Strategy or Structure?
I am often asked by Pilates teachers if I think their client’s movement limitation is structural or strategic. My answer is somewhere around 40% + have structural restrictions, whereas nearly 100% have strategic restrictions. So, what does that mean?
A structural restriction can be any form of limited mobility due to restricted tissues in the musculoskeletal system i.e., fascia, muscle, tendon, ligament, cartilage, bone and even skin. A strategic restriction can be due to novelty of the movement (people don’t know how to do it because they’ve never done it), limited body awareness, fear of injury or re-injury, lack of confidence, poor control, or weakness. I am sure you can think of examples of these limitations experienced by our clients. So how do we know where the movement restriction or limitation is coming from?
I have spent the last three decades refining a model to help Pilates teachers differentiate between strategic and structural limitations. If the movement limitation requires a professional medical intervention by a physiotherapist, chiropractor or osteopath, it falls outside the practice scope of the Pilates teacher. If we knew which clients it was safe to work with and when best to refer to a physio or osteopath, we could be more confident in what we are doing. And a formula could be a powerful tool. In Polestar we teach the Principles of Movement. These five principles can drive the assessment by the Pilates teacher to differentiate the cause of the movement dysfunction. I warn you here that movement limitations can have more than one principle affecting movement at the same time. So how do we use the Polestar Principles of Movement to differentiate?
The Polestar Principles of Movement consist of Breath, Mobility, Dynamic Alignment, Control and Integration. Each of these principles should exist in every movement we perform, but do they? We could start off by observing our client’s movement and try to decipher which of the principles is more limited than another. But this can be overwhelming, especially for the novice. We can also observe the client performing a functional task like a squat and apply the following formula.
The most powerful tool we have as Pilates teachers are our eyes observing the client’s movement. First, we’ll look at dynamic alignment while doing a squat. In our instructions we can tell them and even demonstrate the alignment we are looking for in this type of squat, which is to keep the torso vertical. If the client is able to demonstrate the movement with proper dynamic alignment, then that test is done. They are able to perform the squat well and we can observe the next movement. If they can’t perform the squat with the desired upright alignment, we can use one of the principles to unravel why they are struggling to perform this task. We’ll start first with the principle of Movement Integration which we also think of as Coordination.
Coordination: Now is the time to try to influence the proper alignment of the squat through verbal, tactile, and imagery cueing. If their demonstration of the squat drastically improves with your cueing, then you know it is strategy that was the issue and this might have been due to limited body awareness, novelty of the movement or a behavioral limitation like beliefs or fears. If the cueing does not make a significant change to their dynamic alignment, in this case of the squat, then we move onto the second Principle we’ll use which is Control. I remind the reader that the skill of the practitioner can play a major role in successful movement facilitation. A more seasoned teacher might be able to influence proper alignment more effectively than a novice teacher. That said, trust yourself, stay curious and engaged and you will be able to help your clients change their understanding and performance of the movements.
Control: Now is the time to test if the client is able to perform the task with proper dynamic alignment if the teacher reduces the load by holding on to something like a chair, the Trapeze springs or changing the relationship to gravity by doing Footwork on the Pilates Reformer. If decreasing the load allows the client to successfully execute the squat with proper dynamic alignment, then we can assume that the movement limitation is control and the exercise plan would continue to focus on a graded load intervention, gradually increasing load and decreasing assistance until the full task is performed efficiently. If, however, providing load assistance does not improve the dynamic alignment of the task, in this case the squat, then we need to move onto the final Principle of Mobility.
Mobility: If the dynamic alignment has not improved with seeing a demonstration, cueing or assistance, then we need to test mobility. In the case of the squatting task, mobility limitations might manifest in the ankle, the knee, the hip and even the back. We can assess mobility by modifying the range of movement, for example lifting the heels onto a half roll or block of wood to assess ankle mobility. By lifting the heels 4-5 cm, the result, if ankle mobility was indeed limited, is successful squatting with proper alignment. In this scenario, the Pilates teacher can start working on an ankle mobility program and refer out for a manual therapist to evaluate and possibly mobilise or manipulate the ankle.
Only this last scenario requires a referral, and the Pilates teacher can continue with the strategic intervention while the client is receiving treatment. In fact, continuing work on the strategic component is crucial as manual therapy cannot change the person’s long-term ability, they need to continue to practice the movements to embody all of the changes. This content and way of thinking is derived from Polestar’s advanced course work ‘Critical Reasoning’.
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With over 30 years of experience in rehabilitation and movement science, Brent Anderson, PT, PhD, OCS, NCPT is Founder and CEO of Polestar Pilates Education and Polestar Pilates Center. He is also an Assistant Professor at the University of St. Augustine for Health Sciences in the DPT department in Miami, FL. He teaches as an adjunct professor in the Physical Therapy departments at the University of Miami, University of Southern California, and New York University.
Brent is also the creator and host of the Pilates Hour podcast.
To dive deeper into assessment and differentiation through Polestar’s advanced course work ‘Critical Reasoning’, visit polestarpilates.com to find out more.
Senior Educator and Curriculum Director for Polestar International Shelly Power will also be running a Critical Reasoning Course in Perth on 8-9 July and Sydney, Australia on 15-16 July. Get 15 PDP's with the PAA. You can find out how to book here.