Hi Leslie,

I have a client who is 25 and has two metal rods in her back, one on each side of her spine because of terrible scoliosis. She is not very mobile because of the rods, she can manage imprint and neutral but can only do extremely limited flexion and extension. The muscles in her lower back are obviously imbalanced, very strong on her right side and almost non existent on the left. What would you suggest for helping balance out her core strength considering her lack of mobility? Thanks so much!
Erin Whipp

Answer from Leslie Braverman:

Hi Erin:
Nice to hear from you. I hope things are going well!
 
Oooh, I have worked with a few clients that have had metal rods put in their back, and there is a lot you can still do.
 
My suggestion is to continue moving her spine only gently through ranges- mostly keep her neutral, but try to do as many things that challenge her torso strength as you can. Contralateral arm and leg work will be excellent, as well as doing things that challenge weight distribution and proprioceptive awareness. Here are some ideas:
 
1.) Sitting back and front rowing (on a box or platform if necessary to sit in neutral). Do one arm backrowing work preps to get the weaker side stronger. You could even sit her on am unstable surface (ie. a wobble cushion) to build spinal control and learn to control rotation.
 
2.) Side lying work will be excellent. One leg kick, side leg lift series- prop her hip on a small ball to build more strength on an unstable surface as she progresses. Make sure to keep her spine in neutral and avoid rotation or lateral flexion. Do more reps on the side that is weaker.
 
3.) Plank position exercises – push up, leg pull front- add things on a ball.
You can also do plank based exercises against a wall too- standing on a BOSU and/or with two small balls under her hands- again to challenge spinal control and build awareness of body in space. Add contralateral arm or leg work to build strength on one side of the back more than the other.
 
4.) Waiters bow- elephant position- (on or off reformer- use ligher weight) with one arm on the bar instead of two. or just practice going into waiters bow while standing on the floor and reaching one arm up by her ear- standing up with that arm by her ear will work her erectors and deep paraspinals on that one side, as well as challenge rotation and build glut strength.
 
5.) Contralateral prone work without extension- ie. swimming preps
 
6.) Standing on one leg while doing arm work, while high level, will help her build up strenth on one side more than the other.
 
Hope this helps and gives you more ideas. Let me know if you have questions. I can leave out your name if you like too.
 
Thanks Erin! Good luck.

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!

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.

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.

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.

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