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Is Your Ab Workout Hurting Your Back? NY Times
Is Your Ab Workout Hurting Your Back?
by Lesley Powell
A very interesting article was in the NY Times last week. Core training needs to be 3-dimensional. Just training the abdominals is not enough. Especially with our culture being in so much flexion due to computers, cars, tv and the lack of exercise, people are really weak in their backs.
I just taught a Balanced Body University’s Pilates course this weekend. All the students were active professionals. Most were having trouble with extension in getting to the deep extensors of the back. When the deep extensors do not initiated the movement, the back shortens and for some, cause discomfort.
Another problem with abdominal training, is finding qualities of tone. To get to the deeper transverse abdominals, breath is essential. Once found, it has tremendous lightness. In teaching all clients from beginners to teachers, many are firing and compressing the rectus too strongly for the required action. For instance, the rectus abdominus assists in flexion of the spine in crunches and rollups. Many are unneccessarily firing the rectus with a simple pelvic tilts of the lower spine.
“Abdominals come in many flavors” Doris Pasteleur Hall
Training of the spine in different positions is essential for dynamic stabilization. How you organize your spine lying down is very different from sitting, standing, plank pose. Getting aware of where your spine is in space is important.
This simple exercise can be difficult. Many are firing the rectus which will lower the head down. Some have trouble keeping a head-tail connection. You will see the spine rotate and/or unleveled.
What the NY Times article is not addressing is how the training of the limbs in coordination with the core is important. Awareness of how the body moves is lacking in most training. We have constant pressure by clients of having a stronger workout. Many of these clients lack internal awareness of their bodies and training of deeper stabilizing muscles. Many of the deep stabilizing muscles will never have the feel as a bicep firing to lift a weight.
Learning good form is essential for proper conditioning and balance.
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.
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.
Muscular Imbalances vs Scoliosis
by Lesley Powell
There has been some interesting comments to my post Uneven Shoulders. When a problem arises on a body level, a teacher should look below or above the issue.
The other issues is about what is scoliosis.
This is the definition of scoliosis in Wikipedia.
Cause
In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear causal agent [6]. Various causes have been implicated, but none has consensus among scientists as the cause of scoliosis. Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida,[citation needed] although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Occasionally, development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic.[citation needed] Some therapists like the referenced Hanna Somatic therapist believe that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visible on x-ray, although no documentation is offered in her article. [7] Scoliosis often presents itself, or worsens, during the adolescence growth spurt.[8]
In April 2007, researchers at Texas Scottish Rite Hospital for Children identified the first gene associated with idiopathic scoliosis, CHD7. The medical breakthrough was the result of a 10-year study and is outlined in the May 2007 issue of the American Journal of Human Genetics.[9]
Even when a client comes in for a session, many do not record on their intake forms if they have scoliosis. The other issue with clients with a scoliosis diagnosis is how was it determined. Many did not have any medical imaging tests like MRI’s or Xrays.
When I begin an assessment of their posture, I look at how they organized their bodies in standing, lateral and forward pelvic shifts and standing on one leg. A client with a “C” or “S” curve of the spine, I then assess where they are tight and weak. With building a lesson plan of releases, strengthening and movement awareness, I look how their bodies respond.
If their bodies make immediate positive changes (this is also determined on their fitness and awareness levels), I will lean to looking at a muscular imbalances as a diagnosis. If the spine does not make changes, I will put on my back burner that there might be underlying causes for their spinal issues.
When I teach movement to everyone, I allow the client to find movement within their comfort zone. I will make them aware for instance if one side is lateral flexing to one side better than the other. By making them aware of their habits, they will make more positive change.
When I do my Hanna class with Laura Gates at Movements Afoot, the beginning of the class is making us aware of our posture and how we walk. I can see my pelvis is rotated and one shoulder is higher. Through the gentle movements of Hanna Somatics, I feel my spine unraveled. It is better than an adjustment. At the end of the class, I can see my posture has improved as well as my walking.
Uneven Shoulder Blades
“I have noticed that there are many people walking around with scaplua that are not even (i.e. the left is noticeably lower than the right). There have been a few cases in my group mat classes where I brought the client to our resident Physical Therapist who said that there were no spinal or rotator cuff issues that it was a bad habit/posture that caused it. He also said that it is very common. I have brought Telescope Arms, Angel Arms and Sternum Drops into class. What would you suggest?” Cheri Wild
by Lesley Powell
The Physical therapist is right. When you see a problem, you need to look below or above to see how the body is organized. You have to look at the entire body.
When a student comes in, I observe how they walk, stand, sit and lie down. Poor patterns of alignment will keep showing up in an exercise.
Scoliosis could be a major factor why a shoulder might be higher. As a teacher, make your clients aware of feeling balanced in an exercise. Scoliosis for many is a muscular imbalance. Some cases of scoliosis could be hereditary due to spinal or leg differences.
What to look for:
Standing
- standing evenly on both legs
- one hip high or rotated
Sitting
- even weight on sitz bones
- alignment of ribs over pelvis
- side bending – more flexibility on one side
Supine
- pelvis – is it level/rotated?
- ribs – how align with pelvis?
- neutral bridge- are they even on both legs? Legs parallel?
Prone
- more tone on one side of the back
- side bending in prone
Especially in a group mat class, I would keep the students aware of being balanced in an exercise. Are they rolling down evenly on both sides? Do they favor a side? Also finding out which sides are tighter and weaker can help to retrain the problems
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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