Pilates for MS
As Pilates advocates, we pride ourselves on the versatility of this movement method. Depending on the needs of a client, a private session can resemble physical therapy, weight lifting, or dance class. We do our best to tailor classes to specific populations interested in achieving similar results. In particular, Pilates Collective founder and studio owner Clara Gelatt is an expert in teaching Pilates for people living with Multiple Sclerosis.
What is Multiple Sclerosis?
Multiple sclerosis, often abbreviated to MS, is an autoimmune disease affecting nerve cells in the brain. Autoimmune diseases cause a body to attack its own tissues, and in the case of MS, the body attacks the central nervous system.
If you think back to biology class, you might remember that the central nervous system (abbreviated to CNS) consists of the brain and spinal cord. It coordinates movement throughout the body, essentially acting as the messaging system that carries signals from our brain to our muscles. Working in tandem with the CNS is the peripheral nervous system (or PNS), which consists of all the nerves outside of the spinal cord. This includes nerves in the skin, muscles, and joints. By receiving signals from the CNS, the PNS tells our bodies when and how to move, which triggers a response from our muscles.
All of the nerves in the PNS are encased in myelin, a fatty tissue that acts as an insulator; you can think of it as analogous to the casing around electrical wiring. Myelin protects the nerves and ensures that the signals between the CNS and PNS get to their destination unimpeded.
Multiple sclerosis causes a degradation of this protective myelin. Due to inflammation of the myelin itself and the cells that create it, people with MS suffer from impaired transmission of signals between the two nervous systems. The damaged areas around the nerves develop scar tissue, after which the disease is named: sclerosis is another term for scarring.
As the disease progresses, signals between the CNS and PNS can be altered or even stopped completely. Depending on the severity and type of MS, these impaired signals can result in symptoms ranging from numbness or tingling to uncontrollable tremors. Although the cause of MS is still unknown, research points to a genetic susceptibility.
There are four categories of MS people experience, but the most common is Relapsing-Remitting Multiple Sclerosis (RRMS). This form of the disease causes a person to experience symptoms in fluctuations, with periods of symptoms—relapses—and periods with none or a select few—remissions. Each period of relapse typically sees an increase in the severity of symptoms. When relapse occurs, the person may experience no symptoms at all, or they may experience symptoms that have become permanent.
How Does Multiple Sclerosis Affect Movement?
Because multiple sclerosis affects the nervous system, interrupting signals between the brain and the rest of the body, the most noticeable symptoms of MS are related to movement. Many people living with multiple sclerosis do not experience cognitive dysfunction until the disease has acutely progressed, if at all.
As the myelin degrades, the messages between nerves are impeded and muscles are not able to respond appropriately. This manifests in a lack of coordination, muscle weakness, and involuntary muscle spasms. It can also cause spasticity, which is a condition in which a muscle is continuously contracted.
The degradation of muscle use causes people with MS to have trouble performing everyday actions such as walking, balancing, and coordinating movements.
History of Pilates for Multiple Sclerosis
In 2002, a young woman named Mariska Breland was diagnosed with MS. In response to the diagnosis, she became more diligent about physical activity that could ease her symptoms. She discovered that Pilates, a form of functional movement designed by its namesake Joseph Pilates, was particularly helpful in reducing numbness and tingling. Practicing Pilates blossomed into a desire to teach, and within a year, Mariska earned her certification.
Mariska went on to complete a year-long research project studying the effect of Pilates for people with MS. She expanded this into a continuing education course called Pilates for MS, the program that the founder of the Pilates Collective, Clara Gelatt, completed in 2016.
For Clara, specializing in Pilates for people living with multiple sclerosis happened somewhat by chance. While she was teaching (before she opened the Pilates Collective), she mentioned to a client that she missed volunteering and being engaged in the nonprofit world, something she had done frequently before her schedule filled up with teaching and family. The client, who happened to have MS, suggested Clara hold a donation-based Pilates for multiple sclerosis class at the studio. Clara ran with the idea, contacting the National Multiple Sclerosis Society and creating a program in which students received one private session and 6 weeks of an introductory Pilates for multiple sclerosis class. Over a three week period, she had somewhere in the neighborhood of 40 private sessions with clients living with MS. About 10 of them continued onto the group class, during which all donations went towards the MS Society.
Once the 6 weeks were up, Clara continued the class with a pay-what-you-can model. She supplemented her hands-on knowledge by completing the Pilates for multiple sclerosis certification, and upon opening the Pilates Collective, she was sure to put Pilates for MS classes on the schedule. In fact, the very first class held at the Pilates Collective was Pilates for multiple sclerosis, filled with devoted students who had followed Clara into the new space.
The Pilates for MS classes that Clara teaches are tailored specifically for people with the disease, but she’s found that they’re not all that different than the other classes on the schedule. People with MS typically move more slowly on the equipment because they’re extremely careful, but the primary goal is the same: strengthening the connection between body and mind. And the muscles that typically need strengthening in people with MS—glutes, abdominals, hamstrings—are the same muscles that typically need strengthening in most clientele.
“Everyone has these different compensation patterns,” Clara says. “In a Pilates for MS class, we’re not trying to get rid of the compensation, we’re just trying to mitigate the negative effects.” In a person without a neurological disorder, we may address a compensation by optimizing the underlying pattern. We may encourage an alternate pattern of movement that eliminates the compensation and engages the appropriate muscles.
With someone living with multiple sclerosis, that compensation may be a result of neurological damage; the optimal pattern or muscle engagement may not be an option. In this case, Clara works to figure out the alternative that will minimize other compensations and keep the client as mobile as possible.
For example, many of Clara’s clients living with multiple sclerosis use walkers. This is common for people with MS: it improves balance, empowering people to walk more than they would unassisted because they no longer have a fear of falling. However, because using a walker requires leaning forward frequently, those who use them can become kyphotic in their spine. The walker is necessary in order to stay mobile, so Pilates for these clients wouldn’t be aimed towards teaching them to walk with their spine upright.
Instead, Clara may lead them through back extension exercises that reverse the forward curve and alleviate any pain it has caused. She may work with clients on balance in a controlled way, such as by holding onto the tower while lifting one leg. The walker is not the problem—instead, it’s a valuable solution, and it’s our job as instructors to figure out the best way for someone to utilize this tool.
One of the benefits of teaching Pilates to a group of people with MS is that it builds community. Many people have difficulty relying on a walker even when they may benefit from one: there’s a stigma surrounding using a walker and it may make someone feel self-conscious or disempowered.
In the group Pilates for multiple sclerosis class, many people use walkers. By seeing other people with MS living full lives, walker and all, clients may feel inspired to do the same with confidence.
Exercising with Multiple Sclerosis
In addition to the community-building aspects, Pilates is an excellent form of exercise for multiple sclerosis. The unique equipment used in Pilates offers safe, supported ways of moving that take pressure off the joints and remove the obstacle of balance. Footwork on the Reformer in particular has been transformational for Clara’s clients with MS.
“Some people don’t have a chance to do a lot of straightening and bending of their legs,” Clara explains. “The assistance of the springs allows you to do movement that would otherwise be stressful.” While laying down, clients can work their feet, ankles, and legs without concern of falling. Also, a common symptom of MS is a loss of sensation in at least one foot. This can be a huge deterrent against exercising with multiple sclerosis. When doing footwork on the Reformer, clients can press their feet against the footbar, stretching out the muscles and joints with peace of mind.
This further serves as a great reminder that the muscles of someone living with MS are unaffected by the disease. “The muscle is ok, it’s just not getting signals from the nerves,” Clara says. In this way, Pilates offers optimal exercises for people with multiple sclerosis, providing an opportunity to work muscles that normally are not engaged.
Strengthening the appropriate musculature helps people living with multiple sclerosis improve their balance as well. One way of accomplishing this is by doing the side lying legs series, which Clara frequently does with her clients. In addition to the obvious work that’s happening in the top leg, Clara encourages clients to press into the bottom leg for support in order to lift the top leg. Even if someone can’t stand on one leg upright, they can practice one side supporting the other while laying down. That way when they stand up and hold onto something for support, they can use their standing leg the same way they did while lying down.
One aspect of Pilates that is unexpectedly helpful for people with MS is breathwork. Living with a neurological disorder can cause people to hold additional tension in their bodies. The tension is typically protective, and for good reason: people are afraid they’ll fall. While a certain amount of this protection is necessary and beneficial, it can become limiting, for instance if it prevents people from breathing deeply. Just by practicing diaphragm breathing, clients can relax the muscles holding tension and engage their deep core muscles instead.
For one client, learning to breathe properly was transformational. “As soon as she learned how to take that healthy exhale and engage on the inhale, everything got easier.” Clara recalled. “She’s improved her breathing and gotten stronger in her abs, which helps with everything else.”
Watching clients like this woman improve has been immensely rewarding for Clara. She says she enjoys teaching Pilates for multiple sclerosis because it forces her to get creative. She uses the equipment and props in innovative ways in order to best serve the person in front of her.
With Clara’s extensive knowledge and experience, she’s an incredible resource for people living with neurological disorders such as MS. Besides her practical proficiency, she’s kind, intuitive, and easy to talk to. The Pilates for multiple sclerosis classes at the Pilates Collective still follow the pay-what-you-can model, allowing anyone in the area an opportunity to benefit from this practice.
If you or someone you know is interested in doing Pilates to improve MS symptoms, please reach out! We’re always happy to welcome new people into the Pilates Collective community.
Interested in learning more? Here’s some further reading: