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Unit A – Hong Kong | 1 – 3 Oct 2021
October 1 @ 8:00 am - October 3 @ 5:00 pm$1920
UNIT A | MODULE 1 + 2
This is a 3 day course, running 9am till 5.30 pm
- Lumbo pelvic stability & asymmetry
- Patient subgrouping & setting patient specific treatment programs
- Problem solving complex patient presentations
- Functional stability tests & outcome measures
- Cervico thoracic & shoulder girdle stability treatment
- Chronic pain made simple via pattern recognition heuristics.
- Pelvic floor vs bowel & bladder – what are we missing?
- Differentiation of radiological findings
- Function or structure – differential diagnosis tools
- Exercises as clinical tests & treatment tools
- Case studies
This module covers Matwork, Reformer & Trapeze Table work that bears most relevance to patient treatment pathways.
UNIT A – MODULE 1
The Clinical Pilates approach continues to develop as the literature constantly evolves. These changes have
occurred in light of research moving the focus towards impairment based management heralding the
introduction of MBCT (movement based classification & treatment) and the traditional structure based
classification model is no longer supported by the literature. Health reform has also highlighted that chronic
problems need a more cost effective treatment framework based on strong outcome prediction. The unique
MBCT patient subgrouping tool is introduced in this stage of the course. MBCT allows heterogenous, patient
specific exercise treatment programmes to drive more successful management.
Over the last 15 years there has been a growing body of literature rebutting training of isolated muscle
activity i.e. transversus/multifidus (Macdonald, 2006, Alison 2008, Morris 2013) with the focus now on function,
not isolated muscle. This change in focus is further borne out by current motor control literature which does
not support conscious (explicit) muscle training, finding it is not particularly robust, with more support for non
conscious, task orientated (implicit) muscle control training (Benjaminse 2011).
The Clinical Pilates programme has long embraced the shift towards function, with clinical outcome
prediction rules recently validated by Tulloch et al at Otago University (Tulloch E 2012). The simple clinical tests
used in this paper highlighted a new process for identifying a patient’s subgroup & managing
functional/proprioceptive changes based on that subgroup. These proprioceptive deficits are often
identified as the underlying cause for many structural injuries as seen with recurrent injuries, ACLs, falls etc.
The MBCT predictor algorithm, taught in this first module has near perfect inter rater reliability,(.87 Kappa)
showing robust agreement in a broad cross section of DMA trained clinicians (Tulloch E 2012, Yu K 2015).
The key to this predictor algorithm lies in using a process of heuristics & “pattern recognition”, as described by
Wainner (2007). Cardiology literature has used pattern recognition and led the way in simplification of the
diagnostic process, proving that clinicians can effectively predict patient treatment outcome based on 4 key
points. Heuristic information is more effective than the traditional barrage of tests, which ultimately contradict
each other, confusing rather than clarifying the diagnosis (Reilly, Goldman, Chin 2006).
Directional exercise treatment application, already proven with the McKenzie approach, completes the
components that are taught at this stage of the programme, that make up the subgrouping process.
Melbourne University, RCT showed a measurable (46% vs 29%, p=0.07) finding that a Clinical Pilates
programme was better than a general exercise approach, in a chronic, low back pain population over a
relatively short 6 week period.
The current approach to patient management now being proposed with Clinical Pilates training now follows
2 pathways :-
• In the acute injury phase, a structural micro management approach is applicable for 6 – 12 weeks,
during which tissue based, manual therapy and homogenous exercise is the focus of treatment
• In the chronic phase, the focus moves to a macro-management, impairment based approach,
addressing function with heterogeneous exercise programmes that are patient specific and can be
measured for efficacy.
module 2 develops on the treatment prediction algorithm taught in module 1 to cover 3 main topics:
– the use of the directional model in assessment
– identifying & managing “complex” chronic pain/central sensitisation / dysautonomia
– implicit motor control training of pelvic floor in females & males – beyond the “bowel & bladder”
Many musculo skeletal assessments aimed at a structural diagnosis are found to be not structurally
specific.(Cook 2010) Added to this, many tests are carried out in a position or direction that may lead to a
false finding, e.g. a positive hamstring sign with patient in supine that is absent in prone, despite the same
muscle being tested, or a positive hip quadrant that eases when the patient is tested in elbow prop, a
position of potentially greater impingement. Directional assessment tools may be a better process of testing
“structure” as a differential diagnosis (Hughes 2008).
The chronic patient population is causing significant concern in the current health models and “central
sensitisation” appears to be a major contributor to this problem (Janig 1996). The relationship between
hypermobility & dysautonomia (disturbance in autonomic function) is a common finding in the
“chronic/sensitized group” and a strong body of evidence exists that highlights the link to hypermobility,
mechanical spinal cord pressure and cervico thoracic trauma. These patients are often classified under a
wide range of diagnoses such as Chronic Fatigue Syndrome/Fibromyalgia/ME/IBS and the like. Ironically the
symptoms are all very similar (Gazit 2003).
While exercise is strongly promoted with the chronic pain population, a directional subgrouping model, is
paramount to minimize symptoms directly related to spinal cord compression (Karlsson 2006). A checklist of
symptoms including nausea, dizziness, postural tachycardia syndrome, postural orthostatic intolerance, low
blood pressure and gut disturbance can highlight this potential co-morbidity, which often seems to underlie
Pelvic floor literature is also addressed in this stage of the course, looking at the effect of inappropriate “core
stability” strength training on pelvic floor muscle (PFM) function in both males & females. Excessive cueing of
pelvic floor can be detrimental in the absence of any dysfunction and equally ineffective when there is frank
dysfunction (Thompson 2006). Implicit motor training processes, incorporating inspiratory breathing control,
provide a more efficient method of PFM training, which is highlighted using real time ultrasound.
This level builds on the module1 knowledge to incorporate the systematic use of outcome predictors with
outcome questionnaires to measure the efficacy of the clinicians decision making process and treatment
REFERENCESAllison GT et al (2008) Feedforward Responses of Transversus Abdominis Are Directionally Specific and Act Asymmetrically: Implications
for Core Stability Theories JOSPT, May 2008 vol 38,5
Morris S, Lay B and Allison GT (2011) Corset hypothesis rebutted — Transversus abdominis does not co-contract in unison prior to rapid
arm movements http://dx.doi.org/10.1016/j.clinbiomech.2011.09.007
Benjaminse A, Otten E (2011) ACL injury prevention, more effective with a different way of motor learning? Knee Surg Sports Traumatol
Arthrosc (2011) 19:622–627
Wainner R et al (2007) Regional Interdependence:A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys
MacDonald D, Moseley L Hodges P (2006) The lumbar multifidus: Does the evidence support clinical beliefs? Manual Therapy 11
Reilly, B, Evans A (2006) Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To
Make Decisions. Annals of Internal Medicine Vol 144 • No 3 207
Tulloch E, Phillips C, Soles G,Abbott H (2012) DMA Clinical Pilates Directional Bias Assessment: Reliability and Predictive Validity
J Orthop Sports Phys Ther :42(8): 676-687
Wajswelner, H, Metcalf B, & Bennell K. (2012) Clinical Pilates versus General Exercise for Chronic Low Back Pain: A Randomized Trial.
Med. Sci. Sports Exerc., Vol. 44, No. 7, pp. 1197–1205Hughes PC, Taylor NF, Green RA (2008) Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Australian Journal of Physiotherapy 54: 159–170
Gazit, Y., Nahir, A. M., Grahame, R., & Jacob, G. (2003). Dysautonomia in the joint hypermobility syndrome. The American Journal of Medicine, 115(1),
Karlsson A (2006) Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Progress in Brain Research, Vol. 152
Janig W, Levine JD and Michaelis M (1996): Interaction of sympathetic and primary afferent neurones following nerve injury and tissue trauma.Progress in Brain Research 113: 161-84
Thompson, J. A., O’Sullivan, P. B., Briffa, N. K., & Neumann, P. (2006). Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manouevre. Neurourology & Urodynamics, 25(3), 268-276.