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 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.

 

 

Pilates and Lymphedema

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

Hello,
I am a Peak Pilates Certified Trainer in Bradenton, Florida. I have a client that has severe lymphedema and I would like to train her. Her arm is always swolen and she generally has 2-3 infections per year. I am not able to attend you Breast Cancer class but would be interested in purchasing the materials, perhaps. I look forward to hearing from you.

Patty McIntosh

Answer from Melanie Byford-Young:

Hi Patty!
Pilates can be an excellent approach to help her general health and lymphedema. There are several main things that you need to know and keep in mind.
1) Make sure you get clearance from your client’s physician before beginning any exercise program.

2.) wearing her compression garment is a great idea, especially at the beginning, or until you know how she is going to react to the activity.
3.) Diaphragmatic breathing can help stimulates the pumping of the lymphatic system, which will hopefully help with her swelling. Adding lymph massage throughout the session can be very useful if she or you know how to do that.
4.) You do NOT want to overwork the arm! It is suggested that you begin with breathing and some abdominal work to help stimulate the lymph system, then do some leg work; then start some arm work moving the proximal muscles/ joints first, then progressing to the more distal muscles and joints, and then to return to the proximal/ shoulder muscles to help get blood and lymph moving and clearing from the arm. Follow this up with more abdominal and breath work. You can repeat these steps throughout the workout. Minimally, start with the trunk, and then alternate between leg and arm work so as to not overtax the affected arm.
5.) In the past, women with lymphedema were told to never lift anything heavier than 10 pounds. This advice has changed recently, and experts suggest beginning with very light resistance and progressing very slowly. There is a great website www.lymphnotes.com where you can do some more reading on the topic.
6.) You always must consider whether your client has osteoporosis because of her treatments. If there is any concern that she may have decreased bone density, avoid all inverted positions, avoid thoracic flexion and avoid combined flexion and rotation. If she has osteoporosis in her hips, avoid full compression of the hip in a flexed position. If her wrists are involved, then avoid weight bearing through the wrists. Make sure that you include balance work to help prevent falls and fall related fractures. Again, make sure her physician has given her approval and that there are no special exercise modifications to take into consideration.
I cannot take the credit for putting together the STOTT PILATES® Breast Cancer workshops and DVDs, another team created them. The mat and equipment DVDs are excellent and provide a very good introductory preamble,as well as a well balanced exercise program. You can order them on line at www.stottpilates.com or call 1-800-910-0001.
I hope this helps you out. Good luck to you !