Pucker Up the Pelvic Floor

Many people think of their abdominal muscles when asked to engage the core muscles, but, unless someone has gone through pregnancy or incontinence issues, the pelvic floor muscles are a relatively unfamiliar yet critical component of core activation. Exercises that strengthen these pelvic floor muscles through isometric contractions are commonly referred to as Kegel exercises named after gynecologist Dr. Arnold Kegel. The basic premise is to “contract and release” the pelvic floor muscles, and includes variations that increase the number or duration of contractions. Using imagery and guided instructions can help your client find the core’s foundation.

The following verbal instruction series can be taught individually or in a group environment.

DIAMOND IMAGE: Describe the pelvic floor as a diamond shape consisting of points at the pubic bone  in the front, sit bones or ischial tuberosities forming the sides of the diamond, and the tail bone or coccyx at the back.

STACKING TRIANGLES: Divide the image of the bottom and top half of the diamond into two separate triangles cutting on the coronal plane and approach each section individually.

Back Triangle (both sit bones and tail bone): Instruct your student(s) to engage the anal sphincter without squeezing the cheeks of the buttocks as if stopping gas from escaping and then release. Once the area is isolated, contract with a small intensity, then medium, then large intensity contraction consecutively without release and then let go of the large contraction to start again. Do this twice through.

After this is achieved, try doing the small, medium, large intensity contraction followed by a small release with a “catch” of the contraction three times to create what feels like a small, medium, and large release of the contraction. A conscious effort must be made to reestablish the contraction each time or the release will feel like one action instead of three.

The purpose of the small, medium and large intensity contractions is to make the exercise more precise and challenging. This will make a plain isometric contraction feel like less work and easier to maintain.  Note that if you are teaching this individually, you can hold your client’s hand and mimic the intensity squeeze of the small, medium and large contraction for guidance.

Front Triangle (both sit bones and pubic bone): Instruct your student(s) to engage the urethral sphincter as if stopping urine flow without squeezing the anal sphincter or cheeks of the buttocks and then release. Once the area is isolated, contract with a small intensity, then medium, then large intensity contraction consecutively without release and then let go of the large contraction to start again. Do this twice through. After this is achieved, try doing the small, medium, large contraction followed by the small, medium and large release as done above with the back triangle of the diamond.

SIDE TRIANGLES: Now divide the diamond into right and left triangles cutting on the sagittal plane.

Left Triangle (pubic bone, left sit bone and tailbone): Instruct your student(s) to engage the left side of the pelvic floor without squeezing the cheeks of the buttocks and then release. Once the area is isolated, contract with a small then medium then large contraction consecutively without release and then let go of the large contraction to start again. Do this twice through. After this is achieved, try doing the small, medium, large contraction followed by the small, medium and large release as done above.    

Right Triangle (pubic bone, right sit bone and tailbone): Instruct your student(s) to engage the right side of the pelvic floor without squeezing the cheeks of the buttocks and then release. Once the area is isolated, contract with a small then medium then large contraction consecutively without release and then let go of the large contraction to start again. Do this twice through. After this is achieved, try doing the small, medium, large contraction followed by the small, medium and large release as done above.

FIGURE 8 IMAGE:  Now relate the front and the back to engage the entire pelvic floor in the initial diamond image (pubic bone, both sit bones, tailbone). A figure 8 or infinity sign could be drawn around the anal sphincter and urethral sphincter. Squeeze each opening individually as you would pucker the mouth to kiss or as if tightening the cord on a duffel bag and cinch them together while drawing them upward toward the internal organs as if sucking on a straw. Once the feeling of this is established, try the small medium and large contraction pattern as established on the previous preparatory sections.

Understanding the contraction of the pelvic floor is the gateway to engaging the rest of the core muscles and facilitates the engagement of the deeper transversus abdominnis muscle.  A study entitled “Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing,” on the U.S. National Library of Medicine National Institutes of Health website concludes that “Instructing healthy subjects to co-contract pelvic floor muscles results in greater increase in transversus abdominis thickness during low abdominal hollowing in four-point kneeling.”

As well as improving core stability, strengthening the pelvic floor muscles can help with urinary incontinence, but should be practiced with an empty bladder. According to the Mayo Clinc website “Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles, as well as lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.”

Guided instructions using imagery can help your students isolate and contract the muscles of the pelvic floor. Once you have established the muscle memory from the above exercises you can use the imagery in cueing. For example, “cinch your figure 8” or “suck the pelvic straw.” The mind is better able to direct the body when the target is clearly understood. Strengthening the pelvic floor builds the foundation on which the other core muscles can be explored.

Opening the Chest with Towels and Rest

Slumped posture and rounded shoulders are the result of our sedentary lifestyle with hours spent looking at computer screens. Although there are many components to correcting this multi-faceted dysfunction, passive stretching of the upper thoracic spine can be useful for addressing the pain that occurs mid-back between the shoulder blades. Gravity can do the work for your client along with towels, pillows and supports to open up the thoracic region. After your client experiences the pleasant and relaxing result of lying supine using this prop arrangement, your client will have a powerful tool to address future discomfort through home care.

A slightly posterior thoracic curve is part of a regular healthy spine, but when this curve becomes exaggerated and rounded, called kyphosis, it compresses the chest toward the pelvis reducing space for the organs and can cause back pain, difficulty breathing and nerve irritation. This rounding can occur through consistently slumped posture over time or may be a result of more serious degenerative issues, such as bone fracturing found in osteoporosis. Severe kyphosis may require the use of back braces or even surgery. The following towel technique is only for mild rounding and should be discontinued if any pain occurs.

Items Needed:

  • Extra large thick bath towel
  • Hand towel
  • Reformer Long Box or equivalent
  • Small 1″ or 2″ pillow

Optional Items:

  • Small heating pad
  • Microwavable neck wrap
  • Eye cover

I usually set up the client on the Cadillac, but a mat on the floor will also work. Fold the extra large bath towel in half lengthwise and then roll up opposite ends (like 2 tootsie rolls) until one rolls in about 1/3 of the way in and the other side rolls in about 2/3. The rounded ends should meet rolled in together with one side larger creating an evenly sloped angle, rather than two distinct steps of differing heights. This is going to be the main support under the upper thoracic spine, and your client should lie on this towel corresponding approximately to thoracic segments 3-6 with the lower side toward the neck. A good check is to look at the base of the sternum and make sure the towel is situated above the xiphoid process.  It is important to place this towel correctly to open the area of sternal concavity found in rounded back posture and to avoid overextension of the lumbar region. I use a small heating pad over this towel to help relax the back muscles.

A pillow should be placed under your client’s head to ensure that the neck is in proper alignment and that the cervical spine does not overextend with the lifting of the chest. The size of the pillow will be determined by the severity of back rounding—the greater the rounding, the bigger the head lift. Any pillow should work, but I like the Balanced Body vinyl head cushions since they come in incremental sizes.  The pillow addresses the head height, but does not provide enough cervical support. Fold the hand towel in half lengthwise and then roll it up completely to make a tootsie roll shape. Place this towel under the neck. Be sure you see a gradual descent from the lifted chest to the crown with mild extension of the upper chest to minimize the intensity of holding the position. I sometimes also use a heated microwavable neck wrap going from the back of the neck around the shoulders, but the alignment of the chest, neck and head must be maintained. A lavender-scented eye cover is also nice if your client does not suffer from allergies or claustrophobia.

It is important to elevate your client’s legs to prevent low back pain that could occur from the pressure on the lumbar region in this position. The Reformer Long Box works great for this and should be placed widthwise under your client’s legs comfortably meeting the crease behind the knees. Ask your client what furniture at home might replicate the size of the box (an ottoman, stool, low table or pillows).

Make sure your client is comfortable in this position and make any necessary adjustments—use larger or smaller towels, move towel placement, adjust neck support, etc. Advise your client that if the position becomes uncomfortable to inform you as soon as possible. This open supported position is meant to feel good. Ask your client to breathe deeply creating a little tension in the back muscles and then relax with each exhalation. When the back starts to relax, normal breathing is resumed.

After completing the five-minute period of relaxation, have your client draw both knees into the chest to stretch the low back. When he/she gets up from the table, demonstrate the setup you used, and give any specific instructions related to what you observed to allow your client to replicate the experience at home. Start at home with the same five-minute session and incrementally increase to about 15 minutes provided all goes well. One of my long-time clients uses this towel setup after doing a lot of gardening and housework and says it prevents the muscle tension she used to get after her activities. Between regular private sessions and self-care, she no longer has a pronounced rounded upper back.

Although a Pilates session for a client with poor posture would include exercises to strengthen the core and back extensors, many clients enjoy spending the last five minutes of a session in a recuperative state. I will often use the towel setup along with guided meditation or playing Tibetan Singing Bowls (see “Reward Your Client with Tibetan Singing Bowls“), but peaceful relaxing music works well too. Consistent practice of restful thoracic extension using towels can counteract slumping posture and make it easier for your client to once again straighten up and sit right.

Breaking Down the Pilates Hundred

The Hundred (100s) is one of the most widely recognized exercises of the Pilates matwork and also one of the more choreographically complex. It is the first exercise in the matwork series in Joseph Pilates book Return to Life Through Contrology, and its expansive breathing and percussive pumping arms increases oxygen exchange circulating blood and energizing the body for the exercises to follow. The name comes from the hundred pumps achieved through 10 sets of 5 arm pumps during inhalation and 5 arm pumps on exhalation. Breaking down the components of the 100s into individual sections can help students more easily grasp each element as it integrates into the exercise as a whole. This awareness improves mental concentration yielding more fluid and precise movements.

The key elements found in the 100s include quality of breath and its influence on core connection; sequence of abdominal muscle recruitment; and scapular stabilization to power the arms. I have had a few clients who initially expressed a dislike for this exercise, and later changed their minds after integrating the various parts into a more coordinated whole.

BREATHING

The fundamental element in the 100s is breath, and costal (chest) breathing  is necessary to perform the 100s effectively. During a normal breath the diaphragm contracts and descends to make more space available in the chest cavity for the lungs to fill and the belly expands. Although this diaphragmatic breath pattern is oxygen-rich, it is ineffective for the 100s since it does not provide adequate support for the lumbar spine when the legs are in the air. The abdominal muscles must be engaged during the inhalation phase of the breath cycle to counterbalance the weight of the legs. This abdominal cinching action reduces available expansion during inhalation to the chest cavity alone. If your client has only experienced diaphragmatic breathing, it may be difficult to maintain the engagement of the transversus abdominis on the inhalation and she may also feel that she does not get enough air with costal breathing alone. Therefore, proper activation of respiratory muscles must first be explored. Select the exercises most accessible and applicable to your client’s needs.

Exercise 1—Lying in Clay

Have your client lie supine and direct her to imagine she is lying in clay or sand. On the inhalation have her visualize that she squishes the ribcage down and wide making a perfect imprint. The breath should also open the sides of the ribcage so the thought of breathing through gills like a fish can also be useful. Breathe in through the nose for 4 counts and out through the mouth for 8 counts.

Exercise 2—Inner Tube

Note that some people use their facilitating respiratory muscles to do the job of the primary respiratory muscles causing the shoulders to lift and lower during each breath. To prevent this, have her imagine that an inner tube is around the chest and to breathe only in this area. You can wrap a scarf around the ribcage for better feedback. Direct her to pull air through her nose and take as many “sniffing” breaths as possible filling up this inner tube and notice the feeling of the muscles engaging in the chest. The last few sniffs will not yield more air intake, but will feel more like intercostal muscles around the ribcage firing.  After performing this sniffing breath a few times, go back to normal breathing and she should feel that it is easier to expand the chest and fill up the inner tube.

 Exercise 3—One Lung

Have your client imagine that she is breathing only through the right lung. Direct her to feel the breath in the back, front and side of the ribcage. Be sure she feels the expansion of the right ribcage through her focused attention. Then direct her attention to the left side. After feeling each side individually, have her feel the volume available when she breathes into both sides. This exercise demonstrates to your client that she controls muscle activation by thought and that greater attention can lead to an increased reaction.

Exercise 4—Physioball

If your client lacks the proprioceptive awareness of chest expansion, it is helpful to sit next to a physioball and lean into it. The physioball gives better feedback as it “dents in” on the inhalation and “pops back” into the ribs on the exhalation. Assist your client to experience breath in the sideways, dorsal and ventral positions by holding the ball pressed toward her body as she breathes.  Use a smaller ball than the one pictured if your client has shoulder issues and cannot raise the arm comfortably.

 Exercise 5—Marble

Although a full breath in the chest includes breathing into the front of the chest, this can hinder lumbar support when lying supine and holding the legs in the air. When people breathe anteriorly, they often lift the chest off the floor diminishing the supported counter-leverage necessary to hold the legs in the air. Have your client visualize squeezing a marble below the xiphoid process and hold it on the exhalation with the narrowing of the ribs. Suggest that your client take an inhalation without losing the marble. This requires the breath go to the back and to the side of the ribs in a saddle shape. The marble image keeps the thoracic vertebrae pressed into the floor maintaining the strength of the posterior pelvic tilt and support for the lumbar region.

Exercise 6—Elevator

The activation of the transversus abdominis or concept of “navel to spine” requires a cumulative response that evolves and deepens on each exhale. Clients will often tighten the abs in a bracing action as if waiting for a punch to the gut. This is a static engagement and works from the outside in. The transversus abdominis should initiate from the inside, as if the organs are inviting the abdominal wall inward. Guide your client to imagine the abdomen as an elevator. Keep the abdominals engaged holding the elevator level to let the people in on the inhalation (using a costal breath). As she exhales lower the elevator from the 3rd floor to the 2nd floor and feel the navel drop toward the spine in a relaxed action as if a soufflé were to sink in. Hold the elevator still on the next intake of air and exhale again to the 1st floor.

The work phase takes place on the inhalation trying to prevent the belly from expanding and the relaxation occurs during the exhalation deepening the scoop. Any cumulative image will work. For example, deep sea diving going lower and looking at fish; scooping ice cream toward the bottom of the container, etc.

Exercise 7—Segmented vs. Nonsegmented Breath

The 100s breathing can be done in either a continuous regular breath or a segmented breath. The regular breath would include 5 arm pumps on the inhalation and 5 arm pumps during the exhalation. There is also an option to make the breath more percussive inhaling for 5 “sniffs” and exhaling for 5 “candle flickers.” The sniff should have a quality smelling something pleasant (not sniffing a nasal spray) and the blowing out the mouth should be like blowing a candle to watch it flicker, but not blow it out entirely. During the inhalation the ribcage should open and expand into the back with each sniff (as in the “Marble” exercise) and the belly should scoop and deepen during the exhalation (as in the “Elevator” exercise). This percussive breathing can contribute to the invigorating characteristic of the 100s preparing the body for further movement, but for some the saturation of too many details can cause confusion. Choose as needed.

ABDOMINALS

The posterior pelvic tilt or “flat back” position in the 100s occurs in an ordered sequence of abdominal muscle recruitment. If the pelvic tilt is taken in steps, instead of in one action, the low back can lengthen while the abdominals shorten in the front. In contrast, if the low back is pressed into the floor without first tractioning the lumbar vertebrae apart, it creates gripping tension and restricts the ability to scoop the navel toward the spine. My clients have expressed that this sequence gives them a deeper core connection.

Inhale

Step One: Inhale

Take a costal breath expanding the ribcage and using the marble image outlined above, while holding the abdominal wall flat.

Exhale

Step Two: Pelvic Floor with Transversus Abdominis

Engage the pelvic floor at the same time as the transversus abdominis pulling the pubic bone toward the throat (sinking the soufflé as in the “Elevator” exercise). If your client has no experience with engaging the pelvic floor, the direction to stop gas and urination without squeezing the gluts can be helpful. This step happens on the beginning of the exhalation and should feel fairly relaxed. The pelvis will begin to shift into the posterior tilt, but only slightly.

Step Three: Lengthen the Spine and Clamp the Obliques

Direct the head and the tailbone to pull apart from each other to traction the lumbar vertebrae while the obliques bilaterally contract. This action takes place during the middle of the exhalation and should have a strong squeezing or cinching feel to shorten and contract the ribs toward the hipbones while lengthening the low back. The pelvis now moves into a full posterior pelvic tilt.

Step Four: Imprint

Once the above is achieved the low back should have full contact with the floor and an imprint of the lumbar spine is explored. This step occurs at the end of the exhalation and a firm connection with the floor can be felt.

Without releasing the pelvic tilt, begin the process over again until as deep a scoop as possible is achieved (see “Elevator” exercise above).

POWERING THE ARMS

All Pilates exercises include initiation from the core prior to powering the limbs. The pumping arms in the 100s must start from the connection into the back, not the hands going up and down. Firing the lower trapezius, posterior rotator cuff and triceps will intensify the striking action of the arm pump. The arms should not feel like they are slapping, but rather they should be pressing isometrically against imagined thick space such as pressing into peanut butter in a rapid motion.

Exercise 1—Depression of Scapula

Have your client lie supine vertically along a foam roller (or on the floor if you don’t have one). Raise the right hand in the air toward the ceiling and be sure your client feels the scapula either hugging the roller or on the floor and the humerus bone is weighted in the glenohumeral joint.  Elevate the scapula and squeeze the shoulder toward the ear staying connected with either the roller or floor. Lower the scapula to a neutral position relaxing the upper trapezius and then further depress the scapula with the intention of activating the lower trapezius. You may need to put your finger on the target so your client feels the inferior angle of the scapula pressing into you. Once your client feels the lower trapezius activate, have her hold the position and isometrically engage it further to increase awareness. Repeat on the left side and then do both at the same time. 

Exercise 2—Posterior Rotator Cuff

Have your client bend her elbows in front of her body to ninety degrees palms up as if holding a large tray. Stand behind your client and place the fingers of your left hand below the inferior angle of the right scapula and your right hand on her right shoulder with the thumb pressing into the infraspinatus and teres minor muscles.   Ask your client to externally rotate the right shoulder while holding the connection at the posterior rotator cuff and lower trapezius. The elbow has a slightly forward scooping feeling, and the ribs should not release. Repeat this exercise on the other side. After completing both sides ask your client to sit with her arms by her sides and hands on the thighs with the palms up. See if she can widen at the clavicles while pleasantly activating the posterior rotator cuff muscles without letting the ribs protrude. Another option is to have your client hold a scarf or piece of fabric around the mid-back doing the exact same exercise above so that the angle of the arm becomes clearer and provides a little resistance at the elbow.

Exercise 3—Triceps in Upside Down 100s

Performing the 100s in a prone position causes the triceps to go against gravity and activate more intensely. The depression of the scapula and firing of the posterior rotator cuff can also be felt more acutely in this position. Instead of pumping the arms toward the floor, your client will now be pumping the arms to the ceiling doing the exact same 100s exercise while lying prone and scooping the belly off the floor instead of imprinting into the floor. If your client does not experience neck problems, she can activate the back extensors to lift her head an inch or two off the floor keeping the gaze down to maintain the neck alignment. When the exercise is flipped back to the normal supine position, the client is able to feel a better core connection with an increase in isometric effort.

Be sure to modify the 100s to accommodate your client’s needs.

Neck Issues

The entire 100s exercise can be done keeping the head on the floor. 

Low Back Pain

One or both feet can keep contact with the floor.

Hip Flexor Discomfort

Keep the feet on the floor or bend the knees in the air keeping them close to the chest.

Rounded Shoulders

The palms can be flipped to face the ceiling on the pump to work more external rotation of the shoulder.

Difficulty Getting to the Floor

 The 100s can be performed standing alternating legs after fifty pumps or performed seated.

Advanced Challenges

If you want to challenge your client, try the 100s while lying vertical on a half or full foam roller. Do the first half of the exercise with one leg in the air and then exchange legs for the second half. A BOSU can also be used to challenge your client’s skills performed in a supine position with the low back on the arc of the dome. 

The Hundred is a Pilates basic, but can be a coordination nightmare for some new students. Make it easier for your clients to integrate the components by breaking it down into simpler more digestible parts. As with any good building project, start with a solid foundation. Practice breath, abdominal acuity and scapular awareness to build a “power house” that is all about the core.

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!

Coordination and Balance through Cross-Crawling

The coordination training we received as children through the developmental stage of crawling set the foundation for right and left brain hemisphere communication. Since the right hemisphere of the brain controls the muscles on the left side of the body and visa versa, the oppositional nature of arm and leg coordination during crawling activates the nerves across the corpus callosum connecting the two brain hemispheres. As adults, the continued integration of the two sides can result in better coordination, balance and efficient movement. The nerve networks can be stimulated and developed through cross-crawling exercises that utilize oppositional movement patterns.

Although you could crawl on the floor, the “crawling” in cross-crawling does not mean you have to replicate the movement of babies.  The main intention of every exercise is to use the opposing arm and leg. The exercises can be performed in supine, quadruped, sitting, or standing positions. It is also beneficial to try variations that move the limbs in the sagittal, coronal or transverse planes for better spatial awareness.

The following are some samples, but certainly not all the possible options. Be creative and come up with your own choreography that serves the needs of your clients. Do a few repetitions of each action focusing on the ones that are most difficult for your client to achieve. A more challenging combination is to string several different variations in a row requiring quicker changes, rather than repeating one exercise several times. Even harder is to do a combination of several different variations and then decrease the time it takes to complete the entire set.

If your client has difficulty performing cross-crawl exercises, that is an indication that coordination skills are lacking and the exercises should be added to your client’s daily practice. The senior population is one that can especially benefit by preventing falls (and possible breaks) though improved balance and coordination. In addition, clients with a homolateral gait (monkey walk) where the same arm and leg swing together can also benefit. I started doing these exercises with one of my clients who has Parkinson’s and he found them to be very useful in improving his gait and spatial awareness.

CROSS-CRAWL EXERCISES

Supine:

1) Lie of the floor with knees bent and feet flat of the floor. Cross the right elbow to touch the left knee. Return to the starting position. Repeat on the opposite side touching the left elbow to the right knee.

2) Lie flat on the floor with straight legs together and straight arms by your sides. Slide open the right arm along the floor and left leg away from the midline along the floor at the same time and return them back to the center starting position (similar to the action of making a snow angel). Repeat on the other side sliding the left arm and right leg away and back.

Quadruped:

1) Start on all fours with hands below the shoulders and your face looking toward the floor. Simultaneously reach the left arm parallel to the floor by your ear and right leg off the floor in the opposite direction behind you parallel to the floor. Return them at the same time and repeat the opposite side using the right arm and left leg.

2) Try the above exercise with variations. Reach the left arm to the side (rather than overhead) parallel to the floor and take the right leg either back or sideways off the floor to the opposite side like airplane wings (leg side off the floor is more challenging to core strength). Repeat the opposite side using the right arm and left leg.

Sitting:

1) Sit in a chair with feet flat on the floor and arms down by your sides. Step the left foot forward on the floor and reach the right arm out in front of you parallel to the floor. Return to the starting position and then reach the right foot and left arm. This exercise could also be performed with the left foot stepping to the side and the right arm reaching laterally to the opposite side or the left arm reaching back while tucking the right leg under the chair (reaching behind would not be recommended for someone with shoulder issues).

2) Sit in a chair with feet flat on the floor and arms down by your side. Simultaneously step the left foot over the right foot onto the floor, take the right hand and place it on the left hip, and touch the left index finger to the nose. Return to the starting neutral position. Repeat to the other side moving the right foot across the left foot, left hand to right hip and right index finger on your nose.

Standing:

1) Stand with legs hip distance apart and arms by your sides. Raise the right arm reaching toward the ceiling while simultaneously bending the left knee and raising the knee off the floor in a marching position. Return to the starting position. Do the opposite side raising the left arm and right knee.

2) Stand with legs hip distance apart and arms by your sides. Touch the right elbow to the left knee while simultaneously touching the back of your head with the palm of your left hand. Return to the starting position. Do the opposite side touching the left elbow to the right knee while simultaneously touching the back of your head with the palm of your right hand.

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Balance can be improved in the senior population not only with cross-crawling exercises, but also exercises that cross the midline to transfer weight from one leg to another. One of my clients was going to quit her line dancing class because she was frustrated with her poor balance negatively affecting the quick transitions required by the choreography. After about a month and a half of practicing her exercises daily at home, the transition was remarkable! She no longer had problems with her balance and was able to perform more complicated steps. She would have missed out on something fun that provided exercise and social contact had she not made a commitment to practicing.

CROSSING THE MIDLINE

The “jazz square” is useful for practicing weight transfer from one leg to the other crossing the midline. Some people teach the jazz square starting with a forward step, but crossing the midline first may be more useful to practice weight transference.

Jazz Square:

Start standing with legs together. Cross the right leg over the left and transfer the weight to the right foot. Pick up the left back leg and step backward. Shift your weight right to step sideways onto the right leg. Step the left leg forward. The weight will be on the left leg (instead of on two feet as in the beginning) and the step begins again with the right leg crossing over the left to transfer the weight to the right foot. Repeat to the same side several times. Try it on the other side starting with the left crossing over the right, step back with the right, shift side with the left foot and step forward with the right foot.

Switching sides can add a level of challenge. When changing sides the last move in the step is dropped. There are a total of four moves in the step (cross, back, side, front). Perform the jazz square three times with the right foot crossing first over the left foot first. On the fourth set only do the first three moves (cross, back, side). This will put the weight on the right foot. Start the jazz square using the left foot crossing over the right for three sets. On the fourth set only do the first three moves (cross, back, side). This will put the weight on the left foot and the pattern can begin again.

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Coordination and balance are learned skills that begin in our earliest developmental stages. These abilities are perfected through movement challenges and practice. The body in its effort to be efficient will provide less wiring for these activities if they are no longer being used. As we age our activities must reflect a movement vocabulary commensurate with the quality of life we wish to maintain. Cross-crawling exercises that integrate brain function can improve coordination and balance making us more alert and aware. Once again the old adage of “use if or lose it” rings true.

Centering on Rotator Discs

Rotator discs are a great tool to improve dancers’ pirouette form and are also useful for non-dancers to experience postural alignment along a center axis. Although proper alignment prevents injuries and allows our bodies to move most efficiently, it can be challenging to maintain this interlocking jigsaw-like relationship when put in motion. A spinning motion along a central axis using rotator discs can proprioceptively illustrate an understanding of alignment better than words ever could. Your client will either maintain balance and have a conscious experience of a “center” line through the body like that of the lead of a pencil, or she will lose balance and have a warping disjointed experience demonstrating that posture was not maintained.

Rotator discs come in different sizes and are basically two circular plates with ball bearings in the center. You will want to choose a size that is large enough for your client to stand on with both feet side by side—12” is generally good choice. In preparation for this exercise, be sure your client has a clear understanding of proper alignment in a static position and how to engage her core muscles. (See article “The Use of Imagery to Help Your Client Find Lift Through the Core.”) Do not put any person into this exercise who has difficulty balancing on one leg, as the exercise would be too advanced. Make sure to spot your client in case she loses her balance, and allow plenty of floor space around the disc free from any obstacles.

Start your client with one foot on the floor and the other foot placed on the disc. An outside or en dehors turn has the right foot on the disc and requires a counterclockwise turn with the left foot pushing off the floor and then stepping onto the disc. For an inside or en dedans turn to the right, the right foot starts on the disc with the left foot pushing off the floor and turns clockwise. Use the back foot to push off the floor providing momentum for the turn and step quickly onto the disc with both feet.

Applying too much force will throw your client off-balance or increase the revolutions to possibly make your client dizzy. It is best to start with minimal force until your client gets used to how much pressure to apply against the floor. Have your client continue to turn until the disc slows and comes to a stop. Be sure to practice both sides and change directions every few turns. If your client is a dancer, have her practice “spotting” in the turn.

Pru Turn 2The placement of the arms should be considered in the turn. You can have your client hold her arms by her sides or in front of her as if she is holding a ball. If you have a ball that is the size of a beach ball it can be useful to actually hold the ball at the chest. Note that your client might feel more secure having her arms free when first attempting this exercise in case she loses her balance.

If your client is a dancer, the arm placement can be more complicated with the preparatory position in ballet 3rd position moving to 1st position in the turn. Dancers can sometimes lose the volume of 1st position when turning, so holding the ball can give your client a sense of width between the elbows. Make sure that your client anchors her scapulae as well so that the arms are connected to the back with strength.

inside or en dedans turn

inside or en dedans turn to the left

The ball should be placed in the “following” arm, not the lead arm. The arm that follows into the turn is more significant since it provides the “snapping in” effect providing momentum. If this arm is not lively and connected into the back the turn will lose energy and stability. Practicing this movement first with the ball patterns the arm to move toward the midline of the body with volume and proper timing.

Rather than just standing on the rotator disc with both feet flat, dancers can progress to having the working leg in forced arch, coupé and then passé. As the level of difficulty increases, be careful to decrease the torque exerted against the floor or the turn will be difficult to maintain. Parallel and turned out positions are both suitable for practice, but parallel may be preferable for the general public or contemporary dancers.

forced arch foot placement

forced arch foot placement

Rotator discs can effectively teach the concept of center. Your client must stabilize her core (the center of gravity) in addition to holding postural alignment (center axis). When using a rotator disc, the central axis of the body is like the pole in tetherball and the turning action represents the ball going around the pole. It is essential to have the body aligned or the turn will wobble like a tetherball would around a bent pole. Your client receives immediate feedback as to her success and can adjust accordingly. The experience of turning on the rotator disc becomes her instructor and teaches the concept of center better than your explanation ever could.

Reward Your Client with Tibetan Singing Bowls

Tibetan bowlsTibetan Singing Bowls are a great option for finishing a session with your client to leave her feeling centered, relaxed, and rewarded. These bowls from the Himalayan region are made from a combination of metals (bronze alloy, copper, tin, zinc, iron and sometimes other metals depending upon the age of the bowl) and produce vibrating tones when struck or circled along the circumference of the bowl’s rim with a mallet. They are used in yoga classes, holistic sound therapy, chakra re-balancing and personal meditation. Singing bowls produce a calming effect and reinforce the concept of living in the present moment.

The pitch varies on the size and thickness of the bowl, and is played with a wooden stick that creates friction around the rim of the bowl like a wet finger would around a wineglass. The sound changes when using felt covered strikers on the side of the bowl giving it a lower tone. A less metallic sound is also possible using a suede covered mallet. Bowls come in small, medium and large sizes with and without decoration. It is easy to learn how to play them and requires only a quick demonstration on the technique of holding the mallet and how to apply pressure to the side of the bowl.

When the bowls are placed on the chakras they allow the individual to hone in on the energy centers of the body. Although each note is linked to a chakra, relaxation and centering can occur whether or not this pattern is followed. When you buy a bowl, it should specify what notes are played with the striker and mallet. Starting at the 1stchakra the notes correspond in ascending order as C, D, E, F, G, A, and B at the 7thchakra. Although it is helpful to have an understanding of the chakra systems to direct one’s energy and attention, the balancing effect will take place regardless. I tend to place my Tibetan Singing Bowls on a client by size rather than the specific note rendered since the notes played blend together harmoniously.

The calming vibration takes the mind from a cerebral analytical state to an emotional experiential state effectively diminishing internal mind chatter. For those “Type A” personalities, it is truly a gift to get out of one’s head and experience the state of “being-ness.” The opportunity to slow down and recover after a physical workout helps your client transition into the next activity of the day with relaxation and greater ability to focus.

I have also used bowls to finish a group mat class with a guided meditation and have received positive feedback from students. I place the bowls in the center of the room and have the class lie on the floor on their mats like spokes on a wheel with their heads toward the center to clearly hear the sounds. I have even used my bowls in the hospital when my mother was recovering from a traumatic surgery (obviously not near the wound). Now when I go to visit her, she still asks me to bring them because she wants to repeat the relaxing experience.

Blog photoIf there is time at the end of a session I will sometimes do what I call the “spa finish.” I have the client lie supine on the Cadillac with legs propped up on the short box from the Reformer if it is more comfortable. I heat a neck wrap in a microwave and place it around the client’s neck with a lavender eye-cover (ask if lavender is okay—not everyone likes it). I will sometimes cover the person with a heavy blanket to create a swaddling cocoon. I vary the placement of the bowls and how I play them depending on the emotional state of my client using my intuition as a guide. Striking a bowl under the table, one on the chest and playing another one above the body can create a tiered-effect. Occasionally wait for the vibration to stop before playing the next bowl. This silence can align the client with stillness and greater awareness of the present moment.

Pilates is highly adaptable to all skill-levels, but should appropriately challenge your client physically and mentally. After providing your client with this stimulating movement experience, it is helpful to provide some kind of relaxing or centering ritual to finish. There are many ways to end a session, but Tibetan Singing Bowls just might leave your client singing your praises.

Spice Up Your Pilates Palate with GYROTONIC® Exercise

Odds are good that if you are teaching Pilates you have heard of the GYROTONIC®Gyromethod, but you might not be familiar with how it can expand and improve your perspective as a Pilates instructor. There are some people who tout the merits of each method as being the “be all, end all” movement experience. Personally, I tend to gravitate toward the philosophy that the more tools you have, the better equipped you are to assist your client’s needs. Even if you do not plan to get certified in the GYROTONIC® method, it is worthwhile to better understand what it is about and to try a session on your own body to judge for yourself.

The GYROTONIC® method is the brilliant creation devised by Juliu Horvath utilizing three-dimensional movement with resistance. Although one of my friends affectionately refers to it as “gin and tonic” the name actually derives from “gyro” meaning a circle and “tonic” referring to something that is good for you. There are several pieces of equipment in the GYROTONIC EXPANSION SYSTEM®, but the most commonly used piece found in studios is The Pulley Tower. This apparatus consists of two handled wheels attached to a movable bench that sets next to a tower with a weight and pulley system with upper and lower resistance straps.

The genius of this system is that it allows for freedom of movement in all planes in space, while calling upon strength with flexibility to perform the exercises with fluidity and attention to one’s breath. The joints of the body experience lengthened range of motion, and the exercises with handled wheels allow the spine to spiral with complex articulation. This type of spiraling is not practiced using typical push/pull gym equipment, and makes it an ideal exercise method for golfers hoping to improve their swing.

The more extreme demand for shoulder mobility in some of the wheel exercises have allowed my clients with residual problems from shoulder surgeries or injuries to make remarkable improvements in their strength and flexibility. Over time, one of my clients who could barely open her arm laterally after completing physical therapy resumed full range of motion. In the hamstring series, the participant lies supine with legs supported in straps allowing for non-impact full range of hip motion. Several of my clients have commented on how much they enjoy the supported range of motion, and have been able to move from their hip joints without tension.

The GYROTONIC® method observes how energy is directed in the body and physical holding patterns from past injuries can be identified (rather than the more placement-driven viewpoint of Pilates). Physical issues tend to reside where there is a break in the flow of energy, so being able to observe this is useful for honing in on areas of concern. Similar to Pilates, the exercises in the GYROTONIC® method initiate movement from the core, and then radiate the energy outward through the limbs. An ex-dancer client enjoys the rhythmic quality of the movement and says that the exercises can sometimes feel like dancing.

The principles found in GYROTONIC® exercises can also be performed without equipment (similar to Pilates matwork) using Mr. Horvath’s method called GYROKINESIS®. These specialized exercises are done sitting on a stool or lying on a mat and can be performed separately or complimentarily with GYROTONIC® exercises.

From my perspective, the similarities between the GYROTONIC® method and Pilates include core driven movement initiation, eccentric strength, attention to breath and its integration with exercises, and the importance of mental participation for body function. Exercises from both methods supply the necessary tools to address and correct dysfunctional compensatory injury patterns through non-impact exercise. Exercises are adaptable to all physical issues, skill levels and body types.

My experience has found Pilates to be more user-friendly and better suited to introductory back injury rehabilitation, while GYROTONIC® exercises mimics our more “real life” three-dimensional complex movement experiences. Pilates seeks balance in the body with bi-lateral development along the sagittal, transversal and coronal planes. GYROTONIC® exercise explores how the body moves through these planes of space with maximum range.

Even though Pilates is now a recognized mainstream exercise method, its widespread popularity did not occur when Jospeh Pilates was alive. Currently GYROTONIC® exercise is not as widely recognized as Pilates, but its versatility and functionality should catapult it into the public arena before long. GYROTONIC® exercise is an “alive” method, constantly evolving and improving under the tutelage of its originator Juliu Horvath. Even if you do not plan to teach the GYROTONIC® method, studying with first generation teachers is a golden opportunity that should not be missed.

GYROTONIC®, GYROTONIC EXPANSION SYSTEM® and GYROKINESIS® are registered
trademarks of Gyrotonic Sales Corp and are used with their permission.

Addressing Trigger Points to Facilitate Range of Motion

It is common knowledge that stretching can help elongate muscles and reduce stiffness, but there are cases where stretching can actually worsen the situation and increase pain. Stretching a muscle that is already “knotted” and is pulled taut can further irritate it. It can be helpful to release the trigger point (knot) prior to stretching for ease of movement and better range of motion. Although you can refer your client to a massage therapist specializing in myofascial trigger point work, using trigger point release in a Pilates session can expedite improvement for immediate results.

The pioneers of trigger point research, Janet G. Travell, M.D. and David G. Simmons, M.D., define a trigger point as “a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue.” Since we have multiple muscle fibers and these fibers are bundled together to serve a united purpose of joint movement, some of the fibers can remain in a contracted position without all being affected. Releasing the culprits causing irritation can allow the group to work better as a whole. The nodule is very tender to the touch and will elicit a response of discomfort and/or pain when touched depending upon its severity. The pain can be localized to the trigger point or referred to a seemingly unrelated location.

trigger point book picAn excellent user-friendly resource for studio or home use is The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief by Clair Davies. This manual takes you through the process of how to find and release the trigger point with diagrams depicting the areas of referred pain. If you want your client to consistently address trigger point release at home, it can be helpful to show your client a picture of the affected muscle and where the referred pain can be found.

Although pressing your fingers into the affected spot can release the tightness, there are tools available that can make this process easier. A tennis ball, Thera Cane, Wooden Knobble, myofascial release balls or foam rollers can all be useful. Doing the work without equipment can improve your ability to find the trigger points by touch, but over time using tools can prevent excessive wear and tear on your hands. In addition, the tools encourage more consistent practice, because your clients are able to use them at home.

Although it seems counterintuitive to press on a spot that provokes pain, the discomfort diminishes once the trigger point has been loosened. The muscle fibers are holding for a protective purpose, which may have been applicable during a situation of stress, excessive load or trauma. Once that situation has changed, the muscle sometimes needs an outside stimulus to break the loop.

It is helpful to have an ongoing dialogue with your client during trigger point release. Since everyone has a different level of pain tolerance, it is worthwhile to have your client communicate with you throughout the process. Let your client know that the pain should register about a “7” on a scale of 1-10 with 10 being the most intense. As you press on the trigger point, you can have your client count you in “5, 6, 7” so you don’t push beyond the appropriate level of tolerance. If you press in the intensity of a 9 or 10, you will not have good results because the body will resist, and, if you do not press hard enough, there will be insufficient pressure for release to occur.

You can also coach your client to inhale and tighten the muscle breathing into the pain and then relax the muscle during the exhalation. Instead of holding the trigger point consistently throughout, pushing on the trigger point on the inhalation and releasing pressure on the exhalation can at times make it easier for the client to let go. You know if the process is working when you continue to press with the same intensity and your client’s perception of the intensity decreases. It also gives the client a level of comfort to know that going INTO the discomfort has actually DECREASED the feeling of pain providing a positive experience.

Trigger point release in a Pilates session is a means to an end. Your objective is to release the offending trigger points, so that the chosen exercise can be performed with greater ease and range of motion. If the work required is extensive, refer your client to a massage therapist trained in this method. Although it does take time to get the “feel” for trigger points, knowing how to release them can provide immediate benefits to your clients.

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.