Pilates Consult brought to you by Team Pilates

Pilates Consult brought to you by Team Pilates: Commonly Asked Questions: The Mystery Behind Spine...

2011-11-20T21:02:00.000-08:00

Pilates Consult brought to you by Team Pilates: Commonly Asked Questions: The Mystery Behind Spine...: Ang, I am reading the Pilates Style Mag nov/dec issue & pg 50 spine stretch forward does not roll back on the pelvis like we did at the work...

Commonly Asked Questions: The Mystery Behind Spine Stretch Forward

2011-11-20T20:38:00.000-08:00

Ang, I am reading the Pilates Style Mag nov/dec issue & pg 50 spine stretch forward does not roll back on the pelvis like we did at the workshop. Which way is correct & safe to do in class? I am confused on this exercise again. Debi Frey, PTA Great Falls, MT

Thanks for your question Debi as this is an exercise that is frequently confusing to many Pilates Practioners and students alike.

The key to Spine Stretch Forward is to NOT hinge/tip forward at the waist, but to maintain a rounded back and stable pelvis to ensure a true stretch throughout the spine vs turning it into a hamstring stretch. In Pilatesstyle Magazine (Nov/Dec 2011) on pg 50 you will notice they mention "keep your deep back muscles (which would be Quadratus Lumborum and deep spinal extensors) engaged". The model does not have very much lumbar spine flexibility so that can be confusing if you are trying to assess the movement visually. The purpose is spinal stretch and pelvic girdle stability. In order to achieve this two fold, you must deeply engage the abdominals to keep from "hinging" forward at the waist while reaching forward over the toes (thus the slight posterior pelvic tilt to initiate the movement.)

I would reword the passage in Pilatesstyle as they emphasize engaging the deep back muscles but don't clarify what they mean by "engage". We are trying to stretch the spinal extensors and thus must deeply flex them to achieve this goal vs keeping them extended and in their active state.

On a side note, the Classic Version of "Spine Stretch" in RETURN TO LIFE THROUGH Contrology, by Joe Pilates, he does hinge at the waist and adds a forward stretch with 3 pulses that take you further forward into the stretch. So, we need to be very clear to our clients as to the version we are asking them to perform and what the overall purpose behind the exercise is.

JOE'S CLASSIC VERSION OF "SPINE STRETCH":
1. Spread legs as wide apart as possible. Draw toes upward and backward.
2. Rest palms flat on mat, with outstretched arms and chin to chest. Begin reaching forward with three (3) successive movements as far forward as possible with the abdomin "drawn" in.

NEW! Commonly asked questions! "How to deal with overactive hip flexors"

2011-07-26T06:13:00.000-07:00

Hi Christina,

I hope you are enjoying summer!

Yes, it is common that clients will tend towards gripping their hip flexors. Initiating from the deep pelvic floor and transverses abs prior to movement will help. This takes patience and a continual process from you of educating them on how their body needs to engage before they ever move.

Cueing from the posterior side of the body will be key as well. Heels on the bar for footwork and curing to fully stretch the leg in extension so that the insertion points of the hamstrings, all the way up at the sits bones, engage fully. Sometimes we get too caught up with not wanting to "lock" into a client's knee joints and we lose the ability for them to fully straighten their legs.

I hope this helps!

Angelie Melzer, Owner
Team Pilates
www.team-pilates.com
888-576-0340

On Jul 25, 2011, at 9:39 PM,christinasauerpilates@gmail.com wrote:

Hi Angelie,

Thanks for the information. I wanted to ask you if you can help me with wrapping my brain around the hip flexors. I have a few clients that tend to be grippy. Does that eventually go away with constant cueing?

Also, I have a client who comes to class. She does 2 reformer classes a week plus a mat/springboard. She has recently gone in to her massage and PT for psoas work. I am modifying and decrease resistance for the hip flexors but is this normal. Could there be excessive wear to certain muscles if always used?

Since we do have a lot of exercises where inevitably those hip flexors kick in, how can I approach this? I'm trying to read anatomy trains and see if I can see how to approach this.

Your expertise is always appreciated.

Thank you

Christina

Sent from my Verizon Wireless BlackBerry

Irritable Bowel Syndrome-"How Small Variations can Make a Huge Difference"

2011-05-10T07:01:00.000-07:00

PILATES JOURNAL
BROUGHT TO YOU BY TEAM PILATES

Dear Angelie,

PILATES JOURNAL is your Personal Pilates Consultant. We have featured articles and corresponding programs, bringing you up to date information and news in the Pilates Industry. We strive to give you the tools you need to offer the highest quality Pilates Education and Services!

In this issue:

HOW PILATES CAN HELP IRRITABLE BOWEL SYNDROME (IBS)

FIND YOUR VOICE WITH YOUR CLIENTS

Feature Articles

HOW SMALL VARIATIONS CAN MAKE A HUGE DIFFERENCE

By: Karen Sanzo, MS, PT

Balanced Body Faculty Member

Pilates Unlimited, Dallas, TX

www.pilatesunlimited.com

As a physical therapist, I find that Pilates is an essential extension of treatment for most patients. I realized years ago that just alleviating pain was not enough. I had to educate my patients to live and thrive in their bodies with all the challenges their injuries or disorders present.

One client, we'll call her Jill, came to me with chronic upper back and neck pain. Physical therapy helped resolve each acute episode, but it didn't prevent the inevitable onset of another crisis. She seemed like a perfect candidate for follow-up with Pilates exercises. Jill also suffered from Irritable Bowel Syndrome (IBS), a digestive disorder that afflicts an estimated 15 to 20 percent of the population. It has been called "a disturbance in the interaction between the gut, the brain, and autonomic nervous system which regulates involuntary reactions of internal organs." [1] Symptoms include bouts of diarrhea alternating with constipation, painful colon spasms, cramping, gas, and bloating. The pain from the IBS often prevented her from doing exercises that she had been told would strengthen her core, which would give her needed support for her back.

Jill was very enthusiastic about Pilates. The idea of strengthening the core seemed ideal for both her back problems and her digestive issues. Unfortunately, her IBS symptoms worsened after every session. Exercises such as Hundred Beats brought on cramping, and after the session she reported increased gas and bloating, which signaled the beginning of an IBS attack. This made her extremely wary of attempting to do the routine Pilates exercises.

Over the years, working with many different types of body issues, I have learned that just a small variation on a traditional exercise can make a huge difference in how the client feels. There are nuances in the work that have the power to help many people who have come to believe that exercise is not for them. In working with Jill, I made minor alterations, removed certain exercises from the routine, and educated her on breathing and on developing awareness of what she was doing as she exercised.

Nuance #1 BREATHING

The mark of success in Pilates is when a client "gets it" and carries the concepts they learn in class over into their daily lives. For this, education is key. Without awareness, people can't change. The first area we worked on was Jill's breathing. She learned that if she stopped breathing, she was clenching, but if she focused on her breathing, she tended not to grip her abdominal muscles. I taught her that rhythmic breathing pushes the diaphragm down to stimulate abdominal organs, which helps you avoid bracing. For Jill, it was her "Aha" moment.

Sometimes it's the cue that throws people off. A common cue for scooping is "knit the ribs." For some people, especially those who experience a lot of stomach pain, that means "clench." They're so used to trying to keep their gut relaxed, that when you tell them to scoop, they think "clench," causing the area to become locked and essentially inhibiting the ability to contract the muscles correctly. To help them avoid this, have them stay focused on the inhalation portion of their breath. The portion where the diaphragm is pushing down on the internal organs as the diaphragm moves out of the way to allow the lunges to fill with air. This will eccentrically contract the abdominal area and then will allow for a more natural concentric contraction during the exhalation phase, rather than a forced contraction.

Nuance #2 ABDOMINAL WORK

It is very easy for a Pilates novice to ignore or misunderstand cues for exercises like the Hundred Beats. The instructor is saying Beats and client is thinking Crunches. In their enthusiasm, they grip their abdominals and aggravate their IBS symptoms. The solution is Education, Education, Education!

(1) Demystify the Core. Core work extends beyond trunk flexion. Cut out any abdominal curling exercises from the regimen and explain why the curling compresses the digestive organs, aggravating their symptoms.

(2) For some, even the Scoop (transverse abdominus exercise) is too much. Focus on the Kegel instead. Research has shown that a good Kegel will activate the trA, avoiding the tendency to brace.

Assess if your client is engaging the abdominals by putting your hands on the front and back of the trunk, then cue the client to relax the clench.

Nuance #3 BACK WORK/SPINAL EXTENSION, Swan with Propped Passive Extension

IBS sufferers often present with closed front body. That could be a protective instinct, from bracing, or from any number of other causes. If you just focus on Swan, the client may only extend from the lower back and never open the chest.

Have the client lie supine over a folded blanket or towel (the ½ barrels and foam rollers are too hard). Place it east/west approximately at the shoulder blades (depending on the height of the client). You're looking for a lengthening of the infrasternal angle away from the pubic bone. This passive extension will allow the client to begin experiencing chest opening and abdominal lengthening.

Gradually progress to prone on elbows and Swan, using the arms to press up. The key is to maintain the open chest and lengthened abdominals while teaching the arms and the spinal extensors to lift up.

Don't be afraid to encourage Passive Extension each session. The IBS sufferer needs to feel that sense of space and opening in the front body.

Nuance #4 LENGTHENING

In axial extension, with all the intervertebral spaces maximized, the front and back bodies are lengthened equally. You have to educate your client before they can achieve this. Spinal lengthening is often confused with spinal extension. Telling someone to sit up tall may not be the ideal cue if, when doing so, they increase their lumbar lordosis and roll the pelvis forward. Indirectly, this anterior pelvic tilt often inhibits the action of the Kegel. Instead, educate on sequential use of the spine. Line the client up using a yardstick or a wall, or if they are seated, have them place their feet flat on the floor. When they lengthen up, make sure they are lifting the front and back ribs equally, not changing the position of the pelvis. Traveling up the spine requires that the sternal area be lifted without moving anything below. A useful cue for that is what I call the Necklace: Imagine you are showing off a beautiful necklace as you lift just your chest.

Pilates, so often thought of as synonymous with Core work, is often counterproductive for IBS sufferers. But with some nuances, it can actually be beneficial. Education and clear explanation is more important initially than the exercises themselves. But with that preparation and awareness, the IBS client can gradually ease into a full-blown Pilates program.

*A special thanks to Karen Sanzo for offering her expertise and vast knowledge to the Pilates Journal. We truly appreciate her time and efforts to enlighten our readers on the topic of IBS.

Pilates Unlimited is a Pilates and Physical Therapy clinic located in Dallas, TX. Advanced Pilates devotees will discover exciting new approaches and a deepened understanding of exercise advancement from Karen and her instructors, all of whom have undergone rigorous training programs from various prominent teachers across the country.

Please visit their website at:
www.pilatesunlimited.com

[1] Participate,Quarterly Bulletin of the IFFGD, Vol 8, No. 3, Fall 1999, p. 7

Fast Facts on IBS

Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea due to lack of motility in the colon. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances.

IBS is one of the most commonly diagnosed diseases in America.
1 in 5 Americans, approximately 20%, suffer from IBS.
It occurs more in women than men.
It is characterized by sudden strong muscle spasms in the colon.
IBS causes a great deal of discomfort, but it does not permanently harm the intestines.
IBS does not normally lead to serious disease, such as cancer.
Symptoms include: Abdominal pain or discomfort for at least 12 weeks out of the previous 12 months.
The abdominal pain includes these features: a feeling of uncontrollable urgency to have a bowel movement, relief by having a bowel movement, a change in how often you have a bowel movement, and a change in the form and look of the stool.

Specific Exercises for Scoliosis and a Spinal Fusion

2010-11-14T21:09:00.000-08:00

Pilates Consult

NEW "FEATURED READER" ARTICLE!

The "Featured Reader" article showcases a member of the Pilates community who has approached us with specific issues and questions regarding Pilates and how it will help them.

If you are interested in becoming a "Featured Reader," please contact us at: info@pilatesconsult.com.

Featured Reader: Kimberly Brock
By: Angelie Melzer

Kimberly is a Pilates enthusiast, first introduced to the Method when she moved to Seattle, WA in 1997. Kimberly had a spinal fusion at the young age of 13 years old. At that time, the doctors diagnosed her with Idiopathic Scoliosis. She immediately went into TLSO brace for sixteen hours per day until her growth spurt period was over. During that time, her curve progressed quickly from 41 to 62 degrees in the Right Thoracic, with a compensatory curve in the Lumbar region. She was declared a brace failure. She was told that surgery was her only option as physical activity alone would not be sufficient. Being that Kimberly was an active young lady and a young budding dancer, this news was quite a blow to her.

After surgery, Kimberly felt so grateful they had "stopped" the disease, but felt such a sense of loss. She was left with poor flexibility and a fear that she'd never feel the same. However, she kept a good attitude and remained healthy and moderately active throughout her youth. She had no complications and has been very happy with the strength and flexibility she had gained over time. Still, Kimberly was left with feelings that a part of her musculature and nervous system had been "turned off". She felt disconnected as if she was placed into someone else's body. She learned to compensate and had three successful pregnancies. After her third pregnancy, she began to have acute lumbar discomfort. Her medical doctor looked at her current X-rays to diagnose the pain, but she felt like it was guesswork. He suggested a Chiropractor, to which she declined. Her other options were physical therapy or another surgical procedure. She was so disappointed that she contacted her Pediatric Orthopedic Surgeon's office, but they had no answers, except to seek a new Orthopedic Surgeon. She found very little information on the Internet for Spinal Fusion Patients later in life, and what she did find, scared and discouraged her.

Following her own intuition, she sought out Physical Therapy as it had done the most good for her in the past. Paying out of pocket, she found a Physical Therapist at Body-n-Balance in Apharetta, GA, who was also a Pilates Instructor. At this point, she was in constant pain and had begun to take medication on a regular basis. She was experiencing a dull, broad pain in her lumbar region that made her feel nauseous. The Physical Therapist slowly introduced Pilates into her sessions over the course of several months and it made an immediate improvement in her pain level. She felt as though she could work through her pain and stretch her muscles. The relief was great! Within a year, she had almost no pain, and when she did, it was very manageable. Kimberly is now pursuing her Pilates Certification through PhysicalMind Institute at Body-n-Balance and is so grateful to this gracious group of instructors who have changed her life through their openness, warmth and professionalism.

FEATURED EXERCISES

This section deals with specific issues the Featured Reader is experiencing, and solutions through Pilates exercises.

Kimberly had specific questions on exercises for her Scoliotic condition:

"I'D LIKE TO KNOW WHAT EXERCISES I CAN DO TO RELEASE AND STRENGTHEN A TIGHT PSOAS THAT IS PULLING MY RIGHT HIP FORWARD AND CAUSES PAIN IN MY PELVIS AND SACRUM EACH MORNING?

I HAVE WEAKNESS/TIGHTNESS IN MY SCAPULA, ESPECIALLY ON MY LEFT. I'D LIKE TO KNOW WHICH EXERCISES CAN HELP ME STRENGTHEN THIS AREA, WHERE I'VE HAD A LOT OF ATROPHY DUE TO THE FUSION?

CAN YOU SUGGEST MODIFICATIONS FOR EXERCISES IN DEEP FLEXION SUCH AS ROLL OVER, OPEN LEG ROCKER AND EVEN ROLL UP?

I'D LIKE TO KNOW MORE ABOUT "WAKING UP" MUSCLES THAT HAVEN'T BEEN IN USE DUE TO THE FUSION, WHETHER THOSE NEUROLOGICAL CONNECTIONS ARE LOST FOREVER OR IF THEY CAN BE REBUILT, AND HOW TO BEGIN DOING THAT?"

We have answered her with the following Featured Exercises:

PSOAS RELEASE WITH LUMBAR STRETCH:
Mat Exercises: Lying supine, hug both legs into your chest by holding onto both knees. Gently pull the knees towards your chest in a rocking motion to release your sacrum and lumbar spine.

Lying prone, grab one ankle at a time. Lift yourself into the bow pose by gently lifting and lowering your sternum 1-2" off of the floor. Then lift and lower your thighs gently 1-2" off of the mat. Combine these two movements together and hold for 10 seconds. Release and repeat 4 sets. You may choose to advance to the "Rocking" mat exercise.

Reformer Exercise:
Modified Lunge: Place 1 yellow or blue spring on the reformer. Standing on the floor on the spring end of the Reformer within the springs. Place your hands onto the shoulder rests. If your right psoas is the tight side, place your left leg onto the front edge of the carriage ensuring your heel is slightly below the carriage and the arch is securely on the carriage.

Gently push the carriage out with your left leg as you drop your pelvis straight down towards the floor. Make sure you are in a slight posterior pelvic tilt. Hold this position and then continue forward 2-3" at a time to your maximum range of motion, holding each time at least 30 seconds. Return to the original position and repeat 4-6 sets. You may choose to advance this to Eve's Lunge.

Trapeze Table Exercise:
Lunge on the swing: Face away from the swing and place your right foot into the white strap. Lung forward on your left leg and press your pubic bone forward into a posterior pelvic tilt. Hold this position for 30 seconds, then release and reverse the position, moving your pelvis into an anterior pelvic tilt. Arch and curl your lumbar spine to release the lower back and right Psoas muscle.

SCAPULAR AWARENESS EXERCISES:
Mat Exercise with an Exercise Band: Lying Supine on an Exercise Band placed underneath the tips of your scapula. (Ensure the Band is spread out evenly.) Hold the tips of the Band and pull them upward towards the ceiling, giving your scapula and mid-back region a tightening sensation from the Band. Pulse upward with the Band 20 times. Hold the final pulse up for 30 seconds and slowly release back to a resting position.

Mat Exercise on a Foam Roller: Lying Supine with the Roller parallel to your spinal column and your entire neck supported. Reach your arms up towards the ceiling, spreading the scapula apart. Pull the scapula back together and wrap them around the Roller. Repeat.

Chair Exercise:
Kneeling Lateral Flexion with Scapular Strengthening: Kneel on the floor next to the Pedal of the Chair. With one spring placed in the lowest setting, place your left elbow onto the pedal by laterally flexing to the left. Hold this position and pulse gently downward with the pedal 10 times, focusing on the movement of the scapula up and down along the spine. Hold the final pulse for 10 seconds and then slowly release the pedal completely until you are completely vertical with your torso and in the starting position. Repeat the exercise 4 times. *See below for modified version.

*Modified version of the above exercise: Depending upon your fusion, this can be modified to suit your spinal column and specific needs by taking out the lateral flexion. With the same low setting as above, sit or kneel next to the Chair and depress the pedal all the way to the floor with your left hand. Pulse upward about 1". Repeat this movement 10 times with the scapula moving along the spine and the shoulder elevating and depressing slightly with each pulse.

Modifications for Deep Flexion exercises on the Mat: As with any exercise program, not all exercises are appropriate for all bodies. Roll Over, Open Leg Rocker and Roll Up involve deep and very active flexion of the Spine which is both contraindicated and not possible with certain Spinal Fusions. Therefore, these exercises need to modified or replaced. Always ensure that as you perform the exercises below, the Pilates Principles are being utilized and your breath, form and alignment are all in check.

Modified Roll Over: Place a yoga block or small prop under the sacrum, lifting the pelvis 1-2" off of the floor. Pulse upward with the pelvis lifting gently off of the prop. Focus on the downward movement being slow and controlled as the sacrum comes back onto the prop. The hands can be placed on the pelvis for additional support.

Open Leg Rocker: Seated with bent knees, hook the knees over the hands. Balance against the wall when first attempting this exercise. Give yourself enough space from the wall with the sacrum so that you can perform a posterior pelvic tilt while maintaining the position. Return to an upright, neutral spine and repeat the posterior pelvic tilt.

Roll Up: Place a Yoga Strap or Band around the balls of the feet. Lying Supine, place the feet flat on the mat. Bend the elbows 90 degrees. Maintaining a neutral Lumbar Spine, look towards your knees as you pull gently on the Strap or Band.

"Waking up your Neuromuscular System"
Many times with Scoliosis, nerves surrounding the affected areas begin to lose their capacity to send messages. Whether it is due to a surgical procedure or lack of movement due to the Scoliosis present in that particular area, these areas need special attention through manual techniques, palpation or Tactile Cueing. Through Tactile Cueing, the muscles in these "dead" areas are physically touched in order to cue the nervous system and allow them to contract as we would like them to. Many times, this simply entails placement of the instructor or therapist's hand on the area, gently pressing and pulsing in the direction of pull that is desired. This manual work and Tactile Cueing allows the muscle to "feel" again and enables it to learn the desired contraction and movement. It is very possible that the Tactile Cueing will need to be done every time a certain exercise or movement is performed. However, as the individual gains strength, they may begin to "wake up" in these areas and be able to maintain a contraction for longer periods of time; and possibly contract these muscle without Tactile Cueing all together.

2010-11-14T21:05:00.000-08:00

PILATES JOURNAL
BROUGHT TO YOU BY TEAM PILATES

Feature Article
Pilates & Scoliosis: From the inside and outside
By: Michele Larsson, Founder of Coredynamics Pilates

I have seen a number of excellent articles on scoliosis lately, but all have addressed the condition from an outsider's point of view. I would like to present this topic to you from both the inside of a curve (as someone with scoliosis), and from the outside (what you see in your client).

Scoliosis is a lateral curvature of the spinal column in either a C or S shape. These lateral curves usually involve a rotation in one or more of the vertebra at the point of the curvature.

Outside view

Always speak about the scoliosis as if viewing the individual from behind. You can identify a curve by having the individual bend forward as you watch to see if one side of the back is overdeveloped. The spine curves to the overdeveloped side of the back. The body of the vertebra rotates to the side of the convexity and the ribs follow, causing the rib hump. In a C scoliosis, the shoulder is low on the high hip side. In an S scoliosis the shoulder is high on the high hip side.

The most common kind of scoliosis a Pilates teacher will see is a structural scoliosis. About 70 percent of all diagnosed cases of scoliosis are structural. It is classified by age of onset: infantile, before 3 years of age; juvenile, from 3 to onset of puberty; and adolescent, from puberty to maturity. This form is more frequent in girls.

1-Thoracic Curve
This is more common to the right. The curve usually extends to and includes T 11, 12 or L 1 up to T 4, 5, or 6. This curve is usually very deforming and tends to develop rapidly.

2-Thoracolumbar Curve
This is a longer curve than the thoracic and can occur either right or left. The lower end of the curve can include L 2, 3 or 4 and extend to T 4, 5 or 6. This curve is usually less cosmetically deforming.

3-Lumbar Curve
This is a common curve and is more often to the left. It runs from L 5 to T 11 or 12. There is usually not a large compensating curve above the lumbar. They are not very deforming but can become rigid and lead to severe arthritic pain with age.

4-Double Major Curve
This curve consists of two major curves of almost equal degree. Because these curves are symmetrical and balanced they are less deforming, but they can become a problem if very severe.

Six basic rules

1-Find individual's special one-lung breathing pattern (a technique used to teach/bring awareness to one-sided thoracic movement).
2-Do nothing to make the curve more pronounced.
3-Pad up the hollows (supine), short leg (standing or footwork), or low hip (seated) when needed for warm-up. This also teaches awareness in space.
4-Create a different agenda for side bending and rotation. They may need to side bend and rotate differently from one side to the other so look at the avoidance pattern and structure movement to compensate for the pattern.
5-Imbalance the limbs to balance the work of the trunk muscles.
6-Stabilize the whole body.

View from the inside

Scoliosis is normal to me. It is the way I have been since my mid-teens. I do not feel crooked. I have not been limited in my career choice by the curve-there are many professional athletes, dancers, actors, doctors, bankers, etc. who have scoliosis. On occasion I have pain, which always seems to occur for no apparent reason. The pain is like the irritation of chalk on the blackboard; it is not usually sharp or specific. I become aware of my scoliosis pain when someone remarks on how crooked I am that day. Unfortunately, I do not have the same kinetic sense of center as someone without a curve. I cannot find "center" without a visual aid or specific instruction.

To me, a head-to-tail movement is not this: I, but rather this: ).

For the most part, there are no rules when you work with clients with scoliosis.

At my studio in Santa Fe, we have four clients over 60 who have double major scoliosis. As you will see below, each client reacts differently to Pilates movement and can tolerate differing types of movement.

Client 1 enjoys stabilizing exercises and likes to stabilize to keep the outside very strong. No traction or mobilizing of spine.

Client 2 loves traction, warms up on the slant mat and then does a standard Pilates workout.

Client 3 loves to curve, but cannot perform hyperextension, rotation or side bending unless very modified and small.

Client 4 loves to arch. She is strong and can do most Pilates.

In closing, Pilates is excellent exercise for people with scoliosis. Enjoy your time with your scoliosis people. If you pay attention to their needs and modify accordingly, they will enjoy their workout sessions and reap the many positive benefits that Pilates offers.

*We would like to extend our gratitude to Michele Larsson and PEAK Pilates for sharing this article with us.

Featured Author:
Michele Larsson

Michele Larsson has over 40 years of experience teaching fitness, dance, movement and rehabilitation. She is a former dancer and choreographer who trained at the Julliard School of Music in New York City and received a bachelor's degree in Holistic Health and Dance Theatre from Antioch College. Larsson worked with Eve Gentry for nine years prior to the founding of the Institute for the Pilates Method in June 1991, where she served as the Director of Training. She maintains a diverse local clientele at the Santa Fe studio teaching athletes, post injury/special needs individuals and other Pilates teachers.

2010-07-14T20:02:00.000-07:00

PILATES JOURNAL
BROUGHT TO YOU BY TEAM PILATES

Fast Facts on Scoliosis

Scoliotic curves of 10° or less affect 3-5 out of every 1,000 people

Scoliosis usually occurs in those older than 10 years, but the condition can be seen in infants
2% of women and 0.5% of men are affected by Scoliosis.

The prevalence of curves less than 20° is about equal in males and females.

85% of the time the cause is unknown. The other 15% of cases fall into two categories: Nonstructural and Structural.

Nonstructural is caused by a temporary condition such as one leg being shorter than the other due to a muscle spasm.

Structural is caused by another disease such as a birth defect, connective tissue disorder, muscular dystrophy, metabolic diseases or *Marfan Syndrome.

* Marfran Syndrome is disorder of connective tissue, the tissue that strengthens the body's structures. Disorders of connective tissue affect the skeletal system, cardiovascular system, eyes, and skin.

Benefits of Pilates for Scoliosis
Written by: Angelie Melzer, BS, CPT

Pilates utilizes specific exercises to reeducate the movement patterns of an individual. Therefore, a specialized plan can be put into place for each client. This is ideal for Scoliotic clientele.

When living with Scoliosis, an individual gets into certain patterns of movement caused by the curves and rotation in their spine. In addition, these clients have muscular imbalances caused by the curvatures.

A specific example is with an S curve. Most of the time with an S curve, the main curve is seen in the Lumbar Spine. As the Lumbar Portion of the spinal column is pulled in one direction due to the tightening of the concave side of the curve, the muscles on the convex side become too long and are weakened. Their is then a compensatory curve in the spine, most of the time in the thoracic cage. This curve many times comes with a rotational pattern as well. All of these factors cause the spinal column to become immobile. It is key to keep these individual's spines as "fluid" as possible to avoid future problems from occurring such as disc and compression issues.

The Scoliotic client must utilize specific stretching in the concave portions and strengthening in the convex portions of their spines. They also need overall lubrication of the spinal column due to the nature of Scoliosis and the rotational patterns that are often present. Pilates exercises focus on lengthening of the spine; along with the principal of Spinal Sequencing inherent in most Pilates exercises. The control that is taught by these techniques and Pilates Exercises are extremely beneficial.

(References: National Scoliosis Foundation, Scroth Method, Emedicine Health.)

Scoliotic clients become deconditioned on the convex side of their curvature due to the continual line of pull from the muscles on the concave side. Therefore, hands on cueing is very important. The client's muscles must be touched/palpated on the convex side to aid them in contracting.

Pilates Mat Program for Scoliotic Clients

Below is a general protocol for a Pilates Mat exercise program for clients with Scoliosis. (Please note that each Scoliotic curve is unique and specific protocol will vary with each client.)

FLEXIBILITY AND MOBILITY MAT EXERCISES FOR THE CONCAVE SIDE:

Pelvic Lift
(Modification: Place a small prop underneath the convex side. Cue the client to press into the prop to heighten the awareness of movement away from the concavity.)

Pelvic Lift with a Wag Side to Side

Roll Up
(Focus on Spinal Sequencing and lengthening of the spine.)

Kneeling Cat

Standing Roll Down
(Modification: Press gently into the muscles on the convex side to allow these muscles to "awaken" and contract during movement.)

STRENGTHENING MAT EXERCISES FOR THE CONVEX SIDE:

Swan
(Modification: Press gently into the convex muscles to aid them in the contraction during the extension portion of the exercise.)

Side Lying: Banana Lift
(Perform this exercise lying on the concave side first. On the concave side, focus on keeping the ribs up away from the mat. Lift both legs and hold for 10 seconds. Roll over onto the convex side. On the convex side, do not lift the legs. Instead, lift the upper body by pressing down through the supporting arm and lengthening the upper body towards the ceiling, thus lengthening the convex musculature.)

2009-07-25T06:50:00.000-07:00

Pilates Chair Program for Osteoporosis Clients

Below is an appropriate Pilates Chair exercise program for a client with Osteoporosis or Osteopaenia

Seated Footwork

Reverse Swan on the Chair

Side Bend (without rotation)

Plies

Side Lying leg work

Triceps Press-Seated on the floor

Swan on the floor

Lunges

Mountain Climber

Hamstring Stretch 2-Modified with extension during roll down and a slight knee bend

Note: These are recommended exercises only, and each individual client's needs should be considered prior to starting any exercise program.

2009-07-25T06:49:00.000-07:00

Pilates Exercises to avoid or modify with Osteoporotic clients

General: Extreme flexion and rotation of the Lumbar Spine.

Mat Exercises:

Roll over

Rolling Ball

Rocker with Open Legs

Saw

Swan Dive

Neck Pull

Shoulder Bridge

Spine Twist

Jack-Knife

Teaser

Hip Twist with Stretched Arms

Boomerang

Seal

Crab

Control Balance

Reformer Exercises:

Teaser

Down Stretch

Arabesque (Long stretch series)

Stomach Massage (Round back and Twist)

Short and Long Spine (Reformer/Trapeze)

Semi-circle

Thigh Stretch-Advanced

Kneeling Arms (Drawing Sword with rotation and Side bend overhead pull)

Snake/Twist

Corkscrew

Short box (Round back, Rotation, Spear a Fish

Knee Stretch (Round back)

Balance Control

Mermaid

Grasshopper

Bridge with Arm Pulls

Star

High Bridge

Trapeze Exercises:

Roll back

Magician

Ferris Wheel

Thigh Stretch

Kneeling Roll Down

Breathing

Push Through

Saw/Circular Saw

Teaser

Mermaid

Reverse Tower

Tower/Monkey

Short Spine

Semi-circle

All Hanging exercises

Pilates Chair Exercises:

Bridge with Pumps

Hamstring 1/Washer Woman

Hamstring 2

Hamstring 3

Seated Spine Stretch

Jackknife

Pike/Teaser

Handstand

Push-ups

Side Body Twist/Mermaid

Spear a Fish

2009-07-25T06:48:00.000-07:00

Osteoporosis: Flexion vs. Extension

Written by: Angelie Melzer, BS, CPT

Exercise and an active lifestyle are essential factors in bone health. By age 18, skeletal growth is nearly complete and 97% of bone mass has probably been achieved. By age 20 bone mass has reached it's peak. The amount of peak bone mass achieved and the subsequent rate of bone loss are key determinants of bone density later in life.

In some cases, increases in bone density has been achieved through the third decade of life with moderate increases in physical activity. The ideal exercise is weight bearing, as it places necessary stresses on the bones. Skeletal and muscle mass decrease with age, but preventative measures can be taken with moderate weight bearing exercise and higher impact activities.

Pilates includes a range of exercises that are appropriate in maintaining bone health. Flexion vs. extention exercises have been the focus of numerous studies in post-menopausal and osteoporotic women. One such study was conducted by Sinaki M. Mikkelsen BA in her study: "Postmenopausal spinal osteoporosis: flexion versus extension exercises."

This study was conducted over six years with a control group of 59 women with postmenopausal osteoporosis, ages 49-60. The women were placed into three exercise treatment groups. (E) 25 patients were placed in an all extension exercise treatment program, (F) 9 were placed in an all flexion exercise treatment program, (E+F) 19 were placed in a combined program and (N) 6 were given no therapeutic exercise.

The study revealed that pre and post spinal x-rays showed group (E) at 16% additional fracture rate, group (F) at 89% additional fracture rate, (E+F) at 53% additional fracture rate and (N) at 67% additional fracture rate. Thus, the fracture rate was significantly less in the all Extension exercise group. Those who followed all Flexion exercises had a large increase in fracture rates.

Pilates practioners need to keep in mind that each individual they work with over age 50 should be considered for a DEXA scan or other bone density testing prior to starting a Pilates exercise program. It is the responsibility of the Pilates practioner and profession as a whole to be considerate of the safety of these individuals when designing an appropriate Pilates program for them. Extension versus flexion exercises and recognizing the specific needs of these individuals is of the utmost importance. This becomes especially important in group mat and exercise programming. Not all bodies are the same and thus individual needs should be addressed, especially in a group setting.

Please Note: It is recommended that prior to working with women over 50 and men over 60 years of age, you request their results of a BMD test. If their results or T-score deviates from the norm by -1 to -2.5 this indicates Osteopenia. A T-score deviation of -2.5 or higher indicates Osteoporosis.

(References: National Institute of Health Osteoporosis and Related Bone Diseases-National Resourse Center. Pub Med: Arch Phys Med Rehabil. 1984 Oct; 65(10):593-6.)

2009-07-25T06:46:00.000-07:00

Fast Facts on Osteoporosis

* Out of 34 Million Americans, 55% over 50 years of age have low bone mass

* Of the 10 Million Americans estimated to have Osteoporsis, 8 Million, or 80% are women

* Osteoporosis can strike at ANY age

* Direct National expenditures on the treatment of Osteoporosis in the US Healthcare system is estimated at $47 Million per day and rising

* % of Osteoporotic women who have acquired fractures at the following ages and areas of the body:

Age 50 60 70

Wrist 10% 30% 60%

Spine 5% 10% 70%

Hip 10% 50% 90%

(Reference: National Institute of Health Osteoporosis and Related Bone Diseases-National Resourse Center. Email: orbdnrc@nof.org)

2009-07-25T06:44:00.000-07:00

Reference Links for more information on Osteoporosis

www.nof.org (National Osteoporosis Foundation)

www.ManageOsteoporosis.com

www.fight-fractures.com

www.RA.com

www.SpinalFracture.com

Www.Saveourbones.com/Osteoporosis

2009-07-25T06:41:00.001-07:00

Pilates Mat Program for Osteoporosis Clients

Below is an appropriate Pilates Mat exercise program for a client with Osteoporosis or Osteopaenia.

Hundred

Modified Roll Over with pelvic support from hands

One Leg Circle

One Leg Stretch

Double Leg Stretch

Modified Swan

One Leg Kick

Double Leg Kick

Scissors with modified range of motion

Bicycle with modified range of motion

Side Kick Kneeling

Swimming

Leg Pull Front Support

Leg Pull Back Support

Side Bend with modified range of motion

Push up

2009-07-25T06:37:00.000-07:00

Pilates and Osteoporosis

Osteoporosis is the gradual and silent loss of bone and not a normal aging process. It is defined as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture (NOF 2005). Osteopenia is a mildly reduced bone mass--a loss of approximately 10%-20%--indicating the onset of osteoporosis. It is recommended that prior to working with women over 50 and men over 60 years of age, you request their results of a BMD test. If their results or T-score deviates from the norm by -1 to -2.5 this indicates Osteopenia. A T-score deviation of -2.5 or higher indicates Osteoporosis.

Risk Factors for the development of Osteoporosis are:

Personal history of fracture after age 50

Current low bone mass

History of fracture in a 1st degree relative

Being Female

Being thin and/or having a small frame

Advanced age

A female history of Osteoporosis

Estrogen deficiency

Low testosterone levels in men

Abnormal absence of menstrual cycle (amenorrhea)

Anorexia Nervosa

Low lifetime calcium intake (our total bone mass is set by the age of 30)

Use of certain medications

An inactive lifestyle

Osteoporosis can affect the overall strength of the bones, and is especially problematic in the spinal column and hips. Weight bearing exercise is key in slowing the process of bone loss due to Osteoporosis. Pilates is a wonderful exercise regime for clientele with Osteoporosis because of the controlled mindful nature. However, it is important to remember that their are limitations and precautions that must be addressed with clients who have both Osteoporosis and Osteopenia.

Pilates Exercises to avoid or modify with Osteoporotic clients:

General: Extreme flexion and rotation of the Lumbar Spine.

Mat Exercises:

Roll over

Rolling Ball

Rocker with Open Legs

Saw

Swan Dive

Neck Pull

Shoulder Bridge

Spine Twist

Jack-Knife

Teaser

Hip Twist with Stretched Arms

Boomerang

Seal

Crab

Control Balance

Reformer Exercises:

Teaser

Down Stretch

Arabesque (Long stretch series)

Stomach Massage (Round back and Twist)

Short and Long Spine (Reformer/Trapeze)

Semi-circle

Thigh Stretch-Advanced

Kneeling Arms (Drawing Sword with rotation and Side bend overhead pull)

Snake/Twist

Corkscrew

Short box (Round back, Rotation, Spear a Fish

Knee Stretch (Round back)

Balance Control

Mermaid

Grasshopper

Bridge with Arm Pulls

Star

High Bridge

Trapeze Exercises:

Roll back

Magician

Ferris Wheel

Thigh Stretch

Kneeling Roll Down

Breathing

Push Through

Saw/Circular Saw

Teaser

Mermaid

Reverse Tower

Tower/Monkey

Short Spine

Semi-circle

All Hanging exercises

Pilates Chair Exercises:

Bridge with Pumps

Hamstring 1/Washer Woman

Hamstring 2

Hamstring 3

Seated Spine Stretch

Jackknife

Pike/Teaser

Handstand

Push-ups

Side Body Twist/Mermaid

Spear a Fish

Lower Back Pain and Pilates

2008-09-18T13:25:00.000-07:00

Lower back pain is a common ailment. It can be caused by weak abdominal muscles. Specifically, the transversus abdominus which should involuntarily contract with the multifidus along the spinal column. If the transversus is weak, or the co-contraction does not occur due to some other muscular weakness, lower back "spasms" can occur. A "spasm" can be defined as a tightening of a group of muscle that is not relieved through movement. If a muscle spasm is not treated through muscle relaxants or some other modality, scar tissue can build up which ultimately causes range of motion to decrease.

A few basic Pilates exercises can help in aiding the transversus and multifidus co-contraction for relief of lower back pain.

Prone Extension

Lay on your stomach and place your hands on your lower back. Pull your abdominals in towards your spine. Clasp your hands together and reach them towards you heels as you lift your chest off of the floor. * It is important to pull your abdominals up before you lift your chest off of the floor.

Bridging

Lay on your back and pull your abdominals in and towards your spine. Press your lower back flat into the floor and hold for 10 seconds. Release and repeat. Advance to lifting your pelvis one inch off of the mat as you pull your abdominals in. Once this can be done with no pain, begin to lift your pelvis higher, one inch at a time until you are in a full bridge.

Modified Roll Over

Lay on your back. Place your hands in a triangle shape and place them under your sacrum, just below your lower back. Press your lower back into the floor as you pull your abdominals in. Gently press upward with your hands as you lift your pelvis one inch off of the floor. Try to hold your pelvis off of the floor for one second and then slowly lower back down to the floor. Advance to lifting and holding for two seconds and slowly lower, three seconds, etc.

What is Pilates?

2008-08-15T18:24:00.000-07:00

Pilates is a 100 year old, 'tried and true' exercise and post-rehabilitation program created by Joseph Pilates. It incorporates the idea of working from the 'inside-out'; utilizing the intrinsic core musculature to stabilize and enhance overall body function and awareness. It is included in the Body/Mind genre.

Why does Pilates work? It re-educates the neuromuscular system so that new patterns are established on a deeper level in the body. Therefore, these patterns of movement are not forgotten, even if the exercises are not done for a period of time.

Pilates is truly all encompassing, as it can be done throughout ones life. It can be beneficial to infants through older generations. It can be sport specific for elite athletes, which was how it's beginnings came to be; as well as, fitness based or post-rehabilitative. It can be done at home, in the gym, on the mat or on specialized Pilates equipment.

Pilates is great for individuals with scoliosis, fibromyalgia, arthritis, osteoporosis, chronic back pain and many other special situations such as autism.