Pilates as a Treatment for Trauma: Mindful Movement

Sep 21, 2023

backpain , body , dissociation , exercise , PTSD , sport , stress , trauma

With it's core principles of concentration, breath, and mindful movement, Pilates could provide more than just a physical workout
Psychotherapist Andrew Keefe, who also works as a PT and Pilates teacher, explores how Pilates can support people with trauma
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Much has been written about the power of yoga to heal trauma: David Emerson and Elizabeth Hopper, in their book Overcoming Trauma through Yoga: Reclaiming Your Body, identify four themes through which yoga can help the trauma survivor: experiencing the present moment, making choices, taking effective action and creating rhythms. Their programme “….allows trauma survivors to cultivate a more positive relationship with their bodies through mindfulness, breathing and gentle yoga exercises.”

Less has been written about the potential of Pilates as a treatment for trauma.

I am a psychotherapist, personal trainer and Pilates teacher and work with mind and body to help people recover from trauma and chronic lower back pain. Pilates is one of the best forms of exercise for keeping your back healthy but recently I have begun to explore the potential for Pilates to be used by trauma survivors to relieve their symptoms.

Pilates can look very like yoga from the outside: both are relatively slow-paced, emphasise breathing and slow, controlled movements and happen mostly on a mat. Yoga though is an ancient, spiritual practice while Pilates was developed in the early twentieth century by Joseph Pilates as an exercise system to help wounded soldiers and injured dancers rehabilitate and has more of an emphasis on core strength and control, as well as spinal mobility, making it an excellent choice to treat and prevent chronic lower back pain. But how can Pilates help resolve trauma?

Fight and flight

It’s partly about the hip flexors. Elizabeth Koch, in her work The Psoas Book, shows us how the psoas muscle (one of the main “hip flexor” muscles, along with the Iliacus) contracts (tightens) when the fight / flight mechanism is triggered, in response to danger or a traumatic memory.

The psoas runs from the top of the femur (thigh bone), in front of the hip bones and hooks on to each of the five lumbar vertebrae and the lowest of the thoracic vertebrae (L12). If it is too tight, it pulls the lumbar vertebrae down, squashing them together and squeezing the intervertebral discs. These push out at the back, pressing onto the spinal nerves and are a major cause of lower back pain.

The psoas connects with the Iliacus muscle where they both join the top of the femur. The Iliacus starts on the top part of the hip bone, so when that muscle tightens, it can pull the pelvis into an anterior (forward) tilt, pushing the lumbar spine into an exaggerated curve, another cause of lower back pain.

The psoas also connects to the diaphragm, the umbrella-shaped muscle lying at the bottom of the ribs, which we use to control our breath. Again, when the psoas is tight, the diaphragm tightens, restricting breathing.

The psoas tightens or contracts in fight/flight because of its role in flexing the hip so that the leg lifts, enabling you to run or fight. In chronic trauma, where you live in a constant state of hyper-vigilance, always expecting to be attacked again, the psoas will be permanently tight, causing the back pain and breathing issues mentioned.

Further tension in the body comes from a tightening of the fascia in fight/flight. Fascia is a glutinous, string-like material which covers the body like a net, beneath the skin, holding bones, muscles and organs in place. It is usually slippery and flexible, allowing muscles and joints to move under the skin but can become sticky and stiff, impeding movement in response to trauma: the release of cortisol into the bloodstream, during a traumatic incident or when it is re-experienced, increases the level of glucose in the body which causes the fascia strings to stick together (see David Lesondak’s book: Fascia: What it is and Why it Matters for more background).

Freeze and dissociation: Losing contact with the body

Trauma survivors, especially survivors of sexual violence, often mention they don’t feel they are in their body. It feels numb, unconnected, as if it doesn’t belong to them. People describe not being able to identify the feel of particular muscles in the body. This is not the same as being paralysed – you can move – it is more that your body doesn’t feel your own.

This happens as the body goes into freeze at the time of the original traumatic incident and again when reminded of it later. The brain’s survival system will opt for freeze if fight / flight have been tried or it thinks freeze is a better option. The body goes numb to reduce the impact of the attack. The mind can split off or absent itself from the body for the same reason. And this can keep happening every time you are reminded of the trauma.

How Pilates can help: The principles

In designing and delivering a session or programme, a Pilates teacher is informed by six key principles:

Concentration
Breath
Centring
Precision
Flowing Movement
Control

It is the first two of these, concentration and breath, in particular which make Pilates a helpful practice if you are living with trauma.

The slow, controlled breathing of Pilates, in through the nose, breathing wide into the ribs (Lateral Thoracic Breathing), filling the lungs before a long slow breath out through the mouth, “as if you’re blowing out a candle on the other side of the room”, engages the parasympathetic nervous system (PNS): the PNS is the part of the autonomic nervous system, responsible for calming the body and counteracts the sympathetic nervous system (SNS), which energises the body, preparing it for the action of fight / flight.

All movement in a Pilates session revolves around and works with the breath: usually one inhales to prepare, exhales on the movement and inhales to return to the starting position. Breath facilitates movement and sets its rhythm. Over the hour of a Pilates session, this dance of movement and breath can become hypnotic, calming the body and reducing stress. Specifically, deep, slow, rhythmic breathing relaxes the diaphragm, which, as noted, is linked to the psoas, loosening that muscle too and releasing tension in the lumbar spine and pelvis.

Concentration

Concentration or focus is used in Pilates to build awareness of the body and of what correct alignment, posture and movement patterns feel like, so they become automatic, and the body / nervous system learns to adopt optimal posture and correct movement, automatically. The Pilates teacher encourages their clients to focus on the parts of the body which are moving, the muscles moving them, the muscles keeping other areas of the body stable during the movement and notice how that feels.

You are asked to notice when your thoughts wander away from the body, to let any other thoughts go and return to the movement: Pilates is Moving Mindfulness and this focus on movement helps reconnect the dissociated trauma survivor with the calming body, which gradually feels safe enough to return to.

As we have seen, Pilates works with the breath and a body which is breathing in this way and moving with smooth, Flowing, controlled movements (two more of the six principles), will be a body which is calm, or at least calming itself. When you focus on the state and movement of a calm or calming body, what you notice is relaxation and safety and this is what will be reported to the brain:

Interoception

When someone is “triggered”, something has happened to remind the brain’s threat detector, the amygdala, of a frightening experience from the past and because that part of the brain doesn’t have a sense of time or place, it thinks it’s happening again and sends out the same stress hormones (adrenaline then cortisol) to instruct the body to respond as it responded at the time of the original incident (fight, flight or freeze).

Sensory data will have come to the amygdala from sensory organs in the body (eyes, ears, nose, mouth, muscles, skin, joints) which the brain compares against its database of prior experiences and decides it means the original threat is being repeated: stress and tension in the body is communicated to the brain which sends stress and tension back into the body a spiral of stress commences. To live with high levels of trauma is to be in a constant state of alert, constantly triggered, tense and stressed.

Interoception is the process of the nervous system noticing how the body is, it’s state and condition and communicating this to the brain. The concentration and focus elements of Pilates facilitate and strengthen interoception, boosting the signal. The amygdala starts to receive reports about the calming body, replacing reports about the frightened body. It re-assesses its threat assessment, deciding the body is now safe.

Dissociation and time travel: Noticing the present body

Another feature of fight / flight / freeze is that the brain’s pre-frontal cortex (PFC) is switched off. This is the conscious, thinking part of the brain and its switched off so that the survival brain (the amygdala), can take over and do what needs to be done to keep you alive (if a bear is chasing you, the last thing you should do is stop and think: you need to run, get ready to fight or hide). This is also the part of the brain which knows what day it is and where you are. When it switches off, the timeless amygdala takes over and you feel you’re going back in time to relive the original trauma.

Focusing on movement in Pilates engages the sensory organs in your joints and muscles, transmitting data to the PFC, which switches back on in response, bringing you back into the present where you are safe within the calming, moving body.

Conclusion

Pilates has much to offer in the treatment of trauma, through use of focus, breath and smooth, flowing movement. This calms and relaxes the body, and signals this state of calm to the brain, allowing it to change its assessment of a situation, from one of threat and danger from the past to safety in the present.

Someone cut off from their body through dissociation might find this a safe, non-threatening way to return to their body as it calms, where previously it was a place of tension and fear. As the body calms and the threat signals from the brain quieten, the fascia and the psoas muscle relax, releasing tension around the lower back and pelvis, reducing pain in those areas.

Where the trauma survivor is also in therapy, the underlying traumatic memories which are the cause of the problems, can be processed and worked through. Pilates compliments and supports the therapy, through helping the client to self-regulate and re-connect with their body.

These observations come from what I have learned through clinical experience and teaching Pilates: as always, what is needed is further practice involving more teachers and therapists and research to fully explore what might be possible.

Andrew Keefe is a verified Welldoing psychodynamic psychotherapist, as well as a personal trainer and Pilates teacher