Often, we associate flexibility exercises with “warm-up”, “cool-down” and sit-and-reach test.  But flexibility or mobility is one of the critical functional capacities of our quality of life that is often an after-thought for most of us.    That’s right…the creaking sound when you stretch is a good indication it’s time to take stretching exercises a bit more seriously.  Stretching exercises are often done in tandem with our other sports activities.  If you are looking to improve strength, balance and flexibility at the same time, Pilates could be what you are looking for.  Pilates has been shown to improve flexibility significantly over control groups in studies on elderly and healthy adults, and is shown to be better than static stretching for some body segments, amongst other concurrent benefits of improving in balance and strength of muscles.

Why is Flexibility Important?

American College of Sports Medicine defined flexibility as the functional capacity of the joints to move through the full range of motion (ROM) (ACSM, 2018).  Flexibility is important in performing Activities in Daily Life such as picking things up from the floor or ducking someone who runs smack-right into you (without pulling a muscle), improve postural stability, correct muscle imbalance, balance control, AND prevent musculoskeletal injury (ACSM, 2018).  Hamstrings tightness and lack of low back flexibility are also associated with low back pain (Battie et al., 1990), a modern-life common condition.

As we age, a loss of up to 50% of flexibility can be observed depending on the joint (Holland, Tanaka, Shigematsu, & Nakagaichi, 2002).

For the elderly, having mobility and balance are extremely vital for their quality of life.  In Singapore, falls are a leading cause of injury among older adults. The incidence rate increases sharply with age (HPB-MOH, 2015).   In Singapore’s Emergency Departments (ED), 85% of all trauma in elderly are falls. It is a leading cause of death and disability in the elderly, and studies have also shown that half of elderly who experience a fall will have a recurrent fall in the following year (Singhealth, 2017).

How to improve Flexibility?

Flexibility or stretching exercises should be done when the muscles are warm, after sports or in tandem with strengthening coordinated exercises.  There are four types of stretching categorized by National Academy of Sports Medicine (NASM, 2013): ballistic stretching, dynamic stretching, static stretching (active vs passive static), and proprioceptive neuromuscular facilitation.

Ballistic stretching uses momentum of a body segment to produce a stretch.   This type of stretching is quite controversial as it can cause injury to connective tissue if the stretch is performed too quickly or the joint’s range of motion (ROM) is exceeded.  However, ballistic stretching may be beneficial in warm up for workouts that involve movements that are similar to ballistic movements performed.

Dynamic stretching is a gradual transition from one body position to another, and a progressive increase in range of motion as the movement is repeated several times in a controlled, smooth and deliberate manner.  It is performed through an extended range of motion without exceeding a person’s static-passive ability.  Pilates exercises involve a lot of dynamic stretching.

Static stretching involves slowly stretching a muscle or tendon group and holding the position for a period of 10-30 seconds.  It can be active or passive.  Active static stretching is holding the stretched position using the strength of the agonist muscle without any outside assistance for the stretch.  This is common in yoga.

Finally, we come to Proprioceptive Neuromuscular Facilitation (PNF) stretching. A person holds a light-to-moderate contraction for 3-6s (opposite the direction of the stretch), followed by the direction of the stretch for 10-30s.  The procedure is repeated 4-5 times with increasing range in the direction of the stretch, and may usually require assistance.

Pilates improves flexibility better than static stretching for some body segments

Oliveria et al compared static stretching and the Pilates method on the flexibility of older women, and the study showed that Pilates exercises are more effective for some body segments. The study set up two randomized groups (Static stretching or Pilates) to perform exercises of 60min, twice a week, for three months.  Evaluations were done on trunk flexion movement (TFM), trunk extension movement (TEM), hip flexion movement (HFM), plantar flexion movement (PFM) and dorsiflexion movement of the ankle (DFM) before and after using a flexi meter (Oliveira, Oliveira, & Pires-Oliveira, 2016).

For the static stretching group, twenty static stretching exercises were conducted, as recommended by the American College of Sports medicine for cervical and upper limbs and trunk and lower limbs.

For the Pilates group, twenty Pilates exercises were conducted by a certified Pilates professional starting with an initial stretching on the Cadillac Trapeze (Spine Stretch, Mermaid, Stretching Knee); then strengthening of the lower limbs on the Chair and Cadillac Trapeze, followed by strengthening of the flexor and extensor muscles of the trunk on the Cadillac Trapeze.  Finally, strengthening of the upper limbs on the Universal Reformer and an ending stretch on the Universal Reformer and the Ladder Barrel

The Pilates group showed a significant improvement across all analyzed variables (TFM, TEM, HFM, PFM and DFM) while the static group showed significant improvement only for TFM and HFM. Trunk Extension Movement (TEM) also showed significant difference in favour of the Pilates group.

Pilates decreases fear of falling for elderly

In addition, Pata et al found in their 8-week study that older elderly have decreased fear of falling after Pilates program as well as significant improvement in flexibility measures (Pata, Lord, & Lamb, 2014).  Half of participants who are deemed to have fall risk improved their flexibility (Forward Reach test) to a score no longer considered to be a fall risk.   The number of actual falls also decreased in subsequent two months post Pilates program.

A Pilates based exercise intervention program improved balance, postural stability and mobility, which are risk factors associated with falls in the vulnerable or older adult population.  Pilates stabilizes and strengthens core muscles with precision and emphasizes neutral postural alignment (Barker et al., 2016), thus allowing for greater distal mobility and balance control.  This translates to improved execution of daily functional activities and decreased falls.

Pilates improves flexibility and lumbar-pelvic stability for healthy adults

Phrompaet et al showed that Pilates can be used to improve flexibility for healthy adults as well (Phrompaet, Paungmali, Pirunsan, & Sitilertpisan, 2011), in line with previous studies done on healthy adults (Segal, Hein, & Basford, 2004; Sekendiz, Altun, Korkusuz, & Akın, 2007).  Phrompaet et al’s study also showed Pilates enhances control-mobility of trunk and pelvic segments.

Healthy male and females in early 30’s were randomly divided into Pilates-based exercises and the control group.  All participants did not practice any kind of exercises or sports activities more than 20 minutes per session and 2 times per week.  The Pilates group attended 45-minutes training sessions, 3 times per week, for a period of 8 weeks.  The control group continued their usual sports activities throughout the 8-week period.

The results showed that Pilates exercise group improved flexibility significantly (P<0.00) over control group for both 4 weeks and 8 weeks of the training period.  Flexibility was measured with Sit and Reach Test based on American College of Sports Medicine guideline. There were 85% of the subjects passing the lumbo-pelvic stability test after 8 weeks while no subjects passed for the control group.  Lumbo-pelvic stability was assessed using pressure biofeedback unit in previous studies (Herrington & Davies, 2005; Jull, Richardson, Toppenberg, Comerford, & Bui, 1993).

How does Pilates improves flexibility?

Pilates method is a combination of static and dynamic stretching exercises which are safe to provide an increasing flexibility.  Phrompaet et al postulated that there is neurophysiological properties to stretching exercises.  When Pilates position is applied, soft stretch to tissues and muscles activates Golgi tendon organ, which results in lengthening of sarcomeres (basic unit of muscles tissues)(McArdle, Katch, & Katch, 2010).  Repetitive stress will increase the plastic deformation of tissues in the elastic range, allowing a gradual rearrangement of the collagen fibres (Liemohn, 2001).

Flexibility or stretching exercises is critical to functional quality of life, performance improvement and injury and pain reduction.  Pilates is a proven and safe method for improving flexibility, which is increasingly important as we age.   So if your body does creak a bit when you stretch, it’s probably time to look into how to improve your flexibility.

Reference List

ACSM. (2018). American College of Sports Medicine Guidelines.   Retrieved from http://www.acsm.org/public-information/acsm-journals/guidelines

Barker, A. L., Talevski, J., Bohensky, M. A., Brand, C. A., Cameron, P. A., & Morello, R. T. (2016). Feasibility of Pilates exercise to decrease falls risk: a pilot randomized controlled trial in community-dwelling older people. Clinical Rehabilitation, 30(10), 984-996. doi:10.1177/0269215515606197

Battie, M. C., Bigos, S. J., Fisher, L. D., Spengler, D. M., Hansson, T. H., Nachemson, A. L., & Wortley, M. D. (1990). Anthropometric and clinical measures as predictors of back pain complaints in industry: a prospective study. Journal of Spinal Disorders, 3(3), 195-204.

Herrington, L., & Davies, R. (2005). The influence of Pilates training on the ability to contract the Transversus Abdominis muscle in asymptomatic individuals. Journal of Bodywork and Movement Therapies, 9(1), 52-57. doi:https://doi.org/10.1016/j.jbmt.2003.12.005

Holland, G. J., Tanaka, K., Shigematsu, R., & Nakagaichi, M. (2002). Flexibility and Physical Functions of Older Adults: A Review. http://dx.doi.org/10.1123/japa.10.2.169. doi:10.1123/japa.10.2.169

HPB-MOH. (2015). Falls Prevention among Older Adults Living in the Community. Retrieved from Singapore: https://www.hpb.gov.sg/docs/default-source/pdf/cpg_falls_preventionb274.pdf?sfvrsn=abedeb72_0

Jull, G., Richardson, C., Toppenberg, R., Comerford, M., & Bui, B. (1993). Towards a measurement of active muscle control for lumbar stabilisation. Australian Journal of Physiotherapy, 39(3), 187-193. doi:https://doi.org/10.1016/S0004-9514(14)60481-5

Liemohn, W. P. (2001). Exercise Prescription and the Back (1 ed.). Maidenhead, United States: McGraw-Hill Education – Europe.

McArdle, W. D., Katch, F. I., & Katch, V. L. (2010). Exercise Physiology: Nutrition, Energy, and Human Performance(7 ed.): Lippincott Williams & Wilkins.

NASM. (2013). NASM Essentials of Corrective Exercise Training: National Academy of Sports Medicine.

Oliveira, L. C., Oliveira, R. G., & Pires-Oliveira, D. A. (2016). Comparison between static stretching and the Pilates method on the flexibility of older women. Journal of Bodywork and Movement Therapies, 20(4), 800-806. doi:10.1016/j.jbmt.2016.01.008

Pata, R. W., Lord, K., & Lamb, J. (2014). The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. Journal of Bodywork and Movement Therapies, 18(3), 361-367. doi:https://doi.org/10.1016/j.jbmt.2013.11.002

Phrompaet, S., Paungmali, A., Pirunsan, U., & Sitilertpisan, P. (2011). Effects of pilates training on lumbo-pelvic stability and flexibility. Asian Journal of Sports Medicine, 2(1), 16-22.

Segal, N. A., Hein, J., & Basford, J. R. (2004). The effects of pilates training on flexibility and body composition: An observational study11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated. Archives of Physical Medicine and Rehabilitation, 85(12), 1977-1981. doi:https://doi.org/10.1016/j.apmr.2004.01.036

Sekendiz, B., Altun, Ö., Korkusuz, F., & Akın, S. (2007). Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females. Journal of Bodywork and Movement Therapies, 11(4), 318-326. doi:https://doi.org/10.1016/j.jbmt.2006.12.002

Singhealth. (2017). Preventing falls in the elderly. Tomorrow’s Medicine.