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Pilates and Multiple Sclerosis: Part One

In a two part interview series, we explore the benefits of Pilates for people living with the mysterious monster that is Multiple Sclerosis. Multiple Sclerosis, or MS, is an inflammatory autoimmune disease with no known cause or cure. The base mechanism of the disease is the failure of myelin-producing cells, the protective coating of nerve cells in the brain and spinal cord, an immune system attack of the central nervous system . The symptoms of MS are numerous and far ranging - they can be physical, mental, or psychiatric. The pain caused by the inflammatory nature of the disease makes an active life very difficult for sufferers. Here, Aya Sato talks to Studio 26 Pilates trainer Anita and her client with MS about the ways in which Pilates can help to address the various problems that arise from living with the disease daily.

I understand why Pilates might be highly beneficial to a person with MS - balance, proprioception, and strength are surely big goals for anyone with the illness, but I'm interested to hear why it is helpful, or how you've found it to be helpful for your client in particular?

Those are definitely important aspects of Pilates training that are highly beneficial. I would add strength building, improving joint range of motion, and body awareness. Pilates is often described as a form of exercise that works on the mind-body connection, and I think this is very important to emphasize when working with someone who has MS. As Pilates is generally a low impact type of exercise, the risks of overheating and fatigue - both things that can exacerbate MS symptoms - are low.

I also believe that the Pilates equipment in itself is a wonderful tool for clients with movement limitations. It allows me as the instructor to work around challenges my client has with certain movements, and in many instances the equipment can be used to assist a movement. That makes it a very safe way to exercise and enables a client with movement restrictions, balance issues, or reduced proprioception to move in ways that might not otherwise be possible or safe. I like the fact that the equipment and props used in Pilates can give a client feedback as to where their body is in space and how their body is moving. This is particularly helpful when one side of the body is weaker and less coordinated than the other side, which is often the case in MS. (As a side note, I also incorporate “non-Pilates” equipment and modalities in the sessions with my client. An example would be the TRX suspension trainer. It is great because it allows me to work on movements in the standing position. Holding on to the TRX gives my client just enough support and assistance to feel safe to do exercises that use squats and lunges. After all, standing and walking are extremely important areas for my client to work on and increase strength, coordination, and balance.)

Of course, the focus on posture and proper breathing is another important concept in Pilates that is quite beneficial for a client with MS. As I have pointed out before, one side of the body is often weaker and less coordinated. This means the body will compensate for the weakness, which then leads to misalignment. So, I always address posture and breathing during the sessions.

How has your understanding of MS grown since beginning training with your client? Are there any things that stand out as significant things you've learned?

I have come to understand that as much as MS is an illness that affects the physical body, the mental aspect of MS cannot be ignored, and this will come up during the sessions. On a daily basis, the client is confronted with situations that can be very frustrating because the body is not moving the way it is supposed to move. For example, the simple act of getting into a taxi on the street can be a challenge because lifting the leg to step into the car and maintaining the balance requires a lot of effort. Another example would be walking up or down the stairs during rush hour in the subway. Stairs are hard to navigate for my client, and with this there is the added pressure of trying to move with the crowd and not wanting to hold up other people.

I always talk to my client at the beginning of a session and ask how things have been since we last worked together. If a particular situation stands out that posed a movement challenge in her daily life, I often will make it part of the session to both work on the particular movement in a safe environment and also come up with strategies to cope with it in the future.

Since I started working with my client it has become very clear that stress and fatigue make the symptoms of MS much more pronounced. So it is important that I pick up on that right away and then tailor the session accordingly. That means the structure and content of a session can vary quite a bit from week to week, depending on how my client feels on that day and how much her body is able to do.

Sometimes we focus mostly on alignment and breathing, as well as releasing muscle tightness. At other times, it is much more of a movement and strength training session. I like to incorporate free weights and kettlebells, as I find it transfers very well to activities my client might encounter in her daily life. I also believe it is very empowering for her to lift weights, and it gives her confidence.

My sister in-law with MS describes the seemingly simple action of getting onto the toilet seat as requiring the most intense focus and energy. She explains a large part of living with an illness like MS is working to cultivate a positive attitude and a sort of mental tenacity. How do you think the practice of Pilates plays into this aspect?

Cultivating a positive attitude is a big part of any exercise program for someone with an illness like MS. It is about empowerment and about what the body CAN do. I try to emphasize that every time I work with my client. Living with MS means that someone has to face frustrating situations on a daily basis, where they are often left feeling that they can't do certain things because of the way the body moves or doesn’t move. In the sessions, I focus on what my client is able to do. By no means do I want to “baby” my client. I want her to have a great movement experience, and I want her to enjoy the work we do and have fun with it as well.

I believe that it is important that I challenge my client when we work together, but never to the point where a goal can’t be achieved and the exercise becomes a struggle. I don’t want her to leave the session frustrated but rather with a sense of accomplishment and the feeling of having succeeded. That, of course, requires a lot of trust between me and my client. She needs to trust me that I will not ask her to do something that she can’t do or that is unsafe. At the same time, I need to know her well enough so that I can trust her and her ability to execute a certain movement.

How has your experience training a client with MS influenced you as a trainer? Do you have any desire to go further into this as a specialty?

Interestingly enough, I now work with four other clients who are suffering from chronic illnesses that are directly affecting their ability to move and exercise. (This is not something I have been actively pursuing. It kind of happened by accident. But now that I have been working with my clients for some time, I find that I really enjoy that type of work. It can be challenging, but it is also very gratifying to witness the difference I can make.) Even though the conditions are quite different, I see a lot of similarities between the clients and how I approach the sessions with them. At the same time, there are also great differences in how each person copes with their particular situation. That requires me to have a very good grasp of each client’s personality so that I know when I need to push someone a little bit out of their comfort zone and when it is time to slow someone down and ask them to be easy on themselves.

I believe that I have come to appreciate and recognize the psychological aspect of the work I do much more since I started working with those clients. The beauty of it is that I can affect my clients’ physical and mental wellbeing through movement.

Comments from Anita’s client:

Pilates has helped me to do simple things, like walking, using stairs, sitting & standing, with greater ease and less fatigue (fatigue is a major, major issue for most MS patients). I’m learning to focus and use my core and breath, so I’m not overusing certain muscles unnecessarily. I can’t stress focus enough. I’ve become so much more aware of my body: how I stand, walk, and definitely posture.

Also, strength is key; it’s so important to be strong, so in the event of an exacerbation, weakness is minimal. I remember my MS doctor testing strength in my legs, and being impressed that I was strong, and I thought, “good ol’ pilates.”

My instructor is fabulous at accommodating my needs and limitations that particular day; her resourcefulness always surprises. And I believe Pilates lends itself to that. There are so many “gadgets” on the reformer and so many different moves, that it is never the same routine.

If my session is late and after work, I’m usually stiff, tired, and walking sort of like a drunken Frankenstein. My instructor and I work on stretches and movements that really, really feels like an active massage. Before I know it, I’m doing planks. After my session, I feel more in control. By no means am I running down the stairs of the subway, but I am taking the subway, and although still frustrated that I have to hold onto the handrail for dear life, I know that I’m working to make that better; I’m being pro-active in my treatment.

My instructor tells me all the time how hard I am on myself, and we have a rule that negative comments are banned during the session...funny, but I hear her voice during the day sometimes telling me to ease up!