Pilates and Postural Re-Education: Physiotherapy and Epistemology

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CARTA AO EDITOR
Pilates e Reeducação Postural:
Fisioterapia e Epistemologia
Pilates and Postural Re-Educaon:
Physiotherapy and Epistemology
Luís Coelho*1
1. Escola Superior de Saúde do Alcoitão, ©Reeducação Postural, Alcoitão, Portugal
Recebido/Received: 2023-11-28. Aceite/Accepted: 2024-08-14. Publicado online/Published online: 2024-09-11.
© Author(s) (or their employer(s)) and Gazeta Médica 2024. Re-use permied under CC BY-NC 4.0. No commercial re-use.
© Autor (es) (ou seu (s) empregador (es)) e Gazeta Médica 2024. Reulização permida de acordo com CC BY-NC 4.0. Nenhuma reulização comercial.
PALAVRAS-CHAVE: Dor nas Costas/reabilitação; Força Muscular; Postura; Técnicas de Exercício e de Movimento
KEYWORDS: Back Pain/rehabilitaon; Exercise Movement Techniques; Muscle Strength; Posture
Autor Correspondente/Corresponding Author:
Luís Coelho [coelholewis@hotmail.com]
hps://orcid.org/0000-0002-1947-456X
In a me of fashions, clinical reality seems to be subju-
gated by the expression of methods, paradigms, which
the back pain's theme so well exposes and promotes
in the world of psychophysical rehabilitaon. If the
"spine" itself achieves balance, the excess of models
betrays it, polarizing the relaonship between the
muscular chains and the "muscular" and liberal acon.
If, according to postural models,1.3 balance implies the
synergisc relaonship of a postural musculature - es-
senally posterior - suciently exible, and - therefo-
re - strong and tolerant, with a strength musculature
- essenally anterior - reinforced, it is certain that it's
the excess stretching itself that challenges balance,
generang the "posive" symptom and reinforcing the
cycle of the urgency to stretch; the dogma feeds itself
and the placebo's therapist, lacking precisely the ba-
lance that will propiate the movement and the possi-
bility of previous acon.
It is exactly the movement that cannot be obliterated,
it's the movement that calls for re-stabilizing reinfor-
cement. It should be noted that the "postural" model
is essenally carried out in the "exion" posion, to
recover muscle length, but this paradigm has its major
limitaon in the "discal" model (mainly carried out with
extension maneuvers, aiming the reabsorpon of the
nucleus pulposus of the intervertebral disc4), with the
possibility that Postural Re-educaon may worsen the
process involved, for example, in disc hernias. It is clear
that the model defends itself (it suggests that stret-
ching provides decompression of the inter-vertebral
discs3), and the body defends itself against it, genera-
ng more compensaons, and these are, just like, the
defenses of the therapist. Deep abdominal strengthe-
ning work cannot, in this context, recover lost balan-
ce; it even generates new defenses. It is necessary to
carry out extension work, capitalize on the funcon,
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CARTA AO EDITOR
the movement, and only then will it be worth inclu-
ding, eventually, Pilates. In turn, the exercise of this on
a body in disharmony also promises to create more re-
sistance, later and cyclically, generang painful prac-
ce (of course, the model defends, quite oen, the need
for "pain", but not all pain is worth it) and mulplying
the possibilies for rebalancing. The polarizing process
is a representaon of the "pathos" of spinal pain itself,
as well as the inammaon of paradigms, equally in
the mind of the therapist-paent duo, Subject-Object.
Strengthening the trunk extensors, postural hygiene,
superconscious work on the muscles, all of this further
feeds the models' disharmonious relaonship, spinal
pain, contribung, in fact, to aen the spinal column,
somemes darned by the forces of duality in "eternal
return".
The stretching must be moderate, spontaneous, the
movement must take advantage of it, and the stren-
gth capitalizes on the balance. When Postural Re-e-
ducaon is exceeded, Pilates also has to do the same.
When models propose a new balance, only funcon
can recover harmony, stabilizing the relaonship, re-
solving duality, and recreang the growth of a spine,
where the neurological and cognive process cannot
be neglected. Dogmac pracce proposes the salva-
on of the therapist, not the paent. And that is why
the clinician cannot be obliterated by the messianic re-
-educator or the Pilates teacher. Nor, as such, should
the "Clinic" forget the source of the "idiosyncrasy",
with those pracces embracing, increasingly, the
group approach. The "nomothec" science involved,
for example, in studies related to Pilates will only make
sense if it is contextualized in the paent's idiosyncra-
c balance, only then can the science be ecologically
validated; otherwise, we will have studies that invite
almost coercive pracce. Clinical ecology suggests
that Pilates pracced excessively can also have a ne-
gave impact on herniated discs. Despite the literatu-
re suggesng otherwise, we are, every day, challen-
ged to combine models in a way that stabilizes and
enhances the balance, which oen does not support
the nancial validity of a "praxis" exercised perpetually.
However, it will not be easy to study the eect of a
rebalancing pracce, which allows "arcular" forces to
be resolved, including discal ones, and which therefo-
re has expression in the "neurological" representaon.
Not that this System suers from (lile) "science", but
it congures a structural "long term" that raises, once
again, the threat of "postural" dogma. Here too, func-
on, funconal strength, plays an important role, in-
troducing the "short term" into the postural structure.
And, again, the cycle is represented, which is, siblin-
gly, the relaonship of the ascending "input" with the
descending (i)Reason, of the therapist-paent system
with the ungraspable, unaainable Object. The "short
term", "contextual interference", therefore challenges
the balance that the Context, science, seeks, and it is
competed by duality where the therapist does not ex-
clude himself as an element of the System, but rather
becomes, perhaps, "paent" of it at the expense of the
Other's interference.
RESPONSABILIDADES ÉTICAS
CONFLITOS DE INTERESSE: Os autores declaram não
possuir conitos de interesse.
SUPORTE FINANCEIRO: O presente trabalho não foi
suportado por nenhum subsídio ou bolsa.
PROVENIÊNCIA E REVISÃO POR PARES: Não comissio-
nado; revisão externa por pares.
ETHICAL DISCLOSURES
CONFLICTS OF INTEREST: The authors have no con-
icts of interest to declare.
FINANCIAL SUPPORT: This work has not received any
contribuon grant or scholarship.
PROVENANCE AND PEER REVIEW: Not commissioned;
externally peer-reviewed.
REFERÊNCIAS
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Introdução ao conceito de reeducação postural. Quinta do
Conde: Contra-Margem, 2008.
2. Mézières F. La révoluon en gymnasque orthopédique. Pa-
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3. Souchard Ph-E. Le champs clos. Paris: Maloine; 1981.
4. Coelho L. Raquialgias: Modelos sioterapêucos e preven-
vos. Gazeta Méd. 2020;7:313-4. doi: 10.29315/gm.v7i3.370.
258 · GAZETA MÉDICA Nº3 VOL. 11 · JULHO/SETEMBRO 2024