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

Explaining the 2 Way Stretch of the Pilates Method

Andrea Maida owner of Pilates Andrea explains the Pilates method 2 way stretch in the following article.  Well done Andrea and thank you!

2-Way Stretch and the Anatomy of Pilates

2-Way Stretch and the Anatomy of Pilates

I’ve got a secret.

As a child I underwent a series of surgeries resulting in nerve reconstruction on one side of my body. A facial nerve was cut and reattached using an additional nerve taken from my left leg.

It has been my nearly 15 years of study and continual practice of the Pilates Method that has enabled me to “uncover” a series of weaknesses along my entire left side.

Just when you thought Pilates was about sculpted abs and a tight butt…

After many years of Pilates I began to notice a heightened body awareness that developed as I continued to train in this amazing method. Yes, ‘body awareness’ is a chief benefit of the Pilates method.

But this is in fact, an understatement.

The degree of awareness one can achieve through diligent practice of the method is staggering. It manifests in the sensation of many muscle groups working in unison – a seamless reach from the sides of your back up to the tips of your fingers, or down the entire length of the back of the body.

Left Side Story

But some muscles on the weaker left side simply did not respond in the same manner as their right-side counterparts.

Hmmm… How long has that been going on?

The Pilates exercises had revealed along the left side: a weak arch, knee, buttock, lower stomach, back muscle and neck. I remember vividly the workout that allowed me to realize each of these “separate weaknesses” was really one long chain of imbalance.

Can it be coincidence that all these parts are connected?

I decided to investigate.

Joseph Pilates himself believed (and stated vehemently I gather) that his method was 50 years ahead of its time. I completely agree. The connected muscle systems one finds in the 2-way stretch, for example, are articulated and well known today in the study of connective tissues or myofascial meridians in the body.

From Wikipedia:

“Myofascial meridians (also known as anatomy trainsconnective tissue planesfascial planes, or myofascial trains) are lines of bones and connective tissue that run throughout the body, organize the structural forces required for motion, and link all parts of the body.

The idea of myofascial meridians was first introduced by Thomas Myers in his 1997 article ‘The anatomy trains’. In his 2001 textbook Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, 3e, the term ‘myofascial meridians’ was first used synonymously with the term ‘Anatomy Trains’.

Myers claims myofascial meridians were described by German anatomist Hermann Hoepke in the early 1930s.”

From Anatomy Trains by Thomas Myers:

Anatomy Trains is a unique map of the ‘anatomy of connection’…the interplay of movement and stability.

Ooooh…the anatomy of connection. Yum yum.

My copy of Anatomy Trains confirmed my Pilates discovery. My long chain of imbalances that the Pilates exercises had revealed is officially known as the Deep Front Line. Anatomy nerds will want to check out this amazingly über-detailed and specific discussion of the Deep Front Line which I quote:

“The Deep Front Line is a key component of all things core.”

Oh dear…

The Deep Front Line (DFL) is essentially the lift up the entire front of the body: in Pilates the lift up out of the arch of the foot reaching all the way up the inner leg to the abdomen continuing up to lengthen the neck and to the crown of the head.

So the left side of my core/powerhouse/center was not doing its fair share of the work. Well this solved a bunch of ‘Pilates mysteries’ of the “Why can’t I…?” variety, but sadly it does not make me like the Snake on the Reformer even a weensy bit more.

Please realize that an involved discussion of fascia is not really my gig. I note my experience here as just one example of the depth of information, discovery and jewels that abound within Joe Pilates’ original method.

2-way stretch, yo

The anatomy of movement differs from a study of medical static anatomy. I do not promote an ignorance of the formal study of anatomy, but it does not apply in the same ways to a body in motion as it does to address specific joints, muscles or tissues in a medical setting.

The 2-way stretch is the hallmark of a body engaged in movement. In actuality there are numerous oppositional forces in play during your Pilates workout.

I am a big fan of the 2-way stretch intrinsic to the Pilates Method. So useful, yummy, simple and satisfying, it gives you a particular way of looking at your body in motion.

Teaching the 2-way Stretch

A client of mine, Janet, a former registered nurse, is trained in human anatomy. She marvels that the oppositional forces of the body in motion are quite tangible and yet unexpected given her education in the musculoskeletal systems.

Janet remarks that her knowledge of the traditional anatomy with regard to the individual muscle groups, their function and insertion points is a completely different animal to the anatomy of movement she is finding within the Pilates exercises.

It feels totally different. It feels like the insertion points for the tendons and ligaments aren’t there, the energy [of the lower body] just flows all the way down to my feet, without the different muscles being involved. This is a whole body thing as opposed to picking out an individual muscle group.

I feel like I am using my whole body together and as a result everything works much better. It just flows.

No wonder Jay Grimes has been telling me for years:

“Whatever you’re looking for, it’s in there.

 

By Andrea Maida

 

 

“How can an hour-long training session feel better than a massage?”

A Pilates testimonial from designer, writer, and activist Suzanne Dvells, on Twitter.

How can an hour-long Pilates session feel better than a massage? Beyond her status as a Master Pilates instructor Lynda Lippin possesses deep expertise in a wide range of fitness techniques.

Obliques_Biceps

She cunningly wields a light-handed, wry teaching style that is equally demanding and distracting. Somehow she manages to put her finger on the point of concern, bringing results with amazing consistency.

After just one ten session series, I now commanded basic Pilates techniques that eluded me for years in the hands of other trainers. At the conclusion of a second series, distinct changes in my posture were evident. After a third series, I boast a new body.

Thanks to her many gifts, I walk away from sessions with a fresh point of reference for a healthier mind, body, and lifestyle.”

Would you like easier movement, better posture, and a new body? Nature First Health and Wellness Center now provides Pilates training. There are a few spots left open for Pilates privates or duets, some weekday late mornings (9:30-11:30 am) and afternoons (2 – 4 pm) at 160 Main St. in Erin $ 85, with package rates available.

Want a Pilates group class instead? You can try a form-function class with light equipment on Mondays at 9:30-10:15 am or a Beginner Mat class on Wednesdays 2-3 pm. $20, with package rates available.

Contact the studio to schedule – email info@pilateon.ca or call (519) 315-4221.

Hope to see you soon in the Pilates studio !

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-segnemtal 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.

Hip Flexors vs. Abdominal Muscles

Hip Flexors vs Abdominal Muscles – Are Your Hip Flexors Taking Over Your Ab Exercises?

By Marguerite Ogle, About.com Guide  Updated June 20, 2010

About.com Health’s Disease and Condition content is reviewed by our Medical Review Board

Anterior Hip MusclesAnterior Hip Muscles

If you take Pilates classes you might hear the phrase, stay out of your hip flexors. What does that mean? And can you do it?

First, the hip flexors are a group of muscles that bring the thigh and trunk of the body closer together. You use your hip flexors in many daily activities like walking, stepping up, and bending over. Technically, the hip flexors are the illiacus, psoas major, pectineus, rectus femoris, and sartorius muscles. Obviously, we need our hip flexors. But we usually don’t need them as much as we use them in ab exercises.

     Here is the problem: When we exercise to target the abs, as we do in Pilates, we do exercises that decrease the distance between our thigh and trunk – think situps, roll up, leg lifts. Now the hip flexors are a strong group of muscles, and they try to take over. So we end up working our hip flexors more than our abdominal muscles! This is one of the ways that you can do 500 situps and not have a single one of them truly target your abs.

You know the kind of situps where you put your feet under something that holds them down and do a whole bunch of situps with an almost flat back? Guess what? Mostly hip flexors. Pilates people run the same risk with the many flexion (forward bending) exercises we do.

So how do I get out of my hip flexors?

The answer isn’t simple. A lot of us have to work on the hip flexor habit constantly. For one thing, you can’t really leave the hip flexors entirely out of most ab exercises. They are still an important part of the picture. The idea is to get the abs involved as much as you can and to keep the hip flexors from taking over.

Our first line of defense is always awareness. When you do Pilates or other ab focused work, put your attention on your abdominal muscles. Start to figure out for yourself what feels like abs and what feels like hip flexors. It might help to familiarize yourself with the abdominal muscles and their functions. Work also with being aware of how over tucking the pelvis can bring the hip flexors in to play.

Low back pain and soreness in the groin area may be signs that you are weak in the abs and over-using your hip flexors. Another clue is not being able to keep your feet and legs down when you do a sit up or roll up. Do you see the logic in that one? What’s happening there is that the abs aren’t strong enough to do their up-and-over contraction, but we’ve told the body to get the trunk and thigh closer together, so the hip flexors take over and the feet fly up. (Tight hamstrings play a role too)

To learn Pilates exercises that increase awareness and set the foundation for body mechanics that balance ab and hip flexor attend one of  Samantha Reed’s classes at Temple Fitness clinic in Medicine Hat.  Private training is highly recommended prior to joining classes.  Click on the clinic link above the register for class or private training.  Private training can be booked at Openspace Pilates, Medicine Hat or through Samantha’s web-site: Pilate Body Mechanics.

Finding balance between the upper and lower body.

One of the hardest things to achieve in Pilates and most body work, is balance between the upper and lower body or the torso and the legs. Tight hamstrings and hips can pull the pelvis and spine out of alignment making symptoms worse.  To achieve free movement of the leg while the torso remains in neutral spine, without undue stress and tension try the stretches below, photos courtesy of the Yoga Journal, March 2012.  These stretches can be challenging, thus why working with an instructor is important.  A good instructor can help you re-adjust to maximize results.  Relax and breath your way through these stretches – they will change the relationship you have with your body. 

Hamstring stretch: with a resistance band or yoga strap.  Relax the front of the thigh especially right where the thigh begins at the front of the hip. Exhale press through your foot like it is flat on the ceiling. Inhale bend knee and come out of the stretch slightly, exhale repeat. Keep lengthening sitz bones away from head and maintain neutral lumbar spine. Additions: move straight leg across mid-line of body, move outside mid-line of body staying within a range comfortable for you. Eventually complete straight leg circles, with the assistance of the band then without – keep hips stable!

Hamstring_stretch

Deep Rotator Stretch: There are 6 deep hip rotators most of them rotate the leg externally. Place both feet on the wall with legs at 90 degrees, cross right ankle over left. If you are unable to do this without twisting or hiking the hips (ie you cannot keep your hips level) push away from the wall until you can. Exhale push bent knee and lengthen sitz bones away from head, maintain neutral lumbar spine, inhale release stretch, exhale repeat for several breaths. If tight try this for 5-10 minutes on each side.

DeepHipRotators_Stretch

Hip Flexor Stretch: Freeing up the front of the hip to come.

Pilates Class and Private Training: Form Function Flow

Pilates is a total body workout which focuses on the core; back, abdomen and pelvic floor muscles.  These are the key muscle groups which protect our spine and provide basic strength and power for everything that our bodies do.  Pilates done regularly and properly can restore the natural curves of the spine, improve strength, flexibility and overall fitness.

Pilates covers a broad range of exercises.  It can be gentle and restorative level and advance to complex exercises for the training competitive athletes.  Pilate Body Mechanics classes and private training follow a form, function and flow progression or Pilates 1, 2, 3.   It’s suppose to be simple!  To see current class schedule and to register click registration or click contact to make appointment for private training.

THERAPEUTIC Pilates 0.5:  Level 1 Pilates or Form can be stepped back, making it suitable for those participating in a physical rehabilitation program or those with chronic injury.  Therapeutic Pilates eliminates excessive forward bending.  It works on establishing: a) neutral posture of the cervical, thoracic and lumbar spines, b) core stability and strength, c) hip flexor and hamstring flexibility along with d) micro-movements of the neck, shoulders, hips and pelvis to gently restore mobility.  Most often, private training is recommended prior to joining this class. 

PRIVATE training: integrates the Pilates method with Yin yoga and TRX suspension training techniques to develop a safe and effective program customized to your needs.   Private training again follows Form, Function and Flow formatting.  Classic Pilates mat training is intensified with small props; toning bands and balls, Pilates ring, stability ball and foam roller.

CLASSES

FORM Pilates 1:This class enables you to develop proper form upon which the rest of the Pilates work is developed. Form introduces the five basic principles of Pilates (see September postings) including breath, alignment, and anatomy or landmarks. It helps you build a foundation of exercises and understanding to enable you to move on to the rest of the Pilates repertoire. You will develop longer, leaner muscles, establish core strength and stability, and heightened mind body awareness. This mat-based class is relaxing, yet effective done at a gentle pace. A lot of information is covered to ensure that participants understand how it feels to do the exercises properly and get results. Often participants new to Pilates say “I felt like I really didn’t do anything” or “some of the exercises hurt my neck”. This class steps you through a safe progression to strengthen weak muscles, release tight and over-used ones and improve spinal mobility. It is recommended to start here if you are new to Pilates, new to fitness or have been referred by your health care provider.  



FUNCTION Pilates 2Often participants find a restriction in their body which can hold them back from advancing through the Pilate’s exercises. Building on techniques learned in Form, the Function class steps you through the process of how to achieve fluid mobility of the spine along with proper core strength and flexibility to progress into the intermediate and advanced exercises. Function class stretches and tones all muscles groups while working at a faster pace for a more intense full-body workout. This class will vary from session to session to include foam rollers, fitness circles, resistance rings, toning balls and bands.  

FLOW Pilates 3: Flow classes fuses STOTT PILATES® technique with other Pilates styles to include intermediate to advanced exercise sequences, flowing from one exercise to the next. Classes use STOTT PILATES® as a strong technical base but are unique and personalized depending on the group’s needs. It is best suited for those with a Pilates background who are looking for more of a challenge. Props are used throughout for added interest and intensity. It is 30- 45 minutes in length as it is conducted at a faster pace with less explanation. Flow is a well balanced, total body, strength and flexibility work-out which develops better speed and agility, with a higher cardiovascular benefit. 

To see current class schedule, to register or to make an appointment for private training go to www.pilatebodymechanics.com .