Depression and anxiety affects nearly 19 million adults each year, yet this common disease is often misunderstood or misdiagnosed. You’ve probably heard about some emotional symptoms of depression, but did you know that people with depression live with chronic pain and other physical symptoms?

15 years ago I was diagnosed with depression and I noticed that along with some other symptoms I was experiencing some joint pain, back pain, vertigo, exhaustion and fatigue. Pilates became my exercise of choice and helped me a lot to find my balance, well-being and mind-body connection.

As a Physiotherapist, Pilates instructor and person with depression, I’d like to inform Pilates instructors how to best help clients who have depression.

Why do physical symptoms and chronic pain occur with depression?

Depression is related to improper regulation in nerve cell networks that make connections with the brain areas responsible for emotional information. Some of these networks also process information for physical pain. When a patient with depression complains that he or she is feeling physical pain, there is a chemical reason. The imbalance of serotonin and norepinephrine (both neurotransmitters) explain the connection between painful physical symptoms and depression.

Here are some of the most commons symptoms:

  • joint pain, limb pain, back pain
  • headaches and migraines
  • dizziness or light-headedness
  • chest pain
  • digestive problems like nausea, diarrhea, constipation and appetite changes
  • fatigue, sleeping problems
  • memory loss and poor concentration

Movement heals 

When you have depression, exercise seems like the last thing you want to do. But the truth is, once you get motivated, exercise can make a big difference!

We all know that exercises help prevent and improve a number of health problems. Research on anxiety and depression shows that the psychological and physical benefits of exercise can also help reduce anxiety, stress and improve mood.

Regular exercise helps ease depression in a number of ways, which may include:

  • releasing “feel-good” brain chemicals (neurotransmitters, endorphins and endocannabinoids);
  • reducing immune system chemicals that can worsen depression;
  • increasing body temperature, which may have calming effects.

Moreover exercise has many psychological and emotional benefits too. It can help you:

  • Gain confidence. Meeting exercise goals or challenges can boost your self-confidence. As well as getting in shape can also make you feel better about your appearance.
  • Take your mind off worries. It’s a distraction that can get you away from the cycle of negative thoughts that feed depression.
  • Social interaction. Physical activity may give you the chance to socialize with others and it can help your mood.
  • Cope in a healthy way. Doing something positive to manage depression is a healthy coping strategy.

And why Pilates?

While other forms of exercise can help clear the mind, Pilates is a form of exercise that helps to soothe and create stronger and better pathways in the brain. It is a controlled and concentrated intensive way of doing exercises in which the person is fully engaged with mind and body.

Joseph Pilates used to say when defining Contrology that reawakening ordinarily dormant muscles cells we are reawakening thousands of dormant brain cells, thus activating new areas and stimulating further the functioning of the mind. No wonder why a lot of people describe a sensation of “uplift” after a Pilates class!

Pilates is not just a series of exercises but is how your own body behaves and accept that exercise. If we perform the exercise properly with control, attention and concentration, we are training the brain in the same way as we train our muscles. We grow the attention center which helps to anchor ourselves with our body, in the present, stopping the negative self-talk loop and strengthening the nervous system to handle stress.

Using Pilates as a tool to control the mind is one of the ways you can use to fight against depression. It requires a lot of focus and helps to restore the feeling of being in control of your life again.

A few words of caution…

When working with people with depression it’s important to be careful of a few things.

In the beginning use the entire body during every exercise. Avoid working with very small movements. The idea is not trying to make people very focused to the point that they can get stressed. Once you see that the person is engaging the core muscles and showing fluid movements maybe you will try some isolated motions. In other words it’s more beneficial to start from more superficial systems and then progress to deeper ones.

Focus on creating a good rhythm between movement and breath. But don’t make the person overwhelmed about inhaling/exhaling on the “right” moment. Breathing is a powerful way to make the emotions emerge. You also want to pay attention to not let the person hold the breath. Ideally the breath should last the entire movement. Note: breathing disorder is one of the major problems in depression and anxiety. I’ll mention more about it further in this article.

Don’t make the person feel very tired. Remember that exhaustion and low energy are some of the most common symptoms. The exercises have to be in a way that make the person to feel more energized. Once it becomes easier and more fluid you will be able to add more challenge to the exercises.

Share your experience. When working one-a-one with a depressed client try to mention a few sensations or findings about your own body. It helps to make the person more comfortable to talk about her/his sensations.

Be careful “up there”. Many psychological studies show that usually the emotions like sadness and anguish are “held” in the upper part of the body (chest, collarbones and rib cage area). For some people some movements or touches in these areas can be very uncomfortable. Be extra careful when teaching exercises that involve pushing, stretching and twisting because they have the power to reveal saved emotions.

Stay upright. Avoid exercises where the body is up side down as well as the ones that bring more pressure toward neck and head (like standing roll down, roll over). Especially if you are using the reformer be careful with the combination of body movement + carriage motion that can cause the feeling of falling. Dizziness and vertigo are some of the most frightening symptoms of depression and it can trigger an anxiety and fear attack.

Don’t be surprised if your client complains about different pains every time. It happens and it’s common. But don’t get too focused on the pain! It’s important to show that you are not worried or surprised, that you know how to make it better and that you understand that its not pleasant. Then avoid to ask all the time if the pain is less or “how does it feel?”

Breathing pattern of depression/anxiety:

About 60% of panic attacks are accompanied by hyperventilation and many people suffering from anxiety over breathe when they think they are relaxed. The most important thing to understand about hyperventilation is that although we feel as if we haven’t enough air in our body, actually the opposite is true.

Hyperventilation causes a chemical imbalance because there is too much oxygen but not enough carbon dioxide, which is necessary in some parts of the body, especially the brain. Hyperventilation makes you feel like you need to breathe in more air, but in reality you need to breathe out slower to regain the carbon dioxide balance. This imbalance can cause chest pain, lightheadedness, dizziness and nausea.

This is often the case with vertigo. It’s not technically an anxiety symptom, but dizziness. What anxiety causes is a combination of three different experiences (dizziness, lightheadedness and nausea) that can give the impression of vertigo.

Since vertigo is caused by hyperventilation, the best way to stop the feeling of having vertigo is to make sure you’re not hyperventilating anymore.

Here’s what to do with your client:

  • ask the person to take a long breathe in that last about 5 seconds;
  • hold for a few seconds;
  • then breathe out at a pace that lasts about 7 seconds.

The whole idea is to slow down the breathing and to try to resist the urge to take a deep breath.

Wrapping up

Depression is a very real, physical condition. Like any illness, it needs treatment. Any health practitioner or professional involved in working with other’s people bodies has a responsibility to be informed and know the best way to help.