"It is a key movement in the Pilates system because it addresses the core musculature of the powerhouse in detail. This exercise gives an opportunity for an instructor to observe the body's symmetry. It allows them to cue a client to move straight through the spine, correcting the body's inefficient " (Coleman-Brown and Haley-Kanigel, 2003).

Below are Coleman-Brown and Haley-Kanigel's instructions:

1. Sit on a mat with knees bent, heels together, and knees in line with the shoulders. Place hands behind thighs and make sure shoulders are over hips. Pull the powerhouse in and up, hollowing out the abdomen. Eyes gaze toward navel (photo 2,-page 28).

2. Roll back one vertebra at a time, starting from the base of the spine, until the elbows are straight or only as far back as you can control segmentally. The arms act to assist the abdominals as necessary. Then reverse the move (photo 3,-page 28).

3. Repeat five times, or as many as can be performed precisely.

Kloubec and Banks offer a basic Pilates routine that addresses virtually all the issues involved in hip and knee rehabilitation. They are:

Ab Prep. In a supine position, curl up with your hands by your sides, knees bent and feet on the floor. Stabilize the neck, scapula, and ribs, pull in and flatten the transverse abdominus, exhale to initiate movement, hold for one inhale, release and return on exhale.

Breaststroke. In a prone position, raise your arms overhead and sweep them to the side as the torso lifts from the mat. Holding your arms at the side, the torso "hovers." Then sweep your arms back overhead. Keep your neck long and the scapula retracted.

Half Roll Back. Sit upright with legs bent and feet flat on the floor. Roll half way back down to the floor, hold for one breath (inhale), exhale, and return to a seated position.

Spine Twist. Sitting upright, with legs extended in front slightly farther apart than hip width, and arms horizontally extended from the shoulders, twist the torso to the right on three exhaled breaths. On the inhale, return to center. Repeat on left side. Maximally rotate on the first exhale, then lengthen and increase the motion of rotation with the next two breaths.

Swan Dive Prep. In a prone position with arms extended overhead, press your torso into limited hyperextension. As the torso returns to the mat, extend and lift your legs (rocking on the pelvis).

Rolling Like a Ball. Lift your legs up to the chest, balance on the sitz bones, roll backward, and return to a seated, balanced position. Repeat. Concentrate on staying in full flexion (C-curve) throughout the movement. Use abdominals to initiate and control the movement.

Leg Pull Front Prep. In a prone position, extend your arms to assume a push-up position, lift one leg, extend the back and flex forward on the toes. Then repeat with the other leg. Keep your neck in line with the spine, with the scapula retracted and the transverse abdominals tightened throughout" (Kloubec and Banks, 2004, p. 34+).

Exercises using the Swiss Ball

Designed in many cases to be useful for prevention of low back pain, exercises with a Swiss ball or physio ball are also common to Pilates and have implications for rehabilitation of the hip and knee because they are non-weight-bearing, but do offer strengthening and muscle control rehabilitation (Spine-Health Web site, 2005).

With the exercise ball, an element of instability is introduced to the exercise that one would not normally get in a floor exercise. The body responds naturally and automatically to this instability to keep balanced on the exercise ball. Over time, the muscles used to keep in balance on the Swiss ball become stronger. In essence, individuals build strength in important back muscles and abdominal muscles without knowing it" (Spine-Health Web site, 2005), and this assists in creating a foundation for knee and hip rehabilitation exercises.

In addition, "it is theorized that the type of spinal movement induced by using the exercise ball (small range, adjustment of balance) may help reduce pain by stimulating the body to produce increased amounts of natural pain inhibitors" (Spine-Health Web site, 2005).

Case studies

Following are two case studies involving Pilates,

Female 'C', age 26, Interior Designer.

C' had injured her knee in a skiing accident. She was diagnosed as having a subluxation in the extension of both patellae due...

After six weeks of physiotherapy she was still limping and in pain.
C' attended the Body Control Studio in South Kensington where she used the special Pilates machines. She was given remedial exercises to strengthen her leg muscles and was also encouraged to work the rest of her body, with due attention to safeguarding her knee. After just six weeks she had made a complete recovery.

C' writes:

had a very bad knee from skiing and could not walk. I knew that if I did not do something, I would not be able to ski again. I have been to gyms and 'pumped iron', but with Pilates I feel relaxed and understand what I am doing'." (Robinson and Thomson, Positive Health Web site, 2002)

Female 'J', age 38, administrator.

Referred by her GP for osteopathy with Piers Chandler, having complained of upper back and shoulder pain for approximately two years. She had been involved in a road traffic accident three years earlier. Physiotherapy had made no difference. 'J' has a scoliosis's shape with a high left shoulder and high right hip. Chandler's treatment helped, but he felt she needed to try 'whole body exercise' for scoliosis and, therefore, advised Pilates.

J' joined a group matwork Pilates class. The sessions included exercises to improve body awareness, alignment, relaxation, breathing, core stability, strength and flexibility. The overall postural programme has helped with her scoliosis. In addition, 'J' was given remedial exercises for stretching and mobilising her upper body and shoulders. She then concentrated working to stabilise her scapulae, strengthening the Lower Trapezius, not just with specialised exercises but as part of all her movements. She uses light weights to help build her strength.

Two years on, her level of fitness has improved dramatically and she is now able to do the advanced work without strain.

J' writes:

feel stronger and more flexible, with much improved abdominal strength and a greater range of movement. My osteopath told me that my improved posture had made me taller, and that my back was broader. It has been easy to fit Pilates into my way of life, the classes are enjoyable and relaxing and I have been able to follow the routine easily at home. My ability to do the more advanced exercises has crept up on me steadily. The combination of osteopathic treatment and Pilates has been very beneficial and I have only needed to visit the osteopath once in the last eighteen months'." (Robinson and Thomson, Positive Health Web site, 2002).