I was bicycling home, I noticed a gentleman coming out of an office building, the sign above the door. It read “Integrated Medicine”. As I understand some physicians tend to be more progressive with the prescription of herbal remedies, than other doctors. Oil of oregano may be prescribed for a cold or mild respiratory infection. Having a natural health persuasion myself I think it great for a medical doctor to use natural remedies. Thus the name “integrated medicine” mixing pharmaceutical and herbal medicines. But the practice name “Integrated Medicine” made me ponder, as I cycled by, the broader sense of the phrase integrated medicine and how the word integrated is used and applied quite frequently with the Pilates method.
The way I think of integrated is when explaining how the body is pretty well held together with fascia, an envelope or sheath that wraps every organ and muscle in the body. This sheath is continuous, wrapping it’s way around every item in us – the matrix of the body. When an adhesion occurs in the fascia it causes a strain or stress on the envelop pulling it – like having a knot tied in your shirt – it doesn’t wear properly. This knot or stress/strain in the fascia can be caused from trauma, poor posture, vertebral subluxations, repetitive activities, even psychosocial factors. Resulting in reduced range of motion, stiffness, it may even make us feel nauseous or sick as the facial strain can affect the organs.
Often everything you do to help relieve this problem is ineffective. For example you think your hamstring or shoulder muscles are just tight and you do all the proper hamstring or rotator cuff stretches yet with little change or relief. The integrated medical practice mentioned above most likely will not be able to specifically treat such issues either, yet a referral to a Pilates instructor using an integrated approach will. Pilates will stretch and relax held tensions and strengthen weak or lax muscles and train our muscles and other structures to work in a more balanced, integrated way.
Osteopathy, craniosacral therapy and some chiropractic practitioners have an integrated holistic approach to treating such issues. Osteopathy and craniosacral therapy works mainly on the fascia of the body. Gentle minimal forces mobilizations of the spine and joints of the arms and legs encourages release of the fascia improving energy flow. Often the area of complaint is not what is treated as the body is looked at as a whole. You may complain of neck pain yet addressing an area somewhere else in the body like the knee may treat the neck.Chiropractic treatments adjusts the spinal column and limbs to help correct alignment of the joints, improves fascia and muscle balance or function.
Pilates has an accumulative preventative affect on the body. It too takes an holistic approach working the body in an integrated way. Pilates does not look at the body in sections. Pilates doesn’t exercise the body in separate muscle groups, like in a weight room where we do bicep curls then leg extensions for the quadriceps, etc. Instead it makes the body work as an integrated whole – Pilates is a whole body exercise. Pilates training done with an instructor who has a good eye can help you develop better alignment, body awareness and fine tune the body bringing more strength or flexibility to where it is required.
Pilates instructors look at the body not as a bunch of individual muscles and angles of pull, but rather in facial or muscles lines. Julian Littleford Master Pilates instructor and part of the Passing the Torch Mentor program with Balanced Body University, describes it as starting with the inside arch of the foot, the line of action wraps around the calf to behind the knee to the lower glutes where the top of the hamstrings insert, then connects to the mid-back and abdominals. After which it zig-zags through the body. When awareness is brought to this idea of the muscles wrapping through the body, muscles become integrated and act together pulling the body into better alignment moving from a central powerhouse.
Muscle actions are described in a cross from right to left, for example drawing the right shoulder blade to the left hip and vise-versa forming a cross connection from side to side. Similarly on the front the ribcage, diaphragm and psoas, muscle help connect the segments so that we move from a stable, connected foundation enabling force to be efficiently transferred from the upper body to the lower body and from one side of the body to the other.
Pilates training uses relatively light weights (springs) plus the individuals body weight with specific exercise sequences or repertoire which gets the muscles in the body to fire appropriately, resulting in efficiency of movement. The idea is to have correct muscle firing patterns – the right muscles working for the task at hand.
Other examples of whole body activities which integrate the muscles of the body are crawling, walking, running (when done properly), swimming, climbing, bicycling, surfing and skiing/snowboarding. Where the right and left sides of the body are reciprocal as one side of the body moves the other side is stabilizing and balancing the action of the other. “This is called reciprocal locomotion or coactivation of contralateral upper and lower quarter system throughout the body. For example the swing phase of gait or walking the lower body extremity and the right upper extremity are in tonic (flexion, internal rotation, adduction and pronation) pattern. During stance phase the leg is in extension with the opposite arm and they are coactivating in the phasic system (extension, external rotation, abduction and supination.)” S. Sahrmann, Diagnosis and Treatment of Movement Impairment Syndromes 2002.
When the body is in harmony; muscles are balanced. Muscle balance keeps the interaction of the tonic and phasic patterns optimal for posture and movement. This interaction provides centration of the joints during movement, creating a balance of muscular forces to maintain joint congruency through movement. When the fascia is not caught up there is flow of energy from side to side and throughout the body. When the body’s matrix or fascia is flowing smoothly and body awareness has been trained, integration is easy as can be readily seen. For example when you observe a ballet dancer’s graceful routine they are moving from a strong connected foundation the lines of muscle force are balanced and strength flows. The muscles are firing properly not one more than the other and there is freedom of movement throughout there are no spots of tension or adhesion.
Often running, swimming, bicycling and other such repetitive activities can result in repetitive strain injuries. Runners with knee are foot injuries, swimmers with shoulder injuries and the list can go on. Muscular imbalances can cause facial problems and vise versa . Also there is a neurological link between the upper and lower body systems. Imbalances in one system can lead to postural compensation and adaptive changes in the opposing system leading to problems with co-activation and muscle imbalances.
What I believe is so powerful about Pilates training and it’s advantage over other fitness modalities is that you are under the keen eye of an instructor. Even small adjustments can make huge affects on overall strength and power. Instructor feedback helps you achieve better mechanics and body awareness which not only helps you avoid injury but helps you prevent and heal injuries. A good instructor can suggest the appropriate exercises to help clients change their body’s overall posture, muscle patterning, strength and flexibility. Along with your Pilates practice metabolism changes occur facilitating changes in body content; increasing muscle and lowering fat percentages.
Pilates training often involves some muscle re-patterning as some muscles are over used while others are under used and do not fire or work when they are suppose to. With injury this becomes even more evident as the local stabilizers, the intrinsic muscle tend to become inhibited, while the global stabilizers, muscles which generate forces to control the segmental tend to become overactive at a low threshold or go into spasm Dawson, A., Injury and Special Populations Manual, Merrithew Corp., 2010.
The Pilates method is a healing process taking people deeper into their body awareness and most of this is done through connecting movement with breath. Breath integrated with movement facilitates better strength connection. On the simplest level exhalation with exertion helps increase intra-abdominal pressure, lowers the rib-cage and scapula towards the pelvis activating the abdominal, intercostal and shoulder blade muscles. Often people in pain, aerobic athletes and stressed individuals have high chest breath with their shoulders and ribcage are stuck in and elevated position. The mechanical effects of achieving a full exhalation allows the ribcage to lower, the thoracic spine to relax and lengthen, the scapula to achieve full range of motion which all facilitates the maintenance of neutral spine. When a neutral position of he spine is achieved the spine becomes decompressed, the vertebrae are in the best mechanically efficient position to transfer forces through them. In this position with the breath alone you can invite more space between the vertebrae and lengthen the crown of the head away from the tailbone. Once all of the above is established by being able to perform the essential or level 1 Pilates repertoire then the breath focus can become the inhale.
Inhalation brings awareness to the deeper layers of abdomen activates the diaphragm. The diaphragm is responsible for inhalation as its fibers contract and pull downwards, causing more room in the lungs for air to be drawn in. The insertion of the diaphragm is right next to the iliopsoas. The iliopsoas is the strongest hip flexor and acts alike a mediator between the diaphragm and the pelvic floor. It and the illiacus muscles are muscles responsible for the posture of lumbar spine and pelvis as the iliopsoas inserts directly on to the lumbar vertebrae and the illacus on the ilium or the “bowl” of the pelvis. The psoas is an essential muscle to establish true balance of the body. Balance from front to back and side to side, like a guy wire aligning legs, hips and spine and the only muscle that attaches the spine to the leg as it crosses the hip attaching the head of the femur. It ties the legs to the lumbar spine and the diaphragm. I have heard runners express how the legs are truly your lungs. The iliopsoas and illacus are located in the root charkra, represented by the lotus flower and that is what these muscles are shaped like. The root charkra is for grounding and security, exactly what these muscle do for the body, Staugaard-Jones, J., The Vital Psoas Muscle, Connecting Physical, Emotional and Spiritual Well-being, , Lotus Publishing, 2012.
The diaphragm is active on the inhalation. But the activation of the diaphragm is complex, causing more intrinsic things to happen than the exhalation which causes more changes nearer the outside of the body in the rectus abdominus, external obliques, thoracic spine, and rib cage. The diaphragm is a mushroom shaped muscle that distends towards the pelvis responsible for increasing the lung volume creating a vacuum into which more air is drawn the lungs. The diaphragm insertion is close to the psoas and T12 thoracic lumbar junction. This point in anatomy is relevant as many muscles insert here the quadratus lumborum, the obliques, and the transverse abdominus. In the spine it is here the curvature changes from convex to concave or from thoracic to lumbar vertebrae important part in the spine for energy transfer. In movement analysis this point is significant as the facial lines intersect here crossing the body from left to right and top to bottom. A significant power point of the body Nichols, V., Body Matrix Pilates teacher training course, 1999.
During inhalation the diaphragm pulls downward pushing the organs into the stomach muscle hammock and also into the pelvic floor which accommodates by widening. The stomach muscles and the pelvic floor work together to support and balance activity of the diaphragm. When we inhale the lungs and ribs widen, the stomach and pelvic floor muscles stretch. During exhalation stomach muscles and pelvic floor contract to push the organs upwards again.
This system functions so well that is has permitted mammals to get into a position of domination on this planet. Mammals can even breathe with a minimal thorax movement, with just the diaphragm and the stomach and pelvic floor muscle (E. Franklin, 2003, p 61 Pelvic Power, Princeton book company Publishers).
” The diaphragm is also important for helping stimulate the organs, as it is connected to the organs via a facial sheath called the falciform ligament and the median umbilical ligament which passes into the round ligament of the liver. The round ligament of the liver changes at the lower edge of the liver into the falciform ligament of the liver. This runs between the two lobes of the liver to the diaphragm The diaphragm is hung from the heart, and the heart itself is hung from the cervical spine via ligaments. Following the line along the umbilical ligament is the bladder, so really the whole length of this ligament the bladder hangs from the neck.” Franklin, E.2003 p 90 Pelvic Power, Princeton book company Publishers, 2003
” When inhaling the kidneys lower with the diaphragm, when exhaling they move up. Often the kidneys lower too much which heightens the pressure on the urethra and the bladder, producing incontinence. The kidneys are not held in place by ligaments but are supported by the sucking effects of the diaphragm and held by neighboring organs. The kidneys and the bladder are central importance to the strength of the pelvic floor, as well as problems of the knees, the sacrum and the hips. The state of these organs also strongly influences the balance and posture of the pelvis as well as sexual energy. The kidneys are partially covered by the two lowest ribs and lie behind the transverse abdominal muscle, the psoas and the quadratus lumborum. Every 45 minutes they filter all our blood, distribute hormones and modulate the chemical composition of blood. The adrenal glands are small endocrine glands that lie atop of the kidneys. They consist of cortex and medulla. The medulla produces the well-known hormone adrenaline, which can put our body into a state of great readiness, efficiency and fitness. Movement of the diaphragm or breath work can stimulate the kidneys, bladder and the adrenal glands” (Franklin, E, 2003 p 84 Pelvic Power, Princeton book company Publishers).
“The back extensors multifididus is the antagonists of the pelvic floor muscles. Multifididus meaning split many times muscle. Without a strong active pelvic floor the back extensors do not benefit from the pelvic floor movement. When we activate the pelvic floor tighten the pelvic floor and pull together the tuberosities through a moving forward of the coccyx the lower spine flexes which stretches its muscles. If the floor weak then the back doesn’t enjoy this active stretching or flowing and gliding apart. The consequences is lack of blood supply and therefore tension in the back muscles. Inhalation pushes the organs down into the pelvic floor while exhalation lifts the organs and contracts the pelvic floor.” (Franklin, E., 2003 p 66 Pelvic Power, Princeton book company Publishers, 200).
Blocking breath raises the stress levels which in turn has a negative effect on muscles, organs and continence. ” Stress lowers the tension in the muscles of the organs through the effect it has on the autonomous nervous system thus this is one reason why people have a paunch tummy in spite of rigorous muscle training” (Franklin, E., 2003, Pelvic Power, Princeton book company Publishers). Stress takes its toll on our body. We must breath fully inhaling and exhaling to release stress and have properly working organs. We must integrate our movement with breath to release fascia, stimulate organs, improve posture, reconnect with our muscles and deepen strength all of which will help us move from our core.
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