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.

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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.

 

 

PILATES AND FITNESS FOR SKIING AND SNOWBOARDING

Pilates fitness skiing snowbaording barcelona bienestar

Pilates and fitness for skiing and snowboarding

I am a snowboarder. Anyone who either snowboards or skis will know that the two sports, whilst closely related, are very different in technique and especially mentality. One thing they do have in common (apart from snow) is the training that you need to be able to enjoy the coming season on the slopes.

Specific training for skiing and snowboarding

Skiing and snowboarding bring their own special demands on the body. If these demands are not adequately considered, then the skier or boarder, whatever their level, will reduce their performance potential, and thus reduce their enjoyment. By carrying out a specific training program, benefits can be gained such as:

• Improve endurance, so ski and board for longer
• Improve strength in the appropriate muscles
• Improve flexibility and agility
• Improve balance and control
• Reduce the risk of injury by strengthening areas such as the lower back and knee joints and muscles.

The fundamental skills needed to ski or board successfully are balance, rotary movements, edging movements, and pressure control. Most muscles of the lower body are used, as are the abdominal muscles and some upper body muscles. A planned training program carried out during the off-season can make dramatic improvements when the season arrives. It is also improtant to learn warm-up and warm-down routines which you should use before and after you ski.

Chris Snowboarding 21.2.14 2Happiness is a snowboard in your hands.

Why Pilates?
In order to complete a turn, there must be adequate strength in the core, buttocks, lower back and legs. Flexibility is needed, especially in the hips. We use specific Pilates exercises to target all these areas.

Pilates is a revolutionary full body conditioning program, which focuses on training the mind and body to work together more effectively and efficiently. Pilates dramatically transforms the way the body looks, feels, and performs. It incorporates modern exercise science and rehabilitation principles, eliminating contraindicated movements while emphasizing neutral alignment, core stability and peripheral mobility. It builds strength without excess bulk, creating a sleek, toned body and a flat abdomen. It teaches body awareness and good posture. Pilates improves flexibility, agility and economy of motion, and is a safe form of movement making it optimal for clients that need to rehabilitate injuries.

Pilates exercises train several muscle groups at once in smooth, continuous movements. By developing proper technique, you can actually re-train your body to move in safer, more efficient patterns of motion – invaluable for injury recovery, good posture and optimal health. No other exercise system is so gentle to the body while giving it a challenging workout.

Injury Prevention
Skiing and boarding place great demands on the lower body, which can lead to overuse injuries. The most obvious place for such injuries is the legs, and especially the thighs. It is not so obvious that the core has a vital role to play in keeping the body upright and balanced, and enabling the hips to turn.

The shoulders and back can also become fatigued, and are prone to falling injuries. Such injuries can be reduced by strengthening these areas. This also applies to hand and wrist injuries, which can again be reduced by strengthening the forearm and wrist.

The time to start training for the coming season is now. If you are in Barcelona, then give me a call because Barcelona Bienestar offer specific training on a group and individual training basis. Sessions take place on the beach, in our studio or at client’s homes.  (If you’re in Revelstoke give Samantha an email – group and private Pilates training sessions available).  

There are other functional exercises that great as well, and they can be done on the slopes as a warm up. Check out my video below. I shot a sequence of Pilates/functional movements in La Molina last year.

I love the sun and the sea, but I love the snow just as much. This is one of the many reasons why I love living in Barcelona. Where ever you live or plan to ski or snowboard, you really must start to plan your fitness routine now, before it’s too late.

Origianl article written by:  Chris Hunt, an international Pilates presenter and educator based in Barcelona, Spain. He is the creator of Pilates EVO©, bodyFUNC©, and CEO of Pilates Rehab Limited and Sport Core Strength.

 

 

 

 

 

Integrated Medicine ?

herbal-remedies-for-colds-flu 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.

Note: If you see any typos or corrections please email your findings or comments to samanthatreed@hotmail.com

Research Study; “Clinical guidelines for indentifying those who benefit most from Pilates training”.

There aren’t too many clinical research studies on Pilates training.  Below please see a clinical study conducted by a Lise Stolze MPT, MSc, doctoral student in orthopaedics at Rocky Mountain University of Health Professions, Colorado.  Conducted with guidance of Brent Anderson PT, PhD, OCS, President, Polestar Pilates Physical Therapy and Polestar Pilates education.

“Research study showing clinical guidelines for identifying those clients who will benefit most from a Pilates program by one of Polestar’s senior Educators”
by Lise Stolze, Published in JOSPT in 2012.

Background:
Pilates-based exercise has been shown to be effective for patients with LBP, however no work has previously been done to characterize patient attributes for those most likely to have a successful outcome from treatment.
Methods:
Ninety six individuals with non-specific low back pain participated in the study. Treatment response
was categorized based on changes in the Oswestry Disability Questionnaire (ODQ) scores after 8 weeks.
An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty seven variables measured at baseline were analyzed with univariate and multivariate methods to derive
a clinical prediction rule for successful outcome with Pilates exercise.  Accuracy statistics, Receiver Operator Curves (ROC), and regression analyses were used to determine the association between standardized examination variables and treatment response status.
Results:
Ninety five of the 96 participants completed the study, with 51 (53.7%) achieving a successful outcome.  A  preliminary clinical prediction rule with 5 variables was identified: total trunk
flexion ROM of 70 degrees or less, duration of current symptoms of 6 months or less, no leg symptoms in the last week, body mass Index (BMI) of 25 or greater, and left or right hip average rotation of
25 degrees or greater. If 53 or more of the 5 attributes were present (positive likelihood ratio 10.64), the probability of experiencing a successful outcome increased from 54% to 93%.
Conclusion:
These data provide preliminary evidence to suggest that the response to Pilates -based exercise in patients with LBP can be predicted from variables collected from the clinical examination.
If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision-making in determining which patients are most likely to benefit from Pilates-based exercise.
Clinical prediction rules (CPRs) consist of combinations of variables obtained from self-report measures and the historical and clinical examinations. One purpose is to assist with subgrouping patients into specific treatment-based classifications.  Recently, CPRs have been shown to be useful in classifying patients with low back pain (LBP) who are likely to benefit from a particular treatment approach such as spine manipulation and lumbar stabilization. 16, 26, 35
Because CPRs are designed to improve decision-making, it is important they be developed and validated according to rigorous methodological standards.  Once a CPR has been derived, validated,

and shown to positively impact clinical behavior, it can be helpful in selecting the most effective treatment for an individual patient.
We hypothesized that a parsimonious set of factors would emerge from the clinical examination to identify patients with LBP mostly likely to benefit from the Pilates-based exercise.
Pilates-based exercise has gained popular ity as an option for the conservative management of LBP but the evidence for its effectiveness is sparse and inconclusive.44
Lim et al 44 concluded that the relatively low quality of existing studies and the heterogeneity of studies they reviewed suggest that results should be interpreted with caution. However, the few studies that have examined homogenous subgroups of patients with specific exercise
programs have been promising.35, 42, 58
Hicks et al35 established a preliminary clinical prediction rule for success with stabilization exercises.
The purpose of our study was to derive a preliminary CPR for identifying a sub-group of patients with LBP likely to benefit from the Pilates-based exercise.
In this study, the 54% pretest probability of success shifted to 96% with a positive LR of 23.37 if a subject exhibited 4 or more of the 5 criteria in the preliminary prediction rule, and to 93% with a positive LR of 10.64 if a subject exhibited 3 or more of the 5 criteria in the CPR. However, the 4+ level
of the CPR was so specific that a relatively small percentage of subjects in the study (14%) met that criterion. For this reason, we selected the 3+ level as a clinically sensible threshold because 42% of subjects presented with 3 or more tests positive.  If this CPR can be validated with a randomized controlled trial, recommending the 3+ level anticipates that this rule may help suggest appropriate treatment for about 40% of patients presenting for treatment who are similar to subjects in this study.
Pilates-based exercise as a viable treatment option for patients with LBP. 4, 44, 65
Predictor Variables:
This CPR includes 5 predictor variables that would require minimal time to assess as part of a comprehensive patient evaluation.  1) BMI is a value calculated based on height and weight measur
ements and is significantly correlated with body fat content.54 A BMI of equal to or greater than
25 is considered overweight and was a strong predictor of success (p < .001) for subjects in this study. Research has demonstrated that high BMI has a strong association with LBP, 34, 67 and that being very overweight can change static and dynamic spine mechanics, including increased anterior pelvic tilt and limited thoracic flexion during forward bend activities 75.  Both of these mechanical changes could adversely affect the stresses placed on the lumbar spine.
2) Another predictor for success was total trunk flexion ROM less than or equal to 70 degrees.
3) Evidence exists for a relationship between hip joint flexibility and LBP.17, 25  Hipjoint ROM discrepancy was a variable in the preliminary CPR developed for spinan our study, subjects who had

a mean internal and external hip rotation of less than or equal to 25 degrees in either hip tended not to be successful with treatment. Restricted hip rotation ROM has been established as a clinical indicator of hip osteoarthritis 2, 40 and may complicate the treatment of LBP in those with this comorbidity. This is consistent with studies demonstrating that up to 40% of patients with leg pain who are treated conservatively undergo delayed surgery.
4) Symptom duration of less than or equal to 6 months was a predictor of treatment success even though 72% of all subjects in this study reported having symptoms for more than 6 months. Duration of symptoms for more than 12 weeks may be classified as chronic LBP 10
CONCLUSION
Five predictors collected from the clinical examination comprised a clinically sensible preliminary CPR to identify individuals with LBP who are likely to respond to treatment using Pilates–based exercise: total trunk flexion ROM of 70 degrees or less, duration of current symptoms of 6 months or less, no leg symptoms in the previous week, BMI of 25 or greater, and left or right hip average rotation 25 degrees or greater. If any 3 or more of the 5 attributes were present (which occurred in 42% of study subjects), the positive LR was 10.64: sufficient to yield a large shift from pre-test to post-test probability for experiencing a successful treatment outcome.
KEY POINTS
Findings A preliminary CPR with 5 variables was identified: total trunk flexion ROM <70
degrees, duration of current symptoms <6 months, no leg symptoms in the previous week, BMI >
25, and left or right hip average rotation >25 degrees.   If 3 or more attributes were present (positive likelihood ratio10.64), the probability of experiencing a successful outcome increased from 54% to 93%.
Implications
   These data provide preliminary evidence to support the idea that the response to Pilates-based exercise in patients with LBP can be predicted from variables collected from the clinical examination.
Key Words:  classification, Pilates-based exercise, low back pain
The complete research article can be found at the address below:

http://polestarpilates.com/pdf/JOSPT_website_Stolze_LBP%20CPR_2012.pdf

Why Integrate Pilates into Physical Therapy.

By Kristen Reynolds From put me back together.com

Vsit_overheadwtihBall     For a number of reasons, a common challenge for entry level physical therapists is effectively implementing therapeutic exercise programs. Not all academic programs provide their graduates with a large, mental library of exercises. Athletic patients may be bored with the idea of hamstring curls or crunches, while others require modifications for such exercises because of other co-morbidities or injuries. Some patients have poor kinesthetic awareness and it is difficult to teach their bodies to feel the essence of an exercise. With Pilates being included with a rehab program makes the opportunity for therapists to progress clients back to their previous level of strength and function. Clearly, designing a safe, progressive rehab program that benefits patients with multiple impairments in a limited episode of care is no easy feat. That’s where Pilates came in.

Hip_Mobility_with_Ball

When Pilates Mat exercises were introduced to me at Active Motion
Physical Therapy, my clinical instructor had a conversation after the patient’s treatment about her impairments, functional limitations, and goals of continuing a program on her own after discharge. To sum it all up, the CI looked at me and stated “it just makes sense.” This statement holds true to me more and more each day three years later.

Completing a comprehensive Pilates teacher training program and utilizing
the method in daily practice has sincerely improved my clinical skills in regards to breaking down movements and teaching them in part and whole tasks. Joseph Pilates
developed more than 500 exercises on a handful of apparatus designed to correct alignment and balance muscle development of the entire body utilizing a variety of developmental and gravity-eliminated postures (which I recall learning specifically during PT school lab!) Impaired range of motion, muscle length, and muscle performance are all targeted through sequenced eccentric and concentric contraction. The spring-loaded equipment in particular, significantly enhances neuromuscular re-education and helps the patient actually “get it” when trying to cue lumbar or scapular stabilization. When they “get it” I take an exercise to the mat (and sometimes incorporate resistance bands) to morph the exercise into one for home.

There is always an opportunity for modification and progression to allow for patient success and challenge and most importantly, compliance. Now I split my practice and teach Pilates at OMBE, an integrative health center. A large number of my clients are those with injury or postural-induced pain that are attending acupuncture or chiropractic treatments and need a safe method to resume strengthening or those who have “graduated” from physical therapy because their short-term rehabilitation benefit has been fully utilized. Attending private sessions and small group classes under the direction of a comprehensively certified Pilates instructor is a smart solution for a lifelong fitness regimen when suffering from orthopedic or sports-related injuries.Hamstretch_HipopenrwithBand

About the Author: Kristen Reynolds is a Doctor of Physical Therapy, specializing in orthopedics and sports medicine, and a PMA® Certified Pilates Teacher.

Sean Gallagher P.T.

I have had a Pilates studio in my physical therapy practice since I opened it in 1990. The article supports the fact that patients need a comprehensive exercise program that will not only allow them the health benefits of exercise, which the research supports on many different levels. Exercise machines that have been developed to work only single muscle or to sell exercise equipment do not meet the needs of function. Since the brain integrates movement in dynamic multi-segmental symbiotic relationships trying to develop strength and flexibility through an inter connected skeletal chain with single muscle work or even groups of muscles really doesn’t address these relationships.
What I noticed very early on in my PT career was that most of my patients (80%) would not have needed PT if they had been in a comprehensive exercise program. What other exercise system available today has over 60 years of clinical practice and research (Joe Pilates always talked about his experiments and research into his method) that has continued to provide clinical affirmation for the last 45 years? Pilates is being researched more and more today and most of it is finding that it works as stated and in many instances is as good or better that what it is being compared with.

I think that this is because no other system (unless it is based on Pilates) has provided a methodology that incorporates the developmental sequence, open and closed multi-segmental muscle chain movements, Dynamic balance between stability and mobility, full ROM of every joint in the body( thus allowing for the brain to better integrate a living posture that is balanced), all while being able to make it interesting, challenging for different levels of participants and makes clients feel good after doing it. All using only a few apparatus(since most pilates equipment allows 40-80 exercises on each one their design is in line with the method – functional and integrated) with the eventual goal of self maintenance doing the mat work at home.

So besides the insurance and cost dynamics of Pilates being in a PT clinic the real reason why Pilates should be integrated into physical therapy is that it will not only help your patients with their current injuries it will help them maintain a balanced neuromuscular system that should keep them from needing a return to PT and live a much more productive and healthy life.

Terry Walters • I totally agree with your philosophy and pilates should be offered as a healing process from physicians to their patients. There are so many individuals that do not even know what pilates is.

Samantha Reed

Samantha Reed • Pilates helps people learn how to move & make work more efficient.