Clinical Pilates MBCT Certification Series Overview
For the last 30 years DMA has maintained its reputation as the gold standard in Pilates training for physiotherapists with Clinical Pilates pioneering the links between spinal stability exercise, motor control research and the work of Joseph Pilates.
Only DMA has published research to test efficacy of the Clinical Pilates MBCT treatment tool with a training model focussed on the heterogenous demands of Physiotherapists treating pathology within a clinical pathway.
We know that every patient is different so you will learn how to identify the differences and treat with a focused, reliable prediction tool. Clinical Pilates is not an homogenous exercise class approach, it’s a cutting edge pathology treatment tool. Whats more, no other Pilates course has its sights set on addressing the future challenges of health reform and the pivotal role physiotherapists will play.
READY TO ENROL?
Unit A & B are 3 days per unit 09:00-17:30
plus pre- course e-learning
Unit A is a pre-requisite for Unit B
UNIT A COURSE
UNIT B COURSE
Unit A + Unit B + Unit C
$3312 – SPECIAL
EXTENDED till APR 30th 2020
Course Schedule Calendar
ABOUT UNIT A
– lumbo pelvic stability
– patient subgrouping
We begin with the history behind this concept becoming one of todays most discussed approaches to injury management. An in depth review of the ever changing research clarifies the distinct “point of difference” from standard pilates – MBCT.
Matwork & equipment based reformer exercises are linked to treatment of stability control deficits with 30 “key” exercises & markers for their inclusion / exclusion from treatment.
Clinical applications & pathology management
• patient subgrouping
• functional stability tests
• defining heterogenous/patient specific programmes
• identifying treatment outcome predictors
• differentiating motor control from pathology
• using exercises as treatment
• using exercises as clinical tests
• differentiation of radiological findings
• differential diagnosis tools – is it function or structure?
• gaining effective patient compliance
• case studies to identify patient subgroups & clinical pathway development
– cervico thoracic stability
– chronic pain/pelvic floor
This module introduces the Trapeze Table, adding to the reformer & matwork repertoire
• an increased repertoire of shoulder girdle, upper body and combined stability exercises
• a broadening of reformer exercises & matwork
• attention to manual handling & teaching cues
• introduction to small barrel & spring wobble board
Clinical applications and pathology management
• hypermobility & instability identification & management
• direction bias assessment techniques
• chronic pain & systemic autonomic management
• simplifying the “complex pain” patient
• integrating evidence on pelvic floor in males & females
• using outcome measures with Clinical Pilates
• recording within subject / within session changes
• programme development using case studies
• introduction to CPMATE software
• surgical selection & surgical avoidance criteria
• strategies to address Health Reform changes
UNIT A – MODULE 1
The Clinical Pilates approach continues to develop as the literature constantly evolves. These changes have
occurred in light of research moving the focus towards impairment based management heralding the
introduction of MBCT (movement based classification & treatment) and the traditional structure based
classification model is no longer supported by the literature. Health reform has also highlighted that chronic
problems need a more cost effective treatment framework based on strong outcome prediction. The unique
MBCT patient subgrouping tool is introduced in this stage of the course. MBCT allows heterogenous, patient
specific exercise treatment programmes to drive more successful management.
Over the last 15 years there has been a growing body of literature rebutting training of isolated muscle
activity i.e. transversus/multifidus (Macdonald, 2006, Alison 2008, Morris 2013) with the focus now on function,
not isolated muscle. This change in focus is further borne out by current motor control literature which does
not support conscious (explicit) muscle training, finding it is not particularly robust, with more support for non
conscious, task orientated (implicit) muscle control training (Benjaminse 2011).
The Clinical Pilates programme has long embraced the shift towards function, with clinical outcome
prediction rules recently validated by Tulloch et al at Otago University (Tulloch E 2012). The simple clinical tests
used in this paper highlighted a new process for identifying a patient’s subgroup & managing
functional/proprioceptive changes based on that subgroup. These proprioceptive deficits are often
identified as the underlying cause for many structural injuries as seen with recurrent injuries, ACLs, falls etc.
The MBCT predictor algorithm, taught in this first module has near perfect inter rater reliability,(.87 Kappa)
showing robust agreement in a broad cross section of DMA trained clinicians (Tulloch E 2012, Yu K 2015).
The key to this predictor algorithm lies in using a process of heuristics & “pattern recognition”, as described by
Wainner (2007). Cardiology literature has used pattern recognition and led the way in simplification of the
diagnostic process, proving that clinicians can effectively predict patient treatment outcome based on 4 key
points. Heuristic information is more effective than the traditional barrage of tests, which ultimately contradict
each other, confusing rather than clarifying the diagnosis (Reilly, Goldman, Chin 2006).
Directional exercise treatment application, already proven with the McKenzie approach, completes the
components that are taught at this stage of the programme, that make up the subgrouping process.
Melbourne University, RCT showed a measurable (46% vs 29%, p=0.07) finding that a Clinical Pilates
programme was better than a general exercise approach, in a chronic, low back pain population over a
relatively short 6 week period.
The current approach to patient management now being proposed with Clinical Pilates training now follows
2 pathways :-
• In the acute injury phase, a structural micro management approach is applicable for 6 – 12 weeks,
during which tissue based, manual therapy and homogenous exercise is the focus of treatment
• In the chronic phase, the focus moves to a macro-management, impairment based approach,
addressing function with heterogeneous exercise programmes that are patient specific and can be
measured for efficacy.
• Allison GT et al (2008) Feedforward Responses of Transversus Abdominis Are Directionally Specific and Act Asymmetrically: Implications
for Core Stability Theories JOSPT, May 2008 vol 38,5
• Morris S, Lay B and Allison GT (2011) Corset hypothesis rebutted — Transversus abdominis does not co-contract in unison prior to rapid
arm movements http://dx.doi.org/10.1016/j.clinbiomech.2011.09.007
• Benjaminse A, Otten E (2011) ACL injury prevention, more effective with a different way of motor learning? Knee Surg Sports Traumatol
Arthrosc (2011) 19:622–627
• Wainner R et al (2007) Regional Interdependence:A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys
• MacDonald D, Moseley L Hodges P (2006) The lumbar multifidus: Does the evidence support clinical beliefs? Manual Therapy 11
• Reilly, B, Evans A (2006) Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To
Make Decisions. Annals of Internal Medicine Vol 144 • No 3 207
• Tulloch E, Phillips C, Soles G,Abbott H (2012) DMA Clinical Pilates Directional Bias Assessment: Reliability and Predictive Validity
J Orthop Sports Phys Ther :42(8): 676-687
• Wajswelner, H, Metcalf B, & Bennell K. (2012) Clinical Pilates versus General Exercise for Chronic Low Back Pain: A Randomized Trial.
Med. Sci. Sports Exerc., Vol. 44, No. 7, pp. 1197–1205,
module 2 develops on the treatment prediction algorithm taught in module 1 to cover 3 main topics:
– the use of the directional model in assessment
– identifying & managing “complex” chronic pain/central sensitisation / dysautonomia
– implicit motor control training of pelvic floor in females & males – beyond the “bowel & bladder”
Many musculo skeletal assessments aimed at a structural diagnosis are found to be not structurally
specific.(Cook 2010) Added to this, many tests are carried out in a position or direction that may lead to a
false finding, e.g. a positive hamstring sign with patient in supine that is absent in prone, despite the same
muscle being tested, or a positive hip quadrant that eases when the patient is tested in elbow prop, a
position of potentially greater impingement. Directional assessment tools may be a better process of testing
“structure” as a differential diagnosis (Hughes 2008).
The chronic patient population is causing significant concern in the current health models and “central
sensitisation” appears to be a major contributor to this problem (Janig 1996). The relationship between
hypermobility & dysautonomia (disturbance in autonomic function) is a common finding in the
“chronic/sensitized group” and a strong body of evidence exists that highlights the link to hypermobility,
mechanical spinal cord pressure and cervico thoracic trauma. These patients are often classified under a
wide range of diagnoses such as Chronic Fatigue Syndrome/Fibromyalgia/ME/IBS and the like. Ironically the
symptoms are all very similar (Gazit 2003).
While exercise is strongly promoted with the chronic pain population, a directional subgrouping model, is
paramount to minimize symptoms directly related to spinal cord compression (Karlsson 2006). A checklist of
symptoms including nausea, dizziness, postural tachycardia syndrome, postural orthostatic intolerance, low
blood pressure and gut disturbance can highlight this potential co-morbidity, which often seems to underlie
Pelvic floor literature is also addressed in this stage of the course, looking at the effect of inappropriate “core
stability” strength training on pelvic floor muscle (PFM) function in both males & females. Excessive cueing of
pelvic floor can be detrimental in the absence of any dysfunction and equally ineffective when there is frank
dysfunction (Thompson 2006). Implicit motor training processes, incorporating inspiratory breathing control,
provide a more efficient method of PFM training, which is highlighted using real time ultrasound.
This level builds on the module1 knowledge to incorporate the systematic use of outcome predictors with
outcome questionnaires to measure the efficacy of the clinicians decision making process and treatment
Hughes PC, Taylor NF, Green RA (2008) Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Australian Journal of
Physiotherapy 54: 159–170
Gazit, Y., Nahir, A. M., Grahame, R., & Jacob, G. (2003). Dysautonomia in the joint hypermobility syndrome. The American Journal of Medicine, 115(1),
Karlsson A (2006) Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Progress in Brain Research, Vol. 152
Janig W, Levine JD and Michaelis M (1996): Interaction of sympathetic and primary afferent neurones following nerve injury and tissue trauma.
Progress in Brain Research 113: 161-84
Thompson, J. A., O’Sullivan, P. B., Briffa, N. K., & Neumann, P. (2006). Altered muscle activation patterns in symptomatic women during pelvic
floor muscle contraction and Valsalva manouevre. Neurourology & Urodynamics, 25(3), 268-276.
READY TO ENROL?
ABOUT UNIT B
– motor control & progression
– general /ageing/ neuro / sporting cohorts
As clients improve, clinicians require a broader repertoire to progress patients safely. This module teaches programme progression and indicators to determine if/when client pathologies are stable & suitable to progress.
Clinical applications & pathology management
• problem solving co-existing pathologies
• prioritising between primary & secondary problems
• identifying/ manage multi directional/ global instabilities
• linking neuro research to differentiate motor learning from a pathology management approach
• managing neuro patients with Clinical Pilates and identifying links with normal patients
• managing the ageing population like athletes
• improving sporting/athletic performance with a non-sport specific approach
• Advanced case studies to develop individualized programmes with a strong clinical pathway & reasoning.
– programme based management
– healthcare 2020 & health reform
module 4 links the Clinical Pilates program to the current health reform strategies being implemented by government. consolidates all levels to update the knowledge base, while further extending the exercise repertoire.
Clinical applications & pathology management
• additional clinically relevant exercises
• developing suitability for surgery / prehab programmes
• solving problems not just treating symptoms
• complex case studies for advanced clinical reasoning
• developing clinical pathways
• using outcome measures to quantify efficacy
• costing programmes for better financial returns
• Clinical Pilates cost reduction role in the current health
reform & primary care models
• how to integrate tele-medicine into patient care
• updates on the Clinical Pilates research faculty projects
• preparation for Clinical Pilates certification process
UNIT B-MODULE 3
Progressing patients requires a broader repertoire of techniques. As patients improve they will find exercises
and movement strategies easier. Using “load” to progress will lead to a strengthening/muscle hypertrophy
process that can compromise rather than enhance motor control. Instead, Clinical Pilates exercises are
progressed on a co-ordination/proprioception model that increases motor challenge and feed forward
planning (Hurd 2008).
The “stability” of a patient’s pathology can be tested by progressing from their specific subgroup into a multidirectional programme. If there is no degradation of their functional tests or outcome measures then the
clinician can be confident of further improvement and a change in threshold of provocation. Proprioceptive
deficits are more indicative predictors of injury than strength (Hurd 2008).
Patients will all differ on their ability to tolerate programme changes, as progression is not suitable for
everyone. A heterogenous/patient specific approach is still key and the decision to, or not to, progress is
based on the response to outcome measures & validated tests of function (Tulloch 2012). Outcome
measurements will also be extended to incorporate a greater repertoire of measures of function. Progression
to self-management can also be determined by the effect of measured treatment breaks
The potential of co-morbidities requiring a more complex approach is also covered in this stage of the
programme. A patient may have co–existing pathologies, such as a disc protrusion and a spondylolisthesis,
which will require a multi directional approach, biased 80%–20% between primary & secondary problems
(e.g. in this case disc as primary, spondylolisthesis the secondary problem).
Neurological patients are also showing strong preference to a directional exercise approach, further
strengthening the indication there is a strong sub cortical process in proprioceptive training & function. Pilot
studies on Traumatic Brain Injury & Hemiplegia are showing positive results. This has implications in both the
neuro population and the ageing population, where there is a growing need for developing further
approaches managing this growingly complex & expensive group (Benjaminse 2011).
Similarly, the sporting population often lacks the higher levels co-ordination/proprioception to improve
performance & prevent injury. Strength & conditioning training has a threshold of effect and proprioceptive
deficits are often more to blame for injury than lack of strength (ACL injuries etc.).
Case studies looked at in this stage will further expand participants ability to develop individualized
programmes for challenging presentations, using a simple clinical reasoning basis.
• Hurd,WJ ,Axe,M, Snyder-Mackler,L (2008) A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly
Active Individuals With Anterior Cruciate Ligament Injury Pt 1 Am J Sports Med 2008 36: 40
• Long, A; Donelson, R; Fung,T (2004) Does it Matter Which Exercise?: A Randomized Control Trial of Exercise for Low Back Pain. Spine.
• Benjaminse A, Otten E (2011) ACL injury prevention, more effective with a different way of motor learning? Knee Surg Sports Traumatol Arthrosc
This final stage in the Clinical Pilates programme updates the knowledge base of previous levels with the most
recent relevant literature. The treatment exercise repertoire is also further extended.
With the current focus on global health reform and cost vs outcome, the aim is to be able to provide a cost
effective service that can be measured for both cost efficacy and positive outcomes..
Advanced clinical reasoning is heightened, with the focus moving to using the Clinical Pilates approach
within the current health reform models being established globally. As focus moves to hospital substitution
and simplification of processes to minimize and prevent surgery, there is significant scope for cost effective
programme based management.
In the UK, the NHS reform model has highlighted the need for “get it right first time” management and a
move toward primary care and hospital substitution. The focus on outcome measurement has sharpened to
ensure better treatment models. In Australia the mood is similar, with the shift towards Primary Health Hetworks
and hospital substitution further opening the door for physiotherapy, which is comparatively cost effective
and relatively cheap. Introduction of physiotherapists in extended scope programmes has shown significant
savings and this can be carried into the private system where costs of surgical interventions are rising at
unsustainable rates (www.phiac.gov.au).
The current private health insurance “death spiral“ (Grattan Report 2019) is increasing the load on our
already overstretched public system. While discussions of novel funding models to address the heavy skew
towards surgery & hospitalization, the scene is set for implementation of primary sector programs that can
reduce surgery and hospital admissions, particularly in the ageing population
Pre-surgery physiotherapy programmes have the ability to reduce surgical costs and need for interventions,
screening for patients that will respond to conservative management rather than surgical approaches.
Development of partnerships with private & public funding bodies by providing a licensed programme
model, with trained and certified clinicians delivering Clinical Pilates treatment programmes, has the
potential to fulfill the needs of government policy. The cost of an ageing population and the need to keep
an active approach to management is fundamental. There now exists an approach that is more patient
specific than general exercise and can take into account the effect of structural degradation on
neurological & physical function.
Fritz J (2009) Clinical Prediction Rules in Physical Therapy: Coming of Age? J Orthop Sports Phys Ther 2009;39(3):159-161
Feldman, A (2008). Does Academic Culture Support Translational Research? CTS: Clinical and Translational Science;1(2):87-88
Goldblatt EM, Lee WH. (2010) From bench to bedside: the growing use of translational research in cancer medicine. Am J Transl
NHS ( 2011) www.dh.gov.uk/health/tag/white-paper/
Grattan Report (2015) http://grattan.edu.au/report/questionable-care-avoiding-ineffective-treatment/
Nicholson C (2012) The Evolution of a Primary Health Care System in Australia S25 JABFM March–April 2012 Vol. 25 Supplement
Grattan Report (2019) https://grattan.edu.au/report/the-history-of-private-health-insurance/
Grattan Report (2019) https://grattan.edu.au/a-blueprint-to-rein-in-doctors-bills-reduce-hospital-costs-and-cut-private-health-insuranceOn Completion of UNIT B you will be eligible to enter the Clinical Pilates certification process.
READY TO ENROL?
UNIT C – CERTIFICATION
DMA Clinical Pilates Certified Clinicians are the leaders in an exclusive network of highly qualified Clinical Pilates trained
Physiotherapists – CLINICAL PILATES NETWORK.
- Recognition as a Certified DMA Clinical Pilates™ MBCT clinician
- Priority placement on the exclusive find-a-physio worldwide directory
- Use ‘DMA Certified’ logo
- Join DMA global community of over 10,000 DMA trained clinicians
Opportunity to increase client referrals
- e-health/telehealth consults and support
- Business networking clinic
- Improved employment prospects
- Meet the growing demand for DMA Clinical Pilates™ trained clinicians
- Work with the DMA Clinical Pilates™ advocacy process with health insurers in the rapidly emerging health reform space.