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

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

A slice of pilates heaven in Puyallup, Washington

Just spent the weekend in Puyallup, Washington (just outside Tacoma) teaching a STOTT PILATES level one Barrels Module at lovely Studio Malulani www.studiomalulani.com

Because of the flooding on I-5, I had to fly to Seattle and then drive south to the studio. Of course, the second I arrived, all signs of stress disappeared as I was warmly received by Johnette Schiesz, the owner of Studio Malulani, a STOTT PILATES instructor and Reiki practitioner. The studio is like a slice of pilates heaven.

The girls learned all the essential and intermediate level one barrel work this weekend, and they did beautifully. Each year, Studio Malulani hosts Pacific NW Pilates to teach one or two courses or workshops. In fact, the studio has already trained about ten students to become STOTT PILATES instructors. This spring Melanie will be going there in July to teach the STOTT PILATES Injuries and Special Populations course- I’m jealous!

How do I work with someone with scoliosis?

From Melanie Byford-Young

Hi Jeff,
Great questions about your client.

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