Pilates for Orthopaedic Conditions

I’ve just spent the last couple of months updating my Pilates for orthopaedic conditions knowledge with FutureFit and wanted to focus a bit on exactly why Pilates is so helpful in the treatment of common orthopaedic conditions. Whilst I don’t solely use Pilates in my movement sessions but instead use a range of functional movement protocol the traditional Pilates principles certainly embody and underpin the main focus of exercise prescription for rehab thereby providing a safe and effective recovery.

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Common Orthopaedic Conditions –

  • Back pain (non specific, specific, root nerve pain, disc herniation and piriformis syndrome)
  • Shoulder conditions (rotator cuff tear, impingement and frozen shoulder)
  • Golfers and tennis elbow
  • Hip and knee arthroplasty
  • Arthritis (osteoarthritis and rheumatoid arthritis)
  • Osteoporosis and osteopenia
  • Hypermobility

The Pilates mat repertoire gives a great range of exercises which allow for enough regression or progression to take participants with very limited movement capabilities and progress them in a sustainable way.  The incorporation of the Pilates principles which are taught alongside each exercise help to integrate the breath with core co-contraction, increase body awareness (and therefore autonomy) and focus on the quality of movement.

A tailored programme can offer you many things – principally better alignment and mobility of the spine but also increased muscle strength and endurance, reduced stiffness and improved flexibility, reduced pain, better balance along with improved well-being.

If you are affected by any of these conditions it’s important to seek out an effective exercise programme which meets your needs and minimises your symptoms. Due to covid-19 I am not currently able to offer sessions but feel free to contact me for further advice.

Photo by Harlie Raethel on Unsplash

 

Are You Sitting Comfortably?

In sessions we are often trying to ‘undo’ or improve on aches & pains (limitations) we have, whether it be through bad alignment or injury. Both of these are usually caused by having poor alignment resulting in our inability to maintain a sustainable functioning muscle balance.

If much of your day is spent sitting or sedentary  your body will be cast into that shape, there will be adaptations which define your body as ‘a sitter’ – even if you did a ‘workout’ (whatever that may be). What you do for the majority of your day will dictate how your muscles are conditioned. There will be specific movement pathways that your lifestyle does not expose you to due to ‘modern living’ & in particular the time saving devices we now have at our disposal e.g shopping online instead of walking to the shops & carrying it home, buggies, washing machines, cars etc.

In order to counteract this we need to look at steps we can take to change our environments to afford more movement time, different working postures or movement breaks spread out across the day.

14322757_1152367408139894_4920083886017136014_n3 steps to improving your ‘sitters body’.

  • Work on corrective exercises to help counter the effects of sitting.
  • Try to sit & do the movement we’re already doing with better alignment. See the picture on the left for ideal sitting alignment.
  • Look at ways we can change our environments & lifestyles to incorporate more activity where possible.

 

Take a look back at my post on 6 Ways to Stretch at Your Desk for some ideas on how to counter desk sitting.

Pelvic Floor 101!

In Pilates classes we give a lot of emphasis to using the pelvic floor muscles throughout all the exercises but I wanted to use this post to look a bit more specifically at some of the precursors to pelvic floor problems & signs you may be at risk or already have issues. 

There are specific signs to look out for which can indicate that you may have a pelvic floor problem – these are all suboptimal issues that you do not have to live with, a trip to the women’s health physio (or men’s) will help get you on the road to recovery just like any other muscle injury. I’ll stress again, these are not just conditions of age or things that ‘just happen’ – you can do something about it, just because something is common does not mean it’s normal.

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  • Peeing when you exercise, laugh, cough or sneeze
  • Needing to get to the toilet in a hurry or not making it there in time
  • Loss of control over your bladder or bowel
  • Accidentally passing wind
  • A prolapse – in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping. In men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
    • Pain in your pelvic area, or painful sex
  • Being pregnant & childbirth

The pelvic floor is just like any other muscle so if it’s too tight or too weak or a combination problems can occur but there are certain events in life & lifestyle factors that can contribute to creating imbalances or dysfunction. Some people have pelvic floor muscles that are too tight (hypertonic) & cannot relax. This can be made worse by doing squeezing exercises & overworking the muscles without learning how to relax – this is why I always try to give time in the class to focus on actually relaxing & releasing the abdominals & pelvic floor.

The main precursors for pelvic floor problems will involve any type of unmanaged pressure within the abdominal canister or where there is poor load transfer .

  • History of back pain
  • Ongoing constipation & straining on the loo
  • Being overweight with a BMI over 25
  • Incorrect heavy lifting e.g using the Valsava maneover
  • Chronic cough or sneeze
  • Previous pelvic injury
  • Poor alignment
  • Wearing high heels

With the right technique & exercise selection, Pilates is a great choice to help strengthen the pelvic floor – at any age, whether you’ve just had a baby or your babies are having babies!

Upper Back Mobiliser

Modern living tends to cast our bodies into a forward flexion bias stiffening & restricting movement of the upper back, neck & shoulders. It seems to be one of the main complaints & one of the things most class participants would like to relieve. 

The thoracic spine (upper, mid back) provides much of the rotation & extension of the spine but thanks to lifestyle factors such as looking (down & forward) at phones or computers, driving, leaning down over children or  poor posture it tends to get very restricted. Anyone that plays sport is likely to find their performance limited by stiffness in this part of the spine  & it’s common to get compensation injuries in other parts of the body as a result.

Typically a stiff thoracic can cause pain between the shoulder blades but also transfer excess loads onto the lumbar spine, neck & shoulders, which in turn can lead to pain in these areas as well as headaches. A stiff thoracic spine will also result in the Old Hunchback of Notre Dame look (!) & lead to a Dowager’s (or Bison’s) Hump – a thickening of the soft tissues at the base of the neck. So, some good reasons there to keep up with some basic maintenance to keep it supple!

In the classes we work through a few different exercises both in side lying & on all 4’s to help mobilise the thoracic spine & then follow up with some strengthening work to help keep the spine aligned. Here’s one of those exercises that’s really effective as the ground ‘fixes’ the hips which will give you a better chance at rotating correctly through your thoracic instead of cheating with another joint deformation.

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Make sure you have your knees hip width apart & hands, shoulder width apart. Don’t collapse your supporting shoulder / shoulder blade as you bring the other arm under & as you reach up try to really extend through the arm (….mine is bent, probably from too much baby holding!). Try 10 on each side, exhaling as you extend the arm up.

Test Your Balance, Part 2

As a continuation of the post I did on testing your balance part 1 I wanted to add a simple continuum of exercises from easy to hard that you can practice & use to challenge your stability.

 

So as aforementioned in part 1 the goal of these balances is to test your proprioceptive balance system – that does’t mean using strategies such as bending your knees or holding your arms out high wire style…or fixing your eyes on something, it’s about testing your own internal balance system with your body in the correct (or as close to correct) standing alignment.

pilates_16cYour body uses your proprioception system to create an image of what is internal or inside the skin – in much the same way as a dolphin uses sonar or an animal uses it’s whiskers. Proprioception literally means ‘ones own perception’ & that information about change of skeletal position travels by our neurones to the brain to act on. The more muscle fibres you have firing & the more supple (not tight) the tissue, the better the proprioception.

When you practice these consider your alignment: stand with your feet hip width apart & the outside edges of your feet straight. Back your pelvis up over your heels keeping your ribs aligned over your pelvis. Then draw your head back over your spinal column. When you come on to single leg balance make sure you push down into the floor with the standing leg as opposed to hiking the low back/hip up on the non-weight bearing leg.

1. 2 foot balance eyes open
2. 2 foot balance eyes closed
3. 1 foot balance eyes open
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5. 1 foot balance eyes open with head turns
6. 1 foot balance eyes closed with head turns

Test Your ‘True’ Balance, Part 1

From time to time in class we focus on standing balance – it’s a good way to test all the principles we practice throughout the classes & as an indication of general muscle balance health. So I wanted to use this post to look at what goes on when we try to balance, how to test it & how to improve your ‘true’ balance.
So our body’s stabilise by using the relationship between the proprioceptive system (that’s information coming from the muscles, joints & tendons) & the processing of that sensory input (i.e. what the brain tells the body to do with that information). Tight or shortened muscles send ‘fixed’ information from your proprioceptors and this data/sensory input gives incorrect information to the decision centre (the brain) which in turn acts on this mis-information. The outcome is an overcorrection, a wobble or lurching movement in an attempt to stabilise you. Any restrictions or sub optimal muscle length tension will alter the correct information given to the brain.

Testing your ‘true’ balance – See how well you’re balancing with these simple tests.

pilates_16dStand with your feet pelvis width apart & check your feet are straight (as in the outside edges, see pic) – how does this feel? Any wobbles? Now close your eyes & see if there’s any difference with them open or closed. Maybe you felt you moved about more with your eyes closed – this is the ‘true’ part of the balance test – your eyes are not part of the sensory input we speak about when we mean whole-body balance, they are not part of the proprioceptive system they are part of the vestibular system (eyes & inner ears) but the poorer your proprioceptive system is the more you rely on your eyes to make corrections. So in order to stop the eyes doing all the work (& incurring eye muscle fatigue, dizziness & age-related changes in vision) you need to fix your body’s internal sensory input or proprioceptive system.

The progression to the 2 foot balance with eyes shut is to come onto a single leg with eyes shut. Whilst we may have some muscle tension issues within the body it’s also our inability to process information through our feet & inform our bodies of correct posture, due to footwear that down trains our proprioceptive system. Think any type of heel, thick inflexible soles & too narrow toe boxes.

So hopefully this will give you a clearer idea of what you are aiming for when you consider/assess your balance – test yours & practice some ‘eyes shut’ standing to monitor your progress.

3 Restorative Shoulder Stretches

If you have tight shoulders & are looking for relaxing ways to ‘unstick’ them here’s a few ideas that we use in the classes that also work really well particularly as transitions from one exercise to another. If you imagine where your arms are hanging most of the day & the range with which you mostly use them in you can see that these 3 variations on a shell stretch really take them into much more of an unused plane thereby freeing up all the stuck tissue around pectoralis & latissimus dorsi.

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The picture above shows how you should anchor the stretch. Arms are pushing away into the mat & sit bones are pulling down, so you’re flexing the lumbar/lower spine by engaging the abdominals & pulling the ribs up (in the direction of the second smaller arrow). By drawing the ribcage up you will tension the stretch better through the shoulders instead of over extending into the thoracic spine – have a go with the ribs up & then down on your thighs & you’ll feel the difference.

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If you want to optimise the stretches try to work with the breath by directing it into the ribs & underlying diagram in a 3 dimensional way (think like an accordian). You’ll be able to feel the skin stretch around the rib cage & so try to emphasise that expansion as you inhale & breathe out the tension from the stretch as you exhale.

  • In the first variation the arms are straight out in front, trying to keep the hands in line with the wrists, elbows & shoulder. Head is relaxed, toes are tucked under for an extra, bonus plantar fascia stretch! There are many variations on the specifics of this pose for example Yoga’s Child Pose comes with a different emphasis but here as we are trying to specifically release the fascia around the shoulders I’ve selected these teaching points.
  • In the second picture the arms are externally rotated with the palms up & correspondingly the forearms are also rotating outward – you will feel how this tensions the stretch differently & you’ll probably find it more of a challenge. See how far round (or not!) you can get your thumbs/backs of the hands flat to the floor! Head relaxed & breathing wiiiiide! Keep thinking about the same anchor points, this is not a flop-on-your-thighs-&-go-to-sleep kind of stretch, you want to be actively working on the position both with the breath & with the anchor points. As the intensity of the stretch dissipates you can try to reach a little further.
  • Lastly we’re working more laterally into the sides of the back by bringing one arm all the way across & anchoring onto the the other side. This time we breathe into that side – feel the skin stretch & try to expand it with each inhalation.

For more information or to attend one of my sessions get in touch & fill out my contact form!

……And Breeeeeeathe!!

Different Pilates teachers put different amounts of focus on the breath  & whilst it can add to the seemingly endless checklist of things you are trying to get right in an exercise. For me, it is key to the success of any core restoration & here’s why.

Once you understand the body’s breathing apparatus & functionality it becomes quite clear that we get an intrinsic core contraction (tensioning) with each exhale & an intrinsic expansion (or opening) with each inhale so only by harnessing this inherent bodily function will we truly get the core working optimally. Working against this pattern will help facilitate back pain, exacerbate a diastasis recti & generally leave you vulnerable to injury.

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But as well as providing an intrinsic support system for the body, breathing correctly also helps reduce stress – controlled breathing can cause beneficial physiological changes that include:

  • lowered blood pressure & heart rate
  • reduced levels of stress hormones in the blood
  • reduced lactic acid build-up in muscle tissue
  • balanced levels of oxygen & carbon dioxide in the blood
  • improved immune system functioning
  • increased physical energy
  • increased feelings of calm & wellbeing.

Conversely when a person is under stress, their breathing pattern changes. Typically, an anxious person takes small, shallow breaths, using their shoulders rather than their diaphragm to move air in & out of their lungs. This style of breathing disrupts the balance of gases in the body. Shallow over-breathing, or hyperventilation, can prolong feelings of anxiety by making the physical symptoms of stress worse as well as facilitate adaptively shortened muscles along the neck & shoulders.

Try practising the breathing exercise described above whilst lying on your back in a quiet area – then begin to introduce some gentle core exercises as you do so & see how well incorporating the breath helps engage the whole core system.

5 Core Exercises To Practice

Regular conditioning of your core with proper muscle activation is key to maintaining good alignment & preventing back, neck & shoulder pain. This post will be a reminder for some of the exercises I teach in the classes as well as add a bit of variety for home practice.

post2First make sure you create space & time to focus on your technique – you will need to use your brain to find the right muscles (!) – predominately the co-contraction between transversus abdominis (TVA), pelvic floor & multifidus AS YOU EXHALE!

Try this technique to engage with your TVA:

Lie on your back with your spine in a neutral posture (slight curve in lower back). Take a breath in & as you exhale think about lifting your lower tummy up (not sucking in) & *gently* drawing your tummy button toward your spine – you should not feel any movement of your hips, pelvis or spine & you can feel the TVA activate by placing your fingers on the inside of your hip bones. It should feel like a deep tension not so much that it pushes your fingers away.

Try holding this contraction for 3-5 seconds & then release – breathe throughout this exercise! Repeat & hold for 3 sets of 10 repetitions 3-4 x a day.

Once you’ve mastered this you can apply it to all movements/exercises that involve any level of effort. Just remember to go with the breath pattern always exhaling on exertion to benefit from the intrinsic TVA contraction, tensioning your abdominals & lower back muscles.

So here are 5 exercises to practice whilst integrating TVA & pelvic floor activation through different planes of movement:

1. Single leg extensions: Lying with your spine in neutral (slight curve in lower back) ‘bolt’ your tailbone down as you lift knees up to 90 degree. Moving with the breath exhale as you drop one toe to the floor. Repeat, alternating legs for 10-20 x as along as you have good control with no bulging/doming abs.

2. Ball roll outs: From kneeling with shoulder ‘set’ roll forward until you feel the hips open at the front. Make sure you engage your core (as above) to keep the spine in neutral. Repeat 10-20 reps as along as you have good control with no bulging/doming abs.

3. Squats: Inhale as you go down & exhale to go up, move with the breath. Try to keep your spine neutral by untucking your pelvis an& make sure your knees don’t extend over your toes. Repeat…all day long!!

4. Knee lifts: From all 4’s with shoulder set exhale as you engage core & hover the knees. Repeat 10-20 x

5. Side Lift: Assume the position in last pic, inhale & prep core then exhale to lift the top hip up. Try to keep the supporting elbow under your shoulder (mine’s sliiiiiiiightly forward!) Repeat 10-20 x both sides.

Remember you don’t need to do specific ‘ab’ exercises – rather learn to & actually use your core muscles throughout your daily activities. Crunches will merely retard the body’s correct muscle balance.