Movements Afoot’s Blog
A BodyMind Think Tank – Taking fitness to the next levelArchive for back pain relief
Pilates Basics:Essentials for Backcare
by Lesley Powell
I want to talk about how to work with clients with low back pain. These clients have already ruled out by the medical professional where exercise is contraindicated.
To start a client with low back pain, my first goal is to observe their form as I teach the movement principles/fundamentals.
I am working first on teaching stabilization.
I am conservative about stretching until I know how they will react. Some clients with too much stretching, their muscles go into spasm. Sometimes the tight muscles are the ones trying to stabilize them. Without educating them about proper stabilization, the body does not know what to do.
Teaching the fundamentals, you can see how poor patterns will be reflective throughout the entire workout and their gait. Fundamental education will create better awareness, control and injury prevention skills.
Differentiation of thigh bone
I always start with the thigh lift and the pelvic shift forward, a neutral bridge.
A lot of clients are not using the hip socket correctly. The pelvis is unleveling to lift the leg.
- Is the pelvis stable when the leg is lifted?
- How is the ease in the femoral folds?
- If the pelvis is unstable, is it rotating and/or unleveling?
Bridging: Having a leg to Stand on. (upcoming a new podcast on proper bridging)
I always look at the neutral bridge with back clients. Many clients are very weak in the legs and using the backs to compensate for leg weakness.
In the neutral bridge, the pelvis should shift forward over the feet. The Bartenieff Fundamental, the pelvic shift forward is a perfect name for this action.
The highest place in the bridge should be the pelvis.
When the legs are weak, the back usually arches to push the body higher.
Back care clients are very weak in the deep muscles of the back. Many are compensating with the superficial muscles of the back. This can cause compression/pain in the back. Simple extensions exercises of the upper spine and legs are essential skills to learn. Can your client lift their upper spine and/or legs and then entire body pain free? Are they shortening their backs to do any of these exercises.
By teaching your clients, the basics, you are also giving them tools to take home to practice. Once they accomplished the basics, don’t forget about the Pilates mat exercises:
- Single leg circles
- Single leg kick
- Double leg kick
- Shoulder bridge
Stretching
Once I hurt my back seriously carrying a computer. My back was in spasm for over a week. I stay away from stretching the back. I did a lot of stretching of my legs on the floor with a yoga strap. Roll downs were too painful at that time. Then my next goal was using downward dog to lengthen my back. Even a client putting their hands on the barrel or a wall and doing a modified downward dog can be helpful.
It is essential to teach stabilization exercises. Then intertwine these concepts with your workout using the machines. For example, before doing pulling straps on the long box, here is a routine on the long box.
- 3 upper spine extensions. The Spine raises in line with the box.
- 3 right leg lifts, 3 left. Leg lift is in line with box.
- 3 modified swans. The spine and legs are in line with the box.
- then, pullling the straps.
Below is a link to great exercises for back care. Please feel free to share this link with your clients for their home practice.
Pilates Basics: Enhancing the Core
by Lesley Powell
Thigh Lift
The Bartenieff Fundamental, the thigh lift, is in all Pilates exercises. Learn how to stabilize your pelvis through your deep core muscles and mobility of your thighbone.
Breath yourself to new abdominals
by Lesley Powell
Learn how breath is the secret to deeper stronger abdominals
- Hollowing the Abdominal
Core Coordination
by Lesley Powell
PILATES PRINCIPLES
The coordination of the stability of the torso with the movement of the legs and/or arms is essential for good function. This is deep core work. Stability is a dynamic coordination of the muscles of the torso and entire body depending what the movement is. It is not a static position, but changing as we move in space.
We first need to learn how to apply core stability to simple movements before more complex movements. These are building blocks of foundations for larger, more complex movements.
The thigh lift (Bartenieff Fundamental(tm)) is the precursor to more difficult abdominal exercises as well as a component of our walking. One must stabilize the pelvis to connect to the correct mobility of the femur. The psoas alone will flex the hip. Without the counterbalance of the abdominals, the pelvis is pulled to an anterior tilt. Remember stabilization is about finding quietness in the spine with length as you mobilize the legs. This should be the major underlying principle of all abdominal exercises. To challenge the abdominals more, one can extend and/or lower the legs away from the torso. This is the single leg stretch, the hundred, etc.
THIGH LIFT
Hollowing the Abdominal
Purpose
To learn how to stabilize the pelvis as you lift a leg. This principle is important in all Pilates mat exercises with the use of the legs. The engagement of the core is essential in stability of the pelvis through the deep abdominals.
To start
- Lie on the back with parallel legs bent and feet on the floor. The spine is in neutral. Place the hands on the femoral folds. This is where the hinge of the thigh and the hip
- Inhale and feel the width of the sacrum and back ribcage.
- Exhale and hollow.
The movement
Thigh Lift
- Inhale and breathe wide into the back body.
- Exhale to deflate the abdominals in and lift the bent right leg. The hands are feeling the softening of the femoral fold.
- Inhale and lower the right thigh back to its original position.
- Exhale with a hollow and lift the bent left thigh up to 90 degrees. The pelvis should remain in neutral.
- Repeat 3 more sets
Observation
Was the pelvis quiet during the thigh lift? Did the hollow deepen as you lifted the leg? Or did the belly bulge out? If the back muscles engaged, you must learn to deepen the hollow and maintain it before and during the leg lift.
Double leg.
- Inhale and feel the width and depth of the back body.
- Exhale; hollow and do a right thigh lift
- Inhale and hold the position
- Exhale, hollow and lift the left bent leg next to the right thigh
- Inhale without losing the hollow and lower the right leg down
- Exhale and lower the left leg
- Inhale and deepen the length and width of the spine
- Repeat again starting with the left leg
Observation
Were you able to maintain the hollow throughout the movement? Did your pelvis remain quiet?
Breath- Changes your Core Support
by Lesley Powell
Breath is the key to connecting to the deep abdominal muscles. With breath, the connections of the diaphragm pumping in and out of air forces the transverse abdominal to be like a corset. Being like a corset, this muscle pulls the torso contents in. The pulling in of the abdominals like a corset, we are going to call, the hollow. This is when the transverse abdominus engages. This corset-like muscle is responsible for flattening the abdominal wall and stabilizing the torso.
Breath is one of the best ways to encourage this action. There are physical connections between the diaphragm and the transverse abdominus. The breath is like a hydraulic pump. Inhalation causes the diaphragm to move downward, open the lower ribs and relaxation of the back. Exhalation releases the diaphragm up like a parachute towards your head. The lift of the diaphragm helps the lower abs engage. Consciousness of breath and it’s being three-dimensional is a great way to open the spine and connect to our internal support.
To Start: Lie on the back with knees bent and feet on the floor.
Hollowing
Breath & the diaphragm
- Inhale into the lower ribs. Visualize the diaphragm floating downward. This downward movement is widening the lower torso with depth in the back
- Count the duration of the exhale as the belly deflates. (Start with 8 counts. Each count the belly should sink deeper towards the sacrum. This is the hollow.
- Repeat two more sets
Breath & the Hollow
Place your hands near your navel
- Inhale for 4 counts
- Exhale (8 counts) and narrow your abdominals underneath your hands towards your navel
- Inhale
- Exhale (8 counts), narrow again underneath your hands
- Adding on, inhale
- Exhale (8 counts), narrow and sink your abs towards your sacrum
- Inhale
- Exhale and feel your abs narrow and sink towards your navel
- Inhale and add on
- Exhale (8 counts) narrow, sink and rise your abs up your torso.
- Inhale
- Exhale, feel your abs under your hands narrow, sink and lift towards your head.
Now practice this in different position, sitting, on all fours, standing and in your pilates practice. Hollowing is essential for making change in your core. It is better to do a few exercises with hollowing than lots of repetitions with the abs bulging out. Practicing poor habits does not make you stronger.
* I would like to thank all of my teachers especially Irene Dowd for deepening my knowlegde about the body.
Overuse of the Back
by Lesley Powell
Many overuse their backs due to weakness/stability in other areas of the torso. Another issue is overuse of the superior muscles of the back and weakness of the deeper muscles, the multifidus. Learning correct stabilization is key.
Laban’s concept of mobility/stability is about differentiation. To mobilize a body part, one has to stabilize somewhere else. If the attended mobilized body part is rigid, the body will hypermobilize above or below.
In the last post, we talked about the psoas. This post addresses when the thighbone is not moving well in the hip socket and other compensations in the body. Sometimes the back and sacrum compensates when there is a lack of mobility in the hip socket.
When the thighbone moves inside of the hip socket, it needs to roll, glide and slide. If the thighbone is not moving well, the hips will unleveled or tucked to lift the leg up. There is some posterior tilting of the pelvis, but it is in degrees.
In standing, the back can compensate with a weak standing leg. Many clients (dancers as well) have weak gluteal medias on the standing leg. They compensate to make the hips level using the quadratus and/or shortening the psoas.
As in a prior post about the abductors:
I took a wonderful workshop at the Laban Conference in Novemeber in NYC with Diane Woodruff, CMA, PHD on hip abduction. Diane had us observe different initiations of side leg lifts. Many people were lifting from the back, the quadratus, the tensor facia latae, etc.. She had us do some very simple things to wake up the hip abductors and make sure the initiation stays correct.Alignment is key. Do you have a good head-tail-conncection? Diane had us tap the side of our hips, the gluteal medius & minimus. Then we lifted our leg up cueing to where we had tapped. After each lift, we had to rest.
The rest helped me to get a new length of my abductors and assure the initiation was happening in the correct muscular use. It was amazing how by working correctly how standing changed. So many people are lifting their legs without being conscious of their form. Form is key. Doing a 100 legs lifts wrong can do more to train your back to shorten than toning your legs.
I think of side kicks (abductors lifts) as a sideways differentiation of the thighbone moving in the hip socket and stability of the pelvis. When people cannot feel how to move the thighbone freely in the hip socket, the muscles around the pelvis have to work harder. Harder does not mean functionally well. If the qradratus is working instead of the gluteal medias, this takes away from training the tone of the leg muscles.
In footwork on the reformer, a lot of clients are pushing from their backs and muscles around the femoral fold. I have clients start doing small pushes out half way without unleveling and/or tucking the pelvis. As they learn to feel more stability, they have to work their legs better. Than I increase the range of motion of footwork without the pelvis changing. If the pelvis changes as the legs extends, the workload ususally travels away from the leg muscles and Core.
Backing Into Pilates
By Jennifer Whittemore, Teacher at Movements Afoot
Pain cut through the morning silence. My back ached and my left leg was lit up like a live wire. Breathing was difficult: moving, impossible. I knew immediately that I had inherited the family curse—I had herniated a disc in my lumbar spine.
It took three days before I could get off the floor and into the doctor’s office. Though my mobility had mostly returned, the pain was constant and numbness in my left foot made my gait unsteady. I was familiar with these symptoms because my mother had three discs removed from her spine in the eighties. I had watched her downward spiral for the two years prior to the surgeries and her slow post-operative recovery. This was not a future I looked forward to.
The doctor sent me for an MRI, which returned questionable results. A minor protrusion seemed present at L5/S1, but it was unclear whether the disc was pressing on the left nerve root. The doctor suggested a cortisone shot and a check up in six months. No one was mentioning surgery, but the specter of my mother’s experiences loomed large. I was only 20 and not ready for the kind of consequences she faced: arthritis, further surgeries, immobility and chronic pain.
I scheduled the shot and prayed. I hurt so much that I couldn’t carry my textbooks to and from class. Sitting was agonizing. During lectures, I would either stand in the back of the classroom or lay on the floor when I became too exhausted. I couldn’t move much, save for the hour a day I would spend swimming laps in the college pool. I was told not to do this—the side-to-side motion of the crawl would cause further injury—but I couldn’t bear the stasis. I was simultaneously fit and disabled—a very strange place to be.
Sadly, the cortisone shot offered no relief. I went back to the doctor after six months and surveyed my options. He told me I was a likely candidate for surgery. I asked if I could try physical therapy and he reluctantly gave me a prescription. The sessions consisted of electro-stimulation, followed by traction, and a few take-home exercises. Afterward, I would feel briefly elongated and then descend into ever-more intense pain. I went religiously three times a week for three months before giving up. My chart read: “Patient enthusiastic. Progress, minimal.”
At the nine-month mark, I haunted the library stacks in search of information. Statistics abounded regarding the poor success rate of back surgery. Patients who had had surgery fared much the same as patients who waited a year with no treatment. At my age, the wait-and-see approach was the obvious choice, but I was having a hard time holding it together. Without the aid and support from friends, I don’t think I could have survived.
During my investigation, I came across Joseph Pilates’ original mat series. Pilates was very much a part of the modern dance community, but was not widely known in other circles. After my first attempt at the exercises, I suffered a serious setback. Even though I had always been an active person, I wasn’t very core-connected. I didn’t understand how to use the triumvirate of musculature—the deep abdominal muscles, pelvic floor, and paraspinal muscles—required to stabilize my spine. My low back took over and I strained it as soon as I attempt to perform the hundreds.
I was lucky that I had friends in the dance community who directed me to an instructor with expertise and compassion. I first studied with a dancer and teacher who had extensive experience in Pilates and Body-Mind Centering. Her approach was rehabilitative and focused on helping me stabilize my spine. Cathie Caraker was a caring instructor who encouraged me to keep moving and exploring my relationship to my body. She offered far more than Pilates—she offered movement education, which helped forge a connection with my body that would serve me through many physical passions. Within three months, I was pain free.
It was years later that I decided to become a Pilates and Yoga instructor. The “cure” that I found as a young person morphed into a deep-rooted curiosity about the process of physical transformation. During my back pain episode, friends and family were crucial support systems, but the healing journey was ultimately my own. Pain, in the broadest sense, was an indicator that something needed to shift in my body, mind, and spirit to make way for a deeper understanding and appreciation of life. I had to face my fears and take on new ways of treating my body so that it could repair itself and stay well.
With back-pain clients, I am acutely aware of the distress that comes from living life in constant suffering. I see my role in the process as part inspiration, part expert, and part witness. My work focuses on identifying clients’ pain patterns, strengthening the core and deep spinal stabilizers, and improving whole-body functional movement. My mantra is awareness—when we perceive what is going on in the body, we can relax into our strength. We not only get longer, leaner, and more supple, we begin to move with intelligence. I have seen many clients shift from disability to athletic ability in a few short months.
I encourage anyone in this situation to reach out for help. Pilates and yoga have kept me active and free for many years. They can do the same for you.
For more information, see Jennifer’s website innerpillar.com or contact her at jennifer@innerpillar.com.
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