Knee Stability Post Surgery

We just got this question emailed to us from a student:

This is Christi Tuck from Colorado Springs YMCA. I am a certified STOTT PILATES instructor and I have a question.
I have an inquiry from a possible student regarding some knee issues and if the reformer would be beneficial and are their any concerns. Basically they had surgery recently and the doctor informed them they have no cartilage around the knee. I believe they had the meniscus repaired.
My guess is the reformer would be helpful to strengthen the surrounding muscles and that starting at light resistance would be best. I welcome any comments or suggestions.

Hi Christi-
Thanks so much for your question. As far as your client’s issues are concerned; yes, the reformer would be very beneficial to her recovery. Doing footwork starting with lighter resistance is a great start. I would also do single leg pulses in a variety of positions–laterally rotated, parallel and medially rotated. Make sure when she is doing footwork or single leg that she is really using her quads to draw the kneecap up as she straightens the leg. VMO (vastus medialis oblique) is especially important for knee stabilization and it tends to be weak for many women. I find I really feel the VMO muscle more when doing lateral knee pulses, but that may vary from person to person, so check in with her to see if she is feeling that muscle. Strengthening the posterior leg muscles will also help to stabilize the knees, so make sure you are doing some glute and hamstring work as well.
Melanie Byford-Young has a great workshop on Knee Stabilization if you ever get a chance to take it! She created an exercise where you are sitting on the reformer carriage with no springs attached. One foot is on the floor between the rails and the other leg is lifted up supported by the hands or with a flexband around the thigh. If you have a rotational disc, place the foot on top of the disc and keep the ankle, knee and hip tracking as they slowly move the carriage out and in. This helps to stimulate and strengthen the popliteus muscle which is another deep knee stabilizer.
The more those stabilizing muscles are activated and strengthened, the less wear and tear will occur to the knee and the remaining cartilage. Eventually, you can increase the resistance as those muscles get stronger, but at the beginning we don’t want to overload those stabilizing muscles.
Let me know how things go or if you have any other questions.

How do I teach men about the pelvic floor?

I need some guidance…..

It is regarding the pelvic floor and the issue of whether men and women have the same anatomy and then therefore does the contraction of the pelvic floor  different between men and women and does it essentially feel different.

I guess my take/my understanding that was realistically men have pelvic floor muscles and women have pelvic floor muscles…they are relatively in the same area for men and women and ultimately function the same way but how we describe it to men might be different than how we describe it to women…I know that men have a the cremaster muscles (which women do not have, right?) but other than that, is there really that much difference……

I recently heard that men and women cannot be told to “kegel” engage their pelvic floors the same way and this just seems a bit silly to me……but maybe I am missing the mark on something…

Any clarification on this and HOW we should be explaining this to our training students would be greatly appreciated.  It is a question that often comes up in training courses especially if there are men in the group….
Thanks!

Kelly Dormady
SweatShop Health Club, St Paul, MN LTC

Response from Melanie Byford-Young:

Hi Kelly!
Good question. Indeed men and women have essentially the same muscles (except for the cremaster) and those muscles do both stabilization of the pelvis and sacrum, movement of the sacrum, and closure of the orifices with the sphincter muscles. They work the same. For guys, the feeling is often said to be the same feeling as pulling up their genitals like when walking into cold water. Often the cue I use is indeed very vague ‘your abs and pelvic floor will gently draw in/lift like walking into cold water’. Make sure of course that it is gentle and hardly done with any force at all. The other visuals like ‘an elevator shaft’ can work. One thing I like is to really get to the heart of what we are doing and why; we are trying to stabilize using all of our muscles together, drawing them in towards our center, which sits just in front of the S2. So if you can get the idea that the center of gravity of the body sits just in front of the sacrum, protecting the spine is done by engaging each of the stabilizers together or having them draw in towards that center of gravity.

 There are some clients who I just do not talk about the pelvic floor muscles initially because it would be too awkward and detrimental to the session. This can especially be the case if there is an older gentleman working with a younger instructor. If a client has back pain, SIJ pain, asymmetrical pain, has had prostate radiation, grips a ton in the QL or  erector spinae, or has some specific pathologies, you need to determine if the pelvic floor is working effectively or not.
Let me know if this works well enough.
All the best
Melanie

Ischial Bursitis

Hi Melanie!
 
I recently attended your gait seminars in May, and wanted to relay to you that my clients are absolutely loving the work and the results.  Thank you so very much!
 
If possible, I would so appreciate your input relative to ischitis or ischial bursitis.  Recently, two clients have been referred to me with this diagnosis, one of which has a R hip replacement, L knee replacement, and its the L ischium that’s affected.  Both clients spend too many hours at desk and chair, likely sitting behind their sitzbones.  I’ve referred both to a PT for cranial/visceral work to hopefully release the area of the coccyx. 
 
Naturally, they have hip flexor hypertonicity, but because of their symptomology I avoid hip extension and work only within their comfort range in neutral pelvis/spine.  Any “pearls of wisdom” you could share with me, would be hugely appreciated! 
 
Thank you very much, and I look forwarding to seeing you again soon!
 
Best,
 
Tina Strickland, LMT
Stott Pilates Certified Instructor

Response from Melanie:

Hi Tina!
Ischial bursitis is an interesting and complicated issue to help resolve. Things that characteristically contribute to, or leads to ischial problems include: hamstring dominance over the gluteals/deep rotators, stiffness of the feet or ankles, poor positioning of the pelvis (either anterior or posterior rotation) which places the hip adductors and gluteals in a position of inefficiency, and lumbar spine problems.
Developing gluteal strength in the presence of a hip replacement can be tricky. We like to lie such a client prone over the cadillac or ladder barrel and work on hip extension there where the gluteals are working in midrange. Start out by assisting with the concentric lifting of the leg, make sure that the glutes are set, then have the client control the lowering. Assist as much as required so that the client does not experience the ischial pain.
Try to develop as much ankle and foot mobility as possible. Your client requires the full 20 degrees of ankle dorsiflexion to be able to walk normally and not have to alter the hip to compensate.
See how these ideas work and report back to us.
good luck!
Melanie Byford-Young

Osteiitis Pubis

Hi Melanie
Sorry to seek your assistance so soon again.  If you can find the time to give me some help on this client would again be very grateful.
 
One of my clients has  has osteitis pubis.  She has now had this for 2 years, bought on in her second pregnancy.  She played hockey upto 14/15 weeks of this pregnancy.  She had no pain at that time, but did in the later stages of her pregnancy.  Unfortunately, she didn’t say anything about the pain to her midwife and no pelvic support was used.  After the birth, she pushed herself quite early, and has suffered since.  She saw a PT for quite a long time, but found that she was worse after these sessions so has stopped.  I have seen her 4 times.  I am only doing half hour sessions with her as she tires quickly. I have been working with her to not overdo her lift and contraction of pelvic floor and TA.  Initially, at times, 20% would cause pull in the area, so we dropped it back to 10%.  Now that shearing/pull doesn’t hit until 30-40%, so we are working at about the 20%.  I have been doing supine, sitting, sidelying and today some standing work with her.
 
Supine – very small lateral leg openings with flex band behind leg, also medial leg mvmts, foot on toning ball, scap isolations, light adductor with mini ball, focus on left/right side pc
Side lying – small ext hip rotation, scap isolations
Sitting – I have some gliding discs – on raised mat, small sgl leg presses, then dbl leg presses and today small alt/reciprocal mvts, arm raises and today small swimming arm mvts (at chest height)
Standing – Cadillac push through bar – sgl lat pull and dbl then with roll down bar(small mvmt just until she felt core connection
 
She saw a specialist at the hospital this week who has suggested surgery.  She is not keen to undertake this option and was disappointed they offered her nothing else.  Am I heading in the right direction with Rachel?  What else should I do.
 
My other client with TMJ is currently off on school hols so I will let you know how we get on in a few weeks.
 
Thank you so much
Sonia, Progressive Pilates, New Zealand

Response from Melanie Byford-Young:

Hi sonia!
Great question. Osteiitis pubis can be very debilitating and hard to figure out. You are doing good exercises already.
Essentially you have to imagine that the pubic symphysis can get pulled apart very easily, even just via the contraction of the hip adductors. Your goal is to try to work the myofascial slings to hold her together- the anterior and posterior slings. You need to get the external control adn the internal control of the local stabilizers.
There are several other things you can try
1) breathing- see if she can tolerate breathing like she is sucking in through a straw, and gently lifts the pelvic floor as she does (i.e. uses the breathe to lift the pelvic floor) instead of focusing on contracting the pelvic floor (PF) muscles specifically. It can be a more gentle way and uses the diaphragm with the PF. If she can, use this technique then have her hold the PF up while she exhales. If this works, repeat hourly through the day.
2) swimming prep on hands and knees to get the posterior oblique sling supporting the pelvis and spine
3) footwork on teh reformer- probably 2 springs starting with the stopper out at position 6. Progress range first then weight and rhythm. Running can be very effective at beginning to tolerate weight shifting. Then, progress to shifting weight from on leg to the other.
4) sleeper on the reformer/ V2Max with the  spring from above (flexband supporting the leg)
5) standing arm work on the rotational discs, bosu or just on the floor. Light to moderate weight, bilateral first then unilateral. Eventually you want to do it standing on one leg.
6) sitting on a stability ball and doing imprint  and release, arm circles, spine twist etc. Vary her leg positions as able.
That should keep you busy.
Let us know how it goes!
Melanie

Anatomy Trains in May 1 & 2, 2010 at Pacific NW Pilates!

Pacific NW Pilates is thrilled to be hosting
Anatomy Trains® Myofascial Meridians in 2010!

Anatomy Trains® maps the ‘anatomy of connection’ – the whole-body fascial and myofascial linkages. Anatomy Trains links the individual muscles into functional complexes, each with a specific anatomy and ‘meaning’. Anatomy Trains leads to new holistic strategies for health professionals, movement teachers, and athletes to resolve complex postural and movement patterns.

Anatomy Trains Myofascial Meridians gives you a new understanding of whole-body patterning in posture and function – the interplay of movement and stability. Understanding the ‘Superficial Back Line’ as a whole gives insights into hamstring problems that you cannot get from considering the hamstrings alone. The ‘Spiral Line’ shows how to resolve rotational compensations in a way that no analysis of any single muscle can give.

To find out more information about the workshop visit our website here

AWESOME workshops with John Garey!

This past weekend, John Garey of “John Garey Pilates” in Long Beach, California http://www.johngareypilates.com/ taught six STOTT PILATES workshops at Pacific NW Pilates.

On Friday, he taught “Pilates for Men” this was really fun, and of course, John was the perfect person to teach this workshop since he helped to develop the programming for it with STOTT PILATES. On Saturday, he taught “Pilates for Men on Reformer,” A workout with the mini flex ball and “Athletic Conditioning on the V2 Max.”

Two of everyone’s favorites were on Sunday: “Pilates with Props” and “Cardio and Core on the Mini Tramp.” We would highly recommend this two STOTT PILATES workshops; they were really fun. However, make sure you order really good trampolines if you wish to offer this to your students. John recommended the Professional Urban Rebounder.

If you took the workshops, feel to comment about your experience and tell us what you learned!

John Garey and the Cardio Tramp attendees!

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

Depressed Scapula!

Hi All I have a question for your website blog…. What exercises are good to help correct depressed scapula? I attended ISP training with Melanie in 2007 and I remember she helped another instructor attending the training bring her depressed scapula more into neutral – however, I don’t recall exactly what she did. Thanks and I love your website – lots of great information! Connie Bruce Rochester, MN Response from Leslie Braverman: Hi Connie: Sorry it has taken me a while to get back to you; I hope you are well. I would recommend that you do exercises that help to quiet down the muscles that depress and downwardly rotate the scapula (particularly dominant rhomboids will downwardly rotate the scapula). You also want to watch that the client is not over-working their lats (which will drive the glenohumeral joint downward). So, start to wake-up the trapezius muscles and serratus anterior. Do this by giving exercises that encourage upward rotation and elevation of the scapula and minimize the over-use of rhomboids and lats. Then, re-educate the clients movements in order to achieve good balance of all the scapular muscles in a neutral position, making sure mid and lower trapezius are working to place the scapula centered rather than in downward rotation or depression. In addition, you want to encourage the client to set their glenohumeral joint by using their rotator cuff muscles rather than over-empasizing the connection with lats. Exercises that may help: Side-lying overhead push-thru:  Lay the client on his side with his hand on the push-thru bar. Then have him push the bar overhead, watch that he is creating upward rotation and elevation with the scapula. He or she may feel a big stretch on the lats. Help he or she guide the movement of the scapula. Superman:  Lay prone on a box facing the footbar on the reformer. The bar will be down one rung from the top with 1 spring. Have the student push the bar away using his scapula to create the movement. Watch that he is getting pure elevation and upward rotation rather than protraction and the thoracic and lumbar spine stay stable. Make sure the glenohumeral joint stays centered and doesn’t drop forward during the movement. Salute on Reformer and/or with Cadillac Springs: This is a great way to work on getting upward rotation of scapula. Mermaid: Work on the patterning of bringing the arm overhead and watch that he or she is not depressing or downwardly rotating the scapula to initiate the movement- again, you may need to guide that movement for the student- encourage upward rotation of the scapula during the movement. If he or she has been over-working rhomboids or lats there may be a lot of resistance on the scapula. Rotation prone on chair: Getting more range of movement into protraction will help to diminish the overuse of rhomboids. Watch that the scapula glides properly along the ribcage and the client doesn’t side bend but creates true rotation of the spine. Side arm preps on reformer: These will be great to encourage proper stability of the scapula and glenohumeral joint. Make sure that the student’s bones look centered and keep the weight light (1/2 spring is good). The shoulder should look “square” and “placed” rather than depressed. Make sure he or she is placing and moving by using the rotator cuff rather than lats or pecs. Melanie often speaks of “fluffy armpits” to keep a sense of openness in the armpit rather than gripping down into the lats. Push-up on the wall: Again, encourage centering the bones rather than overworking rhomboids and lats encourage mid and lower trapezius support. This could progress to more challenging weight bearing exercises so long as the joints and bones are centered. Remember, always watch that the head is staying centered over the spine and not going into forward head posture during all the exercises listed above. I hope this helps! There are hundreds of others that you could do, but I hope these give you a good foundation to be more creative with the other exercises you know. Also, Melanie will be doing a 3 day upper extremity workshop on September 17-19, 2010 (we haven’t even announced it yet) that you may be interested in participating in. This may be a great hands on workshop for you to learn how to work better with shoulder, scapula and cervical spine. Take Care, Leslie Response from Connie: Leslie   Thank you so much for the response!  It is a HUGE help.   I have only been teaching pilates for 2 years and am still grasping the depth of the exercises.    I would love to take Melanie’s workshop – unfortunately, I am in Rochester, MN and can’t make it.   My significant other’s brother lives in Portland and I am pushing to go visit him and his family – so I can visit your studio for some mat/reformer classes.   Again, thank you, thank you, thank you for taking the time to respond to my email and provide me with such detailed information.   Hopefully I will get to meet you someday.   Connie

Figuring how to work with a fractured figure skater

Hello Melanie! It’s Safia from Toronto.

I have a new regular client who is a figure skater. She primarily does pairs but is currently skating solo while searching for a new partner. She is 17 and has sustained a fractured ischial tuberosity on her right side and severe tendinitis in both ankles (now healed). She lands her jumps on her right leg. We’ve worked together 3 times so far and the last time I worked with her she strained her lower right back near her SI joint during the short spine on the reformer. I asked Sally to look at her quickly and she was the one who said it felt like her SI joint and the soft tissues that were aggravated. However, she has only ever experienced strain on her left SI joint – never her right before.
I did hip release with the mini stability (flex) ball and the mermaid for the rest of the session to help relieve the pain a bit. She took a break from figure skating that day but danced that evening since she had recitals on Friday and Saturday night (she does ballet).
I know I have to strengthen all the little muscles around her joints to help her learn to stabilize. I’m just wondering if you have any advice in terms of exercises to emphasize and also exercises to avoid (besides the short spine of course!!).
I hope you have a chance to come back to Toronto soon. It’s wonderful to have you in the studio!!
Take care and best wishes,

Safia

Response from Melanie:

Hi Safia!
Thank you for writing. With your permission, we will post this on the blog so that others can also learn from your great question.
 
What comes to mind immediately is the strength and control of your clients hip extensors, particularly the relationship of the deep hip rotators, the glutes and the hamstrings. I suspect that she does not have adequate eccentric control of her glutes, which would result in less control of her SIJ/ low back, more strain on her ankles and poor landing mechanics. For this, you would do exercises including (as able): shoulder bridge (prep and full)- progressing to single legged, and with feet on an unstable surface; side lying one leg pull on reformer- straight and bent leg; supine and side lying feet in springs on the cadillac; the step up and step down series on the chair; and of course plyometrics focusing on the landing. Other balance challenges such as fencers lunges on the cadillac would be beneficial.
 
For her ankles, make sure that you do a lot of ankle lower and lift on reformer and chair. Make sure you do a variety of positions (parallel, laterally and medially rotated in second), and at a variety of paces. Also do unilateral and weight shifting. Lower and lift in the sleeper position will help with lateral stability of the ankle and hip. Other things like standing on one leg while doing side arm series at the cadillac will help with balance and the tendonitis.
 
Other great exercises for a skater include arabesque, front and back splits, knees off knee stretches, and anything for the abs in extension.
 
I have not given you specifics for her SIJ so let me know if that did not resolve immediately and needs help.
 
I hope this helps. Let us know how you progress.
sincerely
Melanie Byford-Young

Herniated Disc Injury

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

Hi,
I wanted to ask about herniated disks. I have a client who has a herniated disk between L4 & L5, she does not currently have pain. Is it correct to not do any kind of lumbar flexion with thorasic rotation(i.e. short box round back with twist or mat obliques roll back), just rotation of thorasic with lumbar in neutral to avoid any further herniation?
Thanks,
Deanna Murray

Response from Leslie Braverman:

Hello Deanna:
Thanks for emailing. When the disc ruptures or herniates, a portion of the spinal disc pushes outside its normal boundary. When a herniated disc bulges out from between the vertebrae, the spinal nerves and/or spinal cord can become compressed. So depending on where this is happening will determine which movements to avoid. Typically, it is recommended that people avoid spinal flexion and rotation, because the disc most frequently herniates posterior-laterally and flexion and rotation would exacerbate the problem and/or create pain. To be perfectly sure which movements are to be avoided, it is best to speak with a physician or physical therapist that has worked with your client and has seen the notes from an MRI and knows exactly where the bulge is occurring. Unfortunately, as a pilates teacher, it is often hard to get this information.

If your client were still having a lot of pain, I would suggest that he/she consult with a doctor and, ideally, work with a physical therapist before doing pilates.

Since your client is no longer having pain it is possible that the disc problem has been resolved and the annulus is no longer irritable and pushing on the nerves. In this case, you can progress your client through all exercises and use her symptoms as a guide. Initially, be cautious of lumbar flexion and rotation. On the other hand, your client may have lost a lot of disc height and have too much segmental mobility and/or  instability where the disc was herniated. Progress slowly and be cautious of too much flexion load on her lumbar spine. Be very conscious of her ability to sit in neutral lumbar position. Most likely,  your client will need to sit on a box or cushion to have a proper position without stressing the lumbar area.

I would recommend that you focus your programming on work that encourages your client to become very stable in neutral positions. Really monitor what is happening at L4-L5. You may need to place your hand on her back to really be sure that she is not flexion or extending, even minutely, at this level. Often people with L4-L5 herniations will not know how to sit properly in neutral position, so really check that her lumbar and sacrum are absolutely correct.

Giving your client lots of exercising that challenge stability in neutral positions will be key to her avoiding future herniations or other deterioration of the spine. Here are some examples. Use these ideas with discretion-depending on the clients level and innate strength at this time- use your professional judgment:

1.) Cat position exercises- all variations to build stability in neutral:
-picking up one hand at a time
-sliding one leg out at at time
-alternating opposite arms and legs (i.e. swimming prep on hands and knees)

2.) Shoulder Bridges- Glut strength is paramount for people that have lower back instability
-advance to picking one leg up at a time
Make sure she is getting Glut medius and deep fibers of Glut Max- not just her deep rotators and hamstrings- watch she doesn’t tuck her sacrum under. Keep your hand on L4-L5 to maintain neutral.

3.) Leg Pull Front Prep

4.) Reformer- Footwork- keep your hand on L4-L5- maintain neutral

5.) Short Box- Straight back
You could do this on the reformer too with the arm straps (like roll back with a straight back) add bicep curls if able

6.) In kneeling positions, make sure that her hips are open enough to get head of femur over the knee so her spine can stay neutral. Her hips may be tight and not allow her to do this.

7.) Extension work is great- my guess is that it was a posterior herniation- if there is any pain avoid it. You can definitely do things like breast stroke that encourage upper back extension. If things like Swan Dive feel good, then do them. As usual, check that she is not hyper-extending at any one spinal level.

8.) Lateral flexion- watch alignment is excellent.

Hopefully, this gives you some good ideas. Challenge her in standing, kneeling and sitting positions- as long as there is no pain. Add upper body and lower body resistances to challenge her ability to stabilize her back against rotational pulls. Side lying work would be great too.

Then, once she is really strong this way, I would begin to introduce more flexion and rotation. Make sure that she is getting movement in all segments of the spine, and she is distributing and translating movement throughout the spine and not giving in at one level.

Some clients will fully recover from disc issues and some will always have a degree of vulnerability. You will have to find out slowly over time and with thoughtful progressions. When in doubt, be open to consult with your clients’ other health advisors and clinicians.

I hope this helps!

Best, Leslie Braverman

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

Is Your Ab Workout Hurting Your Back? Comments about The New York Times Article

There has been alot of “talk” about an article written for The New York Times by Gretchen Reynolds entitled “Is Your Ab Workout Hurting Your Back?”

We thought others might want to join in on the conversation! We welcome your thoughts.

Here’s the original article:

http://well.blogs.nytimes.com/2009/06/17/core-myths/?emc=eta1

Comment #1:

That’s kind of confusing. What is he saying exactly? No transversus/no scoop? Yet, some of the exercises are like what we do. What’s your take?

My take on it is that having a stable trunk is far more complex and integrated then just asking someone merely to pull in their abs and do thousands of crunches a day.

He is not saying that we shouldn’t do them at all but says, “(i)nstead…a core exercise program should emphasize all of the major muscles that girdle the spine, including but not concentrating on the abs.” He points out doing exercises as plank and swimming prep (bird dog)- again exercises that require integrated stability in neutral positions. This supports everything that we already teach at our studio, and our mentors (Melanie, Greta and others) have been expounding for years. As we know, “the core” is comprised of not only the abs, but the deep psoas, multifidis and pelvic floor. The article does not go into these specifics, but instead, points out that “if you concentrate on strengthening only one set of muscles within the core, you can destabilize your spine by pulling it out of alignment.” This idea of balance in fitness is something that I think all of our teaching supports.

The only thing about this that could be bad is that it is not specific enough and some people will now believe that doing ALL pilates and personal training is bad for the them; those people that actually read it, with some knowledge base, that have done work with someone that doesn’t just give thousands of crunches, roll ups and imprinted back exercises sees that good exercise requires balance from all the muscles groups, will see the validity of the article. My take on the “pulling the belly button in” is the fact that most people can’t do this without flattening their back and putting undue stress on their discs.

That’s what I think anyway.

Comment #3

Thank you – this is very interesting. I hope we will have a “Share Pilates” about this and possibly other research and experiences that we are learning about that inform how we exercise.

Comment #4

Thanks, Leslie, for forwarding this article. It was interesting and, for me,affirming that the work we are doing with people is actually focusing on the whole of the body and the whole of the core muscles thruout. Pilates is helping their “abs”, their spines, their joints and their overall body alignment, symmetry, strength and flexibility.

On a positive note, I think there is always a place for modern movement applications and advancements in the understanding of functional anatomy to be incorporated and applied to health and fitness instruction. I would also agree with this author that the oversimplification of the Pilates Method (or others that attempt to address “core support” and functional movement) to simply telling people to do crunches and suck in their abs is one that has the potential to endanger people’s overall posture and make them injury-prone. I would also say too that it reduces and impoverishes the benefits/contributions that Pilates and others attempted to make to overall fitness and wellness.

However, I can’t help but respond to what seems to still be a good bit of nebulous understanding about “the core” that even the writers of this article seem to have….
Here’s a few i.e.’s from the article:

1. Transverse Abdominus is the only/primary core mucsle (leaving out the PF, rest of the deep abs and all the deep spinal muscles)

2. People who are working their core(per article TA) are getting 6-pack abs…that’s Rectus’ domain not the deep abs and, of course, they may hurt their backs that way.

3. Working the core in Pilates-type classes focuses only on the abs (I would agree this is probably the case in the gym format classes and people can get hurt). However, Joseph Pilates says several times that the uniform development of the muscles of the whole body and its balance is primary to his work and to moving well in the world.

There’s my off-the-cuff response to the article. Thanks for contributing to my brain working a bit today,

Comment #5

I had similar feelings…I thought the article was great in some respects, but the fact that some of it was vague would make a less-informed individual assume that all pilates could be bad. I think that the writer or person interviewed could have been more specific about what is considered “the core” too.

Comment #6

I agree with your take as well. Posting the conversations on the blog could be good. Makes me want to respond to the NY Times too.

The Pilates “V”: Vital Exercise Tool or Pilates Dogma?

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

Hi Leslie,
I recently had an instructor teach me as part of an interview process & i try to be open to other schools but in every exercise that was open chain i had to be in the Pilates v,so i asked why?The response was stated with attitude that inner thighs help activate the corset,& it was  said as if a scientific fact.I know partly this is true,but parrallel add & abd with a ball between the legs helps activate adductors & inner thighs,but they kept repeating on & on about Pilates v as if it was the most effective or the only way that worked.
I did not want to get into a battle or even sound as if i was correcting them,but could you let me know how you would have responded as i would be interested in your thoughts!
Best regards

Lucy Garcia

Response from Leslie Braverman:

Leslie

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.

Lower Extremity Workshops with Melanie Byford-Young

Two weeks ago, several of us were lucky enough to take a three day STOTT PILATES® intensive workshop with Melanie Byford-Young on the Hip, Knee, Ankle, Foot and the mechanisms of gait.

For those of us who took all three days of workshops it was an intense, but exhilarating experience! A lot of information was received, but we were also given plenty of time to experiment with each other and make actual change happen! From a personal perspective, I was able to change my wobbly gait pattern (due to a rigid right midfoot issue) and start getting my center of gravity over that foot in a much better way.  I still have a lot of homework to do, but the changes to my whole alignment from ankle to spine have been truly amazing!

It has also been very interesting to me to see how many clients have come in over the last two weeks with ankle, knee or hip issues! How exciting to have some really cool exercises to try on them and to see some of the same changes happen to them as I and many others experienced  over the weekend! Not all of these changes happen in one session, but I feel very empowered having more tools to address these issues with clients.

I am looking forward to hearing how others in the workshops have been using the information they received. What kinds of success stories can you share with us? Questions? Bring em on!

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