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

A First Hand Account of a Priceless Experience

This was emailed to us by Lindsay Dilworth:

Over the past five weeks, I have been involved in the apprenticeship program for aspiring teachers at Pacific NW Pilates. Saying that I learned a lot would be an understatement. The experience of working directly with clients on a one on one and group basis was priceless, and my only regret was that the program was not every day of the week. Jean Leavenworth, one of the instructor trainers at Pacific NW Pilates, was on watch at all times to be the eyes, ears, and hands of knowledge. Her many years of experience were the major piece of the puzzle that was missing from my practice teaching at home and at the homes of my friends and family.

The program involved a one- hour “Quickstart” session in which five fresh participants came to learn the basics of STOTT PILATES. The majority of these clients had no experience in Pilates and, being able to watch them progress from learning how to breathe to moving through the side leg series with ease, was such a joy. There was a definite feeling of pride surrounding myself and the other two apprentice teachers as we assisted Jean in teaching this class. It is hard not to smile when you watch someone finally able to stabilize their spine in imprint and perform an open chain movement with their legs. That sense of control and confidence reminded me of the day that I finally felt new things in my own body; it still excites me to think about it.

The second part of the program consisted of a one- hour private session with clients of several different ability levels. This was where Cheri, Kate, and I took the reigns and guided each of our clients through a series of workouts that we put together on our own. We were given their history and the level that they had achieved so far and we were challenged to push them to new heights in their workouts. Each of the three clients brought something exciting and challenging for us to work with. One client was extremely controlled and very focused on improving her already strong core. Another client was brand new to the studio and brought the challenge of teaching the basic principles in different ways that she might be able to understand it in her own body. The third client brought a wonderful sense of fun and energy to every day we spent with her, as well as the challenge of working with someone living with Muscular Dystrophy.

I could not praise this program enough for what it has given me. I have reached a new found confidence level in my skills as a teacher. If I wasn’t in love with Pilates before, I know that I am now and that I would never be able to turn my back on it. Like many people, I struggled with depression for several years and had lost touch with my previously fine- tuned dancer body. Rediscovering Pilates at Pacific NW Pilates has changed my world and my outlook on life. The teachers that I have had the privilege of working with have all been so wonderful and given me so much.

I would recommend the Pacific NW Pilates Apprenticeship Program to every aspiring teacher. It took my awkward cueing and low self confidence completely away and helped me to break out of my shell. Although I will be moving soon to San Luis Obispo in beautiful, sunny California, I will always consider Pacific NW Pilates a home of mine and a place where I will always come back to learn more. I have also made the promise to myself to always be a student. I learn new ways to control my muscles using my mind every day and I could not do that without the time and energy I have devoted to studying the material I have learned at Pacific NW Pilates.

Thank you so much to everyone who has been a part of this first phase of my Pilates journey.

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.

Special conditions- asthma, arthritis & degenerative disc disease

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

From Jeff to Pacific NW Pilates:

Jeff Ong

From Leslie Braverman

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

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

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

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

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

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

Thanks.
–
Leslie