PILATESPRESCRIPTIONFOR

MENOVER50WITH

PRE-EXISTINGINJURIESTO

SHOULDER,KNEE,ANKLE

ANDLOWERBACK.

ANDCHRONICC.O.P.D.

CharmaineBeattie

DefinityFitness

Harare,Zimbabwe

October2018

ABSTRACT

ThisAssignmentwillbelookingattheimpactofawell-roundedPilatesPracticeformenovertheageof50whoallpresentwithpre-existinginjuriestotheankles,knees,lowerbackandshoulder.

Thisparticulargroupofadultmalesareallsuccessfulbusinessmenwhoplayedsomeformofcompetitivesportathighschooland/orcollegelevelandhaveinjuriesrelatingtothesesports–namelyrugby,waterpoloandcricket.

Theseinjurieshavebeencompoundedandexacerbatedbyanowsomewhatsedentarylifestylebehindadeskduringtheweekandoccasionalboutsof“WeekendWarrior”activityduringtheweekends.

Some,butnotall,oftheclientsarecarryingexcessweightwhichalsodoesnothelpwiththeirinjuries,postureandoverallgait.Ihaveoneindividualwithapartiallyfusedankle,twowithshoulderpathologiesandimpingementtovaryingdegrees,onehashadatotalkneereplacementunilaterallyandallofthemenpresentwithextremelytighthamstringsandvaryingdegreesoflowerbackdiscomfortandtightness..AswellasCOPDinoneparticularclientwhoneedstoimprovehisoverallbreathpatternandlungcapacity.

Thesemenhavepresentedasagroupoflike-agedmenwithsimilargoals–backpainalleviation,hamstringstretch,overallflexibility,jointmobility,betterpostureandbetterbodyawarenessandmovementpatterns.Theyareallalsohopingtobecomegenerallymorefitallroundandtoperhapslosesomeweight.

TheuseofthereformerandoccasionallytheWundaChairandCadillacarehighlyrecommendedinaPilatesPrescriptionforthisgroupofindividuals.Theequipmentallowsmetoobservethemclearlyandtokeepthemsupportedandtogentlymakeallowancesforeachindividualbodyinordertoaddresseachoftheirparticularconcernswhilststilltreatingthemallasagroupofmenwithlowerbackandposturalissues.

ThemostimportantprotocolofallinthefollowingAssignmentistosimplykeeptheclientsmovingandflexibleandaspainfreeaspossible.

TABLEOFCONTENTS

• TitlePage-page1• Abstract–page2• TableofContents–page3• AbriefhistoryofPilates–pages4to5• Introduction–pages6to7• WhyPilatesisrelevantandapplicableformenover50…–page8to9• TheLumbarSpine,itsStructureanditsPathologies–pages10to11• TheHipJoint,itsStructureanditsPathologies–pages12to13• TheShoulderGirdle,itsstructureanditsPathologies–pages14to16• TheKnee,itsstructureanditspathologies–pages17to18• TheFootandAnkle,itsstructureanditspathologies–pages19to21• PilatesBreathinganditsRelevanceinTreatingC.O.P.D.–pages22to23• Generalinflexibility,minorachesandpainsandweightgain–page24• GeneralEquipmentandMatProgram-Weeks1to10–page25• GeneralEquipmentandMatProgram-Weeks10to20–page26• Conclusion–page27• Bibliography-page28

ABRIEFHISTORYOFPILATES

JosephPilateswasborninGladbach(nowMonchengladbach)inGermanyin1883.Oneof9childrenhelivedalifeofpoverty.HisfatherwasasteelworkerandasayoungadultJosephspenttimeinhisfather’sAthleticClubwherehewasintroducedtoweightliftingandgymnasticsincludingthepommelhorse,parallelbarsandfloorexercisesaswellassomeboxing–remnantsofwhichwestillseeechoedtodayinhiswonderfullydiverserepertoire.JosephwasanaturalatboxingandwhenhewaslaterinternedatKnockaloeCampforGermanPrisonersofWarontheIsleofManduringtheFirstWorldWar,hetrainedhisfellowdetaineesinthesport.

Josephwasasicklychildandsufferedfromasthma,ricketsandrheumaticfeverandhededicatedhislifetoimprovinghishealththroughphysicalfitness.Bytheageof14hewasstrongenoughtoposeforanatomicalcharts.Itwashisfirmbeliefthatthe“modern”lifestyles,badpostureandinefficientbreathinglayatthebaseofallill-health.Andthisledhimtoultimatelydeviseaseriesofexercisesandtrainingtechniques(aswellasengineeringalltherelevantequipment)toteachhismethodproperly.

HewasoriginallyagymnastandbodybuilderbutwhenhefirstmovedtoEnglandin1912heearnedhislivingasaprofessionalboxer,acircusperformerandaself-defencetraineratPoliceSchoolsandScotlandYard.DuringWorldWarItheBritishauthoritiesinternedhimasaPrisonerofWarandhestartedteachinghisfellowinmatesself-defenceandfitness.Atthistimehestartedrefiningandteachingwhatwouldlaterbecomeknownas“Contrology”.

HereturnedbrieflytoGermanyafterthewarandthenin1925heimmigratedtoAmerica.HemethiswifeClaraonthevoyagetoAmerica.ThecouplemarriedandfoundedaStudioinNewYorkandbeganteaching“Contrology”.Josephbelievedinusingthemindtocontrolthebodyandinfocusingoncoreposturalmusclestokeepthebodybalancedandsupportthespine.JosephwantedPilates(asitwastobecomeknown)toteachawarenessofbreathandalignmentandtostrengthenthedeeptorsoandabdominalmuscles.

JosephandClarasoonestablishedadevotedfollowinginthelocaldanceandperformingartscommunity.Hisexerciseregimebuiltflexibility,strengthandstamina.DanceluminariessuchasGeorgeBalanchineandMarthaGrahambecamedevotees.ModernDancepioneerRuthStDeniscametothestudio–overweightandinconstantpainfromakneeinjury.Josephworkedwithheronhis“Table”whichwouldbecomethe“Cadillac”.Sheattendedsessionsformonthsandafterayear–herkneepainhaddisappeared,shehadlostweightandsheapparentlyhad“theanklesofayounggirl”.Wordofthe“Method”spreadandthestudiobecameextremelypopular.

JosephPilateswroteseveralbooks–includingReturntoLifeThroughControloglyandYourHealthandhewasaprolificinventorwithover26patentscited.Healsomade“infomercials”andatleastonetelevisionappearance.Healsodesignedfurniture–includingrelaxingchairsandtheV-bedalthoughtheyneverbecamemainstream.

JosephandClarahadanumberofdiscipleswhobecame“FirstGeneration”teachersandwhohavecarriedthetorchofthemethodandspreaditfarandwide.ModerndayPilatesisdividedintoboth“Classical”and“Contemporary”andintomanyschools–includingBasi,Stott,Fletcher,Polestarandmanymanymore.

JosephPilatesdiedonOctober9th1967attheageof83withouteverknowingjusthowfarreachingandpopularhismethodwouldbecomeandjusthowamazinghisvisionwas.ItisindisputablethatJosephPilateswasaheadofhistimeinhisthinkingandvision.Pilatesisnowregardedasoneofthefastestgrowingfitnesstrendsintheworldandthe“Method”works!

INTRODUCTION

The dictionary definition of Pilates is - A system of exercises using special apparatus,designed to improve physical strength, flexibility, and posture and to enhance mentalawareness.

Or–aphysicalfitnesssystemdevelopedintheearly20thCenturybyJosephPilates.JosephPilates called his method “Contrology”. It is practiced worldwide – on the mat and onvariouspiecesofequipment.

There are ten basic principles of Pilates that should be adhered towithin every practice.Theseare:

Awareness

Breath

Balance

Control

Centring

Co-ordination

Precision

Flow

Efficiency

Harmony

These Principles are crucial to the practice of Pilates and should be present wheneverteaching,participatingand learning themethod. Ifallof theseprinciplesarepresent thenPilates trulybecomesa fullMindbodyPractice thatmakes itbeneficial toeverybodythatparticipates.

Pilatesissetapartfromallotherexercisemodalitiesbytheveryfactthatitisindeedsuitedto“every”bodyandisapplicabletotheyoungandtheold,theinjuredandthehealthy,theathleteandthenon-conditionedclient,maleandfemaleandthelistgoeson.

It is very important that as men age they concentrate on staying flexible and as fit aspossible especially if theyhavenowbecome sedentarywith desk bound careers and lessopportunityandtimetoconcentrateonmovement,flexibilityandgeneralfitness.

Pilates emphasises quality of movement and breathing and restoration of correctmovementpatterns–aswellasflexibilityandstrength.It isnotasharshonthebodyand

jointsasotherformsofexercisecanbeandthereformerespeciallyisaverysupportiveandcontrolledenvironment.

TheparticulargroupofgentlemenItrainthreetimesaweeksufferfromallofthefollowingpathologies:

BackPain

HipStiffness

TightHamstrings

ShoulderPainandDisfunction

KneePain

Stiff/FrozenAnkles

COPD

GeneralInflexibility/MinorAchesandPains

WeightIssues

In the following dialogue I will cover exactly howwe included all of the relevant bodiesinvolvedinaprogrammethatwasmutuallybeneficialtoallconcerned.

Ihaveattemptedtoaddressalloftheaboveindividualconcernswhilstcontinuingtotreatthe group as a whole and deal with the general issues of inactivity, inflexibility, stress(mentalandphysical)andbreathingpatterns.This isa likemindedgroupofmenwithverysimilar goals and issues and the fact that they are all of the same social demographic ishugely beneficial as they all have very similar issues and goals and they all relate to oneanotherverywellsothey lookforwardtotheworkoutonasocial levelwhichreallyhelpswiththeircommitmentandattendance.

As they are an all-male group, I tend to keep theworkouts fairly “male-centric” and themovementsstronganddynamic.MentendtobefairlycompetitivesoIneedtobecarefultokeepaneyeonthemtoensurethattheydonottryto“out-do”oneanotherandthattheystaywithintheirlimitsandmaintainthe“Stabilise,Initiate,Mobilise”principles.

WHYPILATESISRELEVANTANDAPPLICABLEFORMENOVER50WITHLUMBARDISFUNCTIONANDJOINTPATHOLOGIESAND

MOBILITYISSUES

“Ifyourspineisstiffat30,youareold.Ifyourspineisflexibleat60,youareyoung.”JosephPilates

PilateswascreatedbyJosephPilateswhowasamanandwasoriginallyverymale-centricandhadalotofemphasisonupperbodystrengthandstrongbasicmoves.Ithasbecomefarmorecomplexanduniversal,butisstillveryrelevantforthemalebody.

The average adult male of 50 and over is leading a fairly sedentary and desk boundexistenceandlackssufficientdaytodaymovement,flexibilityandextension.Themajorityof Pilates exercises performed on the equipment are performed in a seated or supinepositionandaresupportedandlowimpact.Theresistanceusedishighlyvariableandeasilycontrolled which make this the perfect workout for older men with various injuries andpathologies.

Pilatesprovidesasafeandsupportiveenvironmentconducivetosafe,effectivemovementwhich helps to reduce the risk of injury and is extremely beneficial for posture andalignmentandtheremodellingofmovementpatterns.

When asked to state their goals, all of themen inmy group stated that theywanted toalleviatebackpain,stretchtheirhamstrings,workonoverallflexibility,strengthentheircore(andwhittletheirwaists),learnsaferandmoreefficientmovementpatternsandsimplytomovemoreandbreakoutoftheirsedentarylifestyles.

Iseethemen,onaverage3timesaweekfor45to60minutes.Theappointmentisatmid-day so theirbodiesarepartiallywarmedup from themovementof thedaybut they stillneedto leavethedaybehindandcentrethemselvesfortheworkout. Iallowfiveminutesforthemtocatchupandgreetonanother.WethendoafullBasiBlockSystemFlowontheReformer,ChairandCadillac.Ikeepthetemposlowandstudiedandgivetheclientsampletimetosettheirbodiesupforeachexerciseandtounderstandthepurposeoftheexercisesotheycanpreparetosetupandalsosotheycanunderstandthepurposeoftheexerciseandwhatmusclerecruitmentisrequired.Whenofferingamoreintermediateoradvancedexercise Imake sure to always also offer the fundamental option for anyonewho is notadequatelypreparedorconfidentenoughforamoreadvancedmove.

I encourage themen to attend aminimum of 2 sessions perweek and all three if at allpossibleandwilloftengivethemstretchestoperformathomeoratworkontheirdaysoff

to keep them mobile.

ALISTANDDISCUSSIONOFTHEINJURIESANDPATHOLOGIESWITHINTHISDISCUSSIONGROUP

THELUMBARSPINE,ITSSTRUCTUREANDPATHOLOGIES(LOWERBACKPAIN)

ChronicLowBackPain(LBP)isaverycommonanddisablinghealthproblem.80%ofalladultsill(atsomestageoftheirlife)sufferfromLowerBackPain.Thissyndromeisexacerbatedbylongperiodsofsittingwithpoorposture,sedentarylifestyleandtoomuchflexioninoureverydaylife.

Thebackconsistsof33vertebrae-7cervical,12thoracic,5lumber,5sacral(fused)and3to5coccygeal.Thespinefollowsaseriesofnaturalcurveswhicharedesignedtoassistwithloadbearing.Itiscapableofflexion,extension,lateralflexionandrotation.Theribsattachedtothespineandforma“cage””aroundtheimportantorgansoftheheartandlungs.Thestringofvertebraeformasafeandstrongcanalthroughwhichthespinalcolumnpasses.Eachvertebraisseparatedbyanintervertebraldiscwhichprovidesupportandallowmovement.Movementisalsofacilitatedbyaseriesoffacetjointsoneithersideofthespine.

Therearemorethan30musclesofthespinethatproducemovementorcontrolstability.Withinthelumbarspinethemostimportantofthesearetherectusabdominus,externalandinternalobliques,transversusabdominusandtheprimaryspinalextensors–theerectorspinae,semispinalis,thedeepposteriorgroupandthemultifidus,thequadratumlumborum,iliopsoasandthepelvicfloor.Allofthesemanymusclesworktogethertoprovidemovement,flexibilityandstabilitywithinthelumbarspine.

Allofthemeninthegroupsufferfromvaryingdegreesoflowerbackpainandstiffnessandinflexibility.Thisiscausedinsomedegreebytheirverytight,butweak,hamstrings.HipFlexorsaregenerallyweakandtightorshortenedfromtoomuchtimespentseatedanddriving.Therewillalsobeadegreeofosteoarthritispresentandperhapssomestenosis(causedbytheosteoarthritisandage-relateddegeneration)andthereisalsosomesciaticapresent.OneclientinparticularhashadaspinalfusionatL1–L3whichhasresultedinlossofrangeofmotioninthelumbararea.Alloftheclientsfinditnearlyimpossibletofullystraightentheirlegswhensupineandarenotabletofullycompletetherolldown.Theyalsofinditextremelydifficulttoextendbothlegsoutwheninaseatedpositionandoftenneedsupportand/ormodification.WemakesuretostartandfinisheverysessionwithaseriesofRollDownsandalwaystakeextratimewhenperformingStandingLunges–takingtimetoholdbothstretchesfor3to5breaths.Noneoftheclientsaresupple,comfortableorconfidentenoughtoperformKneelingorFullLungeatthisstage.TheyalsofindtheHipworkSeries(ontheReformerandtheCadillacverysupportiveandaccommodatingfortheirhamstrings.

UprightseatedexercisessuchasStomachMassageareverydifficultforthisgroupastheiroverallphysiologymakesworkinginatotallyuprightpositionwiththelegsextendedoutinfrontofthemisnotcomfortableorworkableforthemrightnow.Idooccasionallydothestomachmassagebutwiththegroupseatedonasmallboxorwedgeandwedonotoverworkthisposition.

CommonLumbarSpinepathologiesincludeDi.scCondition,Osteoarthritis,Stenosis,Spondylolysis,Spondylolisthesis,LumbosacralFacetJointSyndrome,PosturalSyndrome,SciaticaandSacroiliacJointDisfunction.

TheGeneralguidelinesforworkingwithclientspresentingwithLowBackPain/LumbarPathologiesare:

- Allowtheclienttoworkinslightimprintuntilshe/hecantolerateaneurtralpelvicplacement.

- Allowtheclienttoworkinamodified“TableTop”position–kneestothechest,onelegcrossedundertheother,holdingaballorayogablockbetweentheknees.

- Workallofthecoremuscles,notjusttheabdominals.Striveforbalancebetweenflexors,extensors,lateralflexorsandrotatorstokeeptheLumbarareastable.

- Manylowerextremitymusclesattachonoraroundthelumbarregionsostretchingisverybeneficialtomaintainasuppleandwell-alignedLumbarSpine.

THEHIPJOINT,ITSSTRUCTUREANDPATHOLOGIES(STIFFNESSANDPAINANDLOSSOFRANGEOFMOVEMENT)

TheHipisoneofthelargestjointsinthebodyandcontainsthestrongestligamentinthebody–theIliofemoralLigament.TheHipcanbeseenasthelinkbetweenthelowerandupperbodyandisresponsibleforthetransferralofgreatforcesandmovement.Ithasthesecondlargestrangeofmotionofanyjointandyetmustbeabletosupporttheweightofthebody,armsandheadandstillmaintainstability.Thehipsocketisdeeperthantheshouldersocketwhichassistswiththisstability.Instabilityand/orinjuryattheHipisoftenthecauseofincorrectmovementpatternsandinjuryinotherareasofthebody–especiallytheLumbarSpine,KneesandAnkles.Adequatehipflexionandextensionandcorrectbiomechanicsarevitalforadequateandcorrectgait,aswellasstandingupfromaseatedposition,bendingtoreachandliftthingsandeverydayactivitiessuchastyingourshoes.

TheHipisaballandsocketjointwheretheheadofthefemurinsertsintotheacetabulumofthepelvis.Theprimemovementatthisjointisflexion/extensioninthesagittalplane,abductionandadductioninthefrontalplaneandinternal/externalrotationinthetransverseplane.

ThebonesinvolvedinthehipjointaretheOscoxaorPelvis-whichismadeupoftheilium,ischiumandthepubis–andthefemurwhichisthelongestandstrongestboneinthebody.Thereare3ligamentsthatprovideinternalsupporttothehipjoint–theIliofemoral(thestrongestinthebody),theIschiofemoralandthePubofemoral.

Themusclesactingonthehipregionare:

- Thehipflexors–PsoasMajor,Iliacus,RectusFemorisandSartorius.Itisimportanttostretchthesemusclesbutstillkeepthemstrong.

- Thehipextensors–GluteusMaximumandHamstrings- Thehipabductors–GluteusMedius,GluteusMinimus,TensorFasciaLatae(TFL),

SartoriusandthePiriformis- Thehipadductors–AdductorMagnus,AdductorBrevis,AdductorLongus,Gracilis

andPectinius.- Theexternalrotators–ObturatorInternusandExternus,SuperiorandInferior

Gemillae,Piriformis,QuadratusFemoris,GluteusMaximus,Sartorius,posteriorfibresoftheGluteusMedius(wheninflexion)–thesemusclesareknownasthe“deepsix”orthe“RotatorCuffoftheHip”.

- Theinternalrotators–GluteusMedius,GluteusMinimum,TFLandPiriformis.

TheGluteusMediusistheprimarylateralstabiliserofthehipjoint(especiallyduringsinglelegstance)andisvitalincorrectgaitpatterns.Ifinstabilityorinactivityispresentherethentheentirepelviswillbeunstableandthiscananddoesleadtolumbosacralandkneepathologies.TheIliopsoascantendtobetightandcanpullonthehipandthelumbarspineoutofalignment.Itsmainfunctionistomaintaintrunkextensionandtoliftthefootclearofthefloorinperambulation.Ifitisweaktheclientcanexperiencedifficultywithgettingup

anddown,climbingstairsandevenbasicwalking.Thesebasicfunctionscanplacemorestrainonthepelvis.TheGluteusMaximusisvitalinpropellingthebodyforward–running,climbingstairs,jumping.ItworkswiththeHamstringstoextendthehip.ThePiriformis(oftenthesourceofbuttockpain)isactiveduringinternalandexternalrotation(dependingontheangleofthehipjoint.Itisawell-usedandoftenverytightmuscleandwhenitincreasesinsizeitcanputpressureontothesciaticnervewhichcancause“PiriformisSyndrome”or“Sciatica”.

CommonHipPathologiesincludeOsteoarthritis,TotalHipReplacement,Bursitis,PiriformisSyndromeandHipLabralDisorders.

Noneofthemeninmygrouphaveanyserioushipissuesapartfromgeneral“wearandtear”andstiffnessandlossofrangeofmotion.Theyall,tosomedegreesufferfromtighthamstringsandalsotightbutweakhipflexors.SowedoemphasisStandingLungestretchesandalsoworkingonthehamstringsintheHipWorkonthereformer.Theydostruggletoholdthelegsintabletopwhensupineonthereformersowedousetherecommendedmodificationsofkneesslightlyclosertothebody,onefootcrossedovertheotherorholdingaballoryogablockbetweentheknees.

THESHOULDERJOINT,ITSSTRUCTUREANDPATHOLOGIES(IMPINGEMENT,STIFFNESS,PAINANDLOSSOFMOVEMENT)

TheShoulderisacomplexjointwhichisinvolvedinscapulohumeralandglenohumeralrhythmandmovement.Therearemanymuscles,tendonsandligamentsinvolvedintheabovemovementsandstabilisation.Themostimportantbonesarethescapulae,humerus,andclavicle.Themostimportantmusclesaretherotatorcuff(supraspinatus,infraspinatus,subscapularisandteresminor),thepectoralismajor(andminor),thedeltoids,thelatissimusdorsiandtheteresmajor.Thescapularstabilisersarepredominantlythetrapezius,levatorscapulae,rhomboids,pectoralismajorandtheserratusanterior.

Thelabrumistheliningoftheglenoidfossaandcushionsthehumeralhead.Therearealsoseveralbursapresentinthejointwhichprovide“cushioning”andlubricationofthejoint.

Ifanyoneofthesemechanismsiscompromisedthentheshoulderjointcanexperience–pain,stiffness,impingementorlossofmotion.RotatorCufforImpingementSyndromearetheveryoftenexperiencedinsomedegreeattheshoulderjoint.

Theshoulderisahighlymobilejointwithawiderangeofmovement.Itishighlysusceptibleto“impingement”syndrome–wherethetendonsandligamentsthatinsertundertheAcromionProcessare“trapped”or“impinged”–thiscanleadto“RotatorCuff”painandwillcausepainandlossandlossofmotionincertainplanesofmotion.Itisimportanttobeawareofwherethepainoccursandwhatiscausingtheprobleminordertoavoidaggravatingtheexistingconditionanyfurther.Itisalsowisetobeawareofbursitis,tendinitis(inflammation),tendinosis(apathologyofchronicdegenerationwithoutinflammation),rotatorcufftear,frozenshoulder(asyndromeallofitsown!),shoulderinstabilityandreferredpainfromthecervicalregion.

Observingyourclientandwatchingfor“guarding”orlossofmotionisagoodindicatorofwheretheproblemlies.Itisalsoimportanttonotdiagnosetheproblemyourselfandnottoactoutofyourscopeofpractice–alwaysseekouttheadviceofaspecialistandthenprescribeanexerciseprogramthatisrelevantfortheconditionyouaretreating.

Weaimformaximummobilitywhilstmaintainingstability.Mobilitywithoutstabilitywillleadtoimpropermovementpatternsandinjury.

AllofthemeninthegrouphaveplayedeitherRugby,CricketandTennis(orallthree)competitivelyatschoolandcollegeandassuchhavesufferedrepeatedtraumaandinjurytotheshouldergirdle.Atanyonetimetwotothreeofthemwillcomplainofshoulderstiffnessand/orlossofmobility.Noneofthemhavehadanysurgicalrepairtotheshoulderareaandweareoftenabletoworkthroughthestiffnessandlossofmotionand,insomecases,theywillleavethePilatessessionwiththejointfeelinglesspainfulandmoremobile.

Whenthepainismorecomplexorpresentinanyparticularplaneofmotion,Iwilltheneitherlimittherangeofmotionwithintheexerciseorsimplyeliminateitentirelyforthatindividualorthatlimb.

TheSupineArmSeriesworksbestwiththisparticulargroupastheyarestableandsupportedanditiseasiertocontroltherangeofmotioninthejointandtofullystabiliseandmobilisethejoint.WhenIamwantingtoworkthemeninanuprightpositionItendtodothekneelingarmworkseriesbutseatedonthebox.Thereasonforthisistwo-fold:afewoftheclientshave“bad”kneesandsupportingthemselvesontheirkneesisnotalwayscomfortableorverystableforanylengthoftime.Also–noneoftheclientsareyetsufficientlyself-awareandstrongintheir“core“tosupportthemselvesinthepositionandtoperformachallengingarmseriessafelyandcorrectlyandwithgoodform.

AtleastonceaweekIliketodothestandingarmseriesontheCadillacandthisisgreatwayforthementoengagetheir“core”andreallyworkontheirupperbodystrengthandtheirshouldermobility.Itisaparticularlypopularserieswiththemenastheyaregenerallystrongintheupperbody(injuriesallowing).

Extracaremustalsobetakenwiththisgroupinanyofthefrontsupportorbacksupportexercisesonthereformer(UpStretch,DownStretch,etc.).Thisisalsothecasewithanyoftheexercisesthatmighttaketheshoulderintostrongextension,orinternalorexternalrotation–theseareusuallyadvancedexercisessuchasBalanceControlFrontorBalanceControlBackandthegrouparenotquitereadyfortheseexercisesyetandmaynotbeforquitesometime,ifever.

WhenworkingwithclientswithShoulderPathologiesitisimportanttoremember:

- Strengtheningthebackmusculature(especiallytheupperbackmuscles)andstretchingoutthefrontoftheupperbodycanpromotecorrectshouldermechanicsandcanassistwithproperscapulohumeralrhythm.Afoamrollerisrecommended.

- ConcentrateonteachingscapularstabilisationbycueingtheLowerTrapeziusandSerratusAnterior.

- Asageneralrule,avoidworkinginanoverheadpositionformostshoulderpathologies(unlesstheclientisnowinanadvancedand/orasymptomaticstage.

- Closedchainexercisesarepreferabletoincreasethestabilisationofajointthatisunstableinnature.

- Watchtheclientverycarefullyfor“guarding”and/orpositionsofvulnerability.

THEKNEEJOINT,ITSSTRUCTUREANDPATHOLOGIES(PAIN,STIFFNESS,INJURYANDREPLACEMENT)

TheKnee-tibiofemoraljoint-isoneofthestrongestandmostimportantjointsinthehumanbodyandismadeupofPatellofemoralandtheTibiofemoraljoint-itisasynovialhingejointformedbetweenthreebones–thefemur,thetibiaandthepatella.Itallowsthelowerlegtomoverelativetothethighwhilesupportingthebody’sweight.Movementsatthekneejointareessentialtomanyeverydayactivitiesincludingwalking,running,sittingandstanding.Theprimarymovementsareflexionandextensionbutthereisasmallamountofrotationalso.Themalekneejointtendstobestrongerthanthefemalekneejointduetoanatomicaldifferences(hiptokneeangle),increasedmusculaturearoundthekneejointinthemalebodyandbiomechanicalpatterns.

Severallargemusclesactatandacrossthekneejoint.ThekneeextensorsaretheQuadriceps(RectusFemoris,VastusIntermediusandVastusMedialis),thekneeflexorsaretheHamstrings(Semimembranosus,Semitendinosus,BicepsFemorisandtheAdductorGroupofmuscles.TheGastrocnemiusisimportantinprovidingdynamicstabilisationofthekneeintheterminalstanceofthegaitcycle.TheGluteusMediusaffectskneestabilityduetoitsinfluenceonthefemur.

Ajointcapsulesurroundsthebonesofthekneetoprovidestrengthandlubrication.Manystrongligamentssurroundthejointcapsuleofthejointtoreinforceitsstructureandholdthebonesinthecorrectalignment.TheACL(AnteriorCrucialLigament)isintegraltokneestabilityandismostoftencompromisedorinjured.Therearefourligamentsthatcrossthekneejointandprovidesupportandstability–theAnteriorCruciateLigament(ACL),thePosteriorCruciateLigament(PCL),theMedialCruciateLigament(MCL)andtheLateralCruciateLigament(LCL).Tearsorinjuriestoanyoftheseligamentswillaffectthestabilityandalignmentofthejoint.Therearealsotwo“Menisci”–LateralandMedial-whichdispersefrictionbetweentheTibiaandtheFemur.Themenisciactasashockabsorbersinsidethekneetopreventthecollisionofthelegbonesduringstrenuousactivitiessuchasrunningandjumping.TheMedialMeniscusisthemostsusceptibletoinjury.

Itisimportanttokeepthekneestable,supportedandpainfreeforsafeandeffectivemovementandposture.Concentrationonproper“tracking”andcorrectmusclebalanceisveryimportant.

Inthisparticulargroupofmenallhavecompromisedkneejointswithstiffness,slightswelling,anddifficultyinkneelingandrestrictedmovement–especiallydeepflexion.Iwouldsafelyassumealevelofosteoarthritisinmostoftheclient’sknees.Weavoidexcessivekneelingandwhenwedokneelweusememoryfoampadstocushionthejointorwemovetheexercisetoseatedonaboxtoremovethepressureontheknee.Oneclienthashadatotalkneereplacementontherightknee.Hehascompletedhisrecoveryandrehabilitationandhasbeenclearedforfullactivitybutisstillexperiencingpainonkneeling,lossoffullextensionandrangeofmotiononflexionandthejointisstillslightlyswollenandcanbecometender.Herespondsverywelltofootworkonthereformerwithamediumtoheavyloadandwiththeuseofayogablockbetweenthefeettoaddressadductorcontrol

andcorrect“tracking”withinthejoint.WealsodoworkontheVastusMedialisObliquemusclewithsmall,endofrange,terminalextensionworkonthereformer.

IngeneraltoaddressKneePathologieswe:

- Workoncorrect“tracking”andbiomechanicsatthejoint.- Striveforfullextensionbutavoidingover-extension.- Wedobalanceofproprioceptionexercisestokeeptheclientsstrongandstable.- Wearecarefulwithrangeofmotionandtrytoavoidgoingtoodeeplyintoflexion,

especiallywithanyloading.- Wealwaysaddressthehipabductors(GluteusMedius)toensurecorrectknee

movementpatterns.- WestriveforbalancebetweentheHamstringsandQuadricepstoavoidanymuscle

domination.- Thejumpboard(withalowload)canbeverybeneficialfortrainingthe

biomechanicsoflanding,ankleandkneetrackingandongoinginjuryprevention.Itisalsoverybeneficialforbonedensity,co-ordination,lymphaticdrainageandcardiovascularchallenge.

THEFOOTANDANKLEJOINT,ITSSTRUCTURE,PATHOLOGIES,INJURYANDMOBILITY

Themajorityoffootandankleinjuriesarecausedbyrunningand/orhighimpactsports.Iftheanklehasbecomecompromisedorinherentlyunstablethenaninjurycanoccursimplybyasuddenmovement,twistorlong-termimpropergait.Theanklejointisaffectedproximallybythekneeanditsrelativemechanicsandtrackingandmovement.Pilatesisanidealmodalitytoaddressanklepathologiesandmaintainfitnesswithoutaggravatinganyexistinginjury.WhenworkingwithAnklePathologiesitisimportanttoobservetheentirelowerextremitykineticchainandtoconsiderthePronation,Supination,InversionandEversionthatcananddooccuratthisjoint.

Thereare26bonesthatmakeuptheankle,archandtoesinthefootcomplex.Theankleiscomprisedof7tarsalbones(calcaneus,talus,cuboid,navicularand3cuneiforms),thearchismadeupof5metatarsalsandthereare14phalangesinthetoes(2inthebigtoesand3intheremainingtoes.

Thereare3jointsinvolvedintheankle/footcomplex.TheAnkleorTalocruralJointwherethefibulaarticulateswiththetalus.ThisiswherePlantarflexionandDorsiflexionoccur.TheSubtalarJointwhichoccursbetweenthecalcaneusandtalus.Thisjointisresponsibleforsupinationandpronation.Also,theMidtarsalorTransverseTarsalJointwhichisactually2joints(TalonavicularandCalcaneocuboid)whichfunctiontogetherabout2axesofmotion.

Themusclesofthelowerlegactdirectlyonandaroundtheanklejoint.TheposteriorcompartmentmuscleswhichareresponsibleforPlantarflexion(Gastrocnemius,Soleus,Plantaris,FlexorHallucisLongus,FlexorDigitorumLongus,PosteriorTibialis).ThemusclesoftheanteriorcompartmentofthecalfareresponsibleforDorsiflexion(AnteriorTibialis,ExtensorHallucisLongus,FlexorDigitorumLongus,PosteriorTibialis).Thelateralcompartmentisresponsibleforeversion/pronation(Peroneus–orFibularis–LongusandBrevis).Themedialcompartmentisresponsibleforinversion/supination(TibialisAnteriorandTibialisPosterior).Thelateralandmedialcompartmentareresponsibleforarchsupportwhichisvitaltocorrectfootandanklemechanics.ThePlantarsurfaceofthefootcontainsmuscleswhichareresponsibleforadditionalstabilityandmobilityofthefoot.TheseareknownastheIntrinsics.

ManykneeexercisesinthePilatesrepertoirearerelevantforthispathology.Itisalsoveryimportanttoworkonbalanceandproprioceptiontopromotestabilityandstrengthatthejoint.Promoteclosedchainexercisesandalwaystaketimetostretchthecalfcomplex–calfraisesandprancesonthereformer,chairorCadillacaremostsuitableforthis.

Themostcommonpathologiesinthisjointare“strains”or“sprains”andorchronicoracutestructuralabnormalitiescausedbygait,footwearandlifestyleorcareer(i.e.hairdresserswhostandallday).

Myclientsareallover50andtheiranklesarefairlystiff,havehadvarioussprainsandstrainsthroughouttheirmoreactiveyearsandarenowfairlystiffandimmobileduetodisuse,somedegreeofosteoarthritisandmiddle-agedweightgainwhichisplacingmorestressonthejoint.Oneclienthashadapartialfusiononhisleftanklewhichhaslefthimwithverylittlerangeofmotion.Itrytopromotesinglelegworkonhis“good”ankleandweworkasmuchmobilityintothejointaswecaninanydoublelegwork.Heisalsoverycompromisedinanykneelingorfrontsupportpositionsasthetoesontheaffectedankleareunableto“tuck”undersoweuseballs,padsandcushionstoassisthimwiththisandtrytoavoidthispositiontoooftenforthisclient.HisbalanceandproprioceptionisalsoaffectedsoItrytoavoidpositionsofinstabilityontheequipmentandworkatpromotingbalanceinastableanduprightpositionwhereheissafeandcanbeassisted.

Olderclients(theaverageageofmymalegroupis55to60yearsold)oftenexhibit:

- Reductioninthestrengthandpowerofthedistallegmuscleswhichaffectsgait,propulsionandbalance.

- DorsiflexionandPlantarflexionarealsoaffectedandmobilityofthejointiscompromised.

- Theneuromuscularsystemlosestheabilitytosignalchangesofspeedandtorqueisoftencompromised.

Itishighlyrecommendedthatclientsfallingwithinthisdemographicshouldworkonstrengtheningthedistallegmuscles,improvingbalanceandalsomodifiedjumpboardtoencouragecorrect“take-off”and“landing”mechanismsattheankleandtoencouragestrengthinthemusclesofthelowerextremity.

ThegeneralguidelinesforworkingwithclientswithFootandAnklePathologiesareasfollows:

- Stretchingisveryimportantformostfootandanklepathologies.- Balanceandproprioceptionworkisvitalforlong-termpositiveoutcomes.- Closedchainworkisrecommendedtopromotejointstabilisationandfunctionality.- Itisimportanttopromoteproximalstability–knee,hipandcore–toattainmaximal

stabilisationdistally.- Goodanklestrengthandmobilityarevitalforgait,balanceandfullfunctionality.

THEMECHANISMOFBREATH,ITSIMPORTANCEINTHEPRACTICEOFPILATESANDHOWTOIMPROVEBREATHINGTHROUGHPILATES

“Breathingisthefirstactoflifeandthelast.Ourverylifedependsonit”.JosephPilates.

TheuseofbreathisaveryimportantaspectofPilates.Eachandeveryexerciseisco-ordinatedwitharelevantbreathanditisextremelybeneficialtoperformthemovementsinsynchronisationwiththebreath.Thishelpstocentrethemindandbringittotheexerciseandalsoassistswiththecorrectmusclerecruitmentfortheexercise.However,iftheoveremphasizingthebreathpatternbecomescounter-productive,thenitispreferabletofindanalternativebreathpatternornotpatternatallandallowtheclienttobreatheassuitsthem.

Breathingisvitalfor:

- Oxygenationofthebloodandnourishmentofthebodyonacellularlevel- Improvedcirculation- Calmingthemindandthebody.- Encouragingconcentration- Recruitmentofthecorrectmusclesforthemovement- Providingan“inner”rhythmforthemovements

TheBreathCycle

Inhalation–Airisdrawninthroughthenose–towarmandfilterit–thediaphragmlowersduringcontractionandthepressureinsidethelungsbecomeslowerthanthepressureoutsideofthelungsandairisdrawnintothelungs.

Exhalation–Thediaphragmrelaxesandthevolumeofthethoraciccavitydecreaseswhichcausesthepressureinthelungstoincreaseandairisforcedoutofthebody–usuallythroughthemouth.

Inregularbreathingthediaphragmisresponsiblefor75%ofrespiratoryeffort.Itisacomplexprocesswitharound88jointsand46musclesbeinginvolved.Thethoraciccavityexpandslaterallyandrisestoallowforthelungstoincreaseinsizeandtofillwithair.Whenweexhale(especiallytheforcedexhaleencouragedinPilates)thethoraciccavityisdrawninandhelpstoexpelairfromthelungs.TheforcedexpirationencouragedinPilatesisbeneficialinclearingthelungsofairandreadyingthemforanewbreathofcleanandoxygenatedair.Withamorerigorousor“forced”breathingmanyothermuscleswillbecomeinvolvedintheactofbreathing–includingtheabdominalsandinternalintercostals.

PilatesBreathing

InPilatesthereisaneffortmadetoencourageLateralBreathingorIntercostalBreathing.TherationalebehindthisbreathingpatternistofacilitateandaidinmaintainingabdominalcontractionwhileperformingexerciseswithinthePilatesrepertoire.Itisimportantnotto

maintaintoomuchintra-abdominalpressure(+/-40%).Toomuchpressureandtheglobalmusclestakeoverandwelosetheconnection.

CHRONICOBSTRUCTIVEPULMONARYDISEASE–C.O.P.D.

C.O.P.Disagroupofchroniclungdiseasestheblockairflowandmakeitdifficulttobreathe.

Theconditioncanbehelpedbytreatmentbutitcannotbecured.Itisalifetimediagnosis.

Thesymptomsincludeshortnessofbreathwheezingand/orachroniccough.Thepatientwillexhibitfrequentrespiratoryinfections.Theywilloftenfatigueeasilyandfindrigorousexercisedifficult.Theywilloftenfeelpressureinthechest.

Treatmentwillincluderescueinhalersandsteroids.Self-careincludesphysicalexercise,quittingsmokinganddiaphragmaticbreathing–whichiswherePilatesanditsbreathco-ordinationbecomesverybeneficial.

OneofthemeninmygroupsuffersfromchronicC.O.P.D.Heoftenarrivestiredandlethargicandbeginsto“yawn”soonafterwecommencemovementandbreathingpatterns.

WeworkonemphasisingdeepandregularbreathingpatternsincorrelationwiththePilatesmovements.Itrytoenouragethe“100s”asoftenaspossible(withadaptationsforbackandhippathologies)todeepandregularbreathingandtoencouragebuildinglungcapacityandcontrollingthebreathingmechanism.

Alloftheclientsinthegroupbenefitfromregular“breathwork”astheyallspendalotoftimeseatedand“hunched”overandwiththelungsandorganscompressed.Theyareallalsopronetoshallow“stress”breathingwhereonlytheupperpartofthethoraxandlungsareincorporatedintothebreathingpatternandthebreathingisshallowand“non-nutritive”.AlloftheclientsbenefitfromthestructureanddepthofthePilatesbreathpatternandIfindthatithelpsthemtorelax,re-oxygenateandcalmtheirminds.

GENERALINFLEXIBILITY,ACHESANDPAINSANDWEIGHTGAIN

Alloftheclientsinthisgroupareolder–generally50andover.Assuch,theiroverallflexibilityhasdegeneratedovertheyearsfromimproperposture,toomuchtimeseatedandgeneralagerelatedtighteningandshorteningofthemuscles,tendonsandligamentsduetodisuseandpoorpostureandimpropermovementpatterns.

Thispoorposture,sedentarylifestyleandlackofflexibilitycananddoesleadtominorachesandpainsintheneck,upperandlowerback,thehips,hamstrings,kneesandankles.

Mostofthemenarealsocarryingalittleexcessweight–especiallyonthemidsection.ThisinitselfcancauseincreasedLordosisandlowerbackpainandcanplaceextrastrainonjointssuchasthesacroiliacjoint,thehipjoint,thekneesandtheankles.

AlloftheaboveminorconditionsarelinkedtothemoreprofoundissuesdiscussedatlengthabovebutarepartoftheoverallpathologyofthebodiesIamworkingwith.

WhenaskedwhattheirgoalsareforPilatesandwhytheyarecomingtoreformersessionstheyallstatethattheywishtoworkongeneralflexibility,tightshoulders,generalisedneckstiffness,upperandlowerbacktightness,tighthamstringsandvariousjointissuesanddisfunction.Theyallwishtobepainfree,moreflexibleandarealsohopingto“trim”uptheirabdominalweightandbuildmoremuscleoverall.

Pilatesistheperfectprescriptionforalloftheabove.Thereformeroffersasafeandsupportiveenvironmentinwhichtostretchtightmusclegroups,correctpostureandmovementpatterns,alleviatetightnessanddiscomfort,correctandemphasisebreathingpatternsandalsoaidwithmusclestrengthandweightmanagement–Iencouragethementowalk,swimorcycleregularlytopromotecardiovascularresponseandaidinweightmanagementandoverallfitness.

AGENERALPILATESPROGRAMFORTHEABOVEDEMOGRAPHIC

Weeks1to10

BLOCK EXERCISE LEVEL MUSCLEFOCUSWarmUp

BasicMatWarmUp Fundamental WarmUp

FootWork(Reformer)

FootworkonReformer

Fundamental Hamstrings,Quadriceps,PlantarFlexors

Abdominals(Reformer)

HundredsPrepHundred(Modified)

FundamentalIntermediate

AbdominalsAbdominals

HipWork(Reformer)

FrogCircles(Down/Up)Openings

FundamentalFundamentalFundamental

HipAdductorsHipAdd/HamstringHipAdductors

SpinalArticulation(Reformer)

BottomLiftBottomLiftwExt.

FundamentalIntermediate

Abdominals/HamstringsAbdominals/Hamstrings

Stretches(Reformer)

StandingLunge Fundamental HipFlexors/HamstringStretch

FBI1 N/A N/A N/AArmWork(Reformer–Supine)

ExtensionAdductionUpCirclesDownCircles

FundamentalFundamentalFundamentalFundamental

LatissimusDorsiLatissimusDorsiLatissimusDorsiLatissimusDorsi

FBI2 N/A N/A N/ALegWork(WundaChair)

HamstringCurlHipOpener

FundamentalIntermediate

HamstringsHipExternalRotators

LateralFlexion/Rotation(WundaChair)

SideStretch Fundamental Abdominals/Obliques

BackExtension(Reformer–LongBox)

BreaststrokePrep Fundamental BackExtensors

CoolDown(Standing)

2–3Rolldowns(supported)

Fundamental BackExtensorsStretchandObservation

Weeks10to20

BLOCK EXERCISE LEVEL MUSCLEFOCUSWarmUp(Mat/Reformer)

FundamentalMatWarmup

Fundamental WarmUp

Footwork(Chair)

FootWorkontheChair(witharms)

Fundamental HamstringsQuadriceps

Abdominals(Cadillac)

RollUpwithR/UpBarMiniRollUpsRollupTopLoaded

IntermediateIntermediateIntermediate

AbdominalsAbdominalsAbdominals

HipWork(Cadillac)

FrogCircles(Down/Up)WalkingBicycles

FundamentalFundamentalFundamentalFundamental

AdductorsHamstringsHamstringsHamstrings

SpinalArticulation(Chair)

PelvicCurl Intermediate Abdominals/Hamstrings

Stretches(SeatedonaBall–PoleWork)Canbedonewithaband.

ShoulderStretchOverheadStretchSideStretchSpineTwist

FundamentalFundamentalFundamentalFundamental

LowerTrapeziusPectoralsAbdominals/ObliquesAbdominals/Obliques

FBI1(Reformer)

Scooter Fundamental Abdominals

ArmWork(Cadillac)

ChestExpansionHug-A-TreeCircles(Up/Down)PunchesBiceps

IntermediateIntermediateIntermediateIntermediateIntermediate

LatissimusDorsiPectoralisMajorShoulderExtensors/HorizontalAdductorsTricepsBiceps

FBI2(Reformer)

UpStretch1Elephant

FundamentalFundamental

Abdominals/BackExtensorsAbdominals/BackExt

LegWork (Reformer)

SingleLegSkatingJumpingSeries

IntermediateIntermediate

GluteusMediusQuadriceps,PlantarFlexors,HipAdductors,

LateralFlexion/Rotation(Reformer)

Mermaid Intermediate Abdominals,Obliques,Deltoids,LatissimusDorsi

BackExtension(Reformer)

PullingStraps1PullingStraps2

IntermediateIntermediate

BackExtensorsBackExtensors

CoolDown RollDown2-3 Fundamental BackExtensors,Abdominals,Observation.

CONCLUSION

InConclusion,theabovegroupisanaveragegroupofmenover50yearsoldwithpre-existingpathologiestotheshoulder,lowerback,hips,kneesandankles.

Theyalsopresentwithgeneralisedpoorposture,tighthamstrings,stiffnessandpain,incorrectmovementpatterns,shallowstressedbreathing,COPD,sedentarylifestyleandagerelatedweightgain.

IhaveprovidedcompellingevidenceaboveastothesuitabilityandadvisabilityofPilatesasaprescriptionforthisparticulargroupanditshostofissues.

TheReformer,CadillacandChairallprovidesafeandsupportedplatformsonwhichtoperformcorrectiveexercisesandtoretrainthemovementpatternscausingthepathologies,poorposture,compensatorymovementpatternsandgeneraliseddiscomfort.Ontheequipment,Iamabletoobservetheirbodiescloselyandwatchforanydeviationsand/orcompensationsandtomaketherelevantadjustmentsandsuggestions.

ByusingthespringsystemuniquetoPilates,Iamabletochallengethebodiesinfrontofmetoeachoftheirownindividuallevelofstrengthandfitnessandinlinewiththeirownparticulargoalsand/orlimitations.

ThemeasuredbreathpatternencouragedinPilatesinbeneficialinbothrelaxation,centring,stressreliefandthetreatmentofdisorderedbreathingandC.O.P.D.

ThequietfocusedatmosphereofthePilatesrepertoireandthecamaraderiethesemenhavebuiltupoverthemonthshelpsthemtorelax,stayfocusedandtostaycommittedtoastructuredandregularpracticewhichishelpingthemeachandeverydaytobemorepainfree,movemorefreely,andtobestronganduprightandfilledwithbreathandfocus.

BIBLIOGRAPHY

Google/BingImages

TheCompleteHumanBody–TheDefinitiveVisualGuide–ProfessorAliceRoberts

Reformer–MovementAnalysisWorkbook–RaelIsacowtiz

Cadillac–MovementAnalysisWorkbook–RaelIsacowitz

WundaChair/LadderBarrel–MovementAnalysisWorkbook–RaelIsacowitz

PilatesforPathologiesandInjuries–AdvancedEducationCertificationCourse–SamanthaWood

StudyGuide–ComprehensiveCourse–RaelIsacowitz

PilatesInteractive–OnlineStudyFacility

JosephPilatesQuotes–TheMeaningsBehindTheTopQuotes

JosephPilatesFacts–GoogleOnlineSearch