Pilates and Plyometrics to prevent Achilles Rupture: Insights from an Achilles Rupturee

In Spring of 2010, Melanie Byford-Young ruptured her left achilles tendon. She has taken the time to share her insights with us….thanks Mel.

First of all, it is a bad idea to rupture your Achilles tendon! Don’t try it, even if all the cool kids are doing it these days! But if you are going to do it, I highly suggest rupturing your left ankle- much easier to drive in North America.

I am now part of the Achilles rupture club; I am one of five in our ‘chapter’, and we are not accepting any new members. Two members ruptured while dancing and three of us ruptured playing tennis. Of the tennis players, one ruptured after serving, one running to the net, and me, while doing a split step. Makes you think.

My whole life changed in a microsecond Wednesday April 14, 8:32pm. I was 72 minutes into an awesome tennis lesson when I did a small split step, heard the loud pop and a fierce sting. I hoped that someone at the back of the court was being a jerk and had fired a tennis ball at me, but no. I knew what it was immediately. Everyone on the court heard the pop, and my poor instructor Sonia came running over in disbelief. Ice and phone calls to all of my PT friends to find out who is the best surgeon and where they would go. I did not go into shock, so I drove myself home, had a bath, got dressed with clean ‘presentable’ undies, and then drove myself to the Emergency room. Kevin was in Florida, and I was full of adrenalin, so there was no stopping me.

My brain went immediately into ‘uber problem solving mode’ and I wanted surgery NOW. I called in every favor possible, pushed, pulled and persisted, and fortunately, I only had to wait until Friday. If I’d had to wait longer, I would have driven myself and everyone around crazy. I was still running on lots of adrenalin! My AWESOME surgeon, Dr Crary, did his magic. My friends Annie and Michele rallied and got me to and from the hospital, and took care of me until Kevin got home. Thank God for great friends!!! Thank God for having done Pilates and being strong enough to get around on crutches!!!

There can never be good timing for an accident, but this was VERY bad timing! Very bad! I was scheduled to fly to Toronto, Singapore and the Philippines in three weeks to teach. The E.R. doctor just looked at me and said “Well, that’s not going to happen”. This was the beginning of a one year rehab. FYI- the greatest risk of re-rupture is between 10-20 weeks post surgery. This is when the tensile strength of the tendon is somewhere between 40-60% of normal but the patient is starting to move around more and feels better!!!

What predisposes someone to rupturing their Achilles? Usually it is men in their mid 40’s who are weekend warriors with tight calves who rupture during an explosive activity like tennis, squash, baseball, basketball etc. That description does not fit any of my group, nor David Beckam!!! Age, short calves, long calves (excessive dorsiflexion prior to heel during the gait cycle), a neural issue, maybe some medications, malicious guardian angels…… who knows?

First rule: do exactly what your surgeon says. I had to spend 10 days post-op with my foot elevated all the time. What this time did afford me was insight into how much I missed everyone at work, how lucky I am, and that I do not like to be held down!! My friends immediately spoiled me with deliveries of healthy food, books, coming over to play games, and taking me grocery shopping. Bad idea to go grocery shopping in the first week post surgery!

Next came three more weeks of non- weight bearing in a very attractive purple and green cast. Again, very thankful for a strong midback, arms and abs- you need them for crutch walking and getting in and out of the bath.

Dr Crary said no airplanes for 6 weeks post- op because of the risk of DVTs; that was enough to scare me and call off the trip. Sorry Joe and Vivian!!

Timing was that I could still go to Australia safely on week 9, wearing compression stockings and taking asperin in case of clots.

Second Rule: You need time to heal and you must rest. It was laughable that getting up stairs was enough to demand a nap, and working for several hours required several hours of napping to recuperate. Apparently it doesn’t matter how head strong (a.k.a. stubborn) you are, nor how much adrenaline you have, you need to sleep. If you have your foot down too long, it takes ages for it to settle and when it swells inside your cast, it is not so good! A rolling desk chair, a wheel chair, and great friends enabled me to work part time, and I was so thankful for that. BUT…. You need to rest (and I do say that from the perspective of someone who didn’t rest enough and paid the price for it! Carole, Kevin and my Mom are rolling their eyes right now).

Third Rule: Get a great physio/ therapist and do Everything they say. I am so fortunate to know a bunch of AMAZING physios/ therapists/ clinicians who I trust implicitly. My biggest issue was that I could not go to everyone who I respect and adore. I began my therapy while in my cast, making sure that my spine and hips stayed healthy, that my nerves could glide, that energy would still run through my calf and Achilles to my foot. It was critical to manage the effects of being on crutches.

Pilates-wise, I used the Cadillac and chair to keep me moving starting in week two. It felt amazing to be able to move with the leg supported. Because you spend so much time with your leg elevated, your back is always in flexion. Swan dive and Mermaid felt fantastic. Prone One Leg Kick helped me unwind my hip flexors which were on overdrive, and Side Leg Lift Series helped mobilize my hip and prepare my glutes to work again. From week five post-op, I was able to get on the reformer and begin small range footwork and Sleeper on light springs.

I will be ‘hanging out’ with my physio for months to come, and look forward to getting to do athletic return to tennis style drills somewhere near the end of the year. Now at week twelve, I can begin to load on more springs with footwork, and start to do more Ankle Lower and Lift, focusing on the eccentric strength.

Fourth Rule: DO PILATES TO PREVENT AN ACHILLES RUPTURE or TO MANAGE YOUSELF IF YOU DO RUPTURE YOUR ACHILLES!!!!

Here are the juicy tidbits for pilates instructors and therapists.

While this may sound sick, I have enjoyed learning the lessons associated with this injury, and observing the emotions that crop up. Maybe ‘appreciated’ is a better word than ‘enjoyed’. It is a crazy experience to not be able to balance on your injured leg, and not to be able to compensate or figure out how to do it for 7-10 days.  I am a coordinated, strong person, who understands motor patterns and balance mechanisms. I literally could not center my rib cage over my pelvis and leg to balance. It did not help to contract my abs/ inner thighs/ glute medius nor just to visualize centering over my midfoot. I now understand what that ‘lost or empty’ sensation is that clients have described. What did work was stepping to the side to balance instead of trying static standing or stepping forward. Interesting, eh?

And the emotions; the fear that goes along with the threat of re-rupture is intense. It was so valuable to be able to talk with Dr Crary, and to know that I was in good hands in my physios/ therapists care. You need an outside brain to be in charge of doing enough but not too much.

If you are working with clients who have ruptured, make sure you know the surgeons protocol and stick to it exactly!!!!! Your client is trusting you.

Prevention of ruptures (if possible): Eccentric training and plyometrics!!!! Awesome calves that have strength through range of motion. Balance and proprioceptive challenge. Great dynamic control of the feet, knees, hips (gotta get a Bum), pelvis and spine. Symmetry, suppleness and strength.

One of my great joys is teaching the fabulous gang in my Wednesday ‘Instructor Only’ class; the theme became ‘everything you need to have to cope with being on crutches’, and ‘preventing Achilles ruptures’. There were some sore tushes, calves and arms! Great work girls.

Management of Achilles Ruptures: Eccentric training and plyometrics!!!! Awesome calves that are neither too long nor too short. Great dynamic control of the feet, knees, hips (gotta get a Bum), pelvis and spine. Balance and proprioceptive challenge. Symmetry, suppleness and strength. Sound familiar?

Fifth Rule: You need insurance. One last major point….. Insurance. I have learned a lot about insurance. First of all, get some, some how, some way. That, or put a good amount of money away inyour just in case fund. You have no choice but to have medical intervention when you have a ruptured Achilles. Even with good insurance, an injury like this will cost you thousands of dollars in medical expenses. Medical insurance does not provide income replacement. Most disability plans kick in after three or more months of not working, but do not cover you for the weeks you would miss typically miss this kind of injury. Ironically, we were literally in the process of signing up for Aflac when this injury happened. If we had signed up with Aflac one week earlier, most of my medical costs would have been covered, and I would have been eligible for income replacement starting the day my injury occurred. This kind of support would have alleviated many worries. Please look into short term disability coverage.

I hope this gives you some insight into life post Achilles rupture. There is a lot of good information on the net, but most importantly, ALWAYS follow the surgeons protocol! Every surgeon’s approach is different so respect it!

I need to thank so many people for supporting me and putting up with me over the past 12 weeks. First and foremost is Kevin my wonderful husband!!!! Then my wonderful family, Leslie, Jean, Carole, Daphna (my personal chef) and all the girls at Pacific Northwest Pilates. All of my clients who have been patient with me (and laughed at me when I came back too soon). Michele, Annie, Lori.  Dr Crary, Matt Walsh, Dr Sheila Murphy, Debbie Lehner, Lisa Seitz, , Dr Chris Lord…. And many more! Thanks to everyone.

The Ultimate Girl’s Night Out…in ITALY!

Posted by Trisha Hatfield Graves
In early 2007, I received an email from the owner of a “Learning/Wellness Retreat”, The Cascina Papaveri in Italy. They were interested in having me serve as the Featured International Pilates Instructor for two weeks in June. This retreat was the dream child of a retired British / Kiwi couple in their 70’s, conceived from their dedication to health, their love of Italy, a mutual enjoyment for farming…and their 20-year relationship with Pilates. They also possessed an insatiable interest in people, so, several years ago founded and purchased “The Cascina Papaveri” (The Poppy Farm), consisting of a huge historic farmhouse on an organic farm and vineyard, perched on a hill overlooking miles of rustic northern Italian countryside. This not only became their new home, but was remodeled to provide 10 beautiful 5-Star guests rooms, each with its own private bath. The lower floor of the farm house became an open-breezeway gym, lap pool, sauna / steam rooms and the largest fully-equipped Pilates studio in Europe. They had contacted me because they wanted to bring something different to the retreat for “Women’s Week” and saw that I taught Pole Dancing as well as Pilates.

I was quite honored because this retreat is recognized as featuring “best of the best” in international Pilates instructors. Most of their featured instructors can boast of having DVDs, books and TV spots…and “a following”. I simply owned The Pilates Center of Olympia, a small local studio, and my ‘followers’ consisted of several handfuls of loyal clients, most of whom could not afford the $2499 to take this trip. The pole dancing facet, however, really intrigued the Cascina’s owners, and the philosophies around providing women with an avenue through which to connect with their sensuality seemed like something their guests might enjoy.

I explained that the pole dancing was a package deal. My daughter, Cally, and I co-teach the classes together; spotting, assisting and guiding women. Five months later Cally and I were on our flight to Milan, Italy with two rifle cases containing our heavy-duty removable commercial poles capable of extending to their fourteen foot ceiling. The rifle cases had been revamped a bit, embossed with an aluminum veneer and butterfly pattern, which did not detract from their 60 pound weight!

When we arrived at the Cascina we found waiting for us, three British women; one working for the office of the Prime Minister, a lawyer from London, a woman training to become a Pilates instructor; and 3 Americans. One of these comrades was my client and two were a married couple from Chicago. All looking for a good time to relax, get healthy; and “let their hair down” so to speak.

Guests received multiple amenities, among them, unlimited daily Pilates (both apparatus and mat; taught by me), unlimited use of the gym, lap pool, and sauna/steam room; daily Culinary Arts classes, all meals beautifully prepared using market fresh ingredients and organic produce from the farm; unlimited Private Label wine from the Cascina’s own grapes, trips to local village markets and an added bonus with Cally and I there…unlimited Pole Dancing for Fitness!

Cally and I were put up in a gorgeous little apartment in the village and walked the three miles to and from the retreat each day. It was the most incredible mother-daughter adventure, and with our philosophies around “Women Empowering Women” this represented taking our ‘show’ on the road! The British women loved the liberating experience of pole dancing and while playfully cheering the ladies on one day to “smack their fanny”, one diplomatically explained to me that …ahem…“fanny” means something quite different in Britain.

Out of literally thousands of Pilates instructors worldwide vying for an opportunity to serve as the retreat’s featured instructor, I am humbled and ecstatic that they chose to feature me again last summer. Cally couldn’t go, so I brought another of my instructors, Heather Christopher and 7 clients of my own. We had another wonderful visit. For more info Email Trisha Hatfield Graves:trisha@pilatesatplay.com or Visit: www.cascinapapaveri.com

The Importance and Necessity of Pilates

Pilates have been a tremendously important and essential part in my pain management.

I have had back pain for thirty-four years. This resulted from two ruptured discs at age 21 which required surgery. The pain stopped, but after about a year, it reoccurred. I have tried acupuncture, massage therapy, naturopathic herbs, and water aerobics. Nothing helped. I started falling down on a regular basis and was in almost constant pain. I went to a doctor at Kaiser Permanente and was told that I had ataxia and that I would most likely end up in a wheelchair. In 2005, I was introduced to Pilates after talking with Melanie. Before long, my balance improved immensely and keeps improving with each visit. The days of my falling have ended. Even though I occasionally have a flare-up, usually I am pain-free. Prior to being introduced to Pilates, I often had to remain stationary for extended periods of time.

Thus far, I have only taken private lessons. My goal is to get strong enough to be able to take one of Traci’s group classes.

Now I find that Pilates allow me to maintain an active lifestyle.

Jeannie Tenney

How Has This Changed my Life?

Can Pilates help women facing hysterectomies or other abdominal/pelvic surgeries? Can people move with strength and ease after 50? I am living proof. Recently, I faced two pelvic/abdominal surgeries, only five months apart, to combat the latest effects from my history with stage 4 endometriosis. Each surgery creates new scar tissue, which can create new pain and limitations in my movement and ability to live a normal life. Needless to say, two surgeries so close together (I’ve had 4 all together including a total hysterectomy 5 years ago) was a double whammy for me to recover from and I worried if I’d ever feel well again.

I work in a physical therapy practice as a Rehab Pilates specialist, and so preparing for surgery included what I would recommend for any client – plenty of core work and moving my body safely for strength and stability in all planes of motion. I chose STOTT PILATES for my instructor training because of the emphasis in anatomy, rehabilitation, and adapting the work to fit each unique body’s needs. Setting aside time for Pilates prior to surgery was a chance to experience my body as capable, not helpless, and to feel joy in movement as the springs on the equipment helped me move and soar as I otherwise did not have the strength to do. I literally was doing Pilates in the pre-op little room on my hospital gurney as I waited for them to take me into surgery. My husband laughed, but I knew it would be my last chance to help my abdominal and pelvic muscles be strong and ready to face recovery, and also, it was a welcome distraction from the stress of the moment. Doing Pilates gave me something positive I could do for myself and my healing.

After the surgery, I was able to use what Pilates has taught me to focus the mind with my body… to isolate and relax muscles more easily, use breath to cope with pain, and literally went through the entire recovery without ANY pain meds other than a couple of regular strength Tylenol! My first day back at work, I turned to two women physical therapist co-workers, both extremely athletic young women in their 20’s, and said “ok gals, I need your help in getting me back into shape… let’s do an abs workout.” Imagine my surprise when I, a woman 51 years old, with a total of 4 surgeries to her gut, found I was kicking these younger women’s butts! I thought they were actually going easy on me as we worked out together doing a variety of abdominally challenging Pilates exercises. No, as it turns out, the muscles do have memory and the body does indeed want to return to wellness if you give it the tools. Because Pilates addresses all my muscles, not just the surface ones, my recovery was faster and my power returned quickly. My surgeons were shocked at how fast I bounced back – yet again!

Now at nearly 52, I see each day that age is not a big determiner for wellness. Neither is past surgical trauma. Breathing and moving well is! Each day I move, in all directions and with the stability and strength required to do so safely. At my age, despite having had osteoporosis diagnosed since I was 40, am just as tall and straight as ever. My ribs expand to allow easy full breaths, and my body actually craves the feeling of moving/stretching. Perhaps next time, if there is a next surgery, I won’t be so lucky. I can’t help that, but I can celebrate each day the best I can by moving and challenging my body in ways that feel healthy. It is my best chance at facing whatever life has in store for me with grace and joy.

The thought of advancing age… of possible future illness… none of that scares me anymore. Whatever life brings, I know that my Pilates practice will adapt along with my changing needs, keeping me flexible in mind and body for the whole of my life.

I often think how fortunate I am to have chosen to formally study Pilates at Pacific NW Pilates over all the many choices out there. The level of training and commitment to quality at PNWP is simply heads above the rest! They taught me how to make Pilates relevant for even the most challenging of health situations.

Thank You!
Renata Marsal

Pilates Limerick

Pilates inspires health and happiness

Dear Pacific NW Pilates,

I began taking pilates about 2 1/2 years ago.  It has been amazing for
my teacher (Cheryl) and myself to see and feel the changes that
have happened.

Since starting the reformer in addition to mat class (about 6 months)
I have really felt the positive changes.

In the beginning I would be so tired out by the end of the hour and even
dread coming at first but I knew it was good for me.  I would take what
I learned each week with me throughout the whole week when walking my
dog.  The breathing, connecting of the lower abs.  It was all so rewarding.
I could feel my lung capacity and my whole core working my limbs!

I have felt the work in my lower back becoming stronger and rolling up
through the rest of my back and now into more chest opening.  Everyday
I wake up feeling more refreshed than ever before!!

This has truly been a great experience.  I also love the group of girls in
the classes.  It is just so much fun and makes a wonderful support group.
Cheryl has been a fantastic teacher and I love this studio with its professional
staff.  You are all my heros & life coaches.

Thanks again for your inspiration to healthy & happy living.

Cheryl Lynn

A good pilates teacher gave me great success

I have had such success with my aches and pains and it’s all due to the pilates that I have been doing for the past 3 years. I came to Sue unable to reach over my head and with constant neck and should pains. I also could not carry heavy items because my muscles were not that strong. Little by little I have been healing and today I am stronger and can even do some advance techniques which I thought I’d never be able to do. Just being out of pain has been such a success for me. No pain meds were ever necessary. Sue has been so instrumental in all this. She is very cautious, observant, and extremely patient. Without a good teacher my recovery would have not have so successful. I hope that more women can find and time and means to be able to achieve what I have achieved!

Thank you and see you soon!

Marlina Propersi

My pilates succ-sexy shoulders!

Pilates has brought many success stories into my life but I thought I’d share a funny one on a particular exercise. Cheryl has taught me the “sundress exercise”. I believe this is a Melanie or Jean created exercise. I love this one and quite often do it a home with my 2lb toning balls before heading out in any shoulder baring outfit. One evening before a date, I grabbed my toning balls and did my “sundress exercise”. Over dinner my date told me I had the most beautiful shoulders. This was certainly not a compliment I have ever received but I loved it, because it is all thanks to my “sundress exercises”. Of course I didn’t share that with my date! Thanks for the great shoulders and all the other many benefits of pilates. You ladies do a great job!

Kristi

Pilates saved my life! Really!

Dear Pacific NW Pilates:

You have heard my story before but I credit Pilates for saving my life when I had a ruptured appendix in October of 2006.  While at our home on the Oregon coast, I began having severe abdominal pains.  A trip to the Seaside hospital resulted in an incorrect diagnosis and I was sent home with pain killers and instructions to rest.  A day later the pains were more severe and I returned to the hospital and a surgeon sent me by ambulance to St. Vincent’s where I had surgery immediately.  I had gangrene throughout my body as the organ had ruptured.  I was in the hospital for a week as the doctors were fully expecting secondary infection.  However, that did not occur and I was released.  The day after my release from the hospital I resumed physical activity by walking a mile and two weeks later I was back in the Pilates studio.  My surgeon said he had never encountered anyone in as critical condition as I was and had never seen anyone recover as quickly as I was.  He credited my physical conditioning for saving my life.  Other doctors verified that I lived 24 hours longer than most people would have given the same amount of infection in my body.  So, Pilates did help save my life and made it possible for me to regain full function very quickly.

The same results were true for my recovery from a double mastectomy for breast cancer in December 2008.  My surgeon told my family that I had amazingly strong pectoral muscles which helped make the recovery and reconstruction go smoothly.  Again, a day after surgery I was back on my exercise bike and two weeks after I returned to the Pilates studio.  I fully expect to be a champion over breast cancer through maintaining my physical conditioning.

These life experiences have confirmed for me that physical conditioning and Pilates in particular makes it possible to endure and recover quickly from serious physical injury.  And, that this applies to anyone at any age.

Kay

How do I teach men about the pelvic floor?

I need some guidance…..

It is regarding the pelvic floor and the issue of whether men and women have the same anatomy and then therefore does the contraction of the pelvic floor  different between men and women and does it essentially feel different.

I guess my take/my understanding that was realistically men have pelvic floor muscles and women have pelvic floor muscles…they are relatively in the same area for men and women and ultimately function the same way but how we describe it to men might be different than how we describe it to women…I know that men have a the cremaster muscles (which women do not have, right?) but other than that, is there really that much difference……

I recently heard that men and women cannot be told to “kegel” engage their pelvic floors the same way and this just seems a bit silly to me……but maybe I am missing the mark on something…

Any clarification on this and HOW we should be explaining this to our training students would be greatly appreciated.  It is a question that often comes up in training courses especially if there are men in the group….
Thanks!

Kelly Dormady
SweatShop Health Club, St Paul, MN LTC

Response from Melanie Byford-Young:

Hi Kelly!
Good question. Indeed men and women have essentially the same muscles (except for the cremaster) and those muscles do both stabilization of the pelvis and sacrum, movement of the sacrum, and closure of the orifices with the sphincter muscles. They work the same. For guys, the feeling is often said to be the same feeling as pulling up their genitals like when walking into cold water. Often the cue I use is indeed very vague ‘your abs and pelvic floor will gently draw in/lift like walking into cold water’. Make sure of course that it is gentle and hardly done with any force at all. The other visuals like ‘an elevator shaft’ can work. One thing I like is to really get to the heart of what we are doing and why; we are trying to stabilize using all of our muscles together, drawing them in towards our center, which sits just in front of the S2. So if you can get the idea that the center of gravity of the body sits just in front of the sacrum, protecting the spine is done by engaging each of the stabilizers together or having them draw in towards that center of gravity.

 There are some clients who I just do not talk about the pelvic floor muscles initially because it would be too awkward and detrimental to the session. This can especially be the case if there is an older gentleman working with a younger instructor. If a client has back pain, SIJ pain, asymmetrical pain, has had prostate radiation, grips a ton in the QL or  erector spinae, or has some specific pathologies, you need to determine if the pelvic floor is working effectively or not.
Let me know if this works well enough.
All the best
Melanie

How Refreshing!

Ischial Bursitis

Hi Melanie!
 
I recently attended your gait seminars in May, and wanted to relay to you that my clients are absolutely loving the work and the results.  Thank you so very much!
 
If possible, I would so appreciate your input relative to ischitis or ischial bursitis.  Recently, two clients have been referred to me with this diagnosis, one of which has a R hip replacement, L knee replacement, and its the L ischium that’s affected.  Both clients spend too many hours at desk and chair, likely sitting behind their sitzbones.  I’ve referred both to a PT for cranial/visceral work to hopefully release the area of the coccyx. 
 
Naturally, they have hip flexor hypertonicity, but because of their symptomology I avoid hip extension and work only within their comfort range in neutral pelvis/spine.  Any “pearls of wisdom” you could share with me, would be hugely appreciated! 
 
Thank you very much, and I look forwarding to seeing you again soon!
 
Best,
 
Tina Strickland, LMT
Stott Pilates Certified Instructor

Response from Melanie:

Hi Tina!
Ischial bursitis is an interesting and complicated issue to help resolve. Things that characteristically contribute to, or leads to ischial problems include: hamstring dominance over the gluteals/deep rotators, stiffness of the feet or ankles, poor positioning of the pelvis (either anterior or posterior rotation) which places the hip adductors and gluteals in a position of inefficiency, and lumbar spine problems.
Developing gluteal strength in the presence of a hip replacement can be tricky. We like to lie such a client prone over the cadillac or ladder barrel and work on hip extension there where the gluteals are working in midrange. Start out by assisting with the concentric lifting of the leg, make sure that the glutes are set, then have the client control the lowering. Assist as much as required so that the client does not experience the ischial pain.
Try to develop as much ankle and foot mobility as possible. Your client requires the full 20 degrees of ankle dorsiflexion to be able to walk normally and not have to alter the hip to compensate.
See how these ideas work and report back to us.
good luck!
Melanie Byford-Young

How Pilates Changed My Life

My sixth grade teacher, Mrs. Nelson, sternly warned me that I was going to be sorry if I didn’t learn to stand up straight. This was both confusing and horrifying. I didn’t have the faintest idea of how to stand up straight, but I understood the dire necessity of doing so. A deep dread of a doubtlessly benighted future filled me.  I’d already thrown a fit and refused to go to the physical therapist a few years earlier. The mats smelled funny, and it was all so creepy.
Decades later, I can proudly say that Pilates has enabled me to finally stand up straight. Even my mother said she’d never seen me look so straight, and she’s been watching the whole time. Dance and yoga gave me strength and flexibility, but my body evolved its own quirky ways of working with its dysfunctional spine. I’m here to say that Pilates has straightened me out, Mrs. Nelson.
Pilates has helped me find and use essential supportive muscles that I had never really located before. Pilates has shown me how to push the marble with my nose and that’s been the beginning of it all for me. The upward extension of a spine trained from childhood to curve down down down is a glorious and difficult movement. Upward is not natural for a myopic bookworm. As I’ve struggled to feel wide across collarbone, I’ve moved into an unknown dimension. And Pilates has given me the abdominal muscles that save my poor back from doing all the work. And I’m grateful. If I’m away too long, my back complains, but now there’s a way to fix it. Pilates is forever.

Sherry Charles

Osteiitis Pubis

Hi Melanie
Sorry to seek your assistance so soon again.  If you can find the time to give me some help on this client would again be very grateful.
 
One of my clients has  has osteitis pubis.  She has now had this for 2 years, bought on in her second pregnancy.  She played hockey upto 14/15 weeks of this pregnancy.  She had no pain at that time, but did in the later stages of her pregnancy.  Unfortunately, she didn’t say anything about the pain to her midwife and no pelvic support was used.  After the birth, she pushed herself quite early, and has suffered since.  She saw a PT for quite a long time, but found that she was worse after these sessions so has stopped.  I have seen her 4 times.  I am only doing half hour sessions with her as she tires quickly. I have been working with her to not overdo her lift and contraction of pelvic floor and TA.  Initially, at times, 20% would cause pull in the area, so we dropped it back to 10%.  Now that shearing/pull doesn’t hit until 30-40%, so we are working at about the 20%.  I have been doing supine, sitting, sidelying and today some standing work with her.
 
Supine – very small lateral leg openings with flex band behind leg, also medial leg mvmts, foot on toning ball, scap isolations, light adductor with mini ball, focus on left/right side pc
Side lying – small ext hip rotation, scap isolations
Sitting – I have some gliding discs – on raised mat, small sgl leg presses, then dbl leg presses and today small alt/reciprocal mvts, arm raises and today small swimming arm mvts (at chest height)
Standing – Cadillac push through bar – sgl lat pull and dbl then with roll down bar(small mvmt just until she felt core connection
 
She saw a specialist at the hospital this week who has suggested surgery.  She is not keen to undertake this option and was disappointed they offered her nothing else.  Am I heading in the right direction with Rachel?  What else should I do.
 
My other client with TMJ is currently off on school hols so I will let you know how we get on in a few weeks.
 
Thank you so much
Sonia, Progressive Pilates, New Zealand

 

Response from Melanie Byford-Young:

Hi sonia!
Great question. Osteiitis pubis can be very debilitating and hard to figure out. You are doing good exercises already.
Essentially you have to imagine that the pubic symphysis can get pulled apart very easily, even just via the contraction of the hip adductors. Your goal is to try to work the myofascial slings to hold her together- the anterior and posterior slings. You need to get the external control adn the internal control of the local stabilizers.
There are several other things you can try
1) breathing- see if she can tolerate breathing like she is sucking in through a straw, and gently lifts the pelvic floor as she does (i.e. uses the breathe to lift the pelvic floor) instead of focusing on contracting the pelvic floor (PF) muscles specifically. It can be a more gentle way and uses the diaphragm with the PF. If she can, use this technique then have her hold the PF up while she exhales. If this works, repeat hourly through the day.
2) swimming prep on hands and knees to get the posterior oblique sling supporting the pelvis and spine
3) footwork on teh reformer- probably 2 springs starting with the stopper out at position 6. Progress range first then weight and rhythm. Running can be very effective at beginning to tolerate weight shifting. Then, progress to shifting weight from on leg to the other.
4) sleeper on the reformer/ V2Max with the  spring from above (flexband supporting the leg)
5) standing arm work on the rotational discs, bosu or just on the floor. Light to moderate weight, bilateral first then unilateral. Eventually you want to do it standing on one leg.
6) sitting on a stability ball and doing imprint  and release, arm circles, spine twist etc. Vary her leg positions as able.
That should keep you busy.
Let us know how it goes!
Melanie

My Success Story! Teaching in Dublin, Ireland

Success as I see it is arriving safely in Dublin, making it to my bed and breakfast, remembering that people do speak English here and that I actually should understand what they are saying, getting a bus to town and back! That is success. I think I should be entered into the contest. My challenge was arriving and finding out that I am teaching one more day than I knew about (it was discussed but not confirmed to my knowledge, and now I lose my travel time with Kevin. The extra day was on my confirmation notice but I missed it….. did not start my day well).

Melanie

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