So often I find myself saying to clients we are wonderfully made, however we should have come with a manual given the high incidence of low back pain, neck pain, and other chronic issues.  It’s the way we use our body rather than the task at hand.  We can hurt ourselves simply leaning over the sink to clean our teeth!

Take a middle aged office worker, not to mention our teenagers, sitting all day with a posterior pelvic tilt, faulty breathing pattern, loaded thoracic spine, lengthened deep neck flexors, tight pectorals and levator scapular, tight hip flexors, weak gluteals and poor body awareness, deciding he needs to exercise.  It is only a matter of time before he’s off to his health professional with a strain or pain.

Clients arrive in the studio expecting to strengthen their “core” and stretch until they feel “flexible” to be taught that instead of the “locking it in” they gently breathe it on.  Additionally flexibility comes with proximal control and correct recruitment versus stretching.  The role of the deep tonic muscles is to provide background stiffness and stability.  However there is not a great deal of feedback from these deep local muscles that work at <25% MVC as they hold and control joint translation rather that generate movement. They are very readily inhibited by myofascial and joint restriction, fear avoidance and fatigue.  Movement patterns change when tissues are over loaded and pain inhibits the slow motor units, larger muscle groups take over and problems persist. 

 We are not a series of “bits,” for instance clients present with multiple problems, often related of which these areas of pain are “victims”.  This idea is perhaps reflected by Mosely (2004) who stated people with sub acute neck pain performed badly on the abdominal drawing in task and were at risk of low back pain in the following two years.

Often a client will say “my brain hurts” when trying to incorporate diaphragmatic breathing, transversus abdominus and pelvic floor activation.  Furthermore keeping the ribs “softened” to prevent erector spinae from dominating over multifidus when the sacrum is nutated draws on the strong need for focus. Additionally incorporating upper cervical flexion and lengthening through the crown to activate the deep neck flexors and scapula placement.  In essence, this all takes great teaching skills with effective afferent input from various sources (verbal, tactile, imagery.) Keeping the work achievable and consistent is vital in retraining an automatic anticipatory core response, essential in “rewiring” our motor cortex (Hodges et al., 1997: Hodges and Richardson, 1997; Hodges, 1999)

Our first weekend of the Rehab Pilates Intensive Course covers principles and pre Pilates exercises which are a series of simple movements focusing on correct recruitment and treating the body as a whole.   

Our second weekend covers more complex patterns, unstable bases and resistance work using small equipment.

The manuals are set out as a client handout and clinical resource. The exercises below are four key exercises from our manual.

Knee Floats

Starting position: Lie on your back with knees bent, legs parallel and hip width apart

1. Inhale to prepare                                                     2. Exhale engage TrA as you float one leg up

3. Inhale to lower leg                                                  4. Repeat alternate leg

Repetitions: x5 each leg alternating

Cueing:  Verbal:-                   Lengthen out crown of head as you lift leg

Widen collarbone into the room

Tailbone heavy/anchored

Engage TrA throughout

              Tactile:-                    Place your hand under lumbar curve to offer feedback for neutral spine

Place your Fingers on TrA to help facilitate

Place hand on opposite ASIS or under hip to help stability awareness

               Imagery:-                  Bowl of water for neutral spine

Leg is as light as a feather or effortless

Opposite hip set in concrete

Float knee up on inhalation

Emphasis / Teaching points:

1.                    Focus on lateral pelvic stability

2.                    Watch for flattening or extension of lumbar spine (loss of neutral spine)

3.                    Emphasise TrA activation throughout

4.                    Watch for ribs flaring and thoracic spine extending

5.                    Watch to ensure shoulder and neck posture remains unchanged

Modifications:

1.                    Don’t alternate legs i.e.: x5 on 1 leg then repeat on other leg

2.                    Imprinting for Weak TrA or regress to leg slides

Precautions / Contraindications:

1.                    People with SIJ problems do not alternate until stability improves

Challenges:

1.            Control of lumbar spine movement (extension/rotation) with hip flexion

2.            Core activation verses global

Clams

Starting position: Side lying knees bent, feet in line with bottom, head rested on outstretched arm

1. Inhale to prepare                                          2. Exhale engage TrA as you open one knee, keeping
   feet  together

3. Inhale to close knee                                     4. Repeat

 Repetitions: x10, then change sides and repeat

Cueing:  Verbal:-                    Engage TrA as knee opens

Only open knee to point where pelvis is stable

Keep neutral spine

Lengthen sit bone of top leg towards heels

Draw the ball into the socket as you open

               Tactile:-                    Place your hand on hip to help stabilise and lengthen side

Place your Fingers on TrA to help facilitate

Place hand on underneath waist to keep lifted

Touch shoulder to remind to relax

Palpate posterior gluteus medius to activate

               Imagery:-                  Stake through top hip to keep stable

Opening leg through golden syrup

Back stacked against a wall for neutral spine

Emphasis / Teaching points:

1.                    Focus on pelvic stability

2.                    Emphasise use of correct muscle to lift knee i.e. glut med

3.                    Watch for overuse of hip flexors and loss of neutral spine

4.                    Ensure TrA activation throughout for lumbar stability

5.                    Encourage neck and shoulder relaxation/stability 

Modifications:

1.                    Imprinting in side lying position

2.                    Support under waist if needed 

Precautions / Contraindications:

1.                    Limited hip abduction

2.                    Lumbar instability i.e.  SIJ problems

Challenges:

1.            Lumbar rotation control

2.            PGM activation

Diamond Press

Starting position: Lie Prone, legs together, hands in diamond position forehead resting on hands

1. Inhale to prepare                                                2. Exhale engage TrA as you draw shoulders

                                                                                  down and lengthen out crown of head and

                                                                                   extend thoracic spine

 3. Inhale to hold                                                     4. Exhale lower back to starting position

Repetitions: x5 - 6

Cueing:  Verbal:-                   Lengthen out crown of head as you extend

Gently press pubic bone into mat to keep neutral spine

Lift TrA away from floor

Keep gaze at floor

Soften ribs down towards pelvis

Slide shoulder blades away from ears as you widen across collar bones

               Tactile:-                    Place your hand over lumbar spine to ensure they are not overusing

lumbar

Place your Fingers on thoracic spine to give feedback for where
to extend from

Place fingers on either side of head to help lengthening out of crown

Stroke scapula down

               Imagery:-                  Gently bend over bra strap

Hot plate under TrA to help keep activated and not relax

Turtle lengthening neck out of shell

Emphasis / Teaching points:

1.                    Focus on gentle thoracic extension mobility and lumbar spine stability

2.                    Watch for overuse of lumbar extensors and under use of TrA

3.                    Emphasise lengthening out of crown and shoulder stability

4.                    Watch for overuse of gluts and tension in lower legs

5.                    Watch for mid cervical give on return move 

Modifications:

1.                    Place a towel under lumbar spine to lessen range and ensure lumbar is not used

2.                    If extension sensitive just lie prone and breathe emphasise TrA and lengthening

Precautions / Contraindications:

1.                    Spondylolisthesis

2.                    Osteoporosis 

Challenge:

1.            Control of lumbar extension

2.            Scapula placement

3.            Posterior neck stability

4.            Control of thoracolumbar shear

Swimming

Starting position: Lie on your front, legs extended and arms extended out at shoulder width apart

1. Inhale to prepare and press                          2. Exhale engage TrA and lift opposite arm and

    pubic bone gently into floor                            leg just off floor and lift head slightly

3. Inhale to lower all back to floor                   4. Exhale and repeat lift with other arm and leg

Repetitions: x5 each side alternating

Cueing:  Verbal :-                   Lengthen out crown of head as you lengthen your leg

                                               Draw shoulders down as you lift arms

Squeeze buttocks as you lift legs

Press pubic bone into floor to lengthen lumbar spine

Keep space between neck and shoulders

Keep long and low, lighten and lengthen limbs

               Tactile:-                    Place your hand over lumbar curve to help relax and lengthen

Place your Fingers underneath shoulder blades to help facilitate

correct muscles to help draw shoulders down

Use fingers to poke buttocks to give feedback to help squeeze

Place hands on either side of head to help with lengthening out of

crown

               Imagery:–                 Draw shoulder blades into back pockets

$100 between buttocks to squeeze

Swimming in very shallow water don’t lift high to get breath

Emphasis / Teaching points:

1.                    Focus on lumbar stability i.e. minimal movement and keeping extensors relaxed

2.                    Focus on shoulder stability and neck lengthening

3.                    Emphasise TrA activation throughout

4.                    Watch for overuse of hamstrings or lower legs and ensure correct buttocks use. i.e. looking for correct cross patterning of lats to diagonal glutes

Modifications:

1.                    Relax head between each lift or don’t lift head at all if too much

2.                    Place pillow under tummy to take load off lumbar spine and lessen range

3.                    Breakdown and lift arm and leg separately

Precautions / Contraindications:

1.                    Spondylolisthesis, acute SIJ and extension sensitive people

Challenges:

1.            Control of lumbar extension with diagonal limb movement

2.            Control of posterior neck stability and scapula placement

3.            Multifidus activation