Category Archives: Sciatica

YOU’LL “LOVE” USING TENNIS BALLS TO “ACE” THE PELVIC CLOCK

Tennis balls can add a whole new spin on the introductory Pilates Pelvic Clock exercise.  This basic exercise uses the image of a clock at the pelvis to direct the mover to various points in space that represent the numbers of the clock and illustrates basic pelvic placement positions such as neutral (with lumbar curve) and flat back (no curve). Adding tennis balls to this exercise can improve proprioceptive awareness of pelvic placement and release myofascial trigger points in the gluteus maximus and piriformis muscles leading to better activation of core muscles  (see previous article “Addressing Trigger Points to Facilitate Range of Motion.” ) 

PELVIC CLOCK EXERCISE

The Pelvic Clock (also used in the Feldenkrais method) is a perfect beginning exercise since it illustrates how to initiate movement from the core, but can also be enjoyed by advanced students who continue to garner self-awareness from its repeated practice.  To perform the Pelvic Clock exercise, have your client lie supine with knees bent and feet on the floor (or you can prop the client’s legs on the Reformer Short Box).

 Imagine that the pelvis is a clock with the navel as 12 o’clock and the pubic bone as 6 o’clock. Move the pelvis into a posterior pelvic tilt (flat back) for 12 o’clock and then return the pelvis anteriorly to 6 o’clock (neutral pelvis) where the pubic bone and anterior superior iliac spine (ASIS) points are parallel with the floor and a lumbar curve is present. Repeat pelvic shifts 4 times or as many times as needed.

 After returning to neutral pelvic placement, move to 3 o’clock (left lumbar rotation) and 9 o’clock (right lumbar rotation). For example, you could have your client imagine the pelvis as a boat filled with people. Then visualize all the people walking to one side of the boat, so that it dips in the water to one side heavier than the other. Repeat the left and right shifting 4 times.

 The previous practice moves the client’s pelvis in a cross-like shape relative to the clock (up to down 12 o’clock to 6 o’clock, and left to right, 3 o’clock to 9 o’clock). Next explore the “X” shape on the clock going from 10 o’clock (weighted right waist flat back) to 4 o’clock (weighted reaching left buttock in neutral) and 2 o’clock (weighted left waist flat back) to 8 o’clock (weighted reaching right buttock in neutral). Repeat each sequence 4 times.

 Finally, have your client use their fingers to palpate each number on the clock starting and 12 o’clock and explore each number individually clockwise and counter-clockwise taking one to two full breath cycles at each number.  Once each number has clarity, sew them together like a plate would spin clockwise and counter-clockwise making sure the core initiates the motion, not the feet or legs. The continuous moving clock does not correspond with the breath—the client breathes when needed, not timing it to any number on the clock.

 Please note that the description of the Pelvic Clock is in the perspective of the viewer of the clock (navel as 12 o’clock).  Personally, I would prefer the clock be in the perspective of the person exercising (pubic bone as 12 o’clock), but it is not generally taught this way.  So as not to confuse people, I have conformed to standard practices.

 BREATHING FOR PELVIC CLOCK

Be sure that your client integrates breathing into this exercise. I choose to move the pelvis on the exhalation, as it is easier to feel the activation of the pelvic floor and the transversus abdominis to assist with the transition through core initiation. Be aware that there is a tendency for the client to move the pelvis from a distal initiation by pushing on the feet or legs, so cue your client to feel the pelvic floor and engage the transversus abdominis prior to moving. For example, inhale at 6 o’clock and move to 12 o’clock on the exhalation using core muscles. Hold 12 o’clock on the inhalation and then move back to 6 o’clock on the exhalation.  You may choose to slow the exercise down spending more time on each number to further activate and deepen the abdominals with a cumulative dropping of the abdominal wall on each breath.

 PELVIC CLOCK WITH TENNIS BALLS

Place a tennis ball approximately 4-5” below the posterior superior iliac spine points (PSIS) on the right and left sides of the sacrum in the fleshy part of the buttocks. The target for the tennis balls is either the gluteus maximus or piriformis trigger points. Ask your client to place the balls so they are placed symmetrically right to left and hit these tender trigger points. I usually stand up and demonstrate the ball placement visually before lying supine. Although the balls will likely be uncomfortable, discontinue if the discomfort is intolerable. Hitting the right trigger points may require a little fishing, so tell your client that they may move the balls at any time. Since there is more than one trigger point to address, suggest that the balls be moved if the initial trigger point becomes comfortable.

 Perform the Pelvic Clock as per the instructions above. The objective is to keep the gluteus maximum muscles relaxed as the pelvis is moved to each number on the clock. This will require breathing, concentration and core initiation.  Many people tighten the gluts for stabilization, which can lead to tension in the low back and hip flexors.  Pelvic Clock with the tennis balls illustrates quickly if the gluts are being used since they dig into the muscles on each movement. This helps the user to let go of the gluts and focus instead on the deeper core muscles of the pelvic floor, transversus abdominis and multifidus muscles. The tennis balls also inform the user when the legs or feet initiate the movement since there is more tension over the balls.

 The Pelvic Clock exercise will likely be slowed down when using the tennis balls since it takes time to relax the tension in the piriformis and gluteal muscles. Have your client imagine the buttocks are like honey melting over the tennis balls. The focus is on the journey from clock number to number feeling the tennis balls almost being absorbed into the gluts.  For example, if an ant were walking across the ball, it would take a lot of steps and every bit of the ball surface would be noticed. That should be the feeling experienced when using the tennis balls with Pelvic Clock.

 Point out to your student that the abdominal muscles play a bigger role in a posterior pelvic tilt (12 o’clock) and the lumbar extensors initiate the movement back toward neutral (6 o’clock). Many people have never isolated and observed these muscles in action. Also cue your client to be aware that the low back should feel a stretch when shifting to 12 o’clock where the tailbone feels as if it is reaching toward the back of the calves.  Often people will just push the low back toward the floor with tension and miss out on the experience of the simultaneous contraction in the front waist and lengthening of the back.

 For a group Pilates mat class, the tennis balls are an inexpensive teaching tool that can multi-task. They release the myofascial trigger points that can often interfere with proper core initiation, and provide improved proprioceptive awareness to the user. Always give the option to students to do the Pelvic Clock exercise without the tennis balls, but my feedback from students has been that the addition of the tennis balls is beneficial.  After doing the Pelvic Clock exercise with the tennis balls, remove the balls and your students will be amazed at how comfortable and easy it is to feel neutral pelvis placement. 

 Once you have taught your students the Pelvic Clock, you can reference the clock numbers for instruction in the Pilates matwork.  For example, during a right Single Leg Circle, you can instruct your students to focus on 3 o’clock to stabilize the pelvis and counterbalance the weight of the right leg.  In Double Leg Stretch you might suggest that the students keep a lengthened 12 o’clock imprint.

 The Pelvic Clock exercise is an effective tool for teaching your students pelvic placement, core initiation and integrating breath with movement.  The use of tennis balls takes the exercise to another level adding myofascial release of gluteal muscles and improved proprioceptive awareness of the pelvic region. Many people are unaware on the tension in the superficial gluteus maximus when deeper core muscles are engaged to shift the pelvis placement. The tennis balls alert the user to unwanted gluteal tension prompting relaxation and proper deep core activation of the pelvic floor and transversus abdominis. Once the gluteal tension is released, the subtle shifts in pelvic motions can be observed and the deeper core muscles identified.  Tennis anyone?

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SENTIENT SITTING STARTS WITH THE PELVIS

Cognitive awareness of the subtle shifts of weight on the pelvis can make a difference between being able to sit upright or collapsing into twisted slumping. Implementing this proper pelvic alignment in a seated position requires each individual to consciously recognize where the weight shifts on each of the ischial tuberosities or sit bones If your client can experience the various options of front/back, side/side, and right/left of the pelvis movement repertoire, then choosing “center” becomes a relative position and easier to replicate. These learned proprioceptive skills can correct dysfunctional patterns, reduce back pain and create body symmetry with improved muscular balance.

SHIFTING WEIGHT ON THE ISCHIAL TUBEROSITIES
Although the following exercises are basic movements of the lumbar spine, I came to understand them better through the Arch and Curl Series in GYROKINESIS® and GYROTONIC®. (Learn more about GYROTONIC® under my blog “Spice Up Your Pilates Palate with GYROTONIC®.” ) The Reformer, rotator disc and dowel are used in the following exercises for improved awareness and feedback. If you do not have these tools, only a firm chair or short stool is needed and hands can be placed on the hips. It is important to sit on the edge of the seat with the knees at approximately a 90-degree angle and the feet and pelvis sharing weight

Yoga blocks needed for shorter legs on Reformer.

Unhook all of the springs on the Reformer and instruct your client to sit on the edge of the carriage on a medium-sized 12″ rotator disc facing the footbar holding a medium-size dowel across the sacrum. Advise your client to be careful when sitting down since the carriage has the potential to slide away without the springs. If your client is too short, you may require the use of yoga blocks or some other prop to bring the legs to a 90-degree angle.

FRONT TO BACK: MOVING ON THE SAGITTAL PLANE
 Eric Franklin instructs how the sacrum moves when shifting the pelvis forward and back in his book Conditioning for Dance (page 92) with helpful tactile cues.

“1. Place a hand on the sacrum, and detect the bumps on the back of the bone. These bumps are the spinous processes of its five fused vertebrae. To feel the movement of the sacrum, it is easier to touch the adjoining bones that are easy to feel under the skin, the tailbone and the lumbar spine.

2. Place the middle finger of one hand on the tip of the tailbone, and place the middle finger of the other hand on the spinous process  of the fourth or fifth lumbar vertebra.

3. Tilt the pelvis forward, and notice how the lumbar spinous processes move forward and the tail moves back. The sacrum is doing a forward rotation movement called nutation (deriving from the Latin for nodding.) At this point the sacrum is only doing the first half of a nod…

4. Tilt the pelvis backward, and notice how the sacrum moves back and up. This movement is called counternutation, the second half of the nod…

5. Tilt the pelvis forward again and notice that nutation is linked with the spreading of the sit bones.

6. Tilt the pelvis backward, and notice that counternutation is linked to the converging of the sit bones.

7. Notice that nutation causes the lumbar spine to extend (the feeling is hollowed spine), while counternutation causes the lumbar spine to flex (the feeling is rounded spine).”

Anterior pelvic tilt.

Posterior pelvic tilt.

To give my clients the feeling of the pelvis as a whole, I describe an anterior pelvic tilt (sacral nutation) as a “Christmas tree” with a wider base at the sit bones and narrower feeling at the top of the pelvis (ilium) and a posterior pelvic tilt (sacral counternutation) as a “funnel” with a narrower base and a wider feeling at the top of the pelvis.

The benefit of being on the Reformer without springs is that the carriage should move slightly backward in the anterior pelvic tilt and forward toward the calves in the posterior pelvic tilt. If the carriage does not move front and back, then the initiation of the movement is incorrectly occurring at the rib cage instead of being driven by the pelvis. The dowel also assists in helping your client observe and feel the shifting pelvis. Notice if your client tends to put more weight on one sit bone or the other when moving, but do not mention it yet.

After moving a few times between the front and back positions have your client find neutral pelvis (in between the practiced positions) with the weight slightly forward on the sit bones (ischial tuberosities) and the feet weighted on the floor. In the neutral pelvis position, there is a equal activation of the transversus abdominis in the front of the waist and the lumbar multifidus in the low back to create an equal supported lift much like squeezing toothpaste from both sides on the bottom produces the lift out the top. This abdomen/low back gentle lifted squeezing can also be felt at the sides of the pelvis. This comfortable lifted synching feeling (much like pulling the string to tighten a duffel bag) is important to hold and maintain the neutral pelvis position once it is located and experienced.

Ask your client to be in this neutral position with the least amount of effort. If there is excessive muscular tension held in the body, then proper placement cannot be maintained over time. Help your client find the relaxed supported placement that can be held habitually. (See “The Use of Imagery to help Your Client Find Lift Through the Core.” for ideas about helping your client feel core engagement through imagery.)

Repeat the exercise again and have your client notice the weight on each sit bone while rocking front to back. Have your client put more weight on the right side, then the left, followed by weight equal in the center. The hard rotator disc makes this easier for your client to feel shifts of weight. If you previously noticed your client shifting more weight to one sit bone in the exercise, ask him/her if one side or another is more comfortable and see if it correlates to your previous observation.

If your client tends to sit toward one side, suggest that he/she check in throughout the day to see if this is a habit. Your client is best equipped to make this correction and develop the new habit through conscious attention and a commitment to change.

SIDE TO SIDE: MOVING ON THE CORONAL/FRONTAL PLANE
Next ask your client to rock from side to side feeling each sit bone (the carriage will be stationary). Have your client push off of the right sit bone to sit up taller moving the head toward the ceiling as if making space for the kidney and notice the activation of the right lumbar multifidus muscles. Raising the arms overhead can sometimes make the firing of the low back muscles easier feel. Repeat it to the left.

Both sit bones weighted with lateral rib shift.

After about 5 sets, have your client now try to lift the ribcage laterally to the right while sitting up tall, keeping weight on BOTH sit bones. Have your client observe now that both sides of the lumbar multifidi are activated—it is like having two “rocket boosters” (one on each sit bone) to lift the ribcage off the pelvis instead of one. This equal activation creates a more powered balanced lift.

It may be difficult for your client to keep both sit bones weighted in the lateral ribcage shift. Suggest that the bones of the pelvis are like a boat weighted in the water. Keep the boat heavy while the muscles and flesh lift upward into the lateral shift much like the vertical mast. You may see a crossover from the previous exercise. For example, if you client felt more comfortable with the weight on the right sit bone moving front to back, he/she may tend to lift the left sit bone as the ribcage moves sideways to the right since it is not used to bearing weight.

ROTATE RIGHT TO LEFT: MOVING ON THE TRANSVERSE PLANE
 

Right lumbar and thoracic rotation.

The client is sitting on a moving rotator disc so that lumbar rotation of the pelvis is proprioceptively accentuated. Driving the disc is somewhat like moving the wheel of a car: pulling down on the wheel to make a right hand turn would cause the left side of the wheel to move upward, much like moving the right sit bone backward to rotate the disc clockwise would move the left sit bone forward to further rotate the disc clockwise. Have your client rotate the disc to the right while keeping both knees still and holding the Reformer carriage in place. Most people will shift to one sit bone on rotation so instruct your client to drop the lifted sit bone (“sit the boat in the water”). Be sure to initially isolate pure lumbar rotation by keeping the chest facing forward in place. Repeat to the other side. Watch to be sure your client keeps weight on both feet as there is a tendency to roll one knee inward during the exercise.

After your client experiences moving the disc in rotation, add the thought of siting tall during this twist and to engage the transversus abdominis (lower abs) and lumbar multifidus (low back muscles) so that there is a feeling of lifting upward through the spine. Just as it is necessary to bend the knees and go into the floor prior to jumping, the pelvis must first be weighted on the disc in opposition to the lifted ribcage. Both “rocket boosters” (ischial tuberosities) should be connected in a centered pelvis giving more power to the lift since both sides of the back will be active.

Incorrect lateral rib shift with one sit bone weighted.

Now move the pelvis, chest and head in succession during the rotation. It should feel like a spiral staircase moving upward. Notice if the ribcage moves laterally off the pelvis during rotation and indicate the necessary correction to bring the ribcage centered over the pelvis—if the ribcage is shifted, odds are that one sit bone will also be lifted. Just as in stacking blocks, the lumbar and thoracic sections of the spine are structurally solid on top of each other, rather than precariously stacking on the counterbalanced edges.

Conscious and attentive self-awareness of pelvic placement in a seated position can improve overall posture. Just as a building needs a good foundation, the spine’s structural integrity is dependent upon a solid base. Your client can create new sitting habits, but must first have the knowledge and experience of how to find center. The best way to experience center is through its contrast of shifting weight off-center. Once the relative position of center is understood, and the weight over the ischial tuberosities felt, your client can consciously maintain balanced alignment through daily practice.

Using Thera-bands® to Stretch the Possibilities

Stretching leg muscles with a Thera-band® improves flexibility in the legs, but also relieves tension in the hips and low back with minimal time and effort. The Thera-band is a resistance exercise band available in a variety of strengths indicated by color (the thicker the band the stronger the resistance). Bands are often used in physical therapy rehabilitation, since patients can maintain a consistent practice working at home and strength development can be easily monitored with the progressive color coding system. They can be purchased individually or in bulk rolls and are sold under a variety of brand names offering latex and latex-free versions. (I prefer black Cando bands.) The 50-yard roll can be cut into individual bands making it economical to provide multiple clients and mat class attendees with equipment. Although there are multiple uses for Thera-bands in an exercises program, leg stretches yield quick results and are easy for most clients to practice.      

As with any stretching program, consistency with a long-term commitment to practice is essential. Using a pain scale of 1-10 with “10” being the most intense is a good guide to check in and keep clients on track. As a general gauge, “7” on this scale means your client will be actively stretching without strain or pain, but individuals vary and some may require less intensity. Microscopic tearing of the muscle fibers is a risk for overstretching and the scar tissue that develops can lead to a decrease in muscle elasticity so “more” is not always better. If your client has strained a muscle, stretching may cause further harm, so be sure no chronic condition exists prior to starting a new routine.      

Stretching after warming the muscles is preferable so a brief warmup such as a short walk can be useful to elasticize the collagen fibers prior to stretching. Stretches should be held for thirty seconds to a minute and should evolve; as the stretch is held, the intensity diminishes requiring the limb to move into a greater range to maintain the “7” on the pain scale. These stretches will always be a bit uncomfortable (they should not be painful). Regular practice will increase range of motion and the discomfort will be experienced similarly in the newer more flexible range.      

The stretch reflex is the body’s protective tool to prevent muscle fibers from overstretching and helps protect the tendon origins and insertions from being over-pulled. When the stretch intensifies, the muscle being stretched contracts to prevent it from being forced beyond normal range. Putting the muscle being stretched in contraction helps to inhibit this reflex and can make the process safer and more comfortable. For example, when stretching the hamstrings with the Thera-band, press the leg slightly toward the floor to engage the hamstrings while pulling the band with the hands bringing the leg closer to the chest.      

Conscientious breathing will allow the body to relax with the stretch. Breathe into the tension of the stretch on the inhalation and let it go on the exhalation. This push/pull quality (pushing the limb and pulling with the band) applies to all of the following stretches and will make them feel more like pushing through peanut butter or working with taffy rather than the slack feeling of hanging in a hammock.     

Although the following descriptions indicate which hand to use to hold the band, this is a personal choice based on comfort and body limitations. For example, if your client has arthritis a two-handed hold might be more comfortable or Thera-band exercise handles  could be used to reduce grip tension.     

BAND STRETCHES   

  • Calf

The objective is to stretch the gastrocnemius and the soleus  muscles. Place the band with its full width across the metatarsals (don’t let it bunch up like a tourniquet) and hold each side of the band in either hand. Make sure you do not have a “death grip” on the band or your fingers will fatigue too quickly. Inhale—plantar flex the ankle moving the metatarsals (or ball of foot) into a demi pointe (half point) while spreading the toes. Exhale—dorsiflex the ankle and keep the toes spread. Repeat this approximately five times making sure to keep the hip of the stretching leg pressing into the floor, so the initiation of the movement starts at the core with the ankle being the end result. Variations of this stretch include ankle inversion, eversion and circles. Be careful on inversion to press from the fifth (pinky) metatarsal straight from the body without “sickleing” (shifting medially). A sickled foot is an instable ankle twist waiting to happen in the future, because it lacks strength. The objective of this exercise is to develop ankle strength and flexibility in the calf. This kind of ankle work is very useful for ballet dancers trying to achieve more articulation in their feet.  

  • Hamstrings 

The objective is to stretch the semimembranosus, semitendinosus and biceps femoris muscles. After working the ankle in the above exercise remain in the dorsiflexed position. Inhale—press the thigh toward the floor slightly to activate the hamstrings while keeping the band pulled toward the chest. Exhale—pull the leg closer to the chest while retaining some tension in the hamstrings as if still trying to lower the leg to the floor. Never “yank” on the leg. This stretch can be performed with a bent or straight knee. Both are useful and stretch either the belly of the muscle or the back of the knee. If the knee is bent, keep energy reaching through the heel toward the ceiling so the stretch remains active. This stretch is like a tug of war with the heel being one team and the ischial tuberosity (sitbone) being the other. Both sides need to actively pull on the rope.  

  • Inner Thigh/Adductors

The objective is to stretch the adductor magnusadductor longusadductor brevisgracilis and the pectineus muscles.  It is sometimes more comfortable to hold the band in the same hand as the working leg—left hand holds the band when opening the left leg so the right shoulder can stay open and relaxed on the floor. Open the leg laterally while externally rotating the hip joint. The opposite side of the pelvis should remain on the floor and the body should not roll toward the open leg. If your client is unable to keep the opposite hip down, bend and externally rotate the knee of the leg on the floor to provide a little more leverage in the counterbalance. Be sure the chest presses into the floor and the abdominal muscles are actively engaged. If the abs are not engaged and the ribs lift off the floor, your client may push the head into the floor for leverage creating a discomfort in the neck and shoulders. Use the same push/pull tension strategy as explained in the previous stretches (inhale while creating tension and exhale as the stretch increases). As the leg moves wider and externally rotates, the foot moves closer to the ipsilateral ear, but the hip should remain anchored and the pelvis square. There is a tendency for people to hike the hip in an effort to achieve greater range of motion. A hiked hip does not stretch the inner thigh more—it is like the tug of war image used before except one team walks forward and the other walks backward as they pull apart. The hip must remain down to get the oppositional energy flow.   

  • Outer Hip/Abductors

The objective of this stretch is to stretch the gluteus mediusgluteus minimus and tensor fasciae latae muscle down into the illiotibial tract. Move the leg medially across the center of the body until the hip slightly lifts off the floor, but not so much that a full twist occurs in the lumbar region. It is not important for the leg to reach across the body very far, the stretch occurs when the hip pulls back into the floor (the foot in the band remains held in space and the hip pulls downward in opposition). Having the band in the opposite hand of the leg that is stretching contributes to this opposition. Inhale—pull on the band slightly and press the leg laterally into the band to create tension. Exhale—keep the foot held in space and drop the hip toward the floor using the internal obliques to rotate the spine. Be sure to also lengthen the waist by pulling the head and tailbone apart.     

  • Circles

The circumduction of the hip joint reviews all the previous stretches. The image of an ice cream cone can be a useful tool to mimic the conical pathway. The emphasis should be to press the hip into the floor where the ice cream would go at the tip, and then draw the lip of the cone either on the ceiling or on the walls if your client has greater range. Keep that feeling of pushing through taffy and guide your client to make sure that each hamstring/adductor/abductor position previously stretched is addressed. The leg must externally rotate each time the leg moves laterally to guide the ball in the socket of the hip joint comfortably. Correct the pathway or limit the range if your client experiences clicking in the hip joint.  Be sure to circle both clockwise and counter-clockwise three to five times each.   

  • Splits

The objective is to energize and lengthen both legs while simultaneously activating the core. The feeling should be like doing splits on the ceiling. Hold the band in both hands with an underhanded grip to encourage the shoulders to stay down. Split the legs apart with the lower leg off the floor and lift the head off the floor as well (if your client has neck discomfort keep the head on the floor). Inhale—press the thigh into the band as in the previous hamstring stretch. Exhale—pull the top leg slightly toward the chest while preventing the hip from hiking and deepen the belly scoop. Draw in the transversus abdominis deeper on each exhalation.  Hold for three to five breath cycles.

The improved range of motion from regular stretching may help decrease injuries by preparing the body for a variety of activities.   Mayo Clinic physical medicine and rehabilitation specialist Edward R. Laskowski, M.D. says,   

 “If your joints are not able to go through their full range of motion because of muscle tightness, sports and exercise activities may put an excessive load on the tissue and contribute to injury. Think of a runner with tight calf muscles and a tight Achilles tendon running up a hill. This activity requires that the ankle bend up to accommodate the slope of the hill. But if it can’t because of tightness, the runner may be at risk of getting Achilles tendon irritation and injury.”    

There is a correlation between leg stretching and improved posture in the spine. Tight hamstrings will encourage a posterior pelvic tilt eliminating the necessary lumbar curve for lifted posture (see article The Use of Imagery to Help Your Client Find Lift Through the Core). The lumbar lift and core stability available in a neutral pelvic placement is diminished with the downward pressure of the tucked pelvis. If your client experiences low back pain, leg stretching with a band may be one component in a program to improve this condition.      

Regular leg stretching with Thera-bands can improve mobilization at the hip and ankle joints better preparing your clients for whatever activities they choose. Bands are portable and require almost no storage space and are great for traveling. The leg stretch series also increases blood flow, which facilitates the body’s ability to heal and repair itself. Have your client notice the energy flow into the stretched leg prior to switching sides. Your client should be able to perceive the asymmetry of the stretched and unstretched leg. Noticing an immediate difference for the effort exerted is a great motivation to keep stretching and will keep your client consistently practicing at home. Better posture, improved range of motion, healthy blood flow…what’s not to love!

Help for Sciatic Pain

If your client complains of pain shooting down the back of her leg accompanied by tingling, or numbness, she may be experiencing symptoms of sciatica. Sciatica involves a compression or irritation of the sciatic nerve. The pain can occur for a variety of reasons, including a herniated disc pressing on the nerve roots coming out of the spinal cord into the lumbar region, or a tight piriformis muscle pressing into the sciatic nerve that feeds down into the leg. Although the symptoms may go away over time, there are exercises and stretches available to help alleviate discomfort.

 Pilates exercises that strengthen the core and stabilize the pelvis in neutral placement can decrease the downward pressure on the intervertebral discs. Think about the intervertebral discs like fluffy marshmallows. You can squish them and watch the sides protrude or you can pull your fingers apart to return them to their original shape. Being able to sit tall with muscular support for the low back in a neutral pelvis position gives you better odds at decompressing the irritated nerves if the discs bulge.

 Positions requiring spinal flexion can sometimes increase symptoms. Emphasize core strength in neutral pelvis placement found in sitting, standing, side lying, quadruped, or neutral pelvis supine positions such as footwork on the Reformer. Prolonged standing or sitting can also increase symptoms, so try not to stay in one position too long. Be sure that your client understands how to activate the pelvic floor, transversus abdominis and lumbar multifidi. Most people have never consciously tried to contract these muscles, and need to first find them in order to activate them for pelvic stabilization.

 If your client is not used to sitting up tall, activating postural muscles can cause fatigue. When her back gets tired, make sure she reaches over to grab her ankles and takes a few deep breaths to relieve any tension created in the back to prevent muscle spasms. (See post The Use of Imagery to Help Your Client Find Lift Through the Core.) Sitting in a chair with good back support can also help.

 If sciatica symptoms are present when getting out of the car, you can suggest trying a towel “tootsie roll.” Fold a small bath towel in half lengthwise and roll it up as you would a yoga mat into a tootsie roll shape. Place the towel support at the crease of the car seat to prevent the pelvis from shifting out of neutral into a posterior tilt. This roll can also be placed on a chair for additional support. Be sure that your client understands that the towel tootsie roll is used ONLY at the base of the sacrum (where the crease of the seat and backrest meet) and NOT to be placed at the lumbar spine. The towel’s purpose is to give the pelvis a feeling of rocket boosters at the base of the pelvis shifting the weight slightly forward on the ischial tuberosities, not to force more curve in the low back.

 Tightness in the piriformis muscle can also cause sciatic pain since the pathway from the origin and insertion of the muscle crosses over the sciatic nerve. Improving flexibility through regular stretching may also help relieve sciatic symptoms. The pretzel stretch is useful for stretching the piriformis and can be performed with modifications. 

Directions for the Pretzel Stretch

Lie on your back with bent knees with both feet on the floor. Place your right ankle over the left knee and clasp the back of the left thigh with both hands and pull the left thigh toward the chest. Keeping the left thigh toward the chest, inhale and push the left thigh away from the chest while simultaneously pulling the clasped hands behind the thigh toward you. The leg doesn’t go anywhere, but muscle tension is created. Exhale releasing this muscle tension and pull the left leg closer to the chest. As you do the above, it is very important to keep the sitbones (ischial tuberosities) reaching toward the floor and try to maintain the lumbar curve found in neutral pelvis. This “sitting” toward the floor feeling creates opposition in the stretch providing a better pull. You can also rock the stretch slightly from side to side. Hold the stretch for around one minute and then repeat it to the opposite side. Sitting in a chair can modify this exercise for those unable to stretch on the floor with the emphasis placed on sending the tailbone back and lifting the chest up and forward.

Although some clients will need to see a doctor for their sciatic symptoms, the improved core strength and flexibility provided by Pilates exercises may decrease sciatic discomfort. As we are not stationary beings, understanding how to stabilize the core as we move through space pursuing our daily activities can help prevent aggravation. With the proper knowledge and consistently applied tools, your client can self-correct if she slips into old habits. Although exercise alone may not alleviate sciatic symptoms, the pain experienced by sciatica is often a great motivator for even the most committed couch potato to give it a try.