Hip Perthes

Howdy Leslie and Melanie and All,

Hope the summer has been fab for yous all, mine has been busier!! Along with my clients, I have been working hard at my own rehab. It is coming slowly, but correctly!! My question regards a male client, mid 50’s, with hip perthes. I have done some research and understand the basic of the disease. He has come in several times with it “out” which gives him a leg length difference of 1/2 to 1″. He is in very good muscular shape but lots of disfunction throughout his spine and scapula. Are there any exercises or positions that would be an absolute no-no, or is this a problem that can be worked in any position as long as there is no pain?

Thanks for being available for these type of things! I had never even heard of this disease before!

Happy Still Summer,

James

Response from Melanie Byford-Young:

Legg Calves Perthes disease is when the growth plate at the head/ neck of the femur (the capitol epiphysis) slips, and thus the orientation of the femur is irregular. In order to know what the precautions are, you would have to know what the shape of the hip is, whether or not the socket is a normal depth, and any other dysplasia. Your client or his therapist should know some of this information. In the absence of all of this information, follow the range of motion your client has and do not push it. The neutral position is most likely not symmetrical, so again find the best position and always follow the ease of movement.

Melanie

FREE! Holistic Health Series

Pacific NW Pilates Announces
Holistic Health Series !
 

Pacific NW Pilates is sponsoring a series of lectures on Holistic Health. These upcoming lectures are free and open to the public.

Pacific NW Pilates has been an international leader in the field of rehabilitative pilates and has been committed to giving back to the community since their inception in 2001. This series of lectures spans a wide range of topics and concerns that are increasingly important in our modern, hectic lifestyle.

The Holistic Health Series starts on September 2, 2009 and will be offered every other first Wednesday of the month, from 7:15pm-8:15pm at the Pacific NW Pilates studio. Upcoming lectures are as follows:

September 2, 2009: “Be Your Own Best Coach” with Wendy Mitchell, M.A., C.P.A.

November 4, 2009: “Lymphatic Exercise and Pilates” with Laura Echtinaw, LPTA, STOTT PILATES® Rehab Instructor.

January 6, 2010: “Change Your Frame, and Change Your Story” with Paula Altschul, M.S.N., C.M.C., A.C.C.

March 3, 2010: “More Joy, Less Stress” with Judy Zehr, L.P.C., MHRM

May 5, 2010: “Transform Your Life-One Breath at a Time” with Al Lee

July 7, 2010: “The Many Health Benefits of Running & Walking” with Susan Schmidt, RRCA Certified Running Coach and Marathoner

These lectures will be presented at Pacific NW Pilates, which is located just off the Sylvan Exit at:
5201 SW Westgate Drive, Suite 114
Portland, OR 97221

R.S.V.P  at info@pacificnwpilates.com

SHARE PILATES is a NEW community forum for pilates instructors.

SHARE PILATES is what we are calling our “in-house” educational workshops. Now we are opening them up to other instructors in the community! Come join us for a one-hour exploration about different pilates topics or issues related to movement.

Only $10 for each workshop!

These workshops range from a fun and innovative workout to an anatomy based review. Check out our upcoming listings below:

Ideokinesiology & Laban Movement Analysis with Jean Leavenworth
Aug. 15th 2:15pm-3:15pm

Dancing Without the Stars with Leslie Braverman
Sep 26th 12:15pm-1:15pm

Gyrokinesis with Melissa Framiglio
Nov. 7, 2:15pm-3:15pm

Foot Mechanics with Melanie Byford-Young
TBA, Winter 2010

Call or email the studio today to register or for more information!

(503) 292-4409 or info@pacificnwpilates.com

Ideas for working with a spinal fusion

This question was emailed to us, and we thought others might be interested!

Hi Leslie,

I have a client who is 25 and has two metal rods in her back, one on each side of her spine because of terrible scoliosis. She is not very mobile because of the rods, she can manage imprint and neutral but can only do extremely limited flexion and extension. The muscles in her lower back are obviously imbalanced, very strong on her right side and almost non existent on the left. What would you suggest for helping balance out her core strength considering her lack of mobility? Thanks so much!
Erin Whipp

Answer from Leslie Braverman:

Hi Erin:
Nice to hear from you. I hope things are going well!
 
Oooh, I have worked with a few clients that have had metal rods put in their back, and there is a lot you can still do.
 
My suggestion is to continue moving her spine only gently through ranges- mostly keep her neutral, but try to do as many things that challenge her torso strength as you can. Contralateral arm and leg work will be excellent, as well as doing things that challenge weight distribution and proprioceptive awareness. Here are some ideas:
 
1.) Sitting back and front rowing (on a box or platform if necessary to sit in neutral). Do one arm backrowing work preps to get the weaker side stronger. You could even sit her on am unstable surface (ie. a wobble cushion) to build spinal control and learn to control rotation.
 
2.) Side lying work will be excellent. One leg kick, side leg lift series- prop her hip on a small ball to build more strength on an unstable surface as she progresses. Make sure to keep her spine in neutral and avoid rotation or lateral flexion. Do more reps on the side that is weaker.
 
3.) Plank position exercises – push up, leg pull front- add things on a ball.
You can also do plank based exercises against a wall too- standing on a BOSU and/or with two small balls under her hands- again to challenge spinal control and build awareness of body in space. Add contralateral arm or leg work to build strength on one side of the back more than the other.
 
4.) Waiters bow- elephant position- (on or off reformer- use ligher weight) with one arm on the bar instead of two. or just practice going into waiters bow while standing on the floor and reaching one arm up by her ear- standing up with that arm by her ear will work her erectors and deep paraspinals on that one side, as well as challenge rotation and build glut strength.
 
5.) Contralateral prone work without extension- ie. swimming preps
 
6.) Standing on one leg while doing arm work, while high level, will help her build up strenth on one side more than the other.
 
Hope this helps and gives you more ideas. Let me know if you have questions. I can leave out your name if you like too.
 
Thanks Erin! Good luck.

How do I work with someone with scoliosis?

From Melanie Byford-Young

Hi Jeff,
Great questions about your client.

How to work with prenatal clients

• This question was sent and responded to through email, but we thought others might be interested!

Hello ladies!

I am beginning to teach both mat and reformer to a woman 6 weeks pregnant. With her last child she did not do any physical exercise because she was afraid of miscarrying. However, she would like to try Pilates once a week throughout this pregnancy. Can you give me some tips to use when working with her? Also, she hasn’t done Pilates for the last month and is worried that since she has been “out of practice”, starting up again will be like starting a new exercise program–which is not recommended in prenatal books. I assured her that this would not be a problem, but she would like the official word from the experts at PNWP.

Thanks so much!

Answer from Jean Leavenworth:

Hi there-
I am curious why she stopped exercising completely during her first pregnancy. Was she at risk for miscarrying? That is something to find out as it could still be an issue, and I would highly recommend that she is released by her physician to work with you during this pregnancy and that she is given permission to work with you through each trimester; the first trimester has the highest risk of miscarriage, so it is important that she has been cleared for exercise.

General contraindications during pregancy:

1.) no inverted exercises e.g. rollovers, short spine, etc

2.) no extreme stretching due to lax ligaments, especially side splits!

3.) Prone exercises may be uncomfortable due to breast tenderness and after the first trimester will need to be replaced by a quadruped position.
after 20 weeks, work in an inclined plane instead of supine (use arc barrel, spine supporter or similar device to keep upper body elevated)
be cautious about over-exertion or letting the body get over heated. Strengthening the core muscles will be very helpful to prevent excess lordosis during the pregnancy and it may help during the delivery process too.

4.) Pelvic floor exercises are great, but emphasis should also be placed on learning how to relax and release the pelvic floor too.

5.) side lying leg work is great to strengthen the abductors–use a pillow under belly as pregnancy progresses.

6.) arm work and upper body strength is important to prepare the new mom for carrying the baby around and all the other heavy baby stuff!

7.) Check for any changes in the diastus recti. If it separates during pregnancy, then extra care will need to be taken post-partum to avoid increasing separation of the rectus muscle. Flexion should be avoided or any other exercise that causes the diastus to increase. Strengthening the TA while keeping the spine neutral is optimal for healing the herniation.

Let me know if that makes sense!
Best wishes-
Jean

Pilates and Lymphedema

This question was sent and responded to through email, but we thought others might be interested!

Hello,
I am a Peak Pilates Certified Trainer in Bradenton, Florida. I have a client that has severe lymphedema and I would like to train her. Her arm is always swolen and she generally has 2-3 infections per year. I am not able to attend you Breast Cancer class but would be interested in purchasing the materials, perhaps. I look forward to hearing from you.

Patty McIntosh

Answer from Melanie Byford-Young:

Hi Patty!
Pilates can be an excellent approach to help her general health and lymphedema. There are several main things that you need to know and keep in mind.
1) Make sure you get clearance from your client’s physician before beginning any exercise program.

2.) wearing her compression garment is a great idea, especially at the beginning, or until you know how she is going to react to the activity.
3.) Diaphragmatic breathing can help stimulates the pumping of the lymphatic system, which will hopefully help with her swelling. Adding lymph massage throughout the session can be very useful if she or you know how to do that.
4.) You do NOT want to overwork the arm! It is suggested that you begin with breathing and some abdominal work to help stimulate the lymph system, then do some leg work; then start some arm work moving the proximal muscles/ joints first, then progressing to the more distal muscles and joints, and then to return to the proximal/ shoulder muscles to help get blood and lymph moving and clearing from the arm. Follow this up with more abdominal and breath work. You can repeat these steps throughout the workout. Minimally, start with the trunk, and then alternate between leg and arm work so as to not overtax the affected arm.
5.) In the past, women with lymphedema were told to never lift anything heavier than 10 pounds. This advice has changed recently, and experts suggest beginning with very light resistance and progressing very slowly. There is a great website www.lymphnotes.com where you can do some more reading on the topic.
6.) You always must consider whether your client has osteoporosis because of her treatments. If there is any concern that she may have decreased bone density, avoid all inverted positions, avoid thoracic flexion and avoid combined flexion and rotation. If she has osteoporosis in her hips, avoid full compression of the hip in a flexed position. If her wrists are involved, then avoid weight bearing through the wrists. Make sure that you include balance work to help prevent falls and fall related fractures. Again, make sure her physician has given her approval and that there are no special exercise modifications to take into consideration.
I cannot take the credit for putting together the STOTT PILATES® Breast Cancer workshops and DVDs, another team created them. The mat and equipment DVDs are excellent and provide a very good introductory preamble,as well as a well balanced exercise program. You can order them on line at www.stottpilates.com or call 1-800-910-0001.
I hope this helps you out. Good luck to you !

Special conditions- asthma, arthritis & degenerative disc disease

This question was sent and responded to through email, but we thought others might be interested!

From Jeff to Pacific NW Pilates:

Jeff Ong

From Leslie Braverman

Hi Jeff:
Thanks for your questions; I’m so glad you like the blog and will be attending some of Melanie’s upcoming courses and workshops; she is really the expert in this area, but I thought I would put in my two cents. I know she will have some comments for you to consider too.

This question about asthma as related to the principles of breathing is an interesting one; I don’t think I can recall being asked about it before. At any rate, I have not read a lot about the subject. That said, there are some interesting books out about the topic that you may want to look into. Alexandra Hough has written a book called “Physiotherapy in Respiratory Care” that talks about not only asthma but many other mild and chronic respiratory conditions.
She also has a whole section about breathing techniques for asthma.

To summarize, she says that certain breathing techniques can be used to diminish stress and anxiety (some of the triggers of asthma- although there are many, many others), aid in giving a person a feeling of control, promote relaxation and improve the efficiency of breathing. She emphasizes that the individual should find a comfortable way of breathing, it should be gentle (not deep or forced), encourage breath awareness and diminish residual tension (do these things sound familiar?!) She uses these techniques with patients and encourages them to do them regularly and, particularly, if they feel an attack coming on. I would love to hear if others, with asthma, have felt any changes, positively or negatively, from practicing pilates on a regular basis.

With regard to osteoarthritis (vs. rheumatoid) and degenerative disc disease, the first is a degenerative process in which cartilage around a joint wears away and the second is progressive structural degeneration of the intervertebral disc. Generally speaking, compressive, sheering forces at their respective locations will contribute to both conditions. Therefore, localized joint stability will be really important and, since we are speaking, specifically, about neutral versus imprinted spine and which is better for an individual presenting with spinal osteoarthritis and/or DDD, I would suggest that working in the spine’s neutral position will be most beneficial to individuals with these issues. Working in the spine’s neutral zone with support from the pelvic floor, transversus abdominis and multifidis will be vital to your client’s spinal health, and it will be important that they are cued to avoid bracing, overuse of their erector spinae and/or substituting other superficial muscles for these deep local stabilizers.

I know Melanie will have a ton more information for you about this topic. Diane Lee has also done some amazing studies about neutral spine and lumbopelvic stability; she is worth checking out.

Thanks for your note. Would you mind if I post this, along with our answers, to our blog? I think others will be interested in these topics too, and I would like to hear what others have to say. Let me know.

Thanks.
–
Leslie

Osteoporosis & Pilates

This question was sent and responded to through email, but we thought others might be interested!

Hi Pacific Northwest,
This is Christi Tuck from the YMCA in Colorado Springs. I thought I would run this question by your studio since over the years we have had your instructors come out to the Springs to do our CEC’s. Anyways, I have a client that was recently diagnosed with osteoporosis of the spine and osteopenia of the hip. I have done quite a bit of research regarding safe exercises for her, however I am still not sure about backward flexion, e.g. backrowing roll-down on the reformer … I know to avoid all forward flexion and lateral flexion. Her doctor said minimal spinal rotation with no resistance would be okay. Any thoughts on the backward flexion??
Thanks for any information you can provide. Have a great holiday weekend.

Sincerely,

Christi Tuck

Answer from Leslie Braverman:

Hi Christi:

This is a great question!

The conservative approach is to omit all flexion and rotation from a client’s workout. Unfortunately, most normal people have to conduct some flexion and rotation in their daily lives, so, in my opinion, it is a good idea that they know how to do these movements appropriately and without alot of loaded compression. Practically speaking, an individual will have to do these movements but should be educated to know what is appropriate for the overall health of their bones.

The thing I try to do is to make sure that the flexion and rotation is never in a loaded position and is done minimally during a workout (i.e. with lots of exercises that include extension and neutral spine spaced between.) Loaded flexion includes ANY inverted work. I would make certain never to do any roll over, short spine type of exercises. Especially because the thoracic spine can fracture easily, you want to make very sure that you omit these kinds of exercises—easily done. This is, of course, something to keep in mind when working in a group setting, also, when you don’t know all the students or their history very well.

In addition, you may need to be cautious with other types of loaded rotation or flexion that uses alot of spring tension or sends a great amount of loaded compression through the spine (I would be careful with things like stomach massage and elephant in a round back position). Also, exercises that combine flexion and rotation in one should, generally, be omitted (i.e. saw, stomach massage with twist etc.)

Do your best to keep your client working in neutral positions as much as possible. As an important aside, loading the bones in other ways would be great and makes Pilates a safe and effective tool for bone building! (i.e. footwork, jumping on the STOTT PILATES® jumpboard, armwork with the spine in a neutral position) all of these types of exercises are going to help your client to build bone without stressing one particular area of the spine too much. Good for you…. being a smart and inquisitive instructor!

I also hope that Melanie and Jean will put in their two (or three) cents!

I hope you are well…all my best to everyone in Colorado Springs.

Leslie

Reply from Christi:

Hi Leslie,
Thank you so much for your quick reply. Your information was invaluable and it also helped confirm the changes I have made to her workout. We had a private session on Friday with omitting the exercises you have mentioned with a main focus on staying neutral. She attended my reformer class yesterday so I was able to ask her how her body responded with the changes we made and I am pleased to say she felt great. Fortunately, she has been doing pilates for a while so her mind/body focus is wonderful. I am happy to hear that you think the jumpboard is a good option because she enjoys it. Thanks again for all your information.

Sincerely,

Christi Tuck