Celebrate International Pilates Day at Harmony Pilates & PT in Manoa.

Come Celebrate with us!

Saturday May 6, 2017
12:30 – 3:00 pm

Pilates Demos
10% off class packages
for attendees only, existing & new clients.
Chance to win:
Free classes, Private sessions,
Toe Sox, T-Shirts & more.

rocker

We are celebrating International Pilates Day
at our new Manoa location.
Please join us
Sat May 6, 12:30 – 3:00 pm.

  • * Enjoy appetizers, drinks and Pilates demonstrations.
    * Existing & new clients 10% discount on Pilates class packages.  (not including unlimited          memberships or work shops)
    * Check out Confidence Clothing active wear and other vendors.
    * Enter the raffle to win free prizes.
    * New Unlimited Monthly Membership – online signup for any class we offer.

Try Pilates, feel the difference !

Improving bodies, changing lives – Health in Harmony.

Pilates in the news:
be sure to see this story & video as seen on CBS
Major League Baseball Players do Pilates.

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Pilates in the News – Major League Baseball players do Pilates.

Top Major League Baseball Players who do Pilates

Posted on 02 Mar, 2017

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The core strengthening, flexibility improvements and stability that stem from Pilates exercises is particularly beneficial for athletes. These benefits are the main reason why some of the most successful MLB baseball players reveal that they rely on the Pilates method to maintain their optimal physical shape and improve performance.

Various types of Pilates programs have been developed specifically for the needs of professional sports athletes and ballplayers. These are often used to increase strength and conditioning, reduce the risk of injuries, maximize functional strength, improve overall performance and do effective rehabilitation.

Which popular MLB baseball players do Pilates and how does it help them? Let’s find out.

Jake Arrieta

Arguably one of the best starting pitchers in the history of Chicago Cubs team, baseball player Jake Arrieta touts Pilates for his stellar performance.

Arrieta hasn’t always been a baseball ace. In 2013, he was demoted to Triple A after four starts. At this point, Arrieta considered putting an end to his professional sports career playing baseball.

Midseason, Arrieta was traded to the Cubs, and after arriving in Chicago, he made a promise to turn his life around. It was during this period of his life that Arrieta came across a Pilates studio. He reported that he was “hooked” right from the first session.

Soon after, Arrieta was doing Pilates exercises three times per week. Eventually, he turned his garage into a Pilates studio. He credits the exercises for results in much better body control, as well as mental toughness.

His fitness routine consists of two hours of stretching per day, functional range conditioning and reformer workouts. A reformer is an exercise machine that intensifies Pilates routines through the use of springs that provide additional resistance and challenges. The method is used to stress and strengthen the muscle groups that Arrieta needs as a baseball player including, but not limited to the lats, obliques, and shoulders.

Today, you can even find a Jake Arrieta Pilates routine online. According to the pitcher, this routine is the one that changed his mindset and his career. According to his Pilates trainer, Liza Edebor, it’s possible to go from a regular guy to “just ripped” simply through the reliance on the right Pilates routine.

Trevor May

In 2015, the Minnesota Twins team baseball player, pitcher Trevor May was diagnosed with a stress fracture in his back. The condition, known as pars defect, is characterized by symptoms like lower back pain, stiffness and occasional nerve symptoms.

May has been attempting to overcome the condition through regular rounds of yoga and Pilates.

Doctors confirm that the back issue May suffered from is the result of core instability. Luckily, Pilates is one of the best exercise methodologies that deliver optimal improvements regarding core strength.

Various clinical studies confirm the effectiveness of Pilates for overcoming back and lower back injuries. A systematic review was published in the PLOS Online journal on the topic. Researchers went over 152 studies, and they found out that Pilates exercises offer greater improvements in pain and functional ability in back pain sufferers in comparison to standard care and even physical therapy.

Evan Longoria

Heading into the 2017 campaign, Rays’ pro Evan Longoria announced a change in his offseason fitness routine. He reported that he’d been focusing predominantly on Pilates after taking some advice from none other than pitcher Jake Arrieta.

In an interview with ESPN, Longoria said that Pilates has been delivering much better results than his previous yoga routine. According to Longoria, Pilates is critical to his agility and strength training. It has helped him maximize bat speed and increase core motion for superior performance during the upcoming playing season.

According to Longoria, “flexibility is “the new strength.” He reported that his entire Pilates workout was focused on the range of movements required during baseball rather than on bulking up. Stability plays a crucial role in optimal performance, and according to Longoria, his Pilates exercises help make significant improvements in that area.

Clinical evidence supports Longoria’s claims. A lumbopelvic stability clinical trial was carried out and presented in the Asian Journal of Sports Medicine. Researchers worked with 40 male and female volunteers who were either asked to do a routine of Pilates exercises or were assigned to the control group.

A standard lumbopelvic stability and flexibility test was performed at the beginning, during the fourth and the eighth weeks of the experiment. During the fourth week, there were 65 percent more members of the Pilates group passing the lumbopelvic stability test. The number increased to 85 percent by the end of the eighth week.

Nate Robinson

Nate Robinson is another baseball player who relies on Pilates for his offseason training and preparation.

In 2008, doctors told the pitcher that his flexibility wasn’t at the level it should be for successful athletic performance. Strong but rather stocky, Robinson found out that he needed a change in physique to improve his career.

Immediately after the end of the 2008 season, Robinson considered a change in his workout. This contemplation led to finding Pilates and incorporating it into his workout routine. According to the pitcher, the benefits of the new method include massive improvements in flexibility over a relatively short period.

During the offseason training, Robinson did Pilates three times per week with an instructor. Stretching, agility work and resistance exercises are the ones that make up the bulk of his offseason training program. While doing weight training exercises, Robinson also focuses on typical Pilates balancing routines that maximize both core strength and stability. While most of the exercises are focused on the core and the lower body, there’s also shoulder training, an essential for successful pitching performance.

Dillon Gee

Mets pitcher Dillon Gee embraced the Pilates method in 2012 in an attempt to increase his strength. Former teammate Chris Capuano suggested incorporating Pilates after he found out that Gee had a tough year and was considering himself to be particularly out of shape.

According to Gee, many ballplayers are reluctant as they see Pilates as exercises for women. At the same time, he reported that the workouts are a lot more challenging than one would expect. In the very beginning, he found it almost impossible to complete a routine on the Pilates reformer.

Gee’s Pilates instructor decided to focus on core strength, stability and shoulder exercises. That’s the beauty of the method created by Joseph Pilates in that it can be tailored to address the individual preferences of the practitioner.

Through his Pilates workout, Gee enhanced the strength of the abdominal muscles, the glutes, and the lower back. This way, he became much more capable of keeping his lower body stable, removing the strain on the shoulders during throwing.

The next stage of the training focused on isolating and utilizing specific muscle groups. In time, Gee found himself capable of “accessing” and strengthening muscles that were previously underutilized. Because of these exercises, Gee believes that he has acquired additional strength and resilience, two essentials for being a successful pitcher.

Hunter Pence

Another pro who credits Pilates for getting him ready for an upcoming season is Hunter Pence, one of the most valuable San Francisco Giants team players.

A series of injuries in 2015 forced him to end the season earlier. During the year, Pence experienced problems like a broken forearm, tendinitis and a strained oblique. The last injury was the one that made Pence try out a Pilates routine in an attempt to overcome the pain, recover faster and get in a good physical shape for the upcoming season.

Because of the injury, Pence wasn’t capable of doing any other form of exercise. Pilates was his only option, but he soon started experiencing the many benefits that come with performing the routine.

Thus, the athlete began with gentle recovery exercises that were later on intensified. Today, Pence is in the best physical shape than ever before. This fitness level is part of the beauty of Pilates.  It’s a highly adaptive routine. Apart from helping injured athletes get back on track, it can also result in more strength, and it can effectively prevent injuries in the future.

See Jake Arrieta’s Pilates work out here:  https://www.youtube.com/watch?v=lZg-iCwZb-A

 

Biomechanics of keeping your feet under you – the key to staying vertical.

May 01 2015

Keep your Feet on the Ground: The Key to staying Vertical.

Yesterday, a client came flying in to her session brimming with jubilation‎ as she declared “It’s amazing, I didn’t fall!”

She regaled me with her tale of potential disaster ‎with a smile from ear to ear. It started with her standing on a slippery slope with a hose in one hand and a glass of wine in the other. As she watered her newly planted garden high atop the Oakland Hills, she lost her footing on loose gravel and fallen leaves. In that split second, she miraculously was able to reorient her back foot and catch herself mid-lunge without spilling a single drop of wine. Without a second thought, she stood herself right back up, and realized what had just happened…she had just escaped disaster with her very own strength, balance and agility!

Why, you ask, was this such a momentous occasion? Just one year ago, she had come to me with a similar story that ended in a shattered knee, and subsequent joint replacement. Since that time, and likely even leading up to that point, she had struggled with an intense fear of falling, and a lack of confidence in her own balance and support due to lack of strength. Just one year later, and with an unrelenting dedication to her movement practice, she is able to prove to herself that she has the strength and coordination to maintain control of her own body when faced with these obstacles that inevitably will challenge our ability to remain vertical.

This story inspired me to reflect on what aspects of movement are necessary to keep us upright as we age. Here are just a few of my favorite functional movements that can be accomplished by anyone at home:

1)    The Weight Shift
This movement helps with sit to stand, stair climbing, and side to side balance.
Stand in front of a full length mirror with your feet hip width apart, about 6-8 inches. With hands on your level hips,

Stand_Skeleton_hips

shift all of your weight over your right leg without losing the horizontal level of your pelvis. At this point, your left foot should still be on the ground but you should be able to tap your foot without having to shift your weight further to the right.
Shift back to center, and then shift all of your weight over your left leg in the same manner.
As you perfect this movement, try sliding your unweighted foot towards your weighted leg, and hover the foot just an inch off the floor for 5 seconds.

2)   The Direction Change

These movements increase agility for changing direction quickly, or to catch oneself from falling.
Standing tall with feet hip width apart, step one foot forward and shift some weight into that foot like you are squishing a bug, then step that same foot backward while you squish a bug behind you.  Repeat forward and back several times. Next, step that foot out to the side and shift your weight slightly, step that foot back to standing tall.

Now, putting it all together, squish a bug in front of you then behind you, then to the side and back to standing tall. Repeat this pattern several times.  Start from the beginning on the other foot.  To progress this movement, add a small lunge in each direction.

3)    The Squat
This functional movement is integral in everyday life, and assists in building leg strength for an effective sit to stand from a chair or from the floor.
Stand tall with feet slightly wider than hip width, and arms hanging down by your sides. Keeping your weight evenly distributed on both feet throughout, bend at the knees and hips and sit back as if you are attempting to sit in a chair. As you squat, arc your arms forward to shoulder height as counterbalance. Keep your spine straight, and avoid rounding forward as you squat. Return to standing and lower the arms.
As this movement becomes comfortable, speed it up to a quick tempo to increase blood flow and muscle activity. Repeat to fatigue.

Working with a Movement Practitioner with a strong knowledge of biomechanics can help improve your balance, avoid falls, and provide you with the tools for good functional movement throughout life.

 

Want to integrate proper biomechanics and functional movement into your Pilates practice? Register for ReActive’s upcoming BODY HARMONICS® Certification and Continuing Education courses in Oakland, CA. Visit www.reactivemovement.com/Teacher-Training for more information.

Written by Holly Wallis, Certified Movement & Rehabilitation Specialist
ReActive, LLC    www.reactivemovement.com     510-990-1364

© All rights reserved.

What We Can Learn From Japan – Even Changing The Way We Grow Food

Say Hi To Japan’s High-Tech Indoor Veggie Factories

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It’s no secret that man is openly vulnerable to the random and unforgiving fury of mother nature. Droughts, storms, floods, and many other natural events could at any time, and anywhere, wipe out a major agricultural hub.

But no worries, Japan came up with a solution to this issue. Japanese plant physiologist Shigeharu Shimamura, along with GE, recently developed a special LED fixture that emits light at wavelengths optimal for indoor plant growth.

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They allow Shimamura to control the night-and-day cycle and accelerate growth. The systems allows him to grow lettuce full of vitamins and minerals two-and-a-half times faster than an outdoor farm. He is also able to cut discarded produce from 50 percent to just 10 percent of the harvest, compared to a conventional farm. As a result, the farms productivity per square foot is up 100-fold.

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Furthermore, the LEDs last longer and consume 40 percent less power than fluorescent lights. Ding-dong! This could possibly change the way the world grows food.

Underground Bicycle Garages

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Ha! Try this one bike thieves.

How does it work? Hop off your bike and guide it onto a small platform, insert your card, and voila. Your bike is stowed away out of sight and out of the way, safe and sound, so that you never have to worry about those insistent lock snippers. And it only takes about 10 seconds to retrieve your bike back.

These garages are built entirely underground (average about 38 feet), and can hold around 204 bikes.

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Better Vehicle Parking Garages – Automated Of Course

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Automated (car) parking systems (APS) are mechanical systems designed to minimize the area and/or volume required for parking cars.

An APS provides parking for cars on multiple levels stacked vertically to maximize the number of parking spaces while minimizing land usage.

The benefits?: Increased vehicle security, minimized parking lot damage, physically safer as no one is walking through, reduced engine emissions, better handicap access, minimized construction time, and reduced overall space needed for the garage. 

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Touchscreen Menus At Upscale Restaurants

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While some may argue that the use of touchscreens in restaurants is just another nail in the coffin for social interaction, I believe this idea to be a step forward with regards to efficiency and customer service. How often do you find your waiter/tress too busy to take your order? Or how often is your order taken down wrong to your disappointment?

High Speed Bullet Trains – The Shinkansen Gets The Job Done

Shinkansen II

Japan’s main islands of Honshu and Kyushu are served by a network of high speed train lines that connect Tokyo with most of the country’s major cities. These bullet trains are called shinkansen.

Running at speeds of up to 320 km/h, the shinkansen is known for punctuality (most trains depart on time to the second), comfort (relatively silent cars with spacious, always forward facing seats), safety (no fatal accidents in its history) and efficiency. Thanks to the Japan Rail Pass, the shinkansen can also be a very cost effective means of travel.

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A shinkansen could take someone from Vancouver to Toronto (a trip that normally takes 4 days driving) in about 14 hours. The question is, what the heck are we waiting for North America? Follow suit!

An Organized Approach To Garbage Disposal

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Although not as eco-friendly as Costa Rica or certain European countries, Japan stands as an innovator when it comes to waste management and organization.

In Tokyo, trash (gomi) has to be divided into three categories (combustible trash, non-combustible trash, recyclable trash) for proper disposal. Each category is collected separately on a designated day. Signs in the neighborhood inform residents about the weekdays on which what type of garbage is collected. Burnable garbage is usually collected on two or three days during the week, while non burnable garbage is usually collected once a week.

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Norimitsu Onishi of The New York Times put it beautifully,

“Lipstick goes into burnables; lipstick tubes, ‘after the contents have been used up,’ into ‘small metals’ or plastics. Take out your tape measure before tossing a kettle: under 12 inches, it goes into small metals, but over that it goes into bulky refuse.” 

“Socks? If only one, it is burnable; a pair goes into used cloth, though only if the socks ‘are not torn, and the left and right sock match.’ Throw neckties into used cloth, but only after they have been ‘washed and dried.’”

Kamikatsu, a rural town of 2200, has gradually raised the number to trash categories to 44 varieties, including tofu containers to egg cartons, plastic bottle caps to disposable chopsticks, fluorescent tubes to futons.

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While incineration may not be the best option, Japan makes effective use of the heat energy released during the burning process, such as for power generation and water heating.

There Are Almost No Homeless People In Tokyo

Given the fact that Tokyo is the most populated metropolis in the world (39.2 million), one would naturally think there would be a high number of homeless people, similar to major metropolises in North America (such as New York and Mexico City).

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Thankfully this isn’t the case however. Last year, Tokyo hit an all-time low number of homeless people, a surprising 1700 (7500 for all of Japan, as compared with 600,000 for all of the United States).

Japan has historically had one of the lowest rates of inequality among developed countries. But where Japan is really surpassing the United States, instead, is in the social safety net it offers its citizens.

The Japanese Constitution guarantees its citizens “the right to maintain the minimum standards of wholesome and cultured living.”

Another reason for the low number of homeless may come from the strong support system of Japanese families. Though it is a difficult to quantify, the tradition of Japanese families remaining tight knit and supportive of each member is undeniable.

Time To Learn Something From The Japanese?

These are but a few of the amazing advancements playing out in the Land of the Rising Sun. Of course, no country is perfect, and Japan definitely has some things to work out (i.e., nuclear energy plants being built on fault lines…)

Needless to say, however, if you have an issue, Japan has a solution.

Source:

The Holidaze

Body Mechanics – nourish your tendons and ligaments to keep your body on the move.

Tending to your tendons and ligaments may not be at the top of your “selfcare” priority list. But these structural connective tissues are necessary to keep our bodies moving efficiently—they enable us to sit, stand, walk, and perform virtually all physical activity. Weak or injured tendons and ligaments can be disabling and may lead to chronic pain, making it important to nourish them before problems arise. This becomes especially important as we age.

Tendons and ligaments are strong, flexible connective tissues that are an essential part of the musculoskeletal system. While they are related in collagen_proteincomposition—mostly collagen, with small amounts of elastin and other proteins—and ultimately work as a team, they have different functions in the body. Tendons connect muscle to bone, allowing muscle contractions to move your skeleton, while ligaments connect bone to bone, forming and stabilizing joints and keeping your skeleton intact. The Achilles tendon is one of the more commonly known tendons and the ACL (anterior cruciate ligament) is a well-known (and commonly injured) ligament.

Tendon and ligament injuries are common in athletes and active people, in older adults, and in those who regularly perform activities that require repetitive movement, including work-related activity. Tendons are especially prone to injuries due to overuse, resulting in inflammation and weakening of the tendons. Heard of tennis elbow? That’s actually a case of tendonitis, which is inflammation and irritation of a tendon in the elbow, and rarely is it actually caused by playing tennis.

Collagen, the major component of these connective tissues, begins to degenerate and stiffen as we age. Additionally, tendons and ligaments have a poor blood supply, making existing injuries harder to heal, leading to decreased strength in those tissues and chronic pain.[i] Because the integrity of these connective tissues decline with age, leading to weakened tendons and ligaments and potentially an injury and/or chronic pain, it is important to support them with good nutrition and a few choice supplements.

Collagen. Collagen is the main structural protein that makes up all human connective tissue, including tendons and ligaments, and helps keep these tissues strong. As we age, collagen production slows and existing collagen can deteriorate, causing tendons and ligaments to weaken. A diet high in quality protein will provide the building blocks the body requires to make collagen, including the amino acids proline and lysine.[ii] Additionally, collagen supplements have been shown to stimulate collagen production, helping to maintain healthy tendons and ligaments.[iii]

Dark green vegetables are also excellent examples of food containing collagen producing agents.  Add drak green leafy veggies such as spinach, cabbage and kale to your diet every day.  They are packed with an antioxidant called lutein.  You need 10 mg to get results – which equates to about  4oz. of spinach or 2oz. of kale.  Also Soy products such as soymik and cheese contain an element known as genistein. The presence of genistein gives soy products their collagen production qualities, as well as helping to block enzymes that tend to break down collagen.  Just about any soy product contains enough genistein to be helpful, including soy products that have been developed as substitutes for meat products.

Oestrogen, derived from plants, is vital to making healthy collagen.  Lots of  foods contain plant ­oestrogens (phytoestrogens) that can help replace the effects of lost oestrogen. Try hummus, nuts, soy and pinto beans.

Lycopenesl  Red fruits and vegetables also are excellent sources to up the collagen content of foods in the diet.  The presence of lycopenesl in these types of foods helps to act as antioxidants, which in turn increases collagen production. Try adding red peppers, beets, and fresh or stewed tomatoes to the diet. Also include sweet potatoes, carrots and more.

Vitamin C. Vitamin C is required to convert the amino acids proline and lysine into collagen[iv]; in fact, vitamin C plays such an essential role in collagen production that a deficiency can weaken the tendons and ligaments.[v] The vitamin also reduces inflammation due to injury or overuse. In a human cell model of tendonitis, a proprietary combination of collagen and vitamin C suppressed a number of pro-inflammatory compounds and promoted healing.[vi] Good sources are green pepper (higher vit C content when cooked), dark green leafy veg like broccoli and sprouts, guava, papaya, kiwi fruit and oranges.

Anthocyanidins. The anthocyanidins found in dark-colored fruits such as cherries and blueberries, and in grape seed extract and Pycnogenol®supplements, have been shown to help the collagen fibers link together in a way that strengthens the connective tissue matrix.[vii]

Hyaluronic Acid. Hyaluronic acid is a component of tendons and ligaments and has been shown to stimulate collagen production.[viii] It is also comprises the synovial fluid that surrounds certain tendons, helping to keep them lubricated and moving smoothly.[ix] Researchers recently discovered that a thin layer of “skin” made of epithelial cells covers the tendons;[x] because hyaluronic acid is a major component of connective and epithelial tissues, it is thought to help maintain the integrity of this tendon “skin.” An animal model of tendon injury found that hyaluronic acid significantly speeded healing.[xi]  Hyaluronic acid or hyaluronate is available in capsules or injectables and found in glucosamine supplements.  Beans help your body produce hyaluronic acid.  Aim for at least two tablespoons of beans each day – broad or butter beans make a great substitute for mashed potatoes.

Gelatin. Gelatin-rich foods have long been a part of traditional diets—cultures around the world commonly consume all parts of animals, including the gelatin-rich cartilage and bones. Consuming gelatin has been shown to increase collagen proteins in the blood,[xii] helping to build the structure of both tendons and ligaments. One easy way to introduce more gelatin into your diet is to regularly make and consume bone broth, a savory broth made by simmering bones in water. (Ever made homemade chicken broth from a chicken carcass? That’s one type of bone broth.) Or consider taking a gelatin supplement.

Although caring for your tendons and ligaments may not occur to you until you are already suffering from pain or an injury, maintaining the health of these important connective tissues may just save you from an injury in the first place. A healthy natural foods diet along with a few choice supplements will help nourish these connective tissues, keeping them healthy and strong, and keep you moving smoothly through life.

Article adapted from: Lidsy Wilson, Healthy Hotline, naturalgrocers.com; Kim Jones, 9 ways to keep collagen healthy, The Mirror.CO.UK; Verdungal, How to increase collagen from eating the right foods, Heathcentral.com.

References
[i] http://www.sandiegohealthclinic.com/services/prolotherapy.html

[ii] http://www.whfoods.com/genpage.php?tname=fightdz&dbid=6

[iii] Wilson, L. “Structural Integrity: Collagen for joint and skin health” Health Hotline, Feb 2012

[iv] http://www.whfoods.com/genpage.php?tname=fightdz&dbid=6

[v] http://www.nutritionreview.org/library/collagen.connection.php

[vi] Shakibaei M, Buhrmann C, Mobasheri A. “Anti-inflammatory and anti-catabolic effects of Tendoactive® on human tenocytes in vitro.” Histoland Histopathol 26, 1173-1185, 2011.

[vii] http://www.ncbi.nlm.nih.gov/pubmed/12635161

[viii] Bruce A. Mast, Robert F. Diegelmann, et al. “Hyaluronic Acid Modulates Proliferation, Collagen and Protein Synthesis of Cultured Fetal Fibroblasts.” Matrix Vol. 13/1993, pp. 441-446

[ix]http://www.wellnessresources.com/health/articles/hyaluronic_acid_for_ten…

[x] Susan H. Taylor, Sarah Al-Youha, Tom Van Agtmael, et al. “Tendon Is Covered by a Basement Membrane Epithelium That Is Required for Cell Retention and the Prevention of Adhesion Formation.” PLoS ONE;  2011 January

[xi] Thijs de Wit, Dennis de Putter, Wendy M. Tra, et al. “Auto-crosslinked hyaluronic acid gel accelerates healing of rabbit flexor tendons in vivo.” J Orthop Res 27:408–415, 2009

[xii] Koji I, Takanori H, et al. “Identification of Food-Derived Collagen Peptides in Human Blood after Oral Ingestion of Gelatin Hydrolysates.” J Agric and Food Chem, 2005, 53 (16), pp 6531-6536

 

 

Achilles Tendon Rupture – Diagnosis, Treatment and Pilate’s for Rehabilitation

The Achilles tendon is the confluence of the independent tendons of the gastrocnemius and soleus, which fuse to achilles_backandsideviewbecome the Achilles tendon
approximately 5 to 6 cm proximal to its insertion on the posterior surface of the calcaneus.
The gastrocnemius and soleus muscles, via the Achilles tendon, function as the chief plantarflexors of the ankle joint. This musculotendinous unit provides the primary propulsive force for walking, running, and jumping. The normal Achilles tendon can withstand repetitive loads near its ultimate tensile strength, which approach 6 to 8 times body weight [1].

Complete Achilles tendon ruptures occur most commonly at the mid-substance, but also distally at the insertion site or proximally at the myotendinous junction. These can be traumatic and devastating injuries, resulting in significant pain, disability, and healthcare cost. As many as 2.5 million individuals sustain Achilles tendon ruptures each year and the incidence is rising [2]. This trend is due, in part, to an increase in athletic participation across individuals of all ages.

Achilles tendon rupture is when the achilles tendon breaks. The achilles is the most commonly injured tendon. achilles_tendon_ruptureRupture can occur while performing actions requiring explosive acceleration, such as pushing off or jumping. For a 150 lb person the amount of muscle force that would have to be generated to rupture the Achilles (excluding external trauma forces) would be 900 – 1200 lbs. The male to female ratio for Achilles tendon rupture varies between 7:1 and 4:1 across various studies.

The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced  dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon.  Some other common tears can occur from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury.

Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is 29–49 years with a male-to-female ratio of nearly 20:1.

Diagnosis is made by clinical history; typically people say it feels like being kicked or shot behind the ankle. Upon examination a gap may be felt just above the heel unless swelling has filled the gap. Walking will usually be severely impaired, as the patient will be unable to step off the ground using the injured leg. The patient will also be unable to stand up on the toes of that leg, and pointing the foot downward (plantarflexion) will be impaired. Pain may be severe, and swelling is common.  Sometimes an ultrasound scan may be required to clarify or confirm the diagnosis. MRI can also be used to confirm the diagnosis.

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. Among the medical profession opinions are divided what is to be preferred.

Non-surgical management traditionally consisted of restriction in a plaster cast for six to eight weeks with the foot pointed downwards (to oppose the ends of the ruptured tendon). But recent studies have produced superior results with much more rapid rehabilitation in fixed or hinged boots. Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%).[3]

Non-surgical treatment used to involve very long periods in a series of casts, and took longer to complete than surgical treatment. But both surgical and non-surgical rehabilitation protocols have recently become quicker, shorter, more aggressive, and more successful. It used to be that patients who underwent surgery would wear a cast for approximately 4 to 8 weeks after surgery and were only allowed to gently move the ankle once out of the cast. Recent studies have shown that patients have quicker and more successful recoveries when they are allowed to move and lightly stretch their ankle immediately after surgery. To keep their ankle safe these patients use a removable boot while walking and doing daily activities. Modern studies including non-surgical patients generally limit non-weight-bearing (NWB) to two weeks, and use modern removable boots, either fixed or hinged, rather than casts. Physiotherapy is often begun as early as two weeks following the start of either kind of treatment.

The relative benefits of surgical and nonsurgical treatments remain a subject of debate; authors of studies are cautious about the preferred treatment.[4]  It should be noted that in centers that do not have early range of motion rehabilitation available, surgical repair is preferred to decrease re-rupture rates.[5]

Rehabilitation: There are three things that need to be kept in mind while rehabilitating a ruptured Achilles: range of motion, functional strength, and sometimes orthotic support. Range of motion is important because it takes into mind the tightness of the repaired tendon. When beginning rehab a patient should perform stretches lightly and increase the intensity as time and pain permits. Putting linear stress on the tendon is important because it stimulates connective tissue repair.  Doing stretches to gain functional strength are also important because it improves healing in the tendon, which will in turn lead to a quicker return to activities. These stretches should be more intense and should involve some sort of weight bearing, which helps reorient and strengthen the collagen fibers in the injured ankle. Such as the toe raise on an elevated surface; the patient pushes up onto the toes and lowers his or her self as far down as possible or better yet, foot work on the Pilate’s reformer.

The other part of the rehab process is proper alignment of the foot.  This can be achieved with orthotic support or with Pilate’s reformer footwork training. This doesn’t have anything to do with stretching or strengthening the tendon, rather it is to keep the patient comfortable and place them in as proper alignment as possible. Custom made shoe inserts can be made to help maintain proper pronation of the foot.  If ankle and foot alignment are compromised, it can lead to further problems with the Achilles.

To briefly summarize the steps of rehabilitating a ruptured Achilles tendon, you should begin with range of motion type stretching. This will allow the ankle to get used to moving again and get ready for weight bearing activities. Then there is functional strength, this is where weight bearing should begin in order to start strengthening the tendon in proper alignment and getting it ready to perform daily activities and eventually in athletic situations.[6] [7]

 

Original articles adapted from Soslowsky Laboratory projects, Perelman School of Medicine and
Wikipedia, the free encyclopedia

 

References:

[1] Allenmark, C. (1992). “Partial Achilles tendon tears.” Clinics in sports medicine 11(4): 759-769.
[2] Suchak, A. A., G. Bostick, et al. (2005). “The incidence of Achilles tendon ruptures in Edmonton, Canada.”Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society26(11): 932-936.
[3] Richter J, Josten C, Dàvid A, Clasbrummel B, Muhr G (1994). “[Sports fitness after functional conservative versus surgical treatment of acute Achilles tendon ruptures]”. Zentralbl Chir (in German) 119 (8): 538–44.

[4] Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. (November 2010). “Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures”. The American Journal of Sports Medicine 38 (11): 2186–3.

[5] Jump Up Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M (December 2012). “Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials”The Journal of Bone and Joint Surgery. American Volume 94 (23): 2136–43.doi:10.2106/JBJS.K.00917.

[6] Cluett, J. (2007, April 29). Achilles Tendon Rupture: What is an Achilles Tendon Rupture. Retrieved May 6, 2010, fromhttp://orthopedics.about.com/cs/ankleproblems/a/achilles_3.htm

[7] Jump Up Christensen, K.D. (2008). Rehab of the Achilles Tendon. Retrieved May 6, 2010, from http://www.ccptr.org/articles/rehab-of-the-achilles-tendon/.htm

Body equilibrium – how Pilate’s develops strength from the inside out.

Pilates training develops the necessary strength and mind-body connection to hold our spine, joints and bones in the most anatomically correct positions, enabling us to move more effectively.  It develops the deep muscles which support our skeleton, allowing a more balanced body and connected core.  It helps eliminate creaky hips and shoulders, and trains you to develop better spinal mobility, and placement during exercise.  With this we can train harder, work harder – in general – move more efficiently and with less likelihood of injury no matter what we do from construction to desk work.

Yes, it focuses on the core, yet core does not just mean abs and back.  We in Pilates refer to the core as the deepest layer of muscle which is closest to our skeleton.  These are the local stabilizers which control neutral joint position and segmental motion.  They provide proprioceptive input about joint position, range, and rate of movement. They are also active continuously during movement, thus are endurance type muscles. When there is muscle pain, injury or movement impairment the stabilizers become inhibited and since they control joint placement our body no longer can stabilize itself or we cannot hold our spine or joints properly.  When this happens, our larger more superficial muscles called global stabilizers, have to work harder, become overactive and react to this pathology with spasm.

Stability retraining can only be accomplished with low load core conditioning focusing on the mind-body connection, to retrain motor control and endurance.  Pilates works our body starting with the deepest muscle layer outwards.

The video below is a great example of these principles – this isn’t a normal squat:

Pilates training is essential to any fitness program.  With its emphasis on alignment, breath, total body conditioning, it educates the participant on proper form and function.  The following video demonstrates how paying attention to alignment can greatly increase the challenge of an exercise;

It makes one mindful of how to stand, squat, flex, extend, bend and move in a stronger more stable way.  If you do not develop and  connect with your core muscles no amount of weight lifting, squatting or cross training will change your physique.   In fact you may well continue to develop muscle bulk as the global or superficial muscles continue to over work while the deeper intrinsic muscle layer fights for stability.  Stop the battle!  Let Pilate’s balance your strength and flexibility  – develop body equilibrium.

 

By Samantha T. Reed

Reference: Injuries and Special Populations Manual, Stott Pilates, 2010.