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Accepted Manuscript

Are movement screens relevant for Pilates, circus or dance?

Warrick McNeill

PII: S1360-8592(14)00079-5

DOI: 10.1016/j.jbmt.2014.05.007

Reference: YJBMT 1135

To appear in: Journal of Bodywork & Movement Therapies

Please cite this article as: McNeill, W., Are movement screens relevant for Pilates, circus or dance?,

Journal of Bodywork & Movement Therapies(2014), doi: 10.1016/j.jbmt.2014.05.007.

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http://dx.doi.org/10.1016/j.jbmt.2014.05.007


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Are movement screens relevant for Pilates, circus or dance?

Editorial: JBMT Rehabilitation and Prevention Section

Warrick McNeill

Motion is lifeGray Cook (Cook et al 2010) quotes Hippocrates, paraphrasing it still further that

movement symbolises life. Cook believes that movement is fundamental, once that is

managed other factors like strength, endurance, co-ordination and acquisition of skill also play

a role in (injury) prevention. Movement comes first.

The development of the science and practice of analysing movement and then interpreting the

results so that those in musculoskeletal pain and those who are merely at risk of developing

pain can be rehabilitated or prevented from suffering appears to be at the forefront of current

study and research. The blurring of the distinctions between the target populations of those to

be analysed (pain and non-pain groups) have been discussed in a previous editorial in this

section of this journal, as have two types of exercise to apply to the finding of uncontrolled

movement (McNeill 2014a, 2014b). Movement screening or analysis itself deserves further

attention.

Pilates is perhaps only now beginning to be partially understood from a scientific point of view.

Pilates has been reported as an exercise form that can help those with chronic low back pain

(CLBP) (La Touche et al 2008). Another systematic review aimed at defining Pilates exercise and

how it is applied in the treatment of people with CLBP was published in 2012 as the authors

identified that research into Pilates is difficult to interpret because of a lack of such a definition

(Wells et al 2012). By defining Pilates as it is described in current peer reviewed journals it can

be compared to original descriptions provided by Joseph Pilates to see if there are differences

- particularly modifications of the exercise form for working rehabilitatively with clients with

CLBP as opposed to more general applications of Pilates for the promotion of health.

Pilates was found by Wells and her co-authors to be a mind-body exercise that requires core

stability, strength and flexibility, and attention to muscle control, posture, and breathing.

Exercises can be mat-based, or involve the use of specialised equipment. Traditional Pilates

principles of centring, concentration, control, precision, flow, and breathing may be relevant to

contemporary Pilates exercise. In people with low back pain, posture may be a critical

component of Pilates exercise, but traditional principles, apart from breathing, may be less

important.


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Interestingly a majority of the papers analysed for Wellsreview were opinion pieces, (such as is

this paper) and there were only 17 papers included that focussed on Pilates in relation to

participants with low back pain compared to 49 that looked at Pilates with healthy participants.

It appears that the application of pilates as a rehabilitative tool for CLBP is therefore not yet

reliably confirmed. Perhaps the broad definition of CLBP with its inclusion of differentsubgroups of causes of CLBP as yet not fully understood suggests that in rehabilitation

focussed Pilates, attempts to assess for the faults to be fixed by Pilates need to be

undertaken. Research is required looking for actual faults to be managed with Pilates technique

or modified Pilates. Modifications could be as simple as avoiding imprint for flexion related low

back pain with the maintenance of a neutral spine. This suggests that Pilates Teachers in

rehabilitative Pilates, at least, need to be performing a more formalised assessment procedure.

As Pilates is about movement and Pilates Teachers are expert in teaching movement it

suggests rather clearly that movement is what Pilates Teachers should be formally assessing,recording and managing. It appears that currently Pilates Teachers are managing movement

but not necessarily formally assessing movement first.

Movement testing

Though specific movement tests are in an early validation phase it has become a focus for

study, as, until now, previous injury has been the only reliable predictor of re-injury risk. Other

variables, such as testing joint range, muscle strength and muscle extensibility tend to isolate

the individual joints or muscles in non-functional situations (Mottram and Comerford 2008). In

Hiller et als (2008) study looking at adolescent dancers predictors of lateral ankle sprain, it

was found that a previous sprain of the contra-lateral ankle,younger age, increased passive

inversion range and an inability to balance on demi pointe showed some element of

prediction, however, it was the previous sprain was the only predictor of significance. Cook

states A finding of a normal range of motion at a joint is not a guarantee of normal

movement. Motion is a component of movement, but movement also requires motor control,

which includes stability balance, postural control, co-ordination and perception (Cook et al

2010).

Papers looking at movement tests are becoming more frequent including a currently in-press

paper validating a dissociation of lumbopelvic and thoracolumbar motion test. (Elgueta-

Cancino et al 2014). The study is a reaction to the fact that low back pain causes the sufferer

to show change in their motor behaviour affecting posture, muscle activation as well as

movement. The authors identify that these changes are easily identified in a laboratory but

identify that there is a need to create clinic friendly tests. This test focused on assessing faults

often found in those with low back pain: altered quality of the movement of the lumbar spine

(looking at muscle activity, timing and co-ordination), the ability/inability to move the


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lumbopelvic region relatively independently from the thoracolumbar junction (dissociation), the

quality of the movements direction (i.e. anterior and posterior tilt), the consistency of quality

through the movements repetition, and the ability/inability to maintain breathing. The test

itself proved to be reliable and can be used to identify subgroups within the low back pain

population, though the effects of its use in the clinic have yet to be determined, but, byproving the reliability of the test its use can be explored along with possible interventions that

may later be shown to positively influence clinical outcome.

Janda

In the modern era movement analysis has its roots in the work of the Czech pioneer Vladimir

Janda. At the age of 24 Janda, while working in a rehabilitation centre for postpolio patients,discovered that subjects without activity in their gluteus maximus during hip extension used an

increased anterior tilt of the pelvis to accomplish the extension (Page et al 2010). Page

reported that this was the beginning of his lifelong passion to study movement rather than

individual muscles. Page identified that Janda later noticed a connection between chronic

ankle instability and chronic low back pain: proprioception. This led to Jandas development of

sensori-motor training, a progressive exercise program using simple exercises and unstable

surfaces. He rarely recommended strengthening exercises, instead focusing on balance and

function.

Page suggests that Janda applied a functional approach to managing dysfunction and pain

that highlighted the concept that the muscular system is at a functional crossroadsbetween

the central nervous system and the musculoskeletal system. The muscular system reacting with

inhibition or tightness. Jandas functional approach being more a forerunner of the current

biopsychosocial thought of today as opposed to a structural approach. This is when an

anatomical structure is found to be at fault through physical testing or visible on medical

imaging. All too often physical tests are too blunt to confirm a diagnosis or medical imaging

results are negative, suggesting the cause of the pain may be elsewhere in the system.

In the Janda approach movement testing follows a postural analysis which looks at static

posture as well as dynamic posture in single-limb balance and gait. The primary goal of the

postural analysis is to guide the clinician to look at relevant areas of the body in front of them

during the later movement pattern tests. Acute observation can include the obvious such as an

anterior tilt of the pelvis (weak gluteals), an increased S shape in the proximal groin

(indicating a tight pectineus) to the more subtle such as the shape of the heel such as a

quadratic or square heel (indicating a posterior weight placement overloading the back of the


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foot). Single limb balance looks at how the client handles the transfer of weight onto one limb

with excessive weight transfer - over 2.5cm of pre-shift to the stance leg, or medial rotation of

the stance legs femur during the transfer indicating a failure of aspects of the gluteal regions

control of the movement. Gait is also key with observation being primarily directed to the

pelvis and trunk, or, looking at what sections of the body lead the movements or whatcompensations muscle tightnesses encourage (Page et al 2010).

Though Janda advocated muscle length testing he was equally interested in evaluating

movement patterns as these, he thought, were more reliable than the clients subjective

reporting of pain. Page comments that Janda advocated watching for the quality and control

of the movement pattern including the sequencing and activation of all the synergists involved

- especially at the initiation of the movement as opposed to the final phases of the movement.

Janda described 6 movement tests which are briefly described here. They predate the two later

movement screens discussed in this editorial. The tests were to be observed with as little

clothing on the client as possible, they should be minimally verbally cued or guided with

handling to enable the clients preferred movement pattern to be used, and repeated three

times. The movements are relatively simple and require the assessor to be familiar with the

ideal movement patterns expected so deviations can be noted.

Jandas 6 Basic Movement Pattern Tests

hip extension

hip abduction

trunk curl-up

cervical flexion

push-up

shoulder abduction

In the hip extension movement pattern test, according to Page, the client lies prone on a

treatment couch with the feet hanging off the edge to avoid the foot altering the limbs

rotation and the client is asked to lift the leg posteriorly. The ideal sequence of muscular

patterning is, Page quoting Janda, hamstring / gluteus maximus contralateral erector spinae /

ipsilateral erector spinae. Page identifies that the most common faulty pattern involves

overactivity in the hamstring and erector spine, with an under-active gluteus maximus - being

either absent or late. Other possible findings can show that the movement can be led with

thoraco-lumbar extension or even with the shoulder musculature. Compensations such as


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anterior tilt of the pelvis should be noted. (INSERT PHOTOS 1-4 HERE WITH LEGEND SEE

END OF DOC) The hip abduction movement pattern test involves side lying with the

uppermost leg in line with the trunk and adducted down to the treatment couch surface, the

movement involves abduction to 20 degrees above horizontal. Correct patterning should

mean that the lower limb abducts cleanly to 20 degrees above a horizontal line without flexionor rotation of the limb or loss of pelvic positioning. Incorrect patterning can show flexion of

the hip in the case of overactivity of the tensor fascia lata (TFL), or even a hip hitch if the role

of the quadratus lumborum (QL) converts from being a stabiliser of the pelvis to a prime

mover of abduction. The trunk curl up movement pattern test involves crook lying with the

client rounding the head and shoulders (also allowing posterior tilt of the pelvis) and followed

by a further curling of the spine into a sit up position. Poor patterning can show a minimal

thoracic flexion or an unweighting of the heels when there is dominance of the hip flexors in

the pattern. The cervical flexion movement pattern test compares the relative dominance ofthe deep cervical flexors (longus capitis, longus colli, and rectus capitis anterior) with the

superficial cervical flexors (sternocleidomastoid SCM and the anterior scalenes). The former

providing a gentle rolling of the neck into flexion and the latter muscular dominance shows as

a jutting chin. The push-up movement pattern testis a test of dynamic scapular stabilisation

primarily looking at the force couple of the serratus anterior and the trapezius musculature

with scapula movements involving excessive rotation, winging, tipping, elevation, adduction or

abduction. The eccentric phase lowering the trunk down in the reset for the push up is often

more telling. The shoulder abduction movement pattern test involves sitting and abducting

the bent-at-the-elbows arm looking for a scapula that moves little before 60 degrees

abduction and then appropriate scapula elevation is allowed.

As these tests are not exhaustive Page and his fellow authors add some later tests into their

description of movement patterning tests, as well as describing length tests of the muscles that

typically respond with tightness. Jandas system is also not just assessment but fully

rehabilitative and involves soft tissue work, stretching as well as his sensori-motor rehabilitative

interventions.

Jandas movement pattern tests are deceptively simple, yet very informative, but also forge the

foundation from which all later movement analysis systems have grown.

Of interest, as Janda utilises a prone hip extension (PHE), a spinal physiology paper by Suehiro

et al (2014) is published in this Prevention and Rehabilitation section looking at the control of

anterior tilt in a PHE. An anterior tilt is the obvious compensation for a restriction into

extension from: tightened or short anterior hip structures, or an under recruitment of the

abdominal musculature with or without over recruitment of the erector spinae. The authors of


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this surface electromyography (EMG) study suggest that in the small group of healthy subjects

tested, that an abdominal hollowing strategy is preferable over a bracing strategy for the

stability of the lumbopelvic region during a PHE because it used less global muscle group

activity (internal and external obliques - IO, EO) than the bracing manoeuvre, however, both

strategies managed to control the lumbopelvic motion. A key difference may have been thefocus on the maintenance of breath in the abdominal hollowing strategy while no mention of

breath was made for the bracing. Suehiro acknowledges the exercise utilises a light load. The

EMG does record activity in the IO and EO in the hollowing strategy, which may equally

suggest that a more precise recruitment strategy of the abdominal musculature may result in

efficiencies of muscle activation under lower loads which is appropriate for the task set.

The Functional Movement Screen (FMS)Where Jandas movement pattern testing was developed as a response to those affected by

pain or disease, Cooks Functional Movement Screen (FMS) has been targeted for the use by

those professionals who work with movement as it relates to exercise, recreation, fitness and

athletics - so more the fitness and performance market - those not in pain. A different screen

has been developed by Cook and his co-creators, the Selective Functional Movement

Assessment (SFMA), to address those individuals who have painful movement (Cook et al

2010).

The FMS has been created to screen for injury risk and aid program design. By differentiating

between screening for the exercise industry and assessment for the rehabilitative professions

Cook identifies the divide between them. He advocates that rehabilitative professionals need to

understand strength and conditioning practice and techniques, but so to do strength and

conditioning coaches need to understand rehabilitation concepts. Concepts he discusses with

Strength and Conditioning coaches include what we view as weakness may be muscle

inhibition, or, that weakness in a prime mover might be the result of a dysfunctional

stabiliser, or, what is viewed as tightness may be protective muscles tone, guarding and

inadequate muscle co-ordination, or, what is viewed as bad technique may be the only

movement option for an individual performing poorly selected exercise.

Fundamental to the concept of the FMS, Cook suggests to non-rehabilitative exercise

professionals that as a first priority the aim should be to Manage movement pattern

limitations and asymmetries - mobility and stability problems - before applying a significant

volume of fitness, performance or sports training. Clearly not new to those involved in the

treatment of those in pain but perhaps likely to have be a novel concept to those in the fitness

industry.


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The FMS consists of seven tests, divided into four primitive movement patterns and three

higher level tests. The higher level tests use the primitive movement basic stability and mobility

patterns, (2 tests) and transitional movement patterns (2 tests, that use a higher degree of

stability, co-ordination and control) as a support. The tests are scored on a 4 point scale, whichpain during the test automatically down rates a score to zero. The top score of three is

achieved when the movement pattern fulfils all the criteria. A score of two denotes the ability

to perform a functional movement pattern but with some degree of compensation noted. A

score of one is attained when the subject is unable complete a functional movement pattern.

The usual description of the tests starts with the Higher level movement tests being performed

first, but discussed here in a primitive to higher level order.

The Functional Movement Screen

Primitive movement patterns

Shoulder mobility reaching

Active straight leg raise

Trunk stability push up

Rotary stability

Higher level movement patterns

Deep squat

Hurdle step

In-line lunge

In the shoulder mobility reaching movement pattern test the client reciprocally moves their

hands in a closed fist behind them, one hand behind the neck the other behind the back so

that one shoulder is fully abducted and externally rotated, and the other fully adducted and

internally rotated. This looks not only at the shoulder joint but at the scapulo-thoracic region

as well as at mobility of the thoracic spine and rib cage. (INSERT PHOTO 5 HERE) The Active

straight leg raise movement pattern uses a straight leg raise to look at the active mobility of

the hip in both flexion and extension, and the ability to dissociate the lower limb from the

pelvis. The Trunk stability push up movement pattern is a single action prone push up with a

different start position of the hands for different levels of success or a division between male

and female execution. It is designed to look at the reflex ability of the trunk to maintain

stability without spinal extension or sway. The Rotary stability movement pattern is a

complex multi-plane test from a four point kneeling start position looking at a simultaneous

reciprocal full extension and full flexion of the ipsilateral shoulder and hip. This is the most


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complex pattern in this test. A mid level version tests simultaneous reciprocal extension/flexion

of the contralateral shoulder and hip. The Deep squat movement pattern looks similar to an

overhead squat in that the movement starts with a dowel placed on the subjects head and the

hands greater than shoulder width apart holding the dowel. The arms are pressed straight

lifting the dowel. Keeping the knees aligned the hips and knees are fully flexed into a maximalsquat keeping the heels down. If the test cannot be performed without the heel lifting it is

repeated with a raise under the heels, but this lowers the maximum possible score. The Hurdle

step movement patternis a stance leg balance challenge with a high stepping action over a

height equivalent to the subjects tibia length a heel touch to the floor and a return to the start

position. The in-line lunge movement pattern places the subjects feet in an in-line split stride

with the feet the subjects tibial length apart. The spine is held vertical with a dowel held

behind the subjects back the the uppermost arm being in opposition to the forward leg. The

back knee is lunged to the floor and returned while the trunk maintains verticality.

Interpretation of the results of the suggests what action to take. Pain results in the client being

referred to the SFMA (and/or a healthcare provider). The SFMA has a significant increase in the

number of tests and is designed to classify movement patterns into functional non-painful,

functional painful, dysfunctional painful, and, dysfunctional non-painful movement patternsto

help in the decision tree.

Cook advises those training to use the FMS that if a movement pattern cannot be performed

(i.e. scoring a 1) is a more significant finding than achieving the pattern but through

compensation. Cook the suggests that the aim is to eliminate the greatest asymmetry in the

most primitive movement first and moving on to the next asymmetry found from that start

point. A screen suggests what to take out of an exercise program just as much as what to put

in it. Cook uses the screen to find what movement pattern corrections are required. These he

divides into three primary categories of movement pattern corrections: basic mobility

corrections, basic stability corrections and movement pattern retraining.

Mobility is encouraged to prevent the compensations which lower an FMS score and comes

before stability challenges. Mobility is encouraged with passive mobility corrections including

static stretches, foam rolling, self mobilisation or therapist led soft tissue work, and active

mobility corrections including dynamic stretching and work on the relationship between the

agonist and antagonist, proprioceptive neuromuscular facilitation (PNF). Stability is encouraged

through motor control corrections which focus on changing the brain not the body. These

concentrate on: co-ordination, dissociation, balance, weight shifts, resistance to external forces

- with or with out postural loading, movement of body segments, transitions of postures,

adding co-ordination and alignment as well as challenging the movements while reducing


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proprioceptive input. Cook identifies that these are the things we all learn in the first 2 or 3

years of life.

Effectively, and similarly to Janda, Cooks focus in reacting to the results of the FMS is to place

greater emphasis on managing movement pattern faults before adding fitness,in other wordsdont strengthen the client till the clients movement patterns are no longer dysfunctional.

The Performance Matrix Movement & Performance Screen

An alternative system of movement assessment has been developed by Mark Comerford and

Sarah Mottram, primarily looking at what they term uncontrolled movement. (Comerford and

Mottram 2012). This is different from the FMS which evaluates broader functional movement

and movement patterning in a developmental framework, but the Performance Matrix teststhe ability of the individual to control movement elements that underlie functional movement.

There is greater specificity in the testing. The matrix element of the system refers to the

system being able to identify three dimensions of uncontrolled movement: the anatomical site

at which the uncontrolled movement occurs, the direction of the uncontrolled movement (e.g.

flexion, rotation, translation or other movement) and the threshold at which the movement

failure occurs.

Threshold is important as a movement control failure can be the result of a muscular

weakness, often referred to as a hardware failure, which is identified through tests involving

high loads or speed such as those that might be found in sporting type situations, and

postural loads such as single limb movements or posture changes and are referred to as a

recruitment or software failure, and tested under lighter loading (McNeill 2012). At what

threshold the uncontrolled movement occurs dictates the intervention, leading to efficiency in

the rehabilitative process so only prioritised exercises need be prescribed. A low threshold

problem cannot be fixed by a high threshold strategy and vice versa. Users of this movement

screen may find, at the same joint and direction of movement, that control is found at high

threshold but not at low threshold, or indeed the other way around, which may contradict a

linear progression of rehabilitation exercise process that some may use, starting with gentle

exercise motor control exercise and ending with power led overload training. Identifying the

exact threshold to be working at may possibly enhance the rate of improvement.

The development of the Performance Matrixhas been interesting to watch with its basis in

treating injury and pain in a physiotherapy setting with many tens of tests (the Kinetic Control

model as explained in Comerford and Mottrams (2012) book which primarily looks at single

joint or region movement control), to a rigorous system aimed at managing the threat of risk


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in multi-joint, more functionally relevant movements, such as those performed in sports. The

development of the early Performance Matrix tests consisted of thorough battery of tests that

could be performed by a physiotherapist or an exercise professional, on a client without pain,

but could take a significant amount of contact time to perform. A 10 test version was then

conceived to gain as much information as possible in a manageable time frame25 minutes

while still finding the sites, directions, and thresholds of the individuals uncontrolled

movement. A 10 minute screen has also been developed, the 4x4, however this screen can only

identify that the client has a movement control issue that needs addressing but cannot confirm

the site and direction of the movement fault.

The flexibility of the system allows for each sport or activity to have a specific screen created

that tests the specific requirements or common movement faults (and therefore, potential

injuries) associated with it. To date there have been 15 screens developed that assess foruncontrolled movement within specific sports/exercise such as football, rugby, cycling, running,

judo and in development, the dance matrix. Two have been developed for occupational

activities including - the tactical athlete (i.e. policemen, firemen and soldiers) and another for

the office environment. The Foundation Matrix is a generalized screen that includes hopping

and jumps and is probably the most commonly used version of the process

An example of a low threshold test the Double knee swing test accompanies this editorial

later in this section, it acts as a practical example of how a movement screen test may be

performed showing what a tester is looking for and how they might score the test. As the

testing system is proprietary and there are many tests across the different screens a full

description here is inappropriate, however understanding that the tests are made up of the

building blocks of movement that combine to create functional movement means that new

tests can easily be created. This may consist of a choreography that is similar to the types of

movement and at loads utilised by the sport or activity. The tester can be drawn to look at the

successful, or not-successful control of parts of the movement that make up the tests

choreography. A yes or no question can be asked whether the movement was controlled.

Once a Performance Matrix movement screen has been completed the report generated is the

key tool to facilitate the prioritisation of exercise choices needed to address the movement

faults found. Like the FMS an exercise bank is available and some of the strategies suggested

to rehabilitate the client by the developers have been discussed previously in this section

(McNeill 2014a, 2014b). Motor control and recruitment training feature as fixes for the low

threshold system and these exercises rely heavily on slow movements that enable error

correction during the exercise, as well as being heavily reliant on proprioceptive challenges to

feed into the CNS of the client. The system allows for the practitioner to use the tools they are


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most familiar with to achieve the control of movement tasks. Pilates exercise and equipment

for a Pilates Teacher, a gym environment for a Personal Trainer. A focus on breath and relaxed

(unbraced) movement is important. For higher threshold faults strengthening is employed

though always with a focus on movement control. This could remind one of how a dancer,

gymnast or an acrobat moves even in strength moves. The quality of movement in wellexecuted examples of these artistic disciplines suggest perhaps the pinnacle of human

movement. Athletics without appropriate movement screening and with its desire to create

world records with its in-built competitiveness, is perhaps always playing on the brink between

movement control, over-use and disaster (injury).

Circus, Pilates, Dance

Sean Kempton is a clown. He is currently off work injured, recovering from a right hiparthroscopy for a labral tear he sustained jumping into splits while working for Cirque du Soleil

on tour. He met his wife, Micheala OConnor, a trapeze artist, while they were both training for

the Millennium Dome show that ran in London for the entire year of 2000, as a celebration of

the new Millennium. Initially a physical actor he transferred his skill set via a circus training,

Even though I was physically fit for physical theatre I was nowhere near circus fit. This took at

least a year of 7 or more hour days training to develop. My training included a conditioning

program combined with skill specific work. Circus requires different training methods from

other disciplines and as a clown you may have to develop training from three of the elements

that make up circus - ariel, static balance as well as dynamic floor work. It was a surprise to me

when I first realised that I could change the actual shape of my body depending on the skill I

was currently working on. In the dome show I was doing predominantly bungee work and

some trapeze so my upper body and neck became much wider, my lats really developed but

that altered with the change to performing more rope work, my lats decreased and deltoids

and triceps built but with a longer feel.

Kempton has witnessed an increasing professionalism in Circus which has developed from

family troupes of performers to the likes of the Las Vagas and multiple show world touring

Cirque du Soliel. OConnor, his wife, identifies that there is a role for generalists in circus.

These performers can pick up new or different apparatus quickly and help glue a show

together. The commercial circuss recruit these generalists from the ranks of gymnasts, often at

gym meets, who have developed, from an early age movement control skills and an agility to

quickly move technical skills between apparatus.

Circus performers have a variety of body types with a variety of skills and training

methodologies. Kempton and OConnor note that the influx of high level gymnasts raises the


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bar in training sessions but it is clear to them that there is a divide in what might best be

termed old school training versus the new school training which is heavily influenced by

physio-led intervention and Pilates. Performers interested in longevity in their career spend

more time working on fundamentals of movement - basically correcting movement patterns

and developing controlled movement, warming up and warming down properly. Kempton says,the new school of circus performers are forever concentrating on small musclesand the

control of movement, they are in Pilates class every day, while the old school still work hard on

big muscles,cardio-vascular fitness - hard work but often with little focus.

Kempton points out, as an example, his significant injury history, compared to OConnors very

light history. He admits he has had a tendency to be less thorough in his work on the

foundation of movement, compared to his wife who has always been very movement control

and Pilates led, while he perhaps, has been more cardio-vascular, power and skill led in histraining. Kempton has suffered (previously to this current hip labral tear) a glenoid labral tear.

He reports how the shows physiotherapy team and the performers themselves noticed a

repeated pattern in the incidence of glenoid labral injuries and suspected it was due to the

specific overhead lifting peculiar to the movement in that show. Following the identification of

the fault and the institution of a training program to stabilise the shoulder girdle and

strengthen for that specific move meant that the incidence of that labral injury decreased

significantly. Too late for Kempton, unfortunately.

Kempton has recently observed the shift in focus in the training of younger circus performers

who are concentrating even more on fundamental skills as opposed to the constant repetition

of a single trick. A solid grounding with a holistic approach.

As yet movement screening is not standard practice within the training of circus performers

though there are clear shifts, according to this interview, of a change within the teaching and

preparation of future circus performers that involves more attention being paid to the

fundamental movement control through out the whole body of such an artistic athlete.

Applying a thorough movement screen looking at the entire movement system, under both

postural and higher loads may identify areas of concern that may have only been found, in the

past, traumatically through injury. Movement screening may enable preventative measures to

be taken.

This increase in awareness of improving practice in the training of circus performers reflects

what is happening within the dance world, as research and a scientific approach are becoming

more important in the training of the undergraduate dancer. Organisations such as the

International Association for Dance Medicine and Science (IADMS), established in 1990, whose


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purpose is to enhance health, wellbeing, training and the performance of dancers and provide

a scientific backing to improve current practice.

Dance has always had strong links, since late in the 19th century, with somatic theorists,

educators and practitioners who aim to heighten self-awareness and self guidance usingpassive or more active physical practice, calling for the conscious cooperation of the person

through movement awareness or imagination as catalysts for changing motor/movement

behaviour (e.g., Ideokinesis, Alexander Technique, and The Feldenkrais Method)(websource 1).

Improved proprioception is also a goal for both an un-injured undergraduate dancer as all as a

dancer returning from injury, especially as research quoted in the IADMS resource paper on

proprioception (websource 2) suggest that ballet training alone does not improve ankle joint

position sense or post rehabilitation measures of balance, that trained dancers exhibitperceptual and balance errors in quantitative testing, that professional dancers performance

deteriorated on balance tests (posturography) as the base of support was narrowed. The paper

summarised that it appears that dancers need to continue to train all senses (visual, vestibular,

and somato-sensory) to adapt to changing conditions of technique and environment and to

rehabilitate from injury.

An increasing awareness that motor learning techniques are important in the training of a

dancer, including attention and observation (perception) of a demonstrated skill, replication

(execution) of what has been observed, feedback (knowledge of results/performance and

additional explanation), and repetition (further practice). (websource 3) and that screening is

also important, though the final conclusion in the IADMS resource paper on screening for

dancers states that, Screenings have not yet been proven to be predictive of risk for injury.

The association between screenings and health outcomes at present is not well understood.

Therefore, there is a need for educators and healthcare providers to undertake research aimed

at understanding how performance and wellness can be optimized and how injury and illness

can be prevented. Approaching screening with this objective may help advance the profession.

(websource 4).

It appears then that dance has useful tools for teaching the undergraduate dancer but not

necessarily a developed and honed tool in screening techniques yet. Movement tests like those

described by Roussel (2009) that point to movement control tests as being a true predictor of

injury in dance suggest that movement screening tools that are currently in use or

development are likely to fill that gap. The performance stability dance matrix maybe one such

tool. Movement screening or analysis based on validated movement tests should help further

reduce injury if they are adopted into the circus or dance environments.


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If disciplines like Pilates are going to be accepted as scientifically valid members of the team

influencing the rehabilitation process of CLBP the discipline may need to accept that formal

testing or assessment of their clients might be a necessary step to take. Movement testing

seems to be the most appropriate style of assessment that will also provide useful information

as a working tool.

The final paper in this Prevention and Rehabilitation section (Streicher et al 2014) may be of

interest to Pilates Teacher as this paper through a selective motor control training of the

transversus abdominis (which is not separated out within a Pilates exercise model) shows that

a group class can work nearly as well, though with no significant difference, as individual

sessions covering the same work in a back pain population. The key difference between the

individualsand the groupwas that the group members did not have the individualised feed

back but they still learned from the motor control intervention, so this paper suggests that

group classes are a valid form of delivery of exercise for those suffering from back pain,

though is Pilatesthe same as a motor control training?

References

Comerford, M., Mottram, S., 2012. Kinetic Control: the Management of Uncontrolled

Movement. Churchill Livingstone, Elsevier.

Comerford, M., Mottram, S., 2001. Functional stability re-training: principles and strategies for

managing mechanical dysfunction. Man. Ther. 6 (1), 3e14.

Cook, G., Durton, L., Kiesel, K., Rose, G., Bryant., M. 2010. Movement Functional Movement

Systems Screening Assessment Corrective Strategies. On Target Publications. Aptos

Elgueta-Cancino, E., Schabrun, S., Danneels, L., Hodges, P. A clinical test of lumbopelvic control:Development and reliability of a clinical test of dissociation of lumbopelvic and thoracolumbar

motion, Manual Therapy (2014), doi: 10.1016/j.math.2014.03.009.

Hiller, C., Refshauge, K., Herbert, R., Kilbreath, S. 2008. Intrinsic predictors of lateral ankle sprain

in adolescent dancers: a prospective cohort study. Clinical Journal of Sports Medicine. 18 (1):

44-8

La Touche R, Escalante K, Linares MT. Treating non-specificchronic low back pain through the

Pilates method. J BodywMov Ther 2008;12:36470


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McNeill, W. 2014a. Editorial. Pilates: Ranging beyond neutral. Journal of Bodywork and

Movement Therapies. 18, 119-123

McNeill, W. 2014b. Pilates: Ranging beyond neutral - A practical discussion. Journal of

Bodywork and Movement Therapies. 18, 124-129

McNeill. W. 2012. Editorial. Pilates: Release or recruit? Journal of Bodywork and Movement

Therapies. 16, 101-108

Mottram, S., Comerford, M. 2008. A new perspective on risk assessment. Physical Therapy in

Sport. 9 40-51

Page, P., Frank, C., Lardner, R. 2010. Assessment and Treatment of Muscle Imbalance The JandaApproach. Human Kinetics. Chicago.

Roussel, N.A., Nijs, J., Mottram, S., Van Moorsel, A., Truijen, S., Stassijns, G., 2009. Altered

lumbopelvic movement control but not generalized joint hypermobility is associated with

increased injury in dancers. Man. Ther. 14 (6), 630-635.

Streicher, .H., Mtzold F., Hamilton, C., Wagner, P. 2014. Comparison of group motor control

training versus individual training for people suffering from back pain. Journal of Bodywork &Movement Therapies, http://dx.doi.org/10.1016/j.jbmt.2013.12.006

Suehiro, T., Mizutani, M., Watanabe, S., Ishida, H., Kobara, K., Osaka, H. 2014. Comparison of

spine motion and trunk muscle activity between abdominal hollowing and abdominal bracing

maneuvers during prone hip extension. Journal of Bodywork & Movement Therapies.

http://dx.doi.org/ 10.1016/j.jbmt.2014.04.012

websource 1: http://www.iadms.org/?248




Author

Warrick McNeill, Dip. Phyty. (NZ) MCSP

Physioworks, 4 Mandeville Place, London W1U 2BG, UK


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Tel.: +44 7973 122996. E-mail address: [email protected]

Photo 1.

Hip extension movement pattern start position. Note: Feet over the end of the bed.

Photo 2.

Hip extension movement pattern.


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Photo 3.

Hip extension movement pattern. Hamstring dominance.

Photo 4.

Hip extension movement pattern. Anterior pelvic tilt compensation.

Photo 5.

Shoulder mobility reaching pattern (Right).

fms pilates circo.pdf

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