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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. This is a PDF file of an unedited manuscript that has been accepted for publicatio
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   Accepted Manuscript  Are movement screens relevant for Pilates, circus or dance?Warrick McNeillPII:S1360-8592(14)00079-5DOI:10.1016/j.jbmt.2014.05.007Reference:YJBMT 1135To 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.This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.  A CCEPTED MANUSCRIPT   1 of 17 Are movement screens relevant for Pilates, circus or dance? Editorial: JBMT Rehabilitation and Prevention Section Warrick McNeill Motion is life   Gray 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 srcinal 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.    A CCEPTED MANUSCRIPT   2 of 17 Interestingly a majority of the papers analysed for Wells   review 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 different subgroups 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 als (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  A CCEPTED MANUSCRIPT   3 of 17 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, by proving 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 Jandas 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 crossroads   between the central nervous system and the musculoskeletal system. The muscular system reacting with inhibition or tightness. Jandas 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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