Pilates and Obesity; How can I be an effective instructor?

This question was sent as an email, but we thought others might be interested!

Hi Leslie/Melanie,

I love your Pilates Blog, and I have learned lots from it. I have attended Melanie’s workshop in Toronto; she is a great and skillful instructor trainer.
I have a few obese clients that come to take Pilates. What kind of cues or images would you give to them for engaging their Pelvic Floor muscles & Tranversus Abdominis? For clients with soft tissues around the waistline, would you be using imprint position most of the times for them to engage abdominal muscles?
I would like to hear your advice & comments.

Thanks
Jeff

Response from Melanie and Leslie

Hi Jeff:

Thanks for your great question. Melanie sent me some of her best cues, and I have added a few of my own. Here it goes:

When working with obese clients, it is important (as with all students) to give them lots of visual and sensory feedback. They can visualize drawing their abs and pelvic floor muscles in to a point in the center of their pelvic bowl or a couple of inches in front of the sacrum (S2). Advise your client that they should not feel any gripping or rigidity when they recruit their abs properly.

When first teaching them how to find and recruit the pelvic floor, try having the student sit on a stability ball. This way they may be able to feel the muscles of their pelvic floor in contact with something. In this position, they can lean slightly forward or back to feel either the anterior or poster muscles of the pelvic floor working more. This may be a good place to start them out. If the ball is too unstable, have them just sit on a chair and do the same thing.

In addition, you may be more successful sensing if they are, indeed, finding their pelvic floor and transversus abdominis by having them work in a four point (cat stretch, starting position). If you are able (and the client is comfortable), you can place your hands just on the inside of their hip bones (ASIS) to see if they are drawing those muscles inwards and flat. Because gravity is helping you to see if they are drawing up their abdominals when they are in a four point, cat stretch position, this may be a more successful way for you to help give them feedback and “see” what they are doing. They may put their elbows on a box if this is better for their wrists. Because of their own weight, often finding pelvic floor and transversus abdominis in supine is too difficult; the cat (four point) position will help you see (and feel) what their back is doing and help you determine if their muscles are working (i.e. if you see them lift toward their spine, away from the pull of gravity.)

The timing of recruitment is important. You may wish for them to completely relax (allowing their abdominals to “let go”). Then, cue them gently lift their pelvic floor (teach them how to do this sitting on the ball first, as mentioned before). You should see no change in their spine, pelvis or sacrum when they engage their pelvic floor. In addition, you should not feel their back get rigid. Also, when they engage their pelvic floor, ideally, you should see or feel (if you are able to palpate) that the lower abs gently lift in and flatten in the direction of the fibers. If they are very weak, you may, in fact, have to cue them to also think about gently using their tranversus abdominis– often it will fire properly if their pelvic floor is working. Check to make sure that they are not recruiting their obliques prior to their transversus abdomins by noticing if their back gets rigid or if you see them “cinch in” at the waist prior to flattening their lower abs.

Also, keep in mind that doing things in a closed chain position may really help. Give your student more feedback by having them do abdominal work while their arms are pulling down against resistance (i.e. midback work on the cadillac with their legs over an arc). This will do two things; help close the chain, and pre-tension their transversus abdominis to fire. Because the latissimus dorsi, obliques and tranversus abdominis all feed into the thoracolumbar fascia, this can be a great way to “trick” the abdominals into working. You can either have them pull the arm springs down as they do ab prep, for example, or just have them hold tension on the strap (hover arms above the mat with tension) while doing ab work. It is even a great way to have them pick one foot off the mat at a time with their head down, do hip release, do hip rolls etc. If the arm springs are too heavy, you can also tie the flexband around the cadillic upright bars instead.

As always, keep in mind that you will need to be very encouraging to these clients. Refer to the alignment of their bones when correcting them and try to give them a mental image of what by showing them pictures of the muscles and bones or showing them a skeleton. We find that students that are overweight often appreciate being educated about what is happening at an anatomical level. You will have to be aware certain cues may make them feel uncomfortable or seem insulting. For example, constantly telling them to just “pull their abdominals in” when they really don’t feel what you are talking about at a muscular level and, perhaps, already have a complex about their weight, will be very discouraging to them. I expect you are already keen to this, since you are working to find other ways to cue.

We hope these few ideas will be helpful! Thanks for reading our blog; we love the great questions and look forward to hearing if others have any great ideas too!

Thanks, Leslie and Mel

Pilates and Posture: What is ideal?

Yesterday, one of my new students asked me if I thought Pilates could help their posture, and I told her that over the last ten years, I have seen countless numbers of students radically improve their posture through pilates. So, she asked me to analyze her posture and suggest exercises that would be most beneficial for her to do. Of course, I did this for her, and she was able to leave the lesson with five or six things that she could focus on while working in group classes and on her own.

Later, I realized that this would be a great topic to focus on for our blog. So, here is my first entry about Pilates and Posture. Today, I will talk about what is commonly considered “Ideal Posture.” An ideal posture (or standard posture) is something that we strive for.

In general, ”good posture” is one that promotes overall balance for all the joints and organs and minimizes stress and strain throughout the body. Good posture allows joints to glide and move as they were meant to, minimizing unwanted grinding or sheering. Good posture also is “conducive to good alignment of the abdomen and trunk, so that the chest and upper back are in a position that favors optimal function of the respiratory organs” (Florence Peterson Kendall, PT)

As seen in the profile picture below, the spine has its’ normal curves, the pelvis is level (the two hip bones in the front (ASIS) are on the same plane as the pubic bone), the hip joint is centered in the socket and the thigh bones are stacked directly over the bones of the lower leg (tibia and fibula) and the head sits balanced on the spine so that there is a slight (lordodic) curve in the neck and the chin sits in line with the sternum.

 

The back view of an ideal posture, seen to the right, shows the head balanced (neither tilted or rotated), a straight neck, level shoulders and shoulder blades, a straight spine (right and left sides of the trunk are symmetrical), level pelvis and neutral hip joint and knees. The toes are pointing slightly outward.

 Since there is a direct coorelation between the static alignment of the bones and the balance of the muscles which attach to them, pilates exercise can be used as means to change posture. In order to do this effectively, one’s posture should first be analyzed for deviations that appear different from the standard posture. Then, a qualified instructor should be able to select exercises that help to lengthen or strengthen muscles that contribute to the postural deviation. In addition, the instructor needs to be able to successfully guide the student through the exercises, using props or modifications as needed, in order to ensure that the student is effectively changing their habitual movement pattern and using the correct muscle groups throughout.

Stay tuned for more entries about posture and learn about the three classic postural types and which pilates exercises may be most beneficial to focus on in each case.

 

 

What, exactly, is “the core?”

It’s surprising to me how common the term, “the core”, has become. I hear people talk about it all the time. “I’m going to pilates to work on my core,” or “I think my core is really weak.” But, what exactly is “the core?”

Specifically, “the core” is describing the joints (articulation of two bones), ligaments and muscles that stabilize the rib cage, middle and lower spine, sacrum and pelvic region. When we exercise, “the core” refers primarily to the muscles that control or stabilize this region.

Imagine your trunk, specifically the region from your ribcage to your pubic bone, as a three-dimensional cylinder. If you wrap a large sheet of paper around your trunk, you would have the sides of the cylinder. Then imagine, if you could put a top on the cylinder just under your rib cage and a bottom on the cylinder underneath your sit bones and pubic bone (as if you were sitting on it.) This is the area that is your core.

The core muscles around this region need to co-activiate in order to create and maintain intra-abdominal pressure. That’s seems technical, but mostly what it is saying is that all the muscles in this region that are close to the bones need to work together to create the right amount of pressure to create stability in the trunk. This stability is important because without it your joints and discs are allowed to move too much. Too much movement at any particular joint will create unwanted sheering and will not allow the loads of weight bearing and movement to be transferred between the trunk, pelvis and legs effectively.

Now, imagine you are a long distance runner and every time you move your legs to take a stride, one or two parts of your spine move more than the other parts. In essence, you “give” too much at one or two joints thus creating a lot of friction and sheering at these regions. Over time, these joints will begin to break down, and you may end up with spinal degeneration (i.e. facet syndrome, spinal stenosis, degenerative disc disease).

The primary muscles of your core (that make up the imaginary cylinder) are the pelvic floor (the bottom of the cylinder), the transversus abdominis (the front and sides of the cylinder), the diaphragm (the top of the cylinder), the multifidis (the back of the cylinder) and some of the deep fibers of the psoas muscle.

Learning how to use these muscles correctly during exercise will help develop your core strength and minimize injuries to your spine and pelvis. Cool, huh?

Stay tuned for more information about core stabilization and exercises that help you strengthen it most effectively!

Pilates can condition your body and mind like a dancer’s

I started doing pilates while dancing as a student in New York City at the School of American Ballet during the summer of 1988, and it is still the only kind of cross training I do. I’ve tried yoga, I’ve tried running, I’ve tried weight lifting, but none of them have stuck.

 

Pilates has been used by dancers as a method of improving technique and helping to rehabilitate injuries for decades. In fact, famous clients of Joseph Pilates include Martha Graham and George Balanchine, two of the most influential people in American dance history. Because of this, generations of dancers have studied pilates since the 1940’s.

 

So, what makes Pilates so useful to dancers? And can these concepts be applied to others?

Tracey Carboneau of Bouand DanceCompany

 

When Joseph Pilates worked with students, it is said, that he worked with everyone as an individual and, in fact, he had many of his students that were dancers work in a parallel position versus in a turned-out (externally rotated) position. His logic, likely, was to try to counter the work that dancers normally do (often in an externally rotated position) and provide more balance to the muscles fibers of the legs that get overworked by always being shortened in one way. So, while it may be assumed that the idea of turning out the legs is what makes pilates useful to dancers, on the contrary, it seems it is the idea of balance that is more important.

 

I remember when I first started doing Pilates it felt strange and awkward, to try to keep my legs in a parallel position. In fact, I had to look down at my feet sometimes in order to see if my feet really were in that position. I started to feel new muscles working- my adductors felt sore in a new way, and my quadriceps were really weak in parallel positions, especially when asked to jump or balance in a deep lunge. And strangely, my turn-out improved, and I felt stronger while dancing then ever before! I remember thinking, at the time, how odd it was that my legs would get stronger, be able to go up higher and externally rotate more easily by working on the opposing muscle groups.

 

Today, I find this is true with clients. If I focus on creating balance in their overall movement, they find improvement happens in their other activities. For example, if I work with someone that is a golfer, I try to provide them with a workout that balances their body. In other words, if he or she always hits the ball from one direction, I make sure they do a lot of spinal rotation in the other direction when they do pilates, and, inevitably, their golf swing improves!

 

Another reason, I believe, that pilates is such a useful training system for dancers, is that it asks the dancer to do movement that is efficient and full of ease. Just as with dancing, one must condition him or herself in a way that does not create the look of strain. This is untrue in other training systems, like weight lifting, where, often, the focus is on how much weight can be lifted and power, versus the quality of the movement that is being created. Even a male dancer that has to lift his partner has to be able to do this with ease and grace. This means that the power he has in his body must be gained using technique that is, simultaneously, coordinated, rhythmic and expressive. For a dancer, having power exclusive of these other factors is meaningless.

 

Scott Trumbo and Cate Powers of Bouand DanceCompany

Consider this same concept for other athletes, and the same is true. The greatest basketball players, golfers, skaters, swimmers and runners, all share this same quality. Their movement looks utterly effortless, coordinated and beautiful when done well. Granted Michael Jordan isn’t paying attention to the same kinds of details on the basketball court that Mikhail Baryshnikov is paying attention to in a ballet, but I would bet that the level of concentration, attention to detail and skill is equivalent. If a dancer is unable to execute his or her pirouettes well, he or she is going to think about changing any number of things to correct the problem. Perhaps the way he or she is taking his foot of the floor is effecting the direction of the turn, the dancer will have to consider this change and then work to integrate it into the mechanics of the turn until it becomes natural to do. The same way that a basketball player may need to alter the timing of his throw or how he or she releases the ball from his hands in order to consistently throw the ball in an accurate direction.

 

What I realize as a pilates teacher is that the idea of training your body to be able to do things with precision and ease is a skill that everyone can use. I believe, human beings were designed to use their body that way. In a pilates class, I ask my students to do the same thing I would ask of myself as a dancer: to pay attention to the quality of the movement, the rhythm, dynamic and genesis of it.

 

With this point of view, an exercise like “Footwork” on the reformer becomes quite demanding. A student not only has to think about the placement of his or her feet, but the timing of the movement, the alignment of the knees while they bend and straighten, the position of their back and the recruitment pattern and quality of the muscles that are at work to either stabilize some parts of the body or create effortless, coordinated movement with others. Finally, can all these things be integrated so that the movement is done as efficiently and easily as possible.

 

Pilates, for me, will always be a remarkable conditioning method, because it conditions me like a dancer. It incorporates all the subtle distinctions of training my body as an artist that must take care with the placement of my hands, feet, eyes and head while incorporating the power and control of an athlete that must jump, turn and have fluid, exquisite control.

 

 

 

 

Do abdominal exercises hurt your back?

Do abdominal exercises make your back hurt? They shouldn’t. If you find that your back is sore after doing a series of abdominal exercises (either immediately after or a day or two later), you may want to check to see if you back is gripping while you are doing them.

Here are several tips for helping you learn how to use your abdominals (instead of other muscles) while doing ab exercises (sometimes called crunches or sit ups)

Step One:

Re-educate your body to learn how to find your abdominals without recruiting other, more dominant, muscle groups.

Often when one has weak abdominal muscles, the hip flexor muscles (the muscles at the front of your hip) and back muscles will overwork. Remove the additional challenge of holding your legs in the air, and instead, cue your hips and back to relax.

To do this, place a thick pillow on the ground in front of you and drape your legs over the pillow (or arc). Then actively tell your back and hip muscles to “let go.” You may notice that your back falls into a slight curve so that there is a space between your back and the floor. See if you can maintain this curve during your sit-up and still keep your back and hips quiet! When you do this correctly, you should feel that your abdominals are working more effectively.

Step Two:

The second step is to see if you can do the same thing with your legs up in the air in a supported position. You could do this by placing your legs over a ball (this will be harder since it is an unstable surface). If you need a surface that provides more stability, put your legs over a coffee table or other surface.

Step Three:

The last step is to see if you apply this to having your legs in the air without support. In this position, your hip flexors will have to work in order to hold your legs up against gravity, and your back may need to be placed firmly on the floor (instead of having a curve in it), but your back should still not be working and, overall, you should feel that there is more balance between your abdominals and hip flexors.

Once you have this skill, you should be able to apply it to other abdominal exercises that require more complex movement with your arms and legs.

Good luck.

 

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

Flat abs without back pain

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

Melanie:

What are some good ab exercises that I can do without hurting my back? Do you have research to support these ideas?

Hello,

The most beneficial way to strengthen your abs, flatten your stomach and not hurt your back is to do abdominal exercises that encourage proper recruitment of the spinal and pelvis stabilizing muscles: the pelvic floor and transversus abdominis muscles. To do this, you need to understand how to “recruit” these muscles (in lieu of using other muscles, which is common) and how to tell if they are staying “on” (instead of using those other muscles) while you complete abdominal exercises.
The transversus abdominis is the deepest layer of abdominals. It does not, by design, create movement. Instead, it creates stability for the spine and flattens the abdominals. It is important to make sure that while exercising the transversus abdominis, it is pulling in and flattening sideways (the fibers run horizontally around the trunk like a corset).
These muscles work best when the pelvis and lumbar spine are placed with the natural curve in the lumbar spine (i.e. when the back is not flattened into the mat) and the back muscles are not gripping.

There are several basic exercises one can practice to find the pelvic floor muscles. Since the pelvic floor muscles attach to the underneath side of the pelvis (these are the same muscles that control urination) they are felt easiest by sitting on a ball and gently bouncing up and down or by folding up a small wash cloth and sitting on it. These devices give some feedback for the individual.

To strengthen these muscles, gently connect these muscles by thinking of lifting them upward slightly. (It should feel like the same muscles that work to keep you from urninating.) It is important to be able to gently lift them for a count of 5, hold them on for a count of 5 and release them for a count of 5. They should not be working at 100% but closer to a 25% level.

Transversus should become active just prior to incorporating other muscles. When the transversus abdominis is recruited properly, you see a flattening or drawing in of the lower abdomen without any noticeable movement of the spine or hips.
To get the look of a flat, strong abdomen, you need a variety of different exercises in your routine. Some include:
1) Challenging the spine in neutral (plank, head and shoulders on the ground) ensuring the spine remains as it starts throughout the exercise
a. Toe taps
b. Dead bug series
c. Scissors with head down
d. One leg circle
e. Push ups
f. Leg pull front
2) Flexion routine- ensure that lower abdominals are set prior to and throughout the motion
a. Roll up
b. Obliques with single leg stretch
3) Extension based exercises- keep abdominals lifting up
a. Swan dive
b. Swimming
More info about the transversus abdominis:
1) acts as a corset, drawing in circumferentially as it protects the spine
2) stabilizer of the lumbar spine by virtue of:
- insertion into the thoraco-lumbar fascia, which inserts into the vertebrae,
- its neurological firing pattern (fires before movement begins so that the spine is protected and prepared
- coordinated work with the other stabilizers including the pelvic floor muscles, diaphragm, deep psoas, and multifidus
3) creates motion around the proper axis of motion, and prevents unwanted shearing or translation of the vertebra which can lead to irritation and degeneration of the discs and facet joints
4) provides compression (in a good way) so that the larger muscles have a stable base to pull from
REFERENCES:
1. Lee, Diane: The pelvic Girdle, Third Ed. Edinburgh, Churchill Livingstone, 2004
2. Richardson C, Hodges P, Hides J: Therapeutic Exercise For Lumbopelvic Stabilization: Motor Control Approach to the Treatment and Prevention of Low Back Pain, 2nd edition, Edinburgh, Churchill Livingstone, 2004
3. Vleeming A et al: Movement, Stability and Low Back Pain- The Essential Role of the Pelvis 2nd edition, at press, 2006
Articles
3. Lee, Diane (1998) Stress Urinary Incontinence: A consequence of Failed Load Transfer Through the Pelvis? Proceedings from the Third Interdisciplinary World Congress on low Back and Pelvic Pain. Vienna, Austria www.dianelee.ca <http://www.dianelee.ca>
4. Lee, Diane (2005) Recent Advances in the Assessment and Treatment of the Sacroiliac Joint- Stability & the Role of Motor Control. www.dianelee.ca <http://www.dianelee.ca>
5. Richardson C A, Snijders C J, Hides J A, Pas M S (2002) The Relationship between the Transversely Oriented Abdominal Muscles, SIJ Mechanics and Low Back Pain. Spine 27(4): 399-405
7. Vleeming,A Stoeckart, R, Volkers A C W, Snijders CJ (1990a) Relation between Form and Function in the Sacroiliac Joint, 1: Clinical Anatomical Aspects. Spine 15(2): 130-132
8. Vleeming,A Stoeckart, R, Volkers A C W, Snijders CJ (1990b) Relation between Form and Function in the Sacroiliac Joint, 2:Biomechanical Aspects. Spine 15(2): 133-136