Journal of Bodywork & Movement Therapies (2014) 18, 34e41

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EXERCISE PHYSIOLOGY

Antagonist coactivation of trunk stabilizer

muscles during Pilates exercises
Denise Martineli Rossi, PT, MSc a,*, Mary Hellen Morcelli, PT,
MSc, Ph.D a, Nise Ribeiro Marques, PT, MSc, Ph.D a,
Camilla Zamfolini Hallal, PT, MSc, Ph.D a, Mauro Gonçalves, PT,
Ph.D a, Dain P. LaRoche, BExSc, Ph.D b, Marcelo Tavella Navega,
PT, Ph.D c

a
Department of Physical Education, São Paulo State University, Rio Claro, Brazil
b
Department of Kinesiology, University of New Hampshire, Durham, NC, USA
c
Department of Physical Therapy and Occupational Therapy, São Paulo State University, Marı´lia, Brazil

Received 6 September 2012; received in revised form 9 April 2013; accepted 11 April 2013

KEYWORDS Summary The purpose of this study was to compare the antagonist coactivation of the local
Electromyography; and global trunk muscles during mat-based exercises of Skilled Modern Pilates. Twelve women
Stability; performed five exercises and concurrently, surface EMG from internal oblique (OI), multifidus
Pilates method; (MU), rectus abdominis (RA) and iliocostalis lumborum (IL) muscles was recorded bilaterally.
Physiotherapy The percentage of antagonist coactivation between local (OI/MU) and global muscles (RA/IL)
was calculated. Individuals new to the practice of these exercises showed differences in coac-
tivation of the trunk muscles between the exercises and these results were not similar bilat-
erally. Thus, in clinical practice, the therapist should be aware of factors such as
compensation and undesirable rotation movements of the trunk. Moreover, the coactivation
of global muscles was higher bilaterally in all exercises analyzed. This suggests that the exer-
cises of Skilled Modern Pilates only should be performed after appropriate learning and correct
execution of all principles, mainly the Centering Principle.
ª 2013 Elsevier Ltd. All rights reserved.

* Corresponding author. Tel.: þ55 19 3526 4345.

E-mail address: denisemartineli@hotmail.com (D.M. Rossi).

1360-8592/$ - see front matter ª 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jbmt.2013.04.006
Antagonist coactivation of trunk stabilizer muscles during Pilates exercises
Introduction
The Pilates Method is a kinesiotherapeutic technique
widely used by therapists that was created during the First
World War by Joseph Pilates. The prescription and compo-
sition of the exercises was based on his experience with the
rehabilitation of injured people (Loss et al., 2010). This
method is based on six principles: concentration, control,
flowing, precision, breathing and the centering principle,
considered a differential technique of the method
(Gladwell et al., 2006). The Centering Principle consists of
an isometric contraction of the internal oblique and
transverse abdominis muscles, which contributes to
increased antagonist coactivation of the deep lumbar
muscles (Marques et al., 2012).
Currently, the Pilates Method has been widely applied
in physiotherapy for flexibility training, stimulation of
blood circulation, improvement of postural alignment
and body awareness (Muscolino and Cipriani, 2004). The
exercises challenge the stability of the trunk and acti-
vate the deep muscles of the lumbo-pelvic region (mul-
tifidus, internal oblique and transversus abdominis), and
require endurance of trunk muscles (rectus abdominis,
iliocostalis lumborum and latissimus dorsi) (Endleman and
Critchley, 2008). Thus, the Pilates Method has been used
for both prevention and rehabilitation of low back pain
(Muscolino and Cipriani, 2004; Endleman and Critchley,
2008).
Low back pain is a common musculoskeletal symptom in
modern society that results in significant costs to health-
care systems. It is estimated that 90% of cases of low back
pain have a nonspecific origin, so this condition has a
multifactorial and complex etiology (Ebenbichler et al.,
2001). Among the possible causes of nonspecific low back
pain are muscle dysfunctions, changes in motor control and
inadequate recruitment of trunk muscles, which lead to
reduced stability of the segments of the spine and altered
distribution of loads in this region (Ebenbichler et al.,
2001).
Recently, Skilled Modern Pilates has been proposed as an
adaptation of the traditional Pilates Method which has been
widely applied in physiotherapy. This new approach to the
Pilates Method uses the philosophy created by Joseph
Pilates, but decreases the range of motion of the exercises
and requires a neutral lumbar-pelvic posture (Latey, 2001,
2002). Neutral lumbar-pelvic posture is more adapted to
the physiological curvature of the lumbar spine and also
provides an optimal position to increases the recruitment of
deep lumbar and abdominal muscles (Sapsford et al., 2001;
O’Sullivan et al., 2006).
According to O’Sullivan et al. (2006), in the lumbo-pelvic
upright sitting posture, that is, neutral lordosis of the
lumbar spine, the local muscles, multifidus and internal
obliquus, had 62% and 30% higher activity (respectively)
compared to an extended thoracolumbar spine posture,
and 62% and 48% higher activity (respectively) compared to
a relaxed thoracolumbar spine with a posteriorly rotated
pelvis. Additionally, spinal stability is increased with the
coactivation of the local trunk muscles and this strategy
promotes protection of spine structures during the perfor-
mance of functional activities (Arokoski et al., 2004). In this
35
regard, electromyography has proven to be an important
tool to study the function of the neuromuscular system of
the low back by quantifying the coactivation of antagonist
muscle groups (Granata et al., 2005).
The stability of the segments of the spine is provided by
the interaction of three subsystems: active, composed by
skeletal muscles surrounding the spine; passive, composed
of vertebrae and their articular structures; and neural,
composed of afferent, efferent, and central neural control
mechanisms (Panjabi, 1992). In physiological conditions,
these subsystems provide spinal stability, principally, with
the recruitment of the trunk muscles, which provide dy-
namic stability (Panjabi, 2003). Moreover, it is suggested
that the most widely used mechanism for the maintenance
of spinal stability is the coactivation of trunk muscles, since
this strategy promotes protection of spinal structures dur-
ing the performance of functional activities. In this regard,
electromyography has proven to be an important tool to
study the function of the neuromuscular system of the low
back by quantifying the coactivation of antagonist muscle
groups (Granata et al., 2005).
Studies of spinal stability point to structural differenti-
ation of local and global trunk muscles based on their direct
or indirect attachment to the vertebrae. The local muscles,
such as multifidus (MU) and internal oblique (OI), despite
having a limited capacity to generate torque, have in-
sertions on the vertebrae, which contribute to control the
movement of each lumbar vertebra. On the other hand, the
global muscles, such as the rectus abdominis (RA) and the
iliocostalis lumborum (IL), cross several joints with at-
tachments to the pelvis and the thorax, have a larger
moment arm, and are suited to the control of trunk orien-
tation and the resistance of external forces (Bergmark,
1989; Hodges, 2003).
In clinical practice, the largest recruitment of global
muscles seems to be associated with an increase in spinal
load that has the potential to cause injury or worsen pain in
patients with low back pain (Arokoski et al., 2004). Ac-
cording to Arokoski et al. (2004) therapists should find more
cautious exercises to challenge the local stabilizing muscles
of the lumbar spine without placing an excessive load on
the structures of this region. Thus, considering the impor-
tance of lumbopelvic and segmental spinal stability and the
relationship to the trunk muscle response, the mat-based
Skilled Modern Pilates exercises can be an alternative to
improve conditioning and strength of trunk muscles without
overloading the passive structures of the spine (Arokoski
et al., 2004).
In addition to focusing on the activation of local mus-
cles, the Skilled Modern Pilates exercises are performed in
a neutral position that leads to greater local muscle
recruitment than global recruitment (O’Sullivan et al.,
2006). Also, these exercises can be considered functional
since they require the recruitment and sensoriomotor
control of the trunk muscles while performing limb move-
ments (Menacho et al., 2010).
To our knowledge, no study had investigated the dif-
ferential activation of local and global trunk muscles dur-
ing these exercises. Therefore, the purpose of this study
was to compare the antagonist coactivation of the local
and global muscles during several mat-based Skilled Mod-
ern Pilates exercises to ascertain which exercises stimulate
36
local muscle coactivation most. From the principles of
Pilates, we hypothesized that during the execution of the
exercises in a neutral posture, the local muscle antagonist
coactivation would be higher than the global muscle
antagonist coactivation to minimize the disturbance of
vertebral segments created by upper and lower limb
movements.
Methods
Subjects
This cross-sectional study utilized twelve, young women,
recruited from the university who were physically active
with no previous experience with Pilates exercise (Table 1).
From a pilot study conducted in our laboratory, sample size
was estimated by considering a standardized effect size of
1.2 with alpha error of 0.05 to find differences in the
activation of local and global muscles bilaterally during the
Hundreds (level I) exercise. Subjects were excluded for
orthopedic disorders, neurological problems, cardiovascu-
lar disease, or previous surgery of the spine or abdomen.
This study was approved by the Local Ethics committee
(case number 067/2009), and all volunteers signed an
informed consent.
Procedures
Data collection was performed during two different ses-
sions. On the first day, weight, height, body mass index, age
and physical activity level were recorded. Also, the volun-
teers were familiarized with the Skilled Modern Pilates
Method principles and they practiced all the exercises
performed during the data collection day using the same
protocol. On the second day, the subjects performed a
single trial of each of the five exercises including, Hundreds
level I (HU I), Hundreds level II (HU II), One Leg Stretch level
I (OLS I), One Leg Stretch II (OLS II) and Scissors level I (SC
I), in random order. All exercises were supervised by a
physiotherapist with experience in the Pilates Method.
Concurrently, surface EMG from OI, MU, RA and IL was
recorded bilaterally.
Exercises
The volunteers were taught to recruit their deep abdominal
muscles using a variety of strategies, including visual im-
agery, verbal cueing and demonstration. Moreover the
conscious recruitment of the deep abdominal muscles and
the incorporation of the Pilates principles of breathing
Table 1 Means of body anthropometrics, age and physical
activity level of the subjects (n Z 12).
Mean (SD)
Mass (kg) 56.74 (7.7)
Height (m) 1.62 (0.06)
Body mass index (kg$m2) 21.57 (2.3)
Age (years) 20.05(2.5)
Physical activity level (hours/week) 5.54 (1.91)
D.M. Rossi et al.
control and neutral spinal alignment were taught and
encouraged during the exercises. The neutral position was
defined as the intermediate position between lumbar spine
retroversion and anteversion and was maintained and
monitored during the exercises by a barometric system
specially developed for the study. This was a simple device
composed of a bag that was inflated under the back of
the volunteers which required them to maintain a certain
pressure (and thus position), with a tolerance of
10 mmHg. The device was used to ensure quality and
precision in exercise performance by testing and moni-
toring the position of the low back as a control for the
evaluator and also to provide feedback to the subjects
about the contraction of the abdominal muscles.
Prior to execution of the exercises, the subjects were
placed in an initial position lying supine with their knees
flexed at 45 , feet aligned in the sagittal plane with the
ischial tuberosity, the lumbar spine in a neutral position,
and the arms extended alongside the body. From this
starting position, the five exercises were performed, HU I,
HU II, OLS I, OLS II and SC I, during which the electromyo-
graphic signal of the local and global muscles of the trunk
were recorded.
The HU I exercise was performed with the subjects in the
supine position, with the hips and knees flexed, while the
feet remained flat on the floor and the upper limbs were
held alongside the body. Subjects were instructed to
perform low amplitude shoulder flexion of both upper limbs
with the hands held approximately 15 cm above the floor
(Fig. 1A). The HU II exercise involved the same shoulder
position as HU I, but simultaneously required the subjects
to hold the dominant hip and knee flexed at 90 (Fig. 1B). In
the OLS I exercise the subjects performed only lower-limb
movements. Starting from the initial flexed position with
feet on the ground, the subject performed controlled hip
and knee extensions, lowering the leg until contact with
the ground, one leg at a time (Fig. 1C). In the OLS II exer-
cise, the subjects started from the initial position with both
hips and knee flexed at 90 with the feet off the ground,
and then the subjects unilaterally extended the knee and
hip, while keeping the feet off the ground, returning to the
initial position, which was then repeated with the other leg
(Fig. 1D). In the SC I exercise the subjects started with the
knee and hip flexed at 90 bilaterally with both feet off the
ground. They then touched the toe to the ground, alter-
nating feet, while keeping the contralateral lower limb
suspended (Fig. 1D).
Electromyography
The surface EMG signal was collected during the exercises
using an eight-channel telemetry system (Noraxon
Scottsdale, Arizona, USA) and was recorded with Myor-
esearch software (Noraxon), with a sampling frequency of
2000 Hz and a total gain of 2000 times (20 times in the
sensor and 100 times in the equipment). The signal was
recorded using Ag/AgCl surface electrodes (Miotec, Porto
Alegre, Brazil), placed in bipolar configurations, with a
recording area of 1 cm in diameter and interelectrode
distance of 2 cm. Prior to electrode placement, the skin
was carefully shaved and cleaned with alcohol to reduce
resistance (Gonçalves et al., 2012).
Antagonist coactivation of trunk stabilizer muscles during Pilates exercises 37

Figure 1 A: Hundreds level I; B: Hundreds level II; C: One Leg Stretch level I; D: One Leg Stretch level II and E: Scissors level I.

The electrodes were placed bilaterally on the muscles as
follows: OI, 2 cm medial and inferior to the superior ante-
rior iliac spine; MU, 2 cm lateral to the midline of the
interspinous space L4-L5; RA, 3 cm above of the umbilicus
and 2 cm lateral to the midline; IL, 6 cm lateral of the
intervertebral space L2-L3. A reference electrode was
positioned over the styloid process of the ulna on the right
arm (Hermens et al., 2000; Marshall and Murphy, 2003;
Marques et al., 2012).
Data analysis
Comparisons were made between percentage coac-
tivation between two local antagonist muscles (OI/MU) and
two global antagonist muscles of the trunk (RA/IL) as for
the five exercises using repeated measures analysis of
variance (ANOVA) for the right and left sides of the body
separately. This resulted in a 2 (local vs. global)  5 (ex-
ercises) analysis for each side of the body. Post hoc tests
were performed using the Least Significant Difference (LSD)
statistic to show which exercise had higher antagonist
coactivation. Statistical significant was set at p < 0.05 for
all tests.

EMG signal analysis was carried out using specific routines
developed in Matlab (Mathworks Natick, USA). The EMG
signal was full-wave rectified and smoothed using a 4th
order low-pass filter with a cut off frequency of 10 Hz. The
linear envelope EMG data from each muscle, of each
participant, was used to calculate the level of coactivation.
For this analysis, the area under the signal amplitude curve
was determined for the OI, MU, RA and IL muscles and the
percentage of agonist/antagonist coactivation (% COCON)
for the local muscles OI/MU and global muscles RA/IL was
calculated using the following equation (Candotti et al.,
2009):
Results
Table 2 describes the repeated measures ANOVA results of
the %COCON of the local antagonist muscles (OI/MU) and
global antagonist muscles (RA/IL) in the five exercises
analyzed, for the right and left sides of the body. On the
right side, there was a significant difference for the coac-
tivation between the exercises (f Z 5.145 and P Z 0.002)
and between the local and global antagonist coactivation
(f Z 31.966 and P < 0.0001). On the left side, there was a
difference only for the %COCON between local (OI/MU) and

2  common area AB
% COCON Z  100
area A þ area B
Table 2 Repeated measures analysis of variance results
where % COCON is the percent coactivation between two for comparison of local and global antagonist coactivation in
antagonist muscles, area A is the area below the smoothed five exercises analyzed for the right and left side.
EMG curve of muscle A, area B the area below the smoothed
Right Side Left Side
EMG curve of muscle B, common area A & B is the common
area of activity of muscles A and B (Candotti et al., 2009). f P f p
Exercises 5. 145 0. 002* 1. 645 0. 180
Statistical analysis Dof: 4
Local/global 31. 966 0. 0001* 37. 336 0. 0001*
The PASW 18.0 statistical package (SPSS Inc.) was used to Dof: 1
perform the statistical analysis. Comparisons were made Exercises  local/ 0. 198 0. 624 0. 753 0. 753
for percentage coactivation between local and global global Dof: 4
muscles for the five exercises using repeated measures
*p < 0.05.
analysis of variance.
38
Figure 2 (a) Comparison of the local and global %COCON on the right side; (b) Comparison of the local and global %COCON on the
left side. y Z significant difference between global (RA/IL) and local (IO/MU) %COCON.
global (RA/IL) antagonist muscles (f Z 37.366 and P <
0.001). For both sides, there was no significant difference
in the interaction of exercise and antagonist coactivation.
For the right side, global %COCON (RA/IL) was 52.01%
higher than local %COCON (IO/MU) (Fig. 2a) and for the left
side global %COCON was 45.46% higher than local %COCON
(Fig. 2b). Additionally, HU I exercise had 19.99% and 22.32%
higher coactivation than OLS I (p Z 0.057) and SC I
(p Z 0.013); and HU II had 19.45%, 15.47% and 21.87%
higher coactivation than OLS I (p Z 0.032); OLS II
(p Z 0.058) and SC I (p Z 0.011; Fig. 3).
Discussion
Due to the significance of the Pilates Method to the clinical
population with low back pain, is important to study the
D.M. Rossi et al.
antagonist coactivation of the trunk muscles, particularly
with respect to the potential vertebral overload during
these exercises. Activation of trunk muscles has been
described as one of the mechanisms used to maintain spinal
stability and provide protection to structures. This is
particularly the case for the local spinal muscles used to
minimize the disturbance of the vertebral segments
created by movements of the upper and lower limbs
(Granata et al., 2005). From the principles of the Pilates
Method, which aim to activate the deep muscles of the
lumbo-pelvic region, the initial hypothesis of this study was
that during the exercises in neutral lumbar spinal align-
ment, the antagonist coactivation of the local muscles
would be higher compared to global muscles.
In this study, the comparison of antagonist coactivation
of the trunk muscles during mat-based Skilled Modern
Pilates exercises demonstrated that for the right side, the
Antagonist coactivation of trunk stabilizer muscles during Pilates exercises 39

Figure 3 Comparison of the coactivation between the exercises on the right side. * Z significant difference between HU
I Z Hundreds level I and OLS I Z One Leg Stretch level I; £ Z significant difference between HU I and SC I Z Scissors level I;
x
Z significant difference between HU II Z Hundreds level II and OLS I; U Z significant difference between HU II and OLS II Z One
Leg Stretch level II; z Z significant difference between HU II and SC I Z Scissors level I.

HU I and HU II exercises had higher antagonist coactivation.
In contrast to our findings, Souza et al. (2001) found no
difference in EMG activity between the right and left sides
during the execution of exercises for spinal segmental
stabilization. Our results may be related to possible
compensation in the trunk muscle activation to maintain
stability during the execution of the exercises. The asym-
metry of the load application from the weight of the lower
limbs during the execution of the unilateral exercises
generates disturbance and trunk rotation which may have
led to higher coactivation of trunk musculature on the right
side. Also, the fact that all the subjects of the sample were
right-handed should also be considered.
When investigating the EMG coactivation of the global and
local trunk muscles, in contrast to the initial hypothesis, this
study found that on both sides of the body, antagonist
coactivation of the global muscles, RA and IL, was higher in all
exercises. The anterior and posterior muscles of the trunk,
like RA and IL, play important roles in maintaining the sta-
bility of the vertebral column. Because they are considered
histological and anatomically as global muscles, they are
functionally responsible for generating the torque required
to move the trunk and limbs and to transfer the external
loads to minimize overload of the spine (Hodges, 2003).
During the execution of OLS level I and II and SC level I
exercises, alternating movements of the lower limbs in
both closed kinetic chain (OLS I) and open kinetic chain
(OLS II and SC I) exercises were performed. There is a
relationship between increased antagonist coactivation of
the trunk muscles, the asymmetric load applied, and the
length of the lever arm (McCook et al., 2009). The local
muscles, MU and OI, act to “fine tune” intervetebral
movements and generate shear forces during changes in the
position of the trunk. The global muscles, RA and IL, are
fundamental to pelvic stability during exercises with knee
extension and also work to control the torque generated
by hip extension (Hodges, 2003). Thus, it can be inferred
that besides the need to maintain spinal stability and the
neutral position of the lumbar spine, the highest global
antagonist coactivation of the trunk muscles was necessary
for the production of flexor torque as a result of dynamic
alternation of leg movements and the long lever arm of the
lower limb (Hodges, 2003; McCook et al., 2009).
The control of joint and spinal stability depends directly
on the active system coordinated by the contraction of
muscles. The stability of the system is provided by the
necessary stiffness to appropriately restrict movement. In
the spine, the compressive forces caused by the tension of
passive structures and muscle action in the joints provide
stiffness and stability. The stabilization of the lumbar spine
is significantly increased by the tension applied by the local
and global muscles in the thoracolumbar fascia (Van dieen
et al., 2003a, b; Reeves et al., 2007). According to Van
dieen et al. (2003a,b) the direction of the external pertur-
bation forces is the main factor that will determine which
trunk muscles are recruited to stabilize the spine. Further-
more, despite histological, anatomical, and functional dif-
ferences, the stability of the column is provided by all the
trunk muscles. Thus, the system continuously adjusts the
stiffness of the column to generate the stability required of
certain tasks, and the force and movement characteristics
of the task determine which muscles are more active (Van
dieen et al., 2003a, b, Reeves et al., 2007).
Pilates exercises are used for spinal stabilization and
have been widely used to treat low back pain (Arokoski
et al., 2004). It has been shown that the maintenance of
postural alignment during the exercises stimulates the
activation of stabilizing muscles, such as the internal obli-
que, transversus abdominis and multifidus muscles (Colado
et al., 2011). In the initial phase of rehabilitation,
contemporary approaches involve the recruitment of
abdominal muscles such as transversus abdominis (TrA) and
OI, with minimal activity of the superficial abdominal
muscles. These practices are based on evidence that in-
dividuals with low back pain have dysfunction of these
muscles and exercises that aim to improve the recruitment
40
of these muscles will contribute to vertebral control.
Furthermore, these treatments focus on low-level
contraction, as it has been suggested that low levels of
contraction are sufficient to provide the stiffness required
for control of the intervertebral joints (Urquhart et al.,
2005). However, despite the known beneficial effects of
these exercises, such as reduced intensity of pain and
dysfunction, there is insufficient scientific and clinical ev-
idence of how the actions of the muscles stabilizing the
spine change during the execution of the exercises
(Arokoski et al., 2004; Critchley et al., 2011).
This study examined a sample that did not report back
pain, however, there is evidence that exercise therapy
produces lower activity of trunk muscles in subjects with
low back pain compared with subjects who never had a
previous painful episode (Arokoski et al., 2004). In clinical
practice, the increased recruitment of global muscles
seems to be associated with increased spinal load that can
cause injury or worsen the pain in individuals with low back
pain (Arokoski et al., 2004). Although the recruitment of
local muscles is emphasized in the initial phase of reha-
bilitation, all the muscles of the trunk are considered
important for the restoration of normal function and the
progression of exercises involves strategies for the reha-
bilitation of the muscular system of the trunk as a whole
(Arokoski et al., 2004; Urquhart et al., 2005).
Conclusion
Individuals new to the practice of the mat-based Skilled
Modern Pilates exercises showed differences in coactivation
of the trunk muscles between the exercises. These results
weren’t similar between the sides of the body, because for
only the right side, the HU I and HU II exercises had higher
antagonist coactivation. Therefore, in clinical practice, the
physiotherapist should be aware of factors such as
compensation for weak muscles by one side of the body
that may result in undesirable rotation movements of the
trunk. Furthermore, the antagonist coactivation of global
muscles was higher than local muscles in all of the exercises
and it seems that this is associated with increased spinal
load. Thus, these exercises should be performed after
appropriate learning of the movements and correct
execution of the Pilates principles, mainly the Centering
Principle, which is to activate the local stabilizing muscles
to avoid overloading the spine.
Limitations
A limitation of this study is that the protocol was performed
in a single attempt and results may have differed if the
exercises were performed on separate days. Additional in-
formation of how muscle activation is controlled during the
exercises could have been made if the activity of other
muscles had been studied, such as the external obliques
and stabilizers of the hip. LSD post hoc tests were used to
increase the statistical power due a relatively small sample
size. Therefore, these initial findings should be interpreted
cautiously and the study should be replicated. Another
study limitation is that the volunteers were novices and had
no experience with the Pilates Method, and the muscle
D.M. Rossi et al.
activation response may be different in those familiar with
the exercises. Additional research should be conducted to
study the activation of trunk muscles in people who
routinely perform Pilates exercises to understand the ef-
fect of training on trunk stabilizer muscle activation.
Conflict of interest statement
None.
Acknowledgements
D.M. Rossi was supported by Coordenação de Aperfeiçoa-
mento de Pessoal de Nı́vel Superior (CAPES).
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