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A BodyMind Think Tank – Taking fitness to the next levelArchive for injuries
Leg Alignment
Hi Lesley!!
Here’s my client question: 43 year old former dancer (ballet) and gymnast Runner in her late 20’s until recently when she has been sidetracked by hip bursitis. She spoke with her Doctor and Physical Therapist before starting with me. They said that she can do any type of movement provided it doesn’t cause her pain.They would prefer we don’t do extreme hip rotation.
In my visual assessment, I caught right away that she is bow-legged with hyper-extended knees and her parallel stance is not strong as she prefers turn out. Today, was our first session and we spent a lot of time on the Tower with Roll Down, Push Thru Seated Front and Circle Saw as I wanted to see core strength, rotation ability/mobility and articulation. When I got to Footwork (Bend & Stretch) I found a pattern that surprised me. I expected her to pattern her movement like I used to since I began with bow legs and hyper extended knees. But, instead of her knees splaying out, they come in and almost knock when she corrects her feet to parallel. So, we moved to Reformer Footwork and it was the same, when she pushes the carriage away, if I apply gentle pressure to her heels to “swing” them parallel, her knees “knock” inward. I put the Franklin ball between her knees to keep them apart (when, in my case, I use the ball to keep my knees more together). We then moved to bridging where I discovered the lack of hamstring strength. I focused on the hamstring connection for a while, did some pulling straps/swan and finished with mermaid. Can you offer me any suggestions? Am I on the right path? I do feel that we need to get her hamstrings stronger but will this help with the knock knee/footwork issue? Should I use something bigger than a ball, like maybe a yoga block between her knees?
Or between her ankles? H-E-L-P!! As always, thanks for you insight! Cheri
by Lesley Powell
How a client organizes in a static position can be different when moving. Watch how she organizes her body to stand on one leg. As she stands on one leg, look at the bone rhythms of the legs.
- Does the foot remain stable, supinated or pronated?
- Does the shins rotate inward or outward?
- Does the femur rotate inward or outward?
- What happens to the pelvis and spine?
She might have been doing some compensation patterns in standing to appear not knocked knee. Your working with her on creating balance in the legs is great. Be careful about pushing parallel if she can not maintain it on her own. She has been working on this pattern for awhile.
Sometimes with knocked knees, putting a block/ball between the femurs can be a poor cue. They should not be squeezing the block hard. It might be better to use a theraband tied around their thighs. The tightness of the theraband should be enough to get them to parallel not beyond.
Strengthening the abductors/rotators is important. Since her PT’s do not want her to do extreme range, keep the movements small.
- Rotators – lie on the side with knees bent. Only lift knee a inch off the other leg. Or with theraband tied around thighs tightly lying on the back. Move one knee again in tiny range of motion.
- Abductors – range of motion on side should not be higher than her hip
- Standing – Can she stand on one leg without letting the knee knocking in?
Working on balance of all the leg muscles is important. Since she is not allowed to do range of motion, I would also teach some release techniques for lateral rotators, abductors and adductors, and feet as well.
Training Clients with Foot Problems
by Lesley Powell
Agony of DE-feet
“Have any of you worked with anyone who has had a proximal big toe joint fused due to arthritis? Any experience? opinions? I would imagine it would be an issue for gait – she limps a bit now.
My friend’s surgeon is recommending this since acupuncture and physical therapy haven’t worked. He said there could be a bit of a limp… She’s not a client of mine – i’ve worked with her a few times and she experiences temporary relief but doesn’t do any management herself so she’s looking for a permanent fix…” Pilates Teacher
When a client has arthritis/bunion at the big toe, the joint no longer flexes. It is painful to flex at this joint. So they will have to change their gait to adapt to this. Most probably they will have to turn out at the foot. This allows the foot to come easier through when walking.
With one of my client with a bunion, her walk was more of a shuffle. Because of the inability to push through the foot, this is one way the client develops less hamstring and gluteal strength. The hamstrings and gluteals are also necessary for standing on one leg. She never got well on her legs which is called “midstance” in gait.
Since the client is not doing a proper pelvic shift over the standing leg, they will shuffle or limp. I worked a lot on teaching the client to do a better thigh lift 
to transfer the leg from back to front. This will mean still training the legs especially psoas, quadripceps, hamstrings and gluteals. Training the feet is still essential for grounding forces and alignment of the standing leg.
Psoas: thigh lifts, single leg stretch, double leg stretch, reverse kneeling abdominals on reformer, leg springs/straps to train psoas (lie opposite direction than usual training)
Quadriceps: footwork on reformer and wunda chair, sitting on physioball- bouncing, single leg lifts, squats
Hamstrings & gluteals: leg springs/straps. Bridging especially in neutral, Pilates shoulder bridge with one leg lift, standing using wunda chair, Pilates Upright
Other great exercises: single leg kick, double leg kick, quadriped with opposite leg and arm, quadriped with flexing knee in with flexed back and extending leg and back, swan
Feet: small releves to their comfort zone, footwork with toes curled over foot bar, theraband to strengthen plantar flexion (pointing foot at metatarsal joint and full foot plantar flexion, ankle circles
Psoas Practice
by Lesley Powell
Between my career as a dancer, health reasons and menopause, my psoas has tighten up a lot. I have been doing a lot of work with constructive rest, exercises from Painfree by Paul Escoque and visualization while I move about my Iliospsoas. Another great resource about the psoas is The Psoas Book by Liz Koch and Pelvic Power by Eric Franklin.
I have come to realized that I am tightening my psoas while I am exercising. This is not functional, but a bad habit. I try to visualize the length of my psoas from the attachment to the lesser trocanter to the front of the lower thoracic spine. I work with imagery to feel the space of the illacus to soften and shape to the back of the pelvis. As I am able to connect to a new length and space of the iliospsoas, it is like a reflex for me that the abdominals hollow deeper.
Experiment with finding ways to release the psoas. Sometimes stretching it, tightens the psoas for me. Even training the psoas properly can get me to release the muscles better.
SI Dysfunction
by Lesley Powell
“I have a training question for you. I have a client that has come to me with SI Joint problem. She is seeing a doctor who wants her to get an injection to diagnose it and at this point doesn’t know of any underlying cause for it.
I want to know what movements and exercises will be best for her. Should I work to strengthen the muscles around the SI joint? Also she is a fitness instructor who is pretty flexible & mobile in her joints. Is there anything I can do to bring some sort of stability to her ligaments/joints etc?” BBU Student
I have SI Dysfunction. I primarily got it from my dancing. Especially dancers and gymnasts are prone to this because of movements of extreme range such as splits, arabesques and attitudes can stretch the ligaments of the sacrum.
Lumbopelvic stability is essential and relieving for this condition. I have to work on this all the time. Pre-Pilates, BBU movement principles and/or Bartenieff Fundamentals(tm) are great to address this.
- Pelvic clock. Observe in 6-12 how both sides of the pelvis/sacrum is sequencing evenly on the floor. Sometimes the pelvis is rotated. The pelvic clock can educate your preferences of movement of the pelvis. Put attention to the sides not grounding as well.
- Pelvic floor, transverse abdominal & multifidus training
Thigh lift/toe taps/marching Look how they lift their legs. Many people are not gliding the thigh bone in the hip socket well. This will give the appearance of hip hiking or tightening around the femoral fold. 
Foam roll training is great for this.
It also addresses the stability of the legs. Other ideas on foam rolls- Bridging- getting the legs to do the work. Observe if the hips rise at the same time.
neutral bridging-pelvic shift forward
pelvic shift lateral-typewriter, figure 8’s, bridging with thigh lift - Sometimes mobility exercises such as full short spine are not great for my sacrum.
- Observe how they do foot work and standing. Is their weight on the outside of the foot. Training of the medial lines of the legs are also helpful.
Cues for the Shoulder
by Lesley Powell
Ohhh the scapula comin around the ribcage.
Ohhh the scapula comin around the ribcage.
Ohhh the scapula comin around the ribcage.
Hee Haw
Freeing the Shoulders to Connect to the Core , an article in Pilates Pro, I go over how the bones of the shoulder girdle move. I always in my lesson plans with clients, am teaching them about their bodies.
“Embodied Anatomy improves function” Eric Franklin
One of the first things that I teach is how the scapula glides. When the scapula moves properly, you will solve many problems why the shoulders are up and tense. You will also improve the connection to the anterior serratus.
The movement
- Begin to raise your left elbow to the ceiling, feel the shoulder blade gliding wider on the ribcage. Gradually rotate the humerus bone outward so the entire left arm bent is now facing the wall in front of you. Reach the left elbow to the ceiling to help abduct the scapula more.
- Glide the scapula in more upper rotation and gently increase the outer rotation of the humerus bone to bring the left elbow over your head. The arm stays in the same plane as the scapula and gradually rotates more outward. For most, this will bring your elbow in front of your ears. (To get the elbow in line with the torso, one has to improve the mobility and the mechanics of the scapula).
- As if you were running the film backwards, return the arm back to your hip paying attention to the gradual rotation of the arm and the scapula. When the arm returns to the hip, the arm is slightly inwardly rotated.
- Repeat 4 more times
- Reverse to the other side and other arm
Now try a full arm circle. Can you initiate the movement from the shoulder blade? If you have a partner, let the partner place their hand on the shoulder blade to assist in its gliding. Do not worry about depressing down right now. See if you can get the tip of your scapula to make a small circle around your ribcage. As the scapula follows the curves of the ribcage, many of the problems of the shoulders can be solved.
Next week: Anterior serratus training.
Rotation- getting around to the essence of being
By Dr. Martha Eddy and Lesley Powell
Lesley: When I was working at Dr. Bachrach’s Center of Sports Medicine, one of the client with a back injury came to work with me. He asked how long would it take to get back to playing tennis. I didn’t answer, I just started doing the Bartenieff Fundamentals with him, particularly the knee drop, diagonals and arm circles. 
This client had very little rotational ability in his body. When a person is unable to move well in one plane, they will often overuse the other planes. It was clear how he misused “his body in space” had led to his back injury. His rotation improved immensely as well as total body mobility.
The rotary factor is an important in all of our movement. To rotate is to be human. First look at the human body. There is not one bone without some kind of curve and/or spiral. The pull of the muscles on the bones must follow along the lines of the bones. Rotation is underlying in all of our movement. The movements of the bones are usually rolling, gliding and rotating. Rotation has enabled us our mobility and strength. It is rotation that enables us to make level changes and move through space. The simple action of getting out of bed requires internal and external rotation of the thighbones and the pelvis rotating on the femur heads. Observe a baby lying on the floor and its transitions from the floor to sit, crawl and eventually stand up. You will see gradated rotation of the thighbones and the pelvis to accomplish these tasks.
Martha: I am glad that you talked about babies Lesley. We all begin as babies and babies usually begin their movement workout on the floor. On the floor we can spread out, relax, and see the world. Judith Kestenberg – child psychiatrist and movement expert noted that children gain movement repetoire first on the floor and during this time they gain spinal flexibility and perceptual flexibility.
As we go grow older, the LMA systems believe, that this flexibility transfers to the ability to explore options. In our BodyMind Fitness approach we encourage clients who have lost their capacity to twist and spiral physically to find the horizontal plane again AND to re-engage in exploring options within their environment and attitudes. 
Our approach to rotation has nuances as well. We use phyiscal therapist Irmgard Bartenieff’s brilliant concept of gradated rotation to activate muscle chains in a sequential fashion. This awareness gives equal power to all of the joints along the pathway (from vertabra to vertebra or from finger tip to elbow). By equalizing forces we balance muscles and realign joints. Then we ask clients to note what feels different and how this new way of movement may bring out a new attitude or choice, or not. Options are always options. To quote Bartenieff – “there are always multiple possibilities.” In our fast paced forward moving world the pressures of life sometimes block out our sense of options.
At CKE our motto is “relax, feel, move, take action.” In our BodyMind Fitness work we often also take the somatic approach to finding rotation by getting down on the floor. On the floor we take time to breathe, widen, release, spread out – letting go of the intensity of gravity. Then we activate core and distal muscles with awareness of our movement through space. Instead of just crunches we provide movement options in many different directions. Rotation is just part of the picture but one that is often missing. Our3D Fitness series puts all the pieces of the puzzle together. Join us on April 12 or send a friend at Movements Afoot
Go to online scheduling and workshops to sign up!!
How to work with a client w. Lumbar Lordosis
I have a possble client with a severe lumbar lordosis. Is there specific movements to try on her to correct/help/improve? Any certain ones to really avoid? I have a few ideas but I would love your input.
BBU Student
by Lesley Powell
When a client comes in with certain misalignments, I first observe throughout the lesson how the client organizes movements, what is tight and what is weak. Each client arrives in a certain posture for different reasons: some are structural, habitual, an injury, history of fitness and cultural.
I always go to the basics first, core support, observing what is mobilizing and stabilizing. Their patterns of posture will reflect in all the exercises even simple ones like cat & camel, bridging, basic abdominal training and back extensors training. Part of making change in a client is making them aware of their habits.
How do they lie on their backs? Is the tension of their backs hyperextending their ribs? If I have them stretch the back muscles, does that help? Sometimes just saying “let your back go” can make a change. We all have patterns how we all hold tension. Learning to relax is key. Breath is a great way to help relieve tension.
I always look how they use their legs. When the legs are weak, the back has to carry the load. When they are doing bridging, footwork, etc., what is initiating first; the legs or the back? For instance, observe how they do a neutral bridge. Are they arching their backs to get the pelvis up? Get them to initiate through the legs. Make the movement small until they understand to push from the legs.
Sometimes they are so used to lifting their legs from their backs, they feel pain. Work in small ranges of motion until they can move painfree. Lying prone and lifting their legs, they always feel pain. Take the exercise to a different position and see if they can initiate from the correct place. For example, bridging, Pilates footwork and leg straps or modified side leg kicks. How is their form? Can they differentiate the leg from a stabilized pelvis?
Remember to have patience. A posture is created from years of habits. Keep observing, problem solving and making sure the movement principles are within each exercise. If a client is always in pain, make sure that they see a medical professional to rule out serious problems like disk herniations.
Abdominals come in many Flavors
“Abdominals come in many Flavors” Doris Pasteleur Hall
“I do have a question – on the KNEE STRETCH & KNEELING ABDOMINAL SERIES – why would you choose the rounded back vs the flat back — would it be for body type, body issues, difficult/easier, different focus? Could you explain.” Kris
For a healthy body, training the abdominals with the spine in many positions of neutral, flexion, extension, lateral flexion and rotation is very important. The core muscles coordinate differently for each position. Training core muscles for dynamic movement is essential. This kind of training supports the physicality for good posture and necessary for our movement loves. This will also teach clients how to use their spines without unhealthy compression. A healthy spine should be able to move through all planes: flexion-extension, lateral flexion and rotation.
Knee stretch is the preparation for Advanced Knee Stretch, plank pose, downward dog, Long stretch and Up stretch. It teaches the client the coordination of the all the limbs with the core.
Advanced Knee Stretch
Certain health conditions require modifications. With osteoporosis of the spine and disk problems, knee stretch in flexion is contraindicated. With Stenosis and spondylolisthesis (go to BBU’s Movement principles – info about neutral spine), knee stretch in flexion is a great exercise. As with Stenosis and spondylolisthesis, you might have the client perform a neutral spine with a imprinted spine or supported neutral.
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