Depressed Scapula!

Hi All I have a question for your website blog…. What exercises are good to help correct depressed scapula? I attended ISP training with Melanie in 2007 and I remember she helped another instructor attending the training bring her depressed scapula more into neutral – however, I don’t recall exactly what she did. Thanks and I love your website – lots of great information! Connie Bruce Rochester, MN Response from Leslie Braverman: Hi Connie: Sorry it has taken me a while to get back to you; I hope you are well. I would recommend that you do exercises that help to quiet down the muscles that depress and downwardly rotate the scapula (particularly dominant rhomboids will downwardly rotate the scapula). You also want to watch that the client is not over-working their lats (which will drive the glenohumeral joint downward). So, start to wake-up the trapezius muscles and serratus anterior. Do this by giving exercises that encourage upward rotation and elevation of the scapula and minimize the over-use of rhomboids and lats. Then, re-educate the clients movements in order to achieve good balance of all the scapular muscles in a neutral position, making sure mid and lower trapezius are working to place the scapula centered rather than in downward rotation or depression. In addition, you want to encourage the client to set their glenohumeral joint by using their rotator cuff muscles rather than over-empasizing the connection with lats. Exercises that may help: Side-lying overhead push-thru:  Lay the client on his side with his hand on the push-thru bar. Then have him push the bar overhead, watch that he is creating upward rotation and elevation with the scapula. He or she may feel a big stretch on the lats. Help he or she guide the movement of the scapula. Superman:  Lay prone on a box facing the footbar on the reformer. The bar will be down one rung from the top with 1 spring. Have the student push the bar away using his scapula to create the movement. Watch that he is getting pure elevation and upward rotation rather than protraction and the thoracic and lumbar spine stay stable. Make sure the glenohumeral joint stays centered and doesn’t drop forward during the movement. Salute on Reformer and/or with Cadillac Springs: This is a great way to work on getting upward rotation of scapula. Mermaid: Work on the patterning of bringing the arm overhead and watch that he or she is not depressing or downwardly rotating the scapula to initiate the movement- again, you may need to guide that movement for the student- encourage upward rotation of the scapula during the movement. If he or she has been over-working rhomboids or lats there may be a lot of resistance on the scapula. Rotation prone on chair: Getting more range of movement into protraction will help to diminish the overuse of rhomboids. Watch that the scapula glides properly along the ribcage and the client doesn’t side bend but creates true rotation of the spine. Side arm preps on reformer: These will be great to encourage proper stability of the scapula and glenohumeral joint. Make sure that the student’s bones look centered and keep the weight light (1/2 spring is good). The shoulder should look “square” and “placed” rather than depressed. Make sure he or she is placing and moving by using the rotator cuff rather than lats or pecs. Melanie often speaks of “fluffy armpits” to keep a sense of openness in the armpit rather than gripping down into the lats. Push-up on the wall: Again, encourage centering the bones rather than overworking rhomboids and lats encourage mid and lower trapezius support. This could progress to more challenging weight bearing exercises so long as the joints and bones are centered. Remember, always watch that the head is staying centered over the spine and not going into forward head posture during all the exercises listed above. I hope this helps! There are hundreds of others that you could do, but I hope these give you a good foundation to be more creative with the other exercises you know. Also, Melanie will be doing a 3 day upper extremity workshop on September 17-19, 2010 (we haven’t even announced it yet) that you may be interested in participating in. This may be a great hands on workshop for you to learn how to work better with shoulder, scapula and cervical spine. Take Care, Leslie Response from Connie: Leslie   Thank you so much for the response!  It is a HUGE help.   I have only been teaching pilates for 2 years and am still grasping the depth of the exercises.    I would love to take Melanie’s workshop – unfortunately, I am in Rochester, MN and can’t make it.   My significant other’s brother lives in Portland and I am pushing to go visit him and his family – so I can visit your studio for some mat/reformer classes.   Again, thank you, thank you, thank you for taking the time to respond to my email and provide me with such detailed information.   Hopefully I will get to meet you someday.   Connie

Figuring how to work with a fractured figure skater

Hello Melanie! It’s Safia from Toronto.

I have a new regular client who is a figure skater. She primarily does pairs but is currently skating solo while searching for a new partner. She is 17 and has sustained a fractured ischial tuberosity on her right side and severe tendinitis in both ankles (now healed). She lands her jumps on her right leg. We’ve worked together 3 times so far and the last time I worked with her she strained her lower right back near her SI joint during the short spine on the reformer. I asked Sally to look at her quickly and she was the one who said it felt like her SI joint and the soft tissues that were aggravated. However, she has only ever experienced strain on her left SI joint – never her right before.
I did hip release with the mini stability (flex) ball and the mermaid for the rest of the session to help relieve the pain a bit. She took a break from figure skating that day but danced that evening since she had recitals on Friday and Saturday night (she does ballet).
I know I have to strengthen all the little muscles around her joints to help her learn to stabilize. I’m just wondering if you have any advice in terms of exercises to emphasize and also exercises to avoid (besides the short spine of course!!).
I hope you have a chance to come back to Toronto soon. It’s wonderful to have you in the studio!!
Take care and best wishes,

Safia

Response from Melanie:

Hi Safia!
Thank you for writing. With your permission, we will post this on the blog so that others can also learn from your great question.
 
What comes to mind immediately is the strength and control of your clients hip extensors, particularly the relationship of the deep hip rotators, the glutes and the hamstrings. I suspect that she does not have adequate eccentric control of her glutes, which would result in less control of her SIJ/ low back, more strain on her ankles and poor landing mechanics. For this, you would do exercises including (as able): shoulder bridge (prep and full)- progressing to single legged, and with feet on an unstable surface; side lying one leg pull on reformer- straight and bent leg; supine and side lying feet in springs on the cadillac; the step up and step down series on the chair; and of course plyometrics focusing on the landing. Other balance challenges such as fencers lunges on the cadillac would be beneficial.
 
For her ankles, make sure that you do a lot of ankle lower and lift on reformer and chair. Make sure you do a variety of positions (parallel, laterally and medially rotated in second), and at a variety of paces. Also do unilateral and weight shifting. Lower and lift in the sleeper position will help with lateral stability of the ankle and hip. Other things like standing on one leg while doing side arm series at the cadillac will help with balance and the tendonitis.
 
Other great exercises for a skater include arabesque, front and back splits, knees off knee stretches, and anything for the abs in extension.
 
I have not given you specifics for her SIJ so let me know if that did not resolve immediately and needs help.
 
I hope this helps. Let us know how you progress.
sincerely
Melanie Byford-Young

Herniated Disc Injury

This was emailed to us and we thought others might be interested!

Hi,
I wanted to ask about herniated disks. I have a client who has a herniated disk between L4 & L5, she does not currently have pain. Is it correct to not do any kind of lumbar flexion with thorasic rotation(i.e. short box round back with twist or mat obliques roll back), just rotation of thorasic with lumbar in neutral to avoid any further herniation?
Thanks,
Deanna Murray

Response from Leslie Braverman:

Hello Deanna:
Thanks for emailing. When the disc ruptures or herniates, a portion of the spinal disc pushes outside its normal boundary. When a herniated disc bulges out from between the vertebrae, the spinal nerves and/or spinal cord can become compressed. So depending on where this is happening will determine which movements to avoid. Typically, it is recommended that people avoid spinal flexion and rotation, because the disc most frequently herniates posterior-laterally and flexion and rotation would exacerbate the problem and/or create pain. To be perfectly sure which movements are to be avoided, it is best to speak with a physician or physical therapist that has worked with your client and has seen the notes from an MRI and knows exactly where the bulge is occurring. Unfortunately, as a pilates teacher, it is often hard to get this information.

If your client were still having a lot of pain, I would suggest that he/she consult with a doctor and, ideally, work with a physical therapist before doing pilates.

Since your client is no longer having pain it is possible that the disc problem has been resolved and the annulus is no longer irritable and pushing on the nerves. In this case, you can progress your client through all exercises and use her symptoms as a guide. Initially, be cautious of lumbar flexion and rotation. On the other hand, your client may have lost a lot of disc height and have too much segmental mobility and/or  instability where the disc was herniated. Progress slowly and be cautious of too much flexion load on her lumbar spine. Be very conscious of her ability to sit in neutral lumbar position. Most likely,  your client will need to sit on a box or cushion to have a proper position without stressing the lumbar area.

I would recommend that you focus your programming on work that encourages your client to become very stable in neutral positions. Really monitor what is happening at L4-L5. You may need to place your hand on her back to really be sure that she is not flexion or extending, even minutely, at this level. Often people with L4-L5 herniations will not know how to sit properly in neutral position, so really check that her lumbar and sacrum are absolutely correct.

Giving your client lots of exercising that challenge stability in neutral positions will be key to her avoiding future herniations or other deterioration of the spine. Here are some examples. Use these ideas with discretion-depending on the clients level and innate strength at this time- use your professional judgment:

1.) Cat position exercises- all variations to build stability in neutral:
-picking up one hand at a time
-sliding one leg out at at time
-alternating opposite arms and legs (i.e. swimming prep on hands and knees)

2.) Shoulder Bridges- Glut strength is paramount for people that have lower back instability
-advance to picking one leg up at a time
Make sure she is getting Glut medius and deep fibers of Glut Max- not just her deep rotators and hamstrings- watch she doesn’t tuck her sacrum under. Keep your hand on L4-L5 to maintain neutral.

3.) Leg Pull Front Prep

4.) Reformer- Footwork- keep your hand on L4-L5- maintain neutral

5.) Short Box- Straight back
You could do this on the reformer too with the arm straps (like roll back with a straight back) add bicep curls if able

6.) In kneeling positions, make sure that her hips are open enough to get head of femur over the knee so her spine can stay neutral. Her hips may be tight and not allow her to do this.

7.) Extension work is great- my guess is that it was a posterior herniation- if there is any pain avoid it. You can definitely do things like breast stroke that encourage upper back extension. If things like Swan Dive feel good, then do them. As usual, check that she is not hyper-extending at any one spinal level.

8.) Lateral flexion- watch alignment is excellent.

Hopefully, this gives you some good ideas. Challenge her in standing, kneeling and sitting positions- as long as there is no pain. Add upper body and lower body resistances to challenge her ability to stabilize her back against rotational pulls. Side lying work would be great too.

Then, once she is really strong this way, I would begin to introduce more flexion and rotation. Make sure that she is getting movement in all segments of the spine, and she is distributing and translating movement throughout the spine and not giving in at one level.

Some clients will fully recover from disc issues and some will always have a degree of vulnerability. You will have to find out slowly over time and with thoughtful progressions. When in doubt, be open to consult with your clients’ other health advisors and clinicians.

I hope this helps!

Best, Leslie Braverman

The Pilates “V”: Vital Exercise Tool or Pilates Dogma?

This question was emailed to us, but we thought others might be interested!

Hi Leslie,
I recently had an instructor teach me as part of an interview process & i try to be open to other schools but in every exercise that was open chain i had to be in the Pilates v,so i asked why?The response was stated with attitude that inner thighs help activate the corset,& it was  said as if a scientific fact.I know partly this is true,but parrallel add & abd with a ball between the legs helps activate adductors & inner thighs,but they kept repeating on & on about Pilates v as if it was the most effective or the only way that worked.
I did not want to get into a battle or even sound as if i was correcting them,but could you let me know how you would have responded as i would be interested in your thoughts!
Best regards

Lucy Garcia

Response from Leslie Braverman:

Leslie

Ideas for working with a spinal fusion

This question was emailed to us, and we thought others might be interested!

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.

Costochonritis

This question was emailed to us, but we thought others might be interested!

Me again. In this line of work, I get to meet so many different kinds of people with so many unique challenges. Thank goodness I’m a jazz singer too (so I can think on my feet!)

Anyway, I have a new client coming who suffers from costochondritis. I do not know any specifics yet, but wondered if this is something of which you have heard or tackled. I looked it up online, and it appears there are different aspects of the condition, and even different ways you can “contract” it…viral, bacterial, over-use of the chest musculature, or even a physical force or accident.

Just let me know.

Thanks!

Salle

ps, I was reading the blog response about singing and pilates. I do not use the same breath for singing…I get better depth of sound and endurance if I let my abs forcefully expand and hold them out there while I’m singing.

But my pilates training has helped tremendously because it has allowed me to control my breathing for the activity at hand . For instance, in pilates we lift the pelvic floor for stability…in music, I drop the pelvic floor to reach my high notes. It gives me grounding so that my voice can reach high.

Response from Melanie:

Mel

Response from Jean:

I found this definition from the mayo clinic:
http://www.mayoclinic.com/health/costochondritis/DS00626
I had never heard of it either. My recommendations would be to try to get some gentle thoracic spine movement in all the different planes and work on improving posture and core stability.
Jean

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

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.

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.

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 to do quality pilates when you’re on a budget

Given the current economic climate, it is not surprising that people are having to cut back on their pilates lessons. It’s also not surprising that gyms with pilates programs are having to cut back on their programming. So, what can you do to keep in pilates shape and watch your wallet?

You could select a DVD or find a workout online that you like, but the problem with that is you don’t receive any feedback about how you are doing the exercises and with pilates, feedback is paramount!

Instead, find a reputable instructor in your area (see my recent blog about finding a good pilates intructor) and ask he or she to select a Pilates DVD that is appropriate for your fitness level. Then purchase a small package of private lessons with that instructor in order to work on the exercises highlighted int he DVD. Especially if you have an injury or other special condition, it may be really important to make sure that your pilates technique is being evaluated; in some cases, your instructor may suggest that you omit certain exercises that are taught on the DVD.

Over the last several months, some of my students have chosen this option when they didn’t have the financial means to come to the studio every week. This method has also worked well for students that travel alot. In some cases, these students have continued to supplement their training with group classes while others have simply worked at home and then come in once a month to get their routine changed and their technique reassessed.

This solution requires discipline, but it can be an excellent alternative to getting out of shape or losing interest in your workouts when money is tight. Ask your instructor to provide challenges for you to meet and things for you to work on by the next appointment.

Another idea is to look for studios in your area that offer lessons with Pilates apprentices. These are pilates teachers-in-training that have completed all their course hours but have not completed their examination. In many cases, these students will teach you privately at a highly discounted rate, and they are often observed by a seasoned professional. Check out pilates centers in your area that train students to become certified instructors and offer this as an option.

Here is a link to STOTT PILATES Licensing Centers located throughout the world:

http://www.stottpilates.com/education/centers.html

Each of these locations has an Instructor Trainer available. Licensing centers train students to become STOTT PILATES teachers, so these are some of the most elite studios in the industry, and many of them offer discounted lessons with apprentices.

If none of these locations are convenient for you, check out the Instructor Finder search for other certified STOTT PILATES instructors that are near your area at:

http://www.stottpilates.com/finder/infosearch/infocustomerconfirm.lasso

Good luck!

The 12 days of Pilates workout for New Years Eve!

I taught the whole 12 days of Pilates Workout to 10 lovely women for New Year’s Eve! Of course, we did have to celebrate afterwards with champagne and treats. What a fun and healthy way to celebrate the arrival of a new year.

Pacific NW Pilates wishes you a happy, joyful and exciting 2009!

Do abdominal exercises hurt your back?

Do abdominal exercises make your back hurt? They shouldn’t. If you find that your back is sore after doing a series of abdominal exercises (either immediately after or a day or two later), you may want to check to see if you back is gripping while you are doing them.

Here are several tips for helping you learn how to use your abdominals (instead of other muscles) while doing ab exercises (sometimes called crunches or sit ups)

Step One:

Re-educate your body to learn how to find your abdominals without recruiting other, more dominant, muscle groups.

Often when one has weak abdominal muscles, the hip flexor muscles (the muscles at the front of your hip) and back muscles will overwork. Remove the additional challenge of holding your legs in the air, and instead, cue your hips and back to relax.

To do this, place a thick pillow on the ground in front of you and drape your legs over the pillow (or arc). Then actively tell your back and hip muscles to “let go.” You may notice that your back falls into a slight curve so that there is a space between your back and the floor. See if you can maintain this curve during your sit-up and still keep your back and hips quiet! When you do this correctly, you should feel that your abdominals are working more effectively.

Step Two:

The second step is to see if you can do the same thing with your legs up in the air in a supported position. You could do this by placing your legs over a ball (this will be harder since it is an unstable surface). If you need a surface that provides more stability, put your legs over a coffee table or other surface.

Step Three:

The last step is to see if you apply this to having your legs in the air without support. In this position, your hip flexors will have to work in order to hold your legs up against gravity, and your back may need to be placed firmly on the floor (instead of having a curve in it), but your back should still not be working and, overall, you should feel that there is more balance between your abdominals and hip flexors.

Once you have this skill, you should be able to apply it to other abdominal exercises that require more complex movement with your arms and legs.

Good luck.

How to work with prenatal clients

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

Hello ladies!

I am beginning to teach both mat and reformer to a woman 6 weeks pregnant. With her last child she did not do any physical exercise because she was afraid of miscarrying. However, she would like to try Pilates once a week throughout this pregnancy. Can you give me some tips to use when working with her? Also, she hasn’t done Pilates for the last month and is worried that since she has been “out of practice”, starting up again will be like starting a new exercise program–which is not recommended in prenatal books. I assured her that this would not be a problem, but she would like the official word from the experts at PNWP.

Thanks so much!

Answer from Jean Leavenworth:

Hi there-
I am curious why she stopped exercising completely during her first pregnancy. Was she at risk for miscarrying? That is something to find out as it could still be an issue, and I would highly recommend that she is released by her physician to work with you during this pregnancy and that she is given permission to work with you through each trimester; the first trimester has the highest risk of miscarriage, so it is important that she has been cleared for exercise.

General contraindications during pregancy:

1.) no inverted exercises e.g. rollovers, short spine, etc

2.) no extreme stretching due to lax ligaments, especially side splits!

3.) Prone exercises may be uncomfortable due to breast tenderness and after the first trimester will need to be replaced by a quadruped position.
after 20 weeks, work in an inclined plane instead of supine (use arc barrel, spine supporter or similar device to keep upper body elevated)
be cautious about over-exertion or letting the body get over heated. Strengthening the core muscles will be very helpful to prevent excess lordosis during the pregnancy and it may help during the delivery process too.

4.) Pelvic floor exercises are great, but emphasis should also be placed on learning how to relax and release the pelvic floor too.

5.) side lying leg work is great to strengthen the abductors–use a pillow under belly as pregnancy progresses.

6.) arm work and upper body strength is important to prepare the new mom for carrying the baby around and all the other heavy baby stuff!

7.) Check for any changes in the diastus recti. If it separates during pregnancy, then extra care will need to be taken post-partum to avoid increasing separation of the rectus muscle. Flexion should be avoided or any other exercise that causes the diastus to increase. Strengthening the TA while keeping the spine neutral is optimal for healing the herniation.

Let me know if that makes sense!
Best wishes-
Jean

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