Effect of Pilates Mat Exercises on Neuromuscular Efficiency of the Multifidus and Internal Oblique Muscles in a Healthy Ballerina.
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.
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.
(1.) Baker J, Scott D, Watkins K, et al. Self-reported and reported injury patterns in contemporary dance students. Med Probl Perform Art. 2010 Mar;25(1):10-5.
(2.) Rafferty S. Considerations for integrating ftness into dance training. J Dance Med Sci. 2010 Jun;14(2):45-9.
(3.) Bronner S, Ojofeitimi S, Rose D. Injuries in a modern dance company: effect of comprehensive management on injury incidence and time loss. Am J Sports Med. 2003 May-Jun;31(3):365-73.
(4.) Russell JA. Preventing dance injuries: current perspectives. Open Access J Sports Med. 2013 Sep;4:199-210.
(5.) Khan K, Brown J, Way S, et al. Overuse injuries in classical ballet. Sports Med. 1995 May;5(19):341-57.
(6.) Hincapie CA, Morton EJ, Cassidy JD. Musculoskeletal injuries and pain in dancers: a systematic review. Arch Phys Med Rehabil. 2008 Sep;89(9):1819-29.
(7.) Smith TO, Davies L, de Medici A, Haddad F, Macgregor A. Prevalence and profile of musculoskeletal injuries in ballet: a systematic review and meta-analysis. Phys Ther Sport. 2016 May;19:50-6.
(8.) Smith PJ, Gerrie BJ, Varner KE, Mc-Culloch PC, Lintner DM, Harris JD. Incidence and prevalence of musculoskeletal injury in ballet: a systematic review. Orthop J Sports Med. 2015, July 63(7):2325967115592621.
(9.) Murgia C. Overuse, tissue fatigue, and injuries. J Dance Med Sci. 2013 Sep;17(3):92-100.
(10.) Sekendiz B, Altun O, Korkusuz F, Akin, S. Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females. J Bodyw Mov Ter. 2007 Oct;11(4):318-26.
(11.) Kloubec JA. Pilates for improvement of muscle endurance, flexibility, balance, and posture. J Strength Cond Res. 2010 Mar;24(3):661-67.
(12.) Sewright K, Martens DN, Axtell RS, Rinehardt. Effects of six weeks of Pilates mat training on tennis serve velocity, muscular endurance, and their relationship in collegiate tennis players. Med Sci Sports Exerc. 2004 May;36(5):S137.
(13.) Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008 Feb;7(1):39-44.
(14.) Hubscher M, Zech A, Pfeifer K, et al. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010 Mar;42(3):413-21.
(15.) Kiani A, Hellquist E, Ahlqvist K, Gedeborg R, Michaelsson K, Byberg L. Prevention of soccer-related knee injuries in teenaged girls. Arch Intern Med. 2010 Jan;170(1):43-9.
(16.) Knapik JJ, Bullock SH, Canada S. Influence of an injury reduction program on injury and fitness outcomes among soldiers. Inj Prev. 2004 Feb;10(1):37-42.
(17.) Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012 May 2;94(9):769-76.
(18.) Walden M, Atroshi I, Magnusson H, et al. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ. 2012 May 3;344:e3042.
(19.) Wedderkopp N, Kaltoft M, Lund-gaard B, et al. Prevention of injuries in young female players in European team handball: a prospective intervention study. Scand J Med Sci Sports. 1999 Feb;9(1):41-7.
(20.) Watson T, Graning J, McPherson S, et al. Dance, balance and core muscle performance measures are improved following a 9-week core stabilization training program among competitive collegiate dancers. Int J Sports Phys Ther. 2017 Feb;12(1):25-41.
(21.) Kolyniak IEGG, Cavalcanti SMB, Aoki MS. Isokinetic evaluation of the musculature involved in flexion and extension of the trunk. Pilates Method Effect. Rev Bras Med Es-porte. 2004 Dec;10(6):487-90.
(22.) Kliziene I, Sipaviciene S, Vilkiene J, et al. Efects of a 16-week Pilates exercises training program for isometric trunk extension and flexion strength. Bodyw Mov Ther. 2017 Jan;21(1):124-32.
(23.) Patti A, Bianco A, Paoli A, et al. Effects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine (Baltimore). 2015 Jan;94(4):e383.
(24.) Araujo MEA, Silva EB, Bragade DM, et al. The effectiveness of the Pilates method: reducing the degree of nonstructural scoliosis, and improving flexibility and pain in female college students. J Bodyw Mov Ter. 2012 Apr;16(2):191-8.
(25.) Posadzki P, Lizis P, Hagner-Deren-gowska M. Pilates for low back pain: a systematic review. Complement Ther Clin Pract. 2011 May;17(2):85-9.
(26.) Natour J, Cazotti LA, Ribeiro LH, et al. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015 Jan;29(1):59-68.
(27.) Stieglitz DD, Vinson DR, De Coux Hampton M. Equipment-based Pilates reduces work-related chronic low back pain and disability: a pilot study. J Bodyw Mov Ther. 2016 Jan;20(1):74-82.
(28.) Bryan M, Hawson S. The benefits of Pilates exercise in orthopaedic rehabilitation. Tech Orthop. 2003 Mar;18(1)126-9.
(29.) Muscolino JE, Cipriani S. Pilates and the "powerhouse"--I. Bodyw Mov Ter. 2004 Jan;8(1):15-24.
(30.) Mares G, Oliveira KB, Piazza MC, et al. The importance of central stabilization in Pilates method: a systematic review. Fisioter Mov. 2012 Jun;25(2):445-51.
(31.) David P, Mora I, Perot C. Neuromuscular efficiency of the rectus abdominis differs with gender and sport practice. J Strength Cond Res. 2008 Nov;22(6):1855-61.
(32.) Deschenes MR, McCoy RW, Holdren AN, Eason MK. Gender influences neuromuscular adaptations to muscle unloading. Eur J Appl Physiol. 2009 Apr;105(6):889-97.
(33.) Goulart NBA, Dias CP, Lemos FA, et al. Gymnasts and non-athletes muscle activation and torque production at the ankle joint. Rev Bras Cineantropom Desempenho Hum. 2014 Sep/Oct;16(5):555-62.
(34.) Deschenes MR, Giles JA, McCoy RW, et al. Neural factors account for strength decrements observed after short-term muscle unloading. Am J Physiol Regul Integr Comp Physiol. 2002 Feb;282(2):R578-83.
(35.) Magalhaes I, Bottaro M, Mezzarane RA, et al. Kinesiotaping enhances the rate of force development but not the neuromuscular efficiency of physically active young men. J Electromyogr Kinesiol. 2016 Jun;28:123-9.
(36.) Racinais S, Periard JD, Li CK, Grantha J. Activity patterns, body composition and muscle function during Ramadan in a Middle-East Muslim country. Int J Sports Med. 2012 Aug;33(8):641-6.
(37.) Aragao FA, Schafer GS, Albuquerque CE, et al. Neuromuscular efficiency of the vastus muscles lateral and biceps femoris in individuals with of anterior cruciate ligament. Rev Bras Ortop. 2015 Mar/Apr;50(2):180-5.
(38.) Hides JA, Stokes MJ, Saide MJGA, et al. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 1994 Jan;19(2):165-72.
(39.) Hodges PW, Richardson, CA. Contraction of the abdominal muscles associated with of the lower limb. Phys Ther. 1997 Feb;77(2):132-42; discussion 142-4.
(40.) Pilates JH. Return to Life Through Contrology. Miami, Florida: Pilates Method Alliance, 1945.
(41.) Lessen DL. The PMA Pilates Certification Study Guide (3rd ed). Miami, Florida: Pilates Method Alliance, 2014.
(42.) Silva GB, Morgan MM, Carvalho WRG, et al. Electromyographic activity of rectus abdominis muscles during dynamic Pilates abdominal exercises. J Bodyw Mov Ter. 2015 Oct;19(4):629-35.
(43.) Marques NR, Morcelli MH, Hallal NR, Goncalves M. EMG activity of trunk stabilizer muscles during centering principle of Pilates Method. J Bodyw Mov Ter. 2013 Apr;17(2):185-91.
(44.) Marshall P, Murphy B. The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement. J Electromyogr Kinesiol. 2003 Oct;13(5):477-89.
(45.) Hermens JH, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000 Oct;10(5):361-74.
(46.) Goncalves M, Marques NR, Hallal CZ, Van Dieen JH. Electromyographic activity of trunk muscles during exercises with flexible and non-flexible poles. J Back Musculoskelet Rehabil. 2011 Dec;24(4):209-14.
(47.) Latey P. The Pilates Method: history and philosophy. J Bodyw Mov Ter. 2001 Oct;5(4):275-82.
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; firstname.lastname@example.org.
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
Please Note: Illustration(s) are not available due to copyright restrictions.
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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|
|Date:||Apr 1, 2019|
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