-contraction, stabilize the trunk and control the segmental movement of the spine, keeping it in a neutral position. (38)- (39) No studies have been found that investigate NME of the MU and IO in Pilates practitioners who are ballet dancers. Therefore, the aim of this study was to evaluate the NME of these core muscles through electromyography (EMG) analysis and a torque test, both of which were applied to a classical ballerina before and after a Pilates exercise intervention.


Our study involved one healthy 24-year-old amateur classical ballerina (50 kg, 1.66 meters, and 12 years of practice). The dancer had no previous experience with Pilates. During the study (8 weeks) she was engaged in no physical activities other than ballet, to which she dedicated 12 hours a week. The Pilates training sessions and tests were carried out before she embarked on a dance tour, on alternate hours with her regular ballet classes. All experimental procedures were conducted at the biomechanics laboratory in the department of physical education at Sao Paulo State University (UNESP), Rio Claro, Sao Paulo, Brazil. Our study was approved by the Ethics Committee of Piracicaba Dental School, University of Campinas (UNICAMP), Brazil (protocol: 5418/2017).

Before and after an 8-week intervention the ballerina was tested with a dynamometer for flexion and extension torque of the trunk to measure its isometric strength. Her right and left IO and MU muscles were examined with EMG for calculation of the NME. Comparisons of the torque, EMG, and NME results were obtained.

Training Program

The training program (Table 1) involved 16 45-minute sessions (two sessions a week, 2 days apart) of 18 mat exercises selected from the original 34 exercises listed in Return to Life (40) and in the Pilates Method Alliance (PMA) Study Guide. (41) The Pilates instructor is a professional physical educator with a certificate in Pilates (Power Pilates, New York, USA) and 6 years of experience in mat and apparatus Pilates instruction, beginner to advanced levels.


The isometric trunk torque exerted during the flexion and extension tests was measured with an isokinetic dynamometer (System 4 Pro, Bio-dex[R], Shirley, New York, USA) as the ballerina was sitting on a chair--an accessory of the dynamometer that is essential to evaluation of the trunk, as in this case. The hip angle was set at 90[degrees] (Fig. 1). (22) Tests included three 5-second repetitions for flexion and three for extension, performed alternately, with an interval of 30 seconds. The highest torque values were used to calculate NME.

Prior to the torque test, to avoid excessive forces and potential spinal damage and to familiarize the dancer with the test procedures, she underwent a submaximal isometric trunk flexion and extension warm-up. (31) For the flexion and extension tests, starting 10 minutes after the preliminary warm-up, (42) the dancer was instructed to keep her head immobile, arms crossed over her chest, and statically flex and extend her trunk to the maximum. (21)

The IO and MU muscles were chosen to represent the core muscles of the trunk because they are the main stabilizers of the spine. (38)- (39) To measure the EMG activity of the muscles, the electrodes were placed bilaterally: 2 cm medially and inferiorly to the antero-superior iliac spine for the IO and 3 cm from a line marking the spinous processes of L1 to L5 for the MU. (43)- (45) The electrode placement sites were shaved and cleansed with 70% alcohol to reduce impedance. (46)

A direct transmission system (No-raxon[R], Scottsdale, Arizona, USA) with the software myoMUSCLE (TELEmyo DTS, 16 channels, 1,500 Hz) was used to capture the EMG biological signals using 1 cm in diameter Ag-AgCl electrodes (Miotec[R], Porto Alegre, Rio Grande do Sul, Brazil), placed 2 cm apart. The software was set at a total gain of 2,000 times (20 times for the sensor and 100 times for the equipment) with an analog-digital converter resolution of 16 bits.

EMG signals were filtered (fourth order Butterworth) at frequencies ranging from 20 to 500 Hz and analyzed using the MATLAB[R] software version 2009 (MathWorks[R], Natick, Massachusetts, USA). The flexion and extension torque values were separately divided by the EMG value obtained from the sum of both muscles, resulting in the NME values for IO and MU32-37 where: NME = Torqueflexion / EMG(IOright + IOleft) and NME = Torqueextension / EMG(MUright + MUleft).


Our study is the first to provide evidence that Pilates is effective in improving neuromuscular efficiency in classic ballet dancers. Such improvement can be evidenced by an increase in maximal isometric torque and NME values and a decrease in maximum root mean square (RMS) values. The results of this study show an increase in torque for both flexion and extension (Table 2) and NME of IO and MU (Table 3) and a decrease in the EMG activity of both muscles (Table 4) after the Pilates intervention.


Previous studies have reported a significant increase in the isometric and isokinetic torque of the trunk flexors and extensors after Pilates training. (21-22) Such findings, with regard to the isometric torque, are in accord with those obtained in our study.

The NME is dependent on training intensity and monitoring, conditions prioritized in the Pilates method, which involves automatic recruitment of the trunk muscles, (47) providing them with greater force and lower EMG expenditure. (31)

The ability of the nervous system to recruit and coordinate the IO and MU muscles is related to the adaptation of such muscles to physical training, including Pilates exercises. Our analysis shows the dancer's muscles could adapt to the Pilates exercises, as they increased the torque and decreased the EMG activity.

This study has some limitations, such as the sample size (one ballerina) and, as it is the first of its kind, lack of comparison with scholarly equivalents. Further studies, including a larger number of dancers (preferably both genders as well as both professionals and amateurs), different Pilates exercises, and clinical cases, are needed to confirm our findings.


The study indicates that ballet dancers can benefit from Pilates exercises to improve their muscle strength and, consequently, their neuromuscular efficiency. Hence, it represents an initial step toward putting a scientific foundation under what is already the widespread use of these exercises in the dance community.


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Ana C. Panhan, MSc, Mauro Goncalves, PT, PhD, Giovana D. Eltz, PhD, Marina M. Villalba, Adalgiso C. Cardozo, PT, PhD, and Fausto Berzin, PT, PhD

Ana C. Panhan, MSc, and Fausto Berzin, PT, PhD, Department of Morphology (Anatomy), Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil. Mauro Goncalves, PT, PhD, Giovana D. Eltz, PhD, Marina M. Villalba, and Adalgiso C. Cardozo, PT, PhD, Department of Physical Education, Sao Paulo State University, Rio Claro, Sao Paulo, Brazil.

Correspondence: Ana C. Panhan, MSc, Morphology (Anatomy), Piracicaba Dental School, University of Campinas, Sao Paulo, Brazil;

Copyright [c] 2019 J. Michael Ryan Publishing, Inc.

Caption: Figure 1 The isometric trunk torque (flexion and extension) test on the isokinetic dynamometer.
Table 1 Types of Pilates Exercise and Number of Repetitions Per Session

Exercise               Repetition

Hundred                10 breathing
Roll up                 3
One leg circle          5 each leg
Rolling like a ball     6
Single leg stretch      5
Double leg stretch      6
Scissors                5
Lower-lift              5
Crisscross              5
Spine stretch forward   3
Corkscrew               3
Saw                     3 each side
Swan                    6
Single leg kick         6 each leg
Teaser                  3
Side kick               3 each leg
Seal                    6
Push up                 3

Table 2 Isometric Torque Peak (Nm) Before and After Pilates Intervention

           Before  After

Flexion     79.1    83.9
Extension  175.3   236.6

Table 3 Neuromuscular Efficiency Before and After Pilates Intervention

                                       Before  After

Torqueflexion/EMG(IOright + IOleft)    0.23    0.36
Torqueextension/EMG(MUright + MUleft)  0.70    1.16

Table 4 EMG Activity Expressed in Root Mean Square Microvolts Before
and After Pilates Intervention

            Before  After

IO muscles  342.4   234.5
MU muscles  265.7   202.3

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Author:Panhan, Ana C.; Goncalves, Mauro; Eltz, Giovana D.; Villalba, Marina M.; Cardozo, Adalgiso C.; Berzi
Publication:Journal of Dance Medicine & Science
Article Type:Report
Date:Apr 1, 2019
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