Jan 29, 2015
In Alignment

Sometimes, an athlete’s toughest opponent is his or her own biomechanical flaws. One way to correct them is through a form of Pilates called Contrology.

By Christine Romani-Ruby

Christine Romani-Ruby, MPT, ATC, is an Associate Professor in the Exercise Science Program at California University of Pennsylvania. She is also the owner of PHI Pilates and can be reached at: [email protected].

In 1934, Joseph Pilates wrote, “Incorrect habits are responsible for most of our ailments, if not all of them. Through proper education it is possible to replace bad habits with good ones.”

The creator of the Pilates exercise system, Joseph Pilates devoted a major part of his life to the scientific study of the body. Part of his work involved helping athletes to improve their performance through a method called Contrology, which is just as relevant today.

In Pilates’s own words, Contrology is “the conscious control of all muscular movements of the body. It is the correct utilization and application of the leverage principles afforded by the bones comprising the skeletal framework of the body. It is a complete knowledge of the mechanism of the body and a full understanding of the principles of equilibrium and gravity as applied to the movements of the body in motion, rest, and sleep.”

Today, we would simply refer to this as good biomechanics. More specifically, it is the connection between motor control and musculoskeletal function, and the effects both have on the pattern of muscle use and the shapes of the bones and joints.

As we closely examine athletes’ biomechanics in an effort to prevent injury and enhance performance, Pilates can be a very useful tool. Because of its emphasis on a balanced and controlled body, Contrology specifically can assist the athletic trainer or strength coach to uncover biomechanical flaws and help the athlete work toward correcting them.

BIOMECHANICAL FORCES

Both static and dynamic forces can lead to improper biomechanics. Static forces involve the effects of gravity on muscles, joints, and bones. For example, athletes naturally stand in a sway back posture, with their pelvis forward of the line of gravity. This posture is very common in swimmers and weight lifters because of a lengthened external oblique and shortened rectus abdominis. It leads to a decreased demand on the hip extensor muscles and results in significant atrophy of the gluteus maximus, setting the athlete up for stress to the hip and spine.

Static forces can also alter the shape of bones and joint surfaces. An athlete who presents with genu recurvatum (knee hyperextension) has a downward slope to the articular surfaces of the tibia, a displacement of the femur anterior to the tibia, and an inferior position of the patella. This alignment changes the stresses across the cruciate ligaments and leads to a weakening of the anterior cruciate ligament (ACL).

Improper static alignment continues to cause biomechanical problems when dynamic forces are introduced by creating moments that cause joint malalignment. These moments–as well as frequent patterns of movement–can become factors in movement system imbalance, as they can lead to changes in the recruitment pattern of muscles. This in turn can alter muscle performance and cause a change in the pattern of joint movement, and also create micro trauma to tissue from compensatory movements.

The good news is that these compensatory movements can be eliminated by practicing frequent and deliberate healthy movement patterns in an optimal posture. Contrology offers athletes a variety of apparatuses and exercises to accomplish optimal posture and balanced movement. Two of the main benefits documented in research are improvement in motor control (because of the emphasis on spinal stability) and the recruitment of the deep abdominal and pelvic floor muscles. Pilates equipment offers a variety of ways to apply progressive overload in a non-weight bearing position, which can be an invaluable tool in re-training reactions to dynamic forces.

One of the keys to Pilates exercises is one-on-one attention from a coach who can focus on proper execution and alignment. Visual and verbal cueing is essential to the program in order to provide the necessary stimuli for change. Repetitions are low and the exercises are layered to provide overload. Specific breathing patterns are incorporated into each motion, and we emphasize exhalation for the recruitment of the deep abdominal muscles.

Just like other bad habits, faulty movement patterns can be re-trained with persistence. However, the athlete needs undivided attention and practice to change the biomechanical flaw. With collaboration by the coach and the athlete, the result can be the prevention of future injury or a reduction and resolution of current pain.

CASE STUDY

One example of successful Contrology use with an athlete involved a 20-year-old female soccer player with a history of insidious onset right medial knee pain. While being observed, her static posture revealed medial rotation of the right femur and right tibial varum. When standing, her right patella faced medially and she supinated her right foot when it was in a forward position. The condition worsened when she performed a single-leg stance, with additional medial rotation of the femur.

When she was sitting, medial rotation of the femur was again noted. When she went from a sitting to a standing position, she demonstrated a medial collapse of the right knee.

This athlete’s introduction to Contrology began with a discussion of where her foot should be when standing. She had significant tibial torsion, and when she aligned her foot to the front, it would exacerbate the varus force. Therefore, we taught her to stand using a Pilates V, in which the feet are slightly turned out. This practice also requires the contraction of the deep outward hip rotators to create a sensation of “zipping and wrapping the legs together” to eliminate any light between the thighs. (See Figure One, below.)

Footwork: This body alignment was reinforced with Pilates footwork on the reformer apparatus. In these exercises, the spine is placed in alignment against the stable carriage of the reformer. The carriage or bed of the reformer allows constant proprioceptive feedback for the athlete to hold the neutral position of both the spine and the pelvis while performing the footwork with his or her lower extremities. The coach literally has a bird’s eye view of the lower extremities and can provide verbal and tactile cues to reposition the limbs so the athlete has optimal alignment. As the athlete practices footwork on the reformer, resistance can be modulated from very light to heavy, and can be set to target either core or limb strengthening.

First, the athlete performed the footwork in the Pilates V position, as this provides the most tactile feedback. (See Figure Two, below.) The motion involves not only knee flexion, but also ankle dorsiflexion against the spring resistance. This slow and progressive motion with feedback begins to build a new motor pattern, while also developing strength and flexibility that will create the necessary relationship for muscle balance in the lower extremities.

Next, she progressed to the same movement in a neutral stance, but with her feet still slightly turned out. Again the coach encouraged proper alignment with verbal and tactile cues.

The next phase involved each of these exercises using a single-leg stance. This often takes a while to progress to, and with varus alignment it is important to also address weight shift for the single-leg stance. As the weight is shifted from both to one lower extremity it is important that the pelvis remains stable from the control of the gluteus medius and the pelvic floor. Any resultant hip rotation or lateral tilt of the pelvis will contribute to stress at the knee. The reformer provides the necessary environment to teach this effectively by introducing the single-leg stance in a supine position with reduced resistance. Not only does the athlete have the proprioceptive feedback of the reformer carriage, but he or she has the advantage of the feedback from the coach.

Frog Exercise: In addition to footwork, the athlete performed the frog exercise with the ring on the reformer. For this exercise, the athlete remains supine, but places the feet in the Pilates loops. The loops are connected to ropes that pull the carriage against the springs, so the athlete can work against resistance with the feedback of the carriage movement. This exercise is neither open chain nor closed chain. It is what we call “controlled open chain” because the movement is guided by the ropes.

In the frog exercise, the athlete holds the ring between the ankles with the hips in external rotation and the spine in a neutral position. Then she performs a plié motion while suspended in the ropes. (See Figure Three, below.) This works the hip external rotators throughout the entire range of hip flexion. It also combines several other challenges: flexibility of the hip internal rotators, stability of the core, and strength of the hip extensors throughout the entire range of hip flexion. In the beginning, the athlete usually has a great deal of difficulty holding the ring and the coach needs to provide additional encouragement.

Standing Work: Our soccer player also performed standing exercises on the reformer with resistance to hip abduction. For these exercises, we have the athlete stand in hip outward rotation with one foot on the stable surface and one foot on the moving carriage. The athlete simultaneously abducts both legs while holding a neutral pelvis and spine to open and close the carriage with control. (See Figure Four, below.) After eight repetitions, the athlete changes to the other side. In this same position, the athlete is asked to hold the carriage closed and performs pliés against very light resistance. The knee flexion is limited to the range available without pain.

At Home: For a home and travel program, the soccer player was given a Pilates ring and instructed in three exercises. The first two began immediately and included performing an articulating bridge with the ring first between the ankles and then around the outside of the knees. With the ring between her ankles, the athlete was encouraged to keep the patella over the second toe. (See Figure Five, below). When the ring was around her knees, the athlete was encouraged to abduct gently into the ring. (See Figure Six, below.) For exercises like these, it is important that the athlete be taught to do pattern breathing with each exercise to help engage the deep abdominal muscles. We told her that each exercise should be performed eight times daily.

The third home exercise was challenging, so we waited until the pain had subsided to introduce it. For this one, the athlete wore the ring around the outside of her lower thighs, just above her knees. The goal was to maneuver from sitting to standing and back without losing the ring. We told the athlete to place her feet in the newly aligned outward position, but to have her knees aligned straight ahead. She was encouraged to perform up to eight repetitions of this exercise daily.

The results of the Contrology method were rapid. Our soccer player had a resolution of her knee symptoms in just one week. For many athletes, the problem is not flexibility or strength, but a lack of focus or control. Sometimes the athlete just needs to learn how to position himself or herself to avoid pain. This happens quickly–in some cases after just one session.

INCORPORATING CONTROLOGY

Adding Contrology to your workout offerings does not require extensive study or buying a lot of new equipment. Mainly, it just means understanding that identifying the mechanical cause of an athlete’s pain is a more important step in correcting problems than alleviating the pain. It’s about changing the way you approach pain and looking further into an athlete’s biomechanics to recognize and then solve problems.

It also means realizing that the athlete’s focus is the one main component necessary for success. As Joseph Pilates said, “The acknowledgement of Contrology evidently throws the responsibility for health, efficiency, and happiness upon the individual, where it should belong.”

To read a previous T&C article by Christine Romani-Ruby, click: “Pilates on the Line.”

REFERENCES:

McMillan, Proteau, and Lebe. “The effect of Pilates-based training on dancers’ dynamic posture.” Journal of Dance Medicine & Science 2, no. 3 (1998): 101-107.

Pilates and Miller. Your health. Philadelphia: BainBridge Books, originally published in 1934, reprinted in 2000. p. 20, 63.

Sapsford and Hodges. “Contraction of the pelvic floor muscles during abdominal maneuvers.” Archives of Physical Medicine and Rehabilitation 82 (2001): 1081-1088.

Figure One Figure Two