Pilates Positive Impact!

As you know, Pilates has certainly made a difference to me.

A masseuse told me several years ago about one of her clients saying that Pilates had transformed her body.  I went to that Pilates studio because I had been having trouble sleeping from pain in my shoulders, hips and legs and when gardening I would end up with hobbling lower back and hip pain.  I was also having pain from yoga postures even though I had practiced for years.  The Pilates studio helped me understand how my posture and walking were causing me problems.  My sleep improved and I no longer had pain when gardening.  But they were unable to answer many of my questions, I still had many physical issues, and I felt more was possible.

A chiropractor referred me to the Pacific Northwest Pilates studio and I found my answers.  Now I am stronger, feel better, and understand more about my overall body structure, alignment and posture, and how those affect how I feel.  I also know what exercises will help my particular problems and what to avoid.  At first I had great difficulty even comprehending how certain body movements could be made and Leslie would not only have to demonstrate them to me, but also she would have to move my body as apparently my mind and body had lost all awareness of how to do it.  Fortunately, it would usually take only a few weeks of practice for my body to remember.

I came to realize that the root of my problems were the results of major surgery in 2000-2001, along with chemotherapy, radiation, and a PIC line in the right arm for 6 months, and probably also from birth trauma, childhood habits, and major surgery in 1976.  My body had found ways to compensate but I had never realized exactly what was happening and what were the lingering effects.  Pilates is giving me that awareness and the means to work on changing how my body functions.  I have a long way to go, I still have some pains, and some of my structural restrictions limit how much strength I can gain yet, but I now have the tools and the help I need to improve.  I am more able to feel how my body should move and I get results when I do my home exercises.  I take a reformer class that helps me practice using my body correctly.  The class also brings to my attention any restrictions I have not yet dealt with and when that happens, I have found that a private session focused on that issue always provides me with the answers for the problem.  I no longer feel at the mercy of the unknown, I have some control over how my body feels.  To me, it’s a miracle.  One that would not be possible without the guidance of the Pacific Northwest Pilates studio.

Thanks You.

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!

Pilates & Gardening: Or how to hoe without hurting

This question was emailed to us:

Hi all!  I have a great client who struggles with on and off lower back sensitivity.  She is concerned that her issues will put a damper on her gardening this spring (we live in Chicago, and we take our warm-weather activities very seriously!)

Can you recommend some postural suggestions that might allow her to continue gardening, pain-free?  Also, we would appreciate exercise recommendations to prepare her for the beautiful summer garden months?

Many thanks.

Salle Huber

Hi Salle-
Thanks so much for your inquiry. Here are some suggestions for your client:

1. Work in neutral spine as much as possible. Often what irritates our back from a gardening session is the constant bending over or staying in a flexed spine position for too long. When weeding or preparing the soil, try to squat down as low as possible while maintaining a neutral spine and pelvis. If squatting is uncomfortable, buy a kneeling pad, but again try to work with a neutral spine while on the knees.
2. Vary your activities. There is always a lot of work to be done at the beginning of the gardening season. Tilling the soil or adding compost or fertilizer to the soil. Weeding or removing old plants to get ready for the new. etc. Instead of spending two hours preparing a plot, spend 30 minutes doing that and then switch to another activity like pruning trees or watering. Then go back to the more labor intensive activity. Often, we get so involved in whatever activity we are doing that we spend too much time in one position and that will irritate the back.

In terms of exercise ideas, definitely working the core muscles, (abs, glutes, spinal muscles etc) will allow your client to remain more pain free during her gardening activities. Try adding in some squats or some waiters bows to see if she is able to maintain a neutral spine in a squat position. Waiters bow is a core exercise where you sit on the edge of the cadillac or a couple of reformer boxes (in other words a slightly higher seat than a normal chair) The feet should be firmly planted on the floor though. Have your client hinge forward from the hips maintaining a neutral spine.

Certification student, Patricia Sinclair, demonstrates the waiters bow

The arms can reach forward slightly as the spine hinges forward. Once there is

Standing upright, before hinging to return to bench

enough weight in the feet, the client should be able to stand up. Then reverse the waiter’s bow to sit back on the edge of the cadillac or the boxes. These movements should be performed slowly with control so that no momentum is necessary and there should be no change in the spinal alignment as the client shifts from sitting to standing. Using the pelvic floor, transverse abdominals and multifidus muscles are essential to doing this exercise with control and fluidity.
Using a squat to get down close to the ground or to lift plants or heavy objects can help prevent strain to the back muscles. Again, make sure the abdominals are engaged and use an exhale to perform the lift or the difficult part of the movement. Check out some other great exercises in this article by Leslie Braverman; Pilates and Posture

Patricia demonstrates a good neutral spine while squatting to lift a pot.

Taking periodic breaks to stretch is also a great way to check in on your body and make sure you are not over doing things. Gardening can be a true delight, but it is important to gage your strength and endurance so that you can enjoy your garden throughout the growing season!

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: Kyphosis-Lordisis

One of the classic postural types is called Kyphosis-Lordosis. Characteristically, Kyphosis-Lordosis is a posture in which all the natural curves of the spine are exaggerated.

As seen above, the figure on the left side has increased the curve in the neck (hyper-extension), displacing his head into a forward position; notice the figure’s chin on the left is forward of his sternum, unlike the figure on the right where the head is erect and the chin is in-line with the sternum. In addition, the curve of the upper back (thoracic spine) on the left is more pronounced (increased kyphosis) and the shoulders are rounded forward. Likewise, the curve of the lower back (lumbar spine) is also exaggerated (hyper-lordodic). The exaggerated curve of the lumbar spine is accompanied by a tipped pelvis (anteriorly tipped).

In this set of pictures below, you can see the shape of the bones more clearly. Although the figures are facing the other direction from the figures above, you can compare the curves of the spine and position of the head and pelvis more clearly here. The figure on the right displays the ideal curves while the figure on the left displays Kyphois-Lordosis

So, what can be done in pilates to help offset this particular postural alignment?

First, you must understand what muscular imbalances are associated with this posture.

Because of the position of the head and neck, a small pad or other prop may need to be place behind his or her head during all exercises that are conducted on their back (supine). This will help to keep the head and neck in a more ideal posture. In addition, the individual may need to work in an imprinted position more frequently than in neutral. He or she may be able to eventually work in a neutral position as they become stronger.

Take a look, again, at the curve in the lower back. Notice how the muscles of the lower spine are shortened and the muscles on the front side (the abdominals are lengthened.) This individual will need exercises that encourage he or she to lengthen the tight lower back muscles and recruit the weak abdominals.

It is imperative that a student with lordosis of the lumbar spine, learn to use their abdominals to support their back instead of their hip flexors or hip extensors. In other words, often new students with a lordodic tendency (hyper-extension of the lumbar spine) try to use gluts (bum) or muscles in the front the hip to control their back. Because of this tendency to recruit the wrong muscles, they tend to remain unable to control their back even after years of trying to do “abdominal specific” work.

Here are a few exercises you can do to promote good balance of the abdominals, hip flexors and gluts and lengthen the lumbar spine.

First, Practice lengthening the lumbar spine correctly. Here the student is lying on their back with her legs relaxed over a pillow. She is gently elongating her back into the mat (you can slightly see how the purple waist band is tipped toward her belly button in the second photo), so that the curve in her lower back diminishes (i.e more of her low back touches the mat) . It is important to make sure that your abdominals are moving your back instead of your legs. Any gripping in your back muscles or legs indicates that you may not be finding your core muscles correctly.

sit-up:

Now, try to go into a sit-up position without gripping your legs and back. You are trying to keep your back from moving into a bigger curve (i.e. arch away from the floor.) Your movement may be very small. It is important that you train you abdominal muscles to bring your upper body off the floor instead of changing your lower back or using your legs.

Dead Bug:

Finally, see if you can keep your lower back lengthened on the mat (using your abdominals, like you did in the first exercise) and pick one foot of the ground without arching your back away from the floor. If this is too hard, imprint. Alternate legs.

It is also important to teach the upper back muscles (erector spinae) to learn how to extend the upper back. Take a look at the picture of the skeleton above. Notice how the upper back is rounded, this prolonged posture makes the upper back muscles very weak and the muscles on the front side of the chest very tight (the pecs). So, it is important that this individual learns how to move their back out of this curve, open their chest and work the weak upper back muscles.

Here are a few exercises you can do to promote extension of the upper back without creating unwanted hyperextension of lumbar spine:

Turtle:

Finally, because of the way the pelvis tips, the muscles in the front of the hip can become really short and tight. Conversely, the muscles on the opposite side (the bum and hamstrings) are really weak. Take a look at the little girl’s stance below. Because of the angle of her pelvis, you can see the distance between the front of her hip bone and thigh is very short.

Here is a good exercise to open the hip and, simultaneously, use the gluts and hamstrings:

Bridge

All of these exercises are best done under the supervision of a certified pilates expert.

Tight and Weak Hip Flexors

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

Hi
 
My name is Connie Bruce and I am a Stott certified instructor in Rochester, Minnesota.  I took my first ISP course with Melanie at the Sweatshop in St. Paul, MN this past May!  I was awed and inspired by Melanie’s knowledge and ability to teach/talk in “layman’s terms”. 
 
I have a couple questions that you may be able to use on your blog.
 
1.  Recently a gentleman told me he had a fitness test done and he could leg press approximately 500 lbs.  However, he cannot hold his legs in tabletop when doing mat work.  What exactly is going on in his body and what can I do to help him be able to hold his legs in tabletop?
 
2.  What is going on with someone who is unable to sit cross-legged?  Specifically, when they try to sit cross-legged, their body leans back, their knees stay lifted quite high, and they look extremely uncomfortable in that position.  Again, what can I do to help them be able to comfortably sit cross-legged.
 
Just an fyi – I do know the various modifications to help the above people, but what I am wondering is what is the permanent – so to speak – fix?
 
Thank you in advance.  I love checking into your blog page to see new posts.  I have only been teaching since the end of 2007 and I am starving for any and all wisdom/advice I can find on how to help clients get the most out of their pilates training.
 
Connie Bruce

Response from Melanie-Byford Young:

Hi Connie! Great to hear from you, especially with such great questions!

1.  Recently a gentleman told me he had a fitness test done and he could leg press approximately 500 lbs.  However, he cannot hold his legs in tabletop when doing mat work.  What exactly is going on in his body and what can I do to help him be able to hold his legs in tabletop?

THERE ARE A COUPLE OF THINGS GOING ON HERE. FIRST, THE LEG PRESS, AT THE GYM, USES THE HIP AND KNEE EXTENSORS, WHERE HOLDING HIS LEGS UP IN SPACE IS USING HIS HIP FLEXORS (PSOAS, ILIACUS, RECTUS FEMORIS, TFL, ADDUCTRS ETC).

SECONDLY, THIS MAN HAS POWER, BUT NOT STABILIZATION AND HENCE CANNOT MAINTAIN HIS SPINAL POSTURE AGAINST THE LOAD OF HIS LEGS. YOU COULD REST HIS LEGS UP ON A STABILITY BALL, OR AGAINST THE WALL, WHILE HE DOES AB WORK OR ARM WORK. OVER TIME, HE WILL DEVELOP THE TONIC CONTROL OF HIS SPINE AND LEGS, AND BALANCE HIS CONTROL AND POWER. PROGRESS HIM WITH SINGLE AND DOUBLE LEG STRETCH, AND SCISSORS. HE MAY HAVE AN EASIER TIME WITH THESE EXERCISES INITIALLY WITH HIS PELVIS UP IN AN ARC BARREL SO THAT GRAVITY HELPS HIM INSTEAD OF CHALLENGING HIM.

2. What is going on with someone who is unable to sit cross-legged?  Specifically, when they try to sit cross-legged, their body leans back, their knees stay lifted quite high, and they look extremely uncomfortable in that position.  Again, what can I do to help them be able to comfortably sit cross-legged.
 

THE INABILITY TO SIT CROSS- LEGGED CAN BE CAUSED BY SEVERAL ISSUES, INCLUDING: RESTRICTIONS WITHIN THE PELVIS, TIGHTNESS OF THE HIP ROTATORS, TIGHT ANTERIOR HIP CAPSULE/ DEEP ANTERIOR HIPS, OR ISSUES ALONG THE LATERAL MYOFASCIAL CHAIN.

 WHAT CAN YOU DO? START BY SITTING HIM UP ON CUSHIONS OR A CHAIR FOR ALL SEATED WORK IN ORDER FOR HIM TO BE ABLE TO ATTAIN AND DEVELOP HIS NEUTRAL SACRAL, PELVIC AND LUMBAR POSITION. DO SWAN DIVE PREP AND SINGLE LEG EXTENSIONS IN ORDER TO HELP DEVELOP HIS LUMBAR EXTENSORS AND MOBILITY THROUGH HIS HIP/ SIJ/ LUMBAR SPINE. FOR HIS HIPS, DO EXERCISES TO HELP INCREASE MOBILITY AND STABILITY, INCLUDING BENT KNEE FALL OUT, ONE LEG CIRCLE, BEND AND  STRETCH, SIDE LEG LIFT SERIES, AND FOOTWORK ON THE REFORMER IN LATERAL ROTATION. FOR HIS PELVIS, MAKE SURE THAT HE IS ABLE TO ‘OPEN THE FRONT OF HIS PELVIS’ WHEN TRYING TO ATTAIN THE CROSS LEGGED POSITION; IF SOMEONE OVER-RECRUITS THEIR ABS AND PULLS THEIR ASIS TOGETHER EXCESSIVELY, THEN HE WILL NOT BE ABLE TO EXTERNALLY ROTATE THE HIP AND ATTAIN CROSS-LEGGED SITTING.
TO SUMMARIZE, ENSURE PROPER STABILIZATION AND MOBILITY OF THE PELVIS, WORK ON MOBILITY OF THE HIP IN THE SOCKET, AND WHEN IN SITTING, SIT HIM UP ON A RISER HIGH ENOUGH TO ALLOW NEUTRAL SACRUM AND PELVIS AND A FREEDOM OF MOTION.

Thanks for letting us use your questions on the blog to help others!

Melanie

Pilates for Equestrians

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.

Happy hamstrings: What is the best way to stretch?

Having good hamstring length is important for all athletic endeavors and to comfortably do regular every day activities; to bend over to tie your shoes you will need elongated hamstrings. Without lengthened hamstrings, undue stress and strain may occur in the back, hips and knees.

Commonly, people know static stretches to build passive hamstring length. An example of static hamstring stretching would include lying your back while your instructor holds your leg in the air.

This photo illustrates a static stretch for the hamstrings using a wall to support the leg rather than a person

Static stretching will encourage the muscles to relax in order to create elongation, however, because the stretch is done passively, it may create an imbalance with the opposing muscle groups, make the muscle less sensitive to neural messages sent to the it by the brain, which diminishes its’ ability to generate force, and reduce blood flow in the stretched muscle. Therefore, static stretching is not considered a wise way to stretch prior to strenuous activity; a static stretch should only be held for 6-30 seconds, and should be done only preceding a gentle activity.

A dynamic hamstring stretch, conversely, involves actively taking the muscle in and out of a stretch. Since good flexibility is specific to body position and speed, a dynamic hamstring stretch will lengthen the muscle, but also prepare it for quick, ballistic and/or explosive activity. Consider when a soccer player kicks a ball or a martial artist kicks an opponent, he or she requires long muscles that can respond quickly in a variety of positions. In addition, since dynamic stretching increases blood flow to the muscles, it is an ideal way of stretching to prepare the muscles to be able to lengthen during a variety of situations- from playing sports and to doing other daily activities as gardening or picking up heavy objects. Training your hamstrings to stretch dynamically can greatly diminish the risk of tears and other injuries.

There are numerous exercises on the pilates reformer that can be used to dynamically lengthen the hamstrings. Here are three great exercises that can help you create long, strong and responsive hamstrings.

Feet in straps:

The back is stable against the carriage using the abdominal muscles, and all the muscles of the legs are active (gluts, hamstrings and quadriceps) to maintain the extension of the knees and to create resistance against the straps. When the legs are brought towards the body, the hamstrings are elongated, but the opposing muscle groups are active and the spine and pelvis are stable. This exercise begins slowly and can progress to a faster pace (still with control), 8-10 times.

Elephant:

During elephant, the gluts and hamstrings actively work to press the carriage out, simultaneously, the spine is supported in a neutral position. Then, the carriage is pulled in by using the hip flexor muscles. Notice that the upper body remains completely stable while the movement occurs at the hip joint, as if it were a hinge. This exercise begins slowly and may progress to a quicker pace (still with control), 8-10 times.

Front Splits standing on the floor:

In this exercise, the front leg is straightening to push the carriage out and bending to pull the carriage back in. The quadriceps are working to straighten the knee creating a hamstring stretch, then the hamstrings are working to pull the carriage back in. This exercise begins slowly and can progress to a quicker pace (still with control), 5-8 times.

All of these pilates exercises should be executed under the guidance of a certified pilates instructor.

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