Pilates for longstanding pain

Chronic pain is often difficult to define. Different therapists and researchers will define it as pain lasting longer than 6 weeks, some over 3 or 6 months. What it means is pain that lasts for longer than the original injury (if there was one) would normally be expected to cause painful symptoms.

The theory of what happens is that the nervous system becomes hypersensitised to a painful input, possible from an injury, and continues to send signals to the brain to say there is still a painful injury in the neck/back or any other body part. Often, people who have chronic pain experience it closely with stress, or have negative emotions related to pain, all of which can exacerbate the pain. Explain Pain by Butler and Mosely is a great book on the subject which goes into detail but is easy to understand.

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A common cycle that people can get into with chronic pain is experiencing pain, not knowing what caused it which can lead to thinking the pain is damaging. Then the person will become fearful of moving if it causes the pain, they will start to avoid moving. When we stop moving, our muscles become deconditioned and do not support the skeleton so well which can lead to further injury or discomfort and so the cycle begins again.

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Other cycles of pain which happen frequently are when someone has chronic pain and has a ‘good’ day, they then rush out and do everything they’ve been unable to do whilst in pain. This leads to a ‘bad’ day, or many days, following this, and again the to-do list piles up. This is a boom and bust cycle, or ‘push-crash’.

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Sleep is frequently affected by pain and can cause people to become very fatigued, less able to cope, and then to experience more pain as a result of tiredness and stress.

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Added to that are concerns that no-one believes you, it’s ‘all in your head’ and what can be done about it.

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Maybe you have a good day and try to do some exercise, go for a run maybe because you’ve realised how unfit you’ve become. It maybe goes a little like this:

There seems to be this belief, especially among the running world, that pain is a necessary part of exercise. It’s all about ‘pushing through’ and ‘feeling the burn’. Running websites are full of broad, but rather unhelpful, statements:

Hmm, not really going to help us in this case. Anyway, you’ve gone for that run, ended up unable to move for a week. You then, quite understandably, come to the conclusion that exercise isn’t for you and won’t help.

Then, does this cycle of fear – avoiding activity – becoming deconditioned go on forever? Let’s hope not. There’s plenty you can do to reverse the vicious cycle and turn it into a virtuous one.

Firstly, relaxation – of the body and mind – is a great step towards recovery. You might think you’re spending all day relaxing if you can’t move with pain. But with stress, worries and scary pain distracting you, is this really relaxation? There’s a lot to be said for taking time to become aware of what is happening in the body, even if at first you don’t change it.

This is a good example of a guided body scan. But it doesn’t matter which you use as long as it’s one you find relaxing. And you don’t get annoyed by the voice/music/script! So have a search around. There are plenty other relaxation techniques out there, again it’s about finding one that actually helps you relax.

Next, you might want to explore positions of ease. A physiotherapist can help you find different positions to get into to help reduce discomfort.

An important part of the cycle of recovery is breaking the boom and bust cycles, and learning to pace and space activities.

This is very personal and the exact duration of an activity needs to be worked out based on your stamina and which activities provoke pain. But to give an example, if you know that walking for 20 minutes flares up your pain, we often suggest you then walk for 10 or fewer minutes on a regular basis (this could be 4 minutes and 2 minutes, the same rules apply). It’s then important that this is repeated on a regular basis, every day or second day; and built up very slowly. On average 10% per week. Often this will be worked out with a bit of trial and error, as chronic pain can be very unpredictable. Pacing can take a lot of forward planning and there are some great planning tools available. It can also be quite frustrating when you first see how little you are able to do. But it is about doing the same small amount regularly and building up gradually.

A lot of Pilates exercises can combine the above treatments. They can be performed in your particular position of ease. The focus on breathing and movement can be relaxing, and the exercises can be personalised to your needs. Your Physiotherapist will work with you to find exercises which are comfortable and achievable. Pilates exercises do not need to be on the floor if you find it difficult to get on and off the floor. They do not need to be lying down if this is an uncomfortable position. The beauty of Pilates exercises is that they can work around your needs and abilities, gradually building strength.

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The concentration, focus and precision of Pilates can really start to change the way your body functions and start the progress in the right direction. And after a session, you can stretch out comfortably and focus on relaxing through the body.

Pilates does not necessarily cure the pain, but can be a great tool for helping you to manage the pain and get back to the things you enjoy.

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Pilates for Golfers

 

 

You might be wondering why you would want to do what is predominantly lying-down exercise to benefit your standing-up and walking activity. Well, as you will see, there are many benefits to golfers from Pilates. Let’s start by discussing why Pilates is practiced and loved by Pro Golfers, as the stakes are so much higher for them and they will be sure to follow a fitness regime which protects their musculoskeletal system and improves their performance.

Lee Westwood practiced Pilates after developing nerve dysfunction and pins and needles his arm – he began practicing Pilates, lost a stone and regained control of his swing.

Tiger Woods believes that the physical conditioning he gets from Pilates gives him an advantage and extra gear.

Annika Sorenstam is very smart about how she exercises and trains. She can perform several hundred repetitions of strengthening for her “core” muscles every day without hurting herself. Not all of these repetitions are the typical abdominal crunches. She incorporates Pilates training into her workout for variety and to keep her workout safe.

Dave Duvall: “I’ve added yoga to my routine recently, and combining that with my Pilates programme gives me all of the cardiovascular workout I need. Pilates is a method of conditioning that involves hundreds of exercises designed to improve strength and flexibility without adding bulk.”

The golf swing produces a complex combination of joint mobility and stability along with highly controlled coordination of the whole body. Efficient coordination of multiple linked joints is needed to achieve an effective swing path. The golf swing involves a chain through the whole body, the connection from your feet into your calves, through your legs and into your torso, then down the arms into the club which finally connects with the ball. However, it is repeated frequently, think about how many times you repeat this movement throughout the course of a game. Therefore, even small errors at any point in the chain can cause injury through repetition of the same fault. An injury may not arise at the point where the problem is, for example a calf strain may actually be due to poor recruitment in the core and gluteals (bottom muscles), therefore the calf muscles are overused.

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To give an example of the kinetic chain in action, here are the primary muscles which activate during the swing of a right-handed golfer:

Quads (front of the thigh) on the right side

Hamstrings (back of the thigh) on the left side

Adductors (inner thigh) on the left side

Glutes (bottom muscles) on the left side

Rectus abdominus (superficial abdominal muscle) on the right side

Obliques (middle abdominal muscles) left to right

Latissimus dorsi (back and shoulder) on the right side

Pectorals  (chest) on the right side

Rotator cuff (shoulder muscles) right side

And that’s just the muscles around the torso, think also of the foot and calf muscles and the muscles down the arm and into the wrist which all play their role in stabilising and activating the swing.

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As well as the individual muscles activating, there has to be good timing of the activation – control and coordination. There must be mobility in the joints underlying the muscles to allow these movements to take place effectively, for example, if the upper back does not have the rotation required to move through the full range of the swing, this can lead to problems elsewhere, like the low back and hips. This can be made worse by having poor control of the core muscles which stabilise the low back. The muscles themselves need the strength to generate the power to hit the ball at speed. As a golfer you also need great balance to ensure your body can cope with the demands of the swing.

Looking at the muscles involved above, it is clear that golf will develop one side of a muscle group more than the other. This in itself can cause problems by creating muscle imbalances which can cause problems within the game and in everyday life as well.

A poor swing can give rise to a number of different problems, it can also be caused by underlying problems. Firstly, many amateur golfers are self-taught, and while they may be able to get the ball from A to B, they may have picked up bad habits. They may over-correct (swing too far), this can worsen muscular imbalances, for example, poor core stability coupled with tightness in the rotator cuff.

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Golf injuries are broadly categorised as either overuse or traumatic injury. An overuse injury may arise from a performance fault which often develop as a consequence of compensations for muscle imbalances, and restrictions of rotation or uncontrolled weight shifting. Often golfers are totally unaware of these problems as they are non-painful. However, repeating poor movement techniques can lead to injury and will certainly reduce performance. 

The most common golf injuries are (in order or prevalence): low back pain, wrist, elbow and shoulder injuries. Low back pain has been quoted as accounting for between 25 and 54% of all injuries sustained in golf.

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So, why practice Pilates as a golfer? In a nutshell, Pilates teaches you to use the deep muscles of the torso and effective breathing patterns to control the spine. Pilates helps you to learn to recruit the deep postural muscles, ensure every muscle is doing its job at the right time, it encourages good posture and improves flexibility and strength. All of these elements are required for good golf performance, preventing injury and improving function on and off the golf course.

Sports physician Vijay Vad worked on the PGA tour and suggested that pilates provides “tripod of benefits: 1.stamina, 2. power for distance, 3. injury prevention”.

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For all round injury prevention, within yourself you can modify your fitness, flexibility, balance and core stability. Pilates can help with these. A golfer is also exposed to risks not related to individual fitness, such as the weather and playing surface and the weight and size of equipment. When carried over the five to six miles walked over a round of golf, any poorly fitting bag can become very uncomfortable, especially if it is a one-shoulder design. A trolley and clubs which are measured to fit you are a great investment to prevent any problems arising from carrying bags.

The consequences of imbalances of stability and mobility of muscles leads to altered swing path and ball flight, reduced power and distance and injury

It’s not all negative!!!! You can do things to help – some golfers go through their career injury free but majority experience some problems and it’s knowing how to cope with injury and most importantly how to stop them from happening in the first place.

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Exercise 1 – Backswing:

Specific golf swing problems include backswing sway, where the golfer’s hands drift too far away from the body pulling the torso on the backswing.Too much lateral movement and the lack of balance that entails effects the flight path – slice or hook, neither are welcome! An inability to rotate the upper torso is detrimental to power generation (we’re not suggesting Rory suffers from this problem, he is demonstrating a great backswing above!)    . 

Corrective Pilates Exercise:

CORE TWIST WITH HIP ROTATON

Increases Rotatory motion of Torso

Beginner – spine twist in sitting with resistance band

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Intermediate – working the shoulderblades by drawing a resistance band apart and twisting in high kneeling

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Advanced – using body weight – plank to twist “sidebend into sidetwist”

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Work into full range of motion

Exercise 2 – Follow Through:

Fault: Chicken Winging: Lifting the non-target elbow on backswing changes the angle of the club & swing path, smothers the ball or hitting the top due to shoulder girdle instability.

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Corrective Pilates Exercise:

BOW AND ARROW

Stabilizes shoulder joint working through full range of motion

Strengthens the kinetic chain

  1. using magic circle pull ring to target side then opposite side sitting or standing
  2. using theraband pull on band like bow and arrow at the same time as rotating torsoPicture10

Make sure abdominal muscles are recruited throughout.

Exercise 3 – Stance:

Fault: poor posture at address, manifesting as S-shape or C-shape posture. Excessive arching of the back causing pain, compression of muscles causing stress due to weak abdominals and gluteal muscles, tight low back and hip flexors.

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Corrective Pilates Exercise:

BIRD DOG/SUPERMAN

Strengthens abdominals

Challenges stability of torso/pelvis/shoulders

First, find position and control on hands and knees

Beginner level: single arm or leg extension

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Intermediate: extend both at the same time

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Advanced: Progress with resistance band

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Alignment and posture essential

Exercise 4 – Rotation for Swing:

Fault: Reduced rotation. Changes the angle of the body – poor swing pattern complicated by over compensation in other areas. Poor control and increased compressive forces result in low back pain and/or shoulder pain. This is due to reduced flexibility in thoracic (upper back) region and poor core control.

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Corrective Pilates Exercise:

THREAD THE NEEDLE

Start in a neutral spine position in four point kneeling. As you breathe out bring one arm under the body and through the opposite arm and hold 5-10 seconds to feel the stretch. Then slowly raise the same arm out to the side above the head so you are rotating the opposite way and opening the chest. Hold 5-10 seconds to feel a stretch.

 Alternate sides and repeat 5-10x each side.

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If you have any questions about these exercises, please see your Pilates instructor.

 

Exercise images thanks to Darroch Photography

 

Postnatal Pilates

It’s not Pilates for babies, but how cute is the latest addition to the Pilates Plus team!

It will hardly be a surprise that women’s bodies go through huge changes during pregnancy and that some problems can arise postnatally. These can escalate when a woman has two pregnancies relatively close together.

Pregnancy changes a woman’s posture, pulling the pelvis forward into an ‘anterior tilt’, arching the low back into an increased curve which can be painful. This posture can stick around long after the birth, sometimes years later a woman can still be in a ‘pregnant posture’! In this position, the abdominal muscles and bottom muscles are not used effectively and can become weak. The muscles at the front of the hips become short and tight, keeping the pelvis tilted forward.

After giving birth, looking after baby requires spending time in lots of static positions. The upper back curves forward when breastfeeding or holding baby and can become very stiff. With a lot of time spent bending forward bathing and changing baby, this can add to back pain. Standing and walking with the baby on one hip can make this even worse! Wrists can also become sore with holding baby’s head when breastfeeding.

Abdominal muscles stretch massively during pregnancy and do not snap back into place immediately (although for some lucky women, they do appear to). Also, two thirds of women will experience a split in their rectus abdominis (the external abdominal muscle – six pack muscle), for some this will return to its original position with no additional effort required. For others, it requires careful progressions through a well-designed exercise programme to bring the sides of the muscles back together. Some women’s split will not completely zip up, this can be due to having a wide split in the first place, exercising too early at a relatively high intensity or simply due to lower elasticity in the muscles. The pelvic floor has also gone through big changes and can take time to recover, although women are increasingly aware of the need to do pelvic floor exercises during pregnancy, as soon as able after birth and ideally before getting pregnant in the first place.

Pain in the pelvis during pregnancy can still remain after giving birth as the hormone relaxin continues to circulate round the body for several months after birth. In addition to all of this, there can be added complications if the woman has had a c-section or stitches.

Many of these problems can be resolved within weeks of giving birth, however, full remodeling of the tissues can take up to 18 months.Because of this, among other reasons, the World Health Organisation recommends waiting two years between pregnancies (for more information see this briefing).

Pilates can help with all of these problems and is also a relaxing way to get back into exercise postnatally. For you as the client, there are several benefits:

Pilates improves postural awareness and muscle control, reducing the split in abdominal muscles by building the abdominal muscles from the deepest muscles outwards. With a stronger core and improved awareness of muscle control, it can reduce pain in the low back and pelvis. It also helps to improve control of the pelvic floor, reducing risk of stress incontinence and other problems. For any women reading who do not have children – now is the time to start your pelvic floor exercises, whether or not you plan to have children. In fact, everyone should be doing them, including men!

As well as this, Pilates can help you return to your regular fitness regime and get back to the activities you want to do. The focus on the deep abdominal muscles, which we sometime refer to as ‘corset’ muscles, helps to regain your pre-pregnancy figure. As a client recently said to me: “I just want my body back!”

Postnatal Pilates will help prepare your body if you plan to get pregnant again in future.

As well as benefits to you, postnatal Pilates will benefit your baby too. Because the exercises make you stronger with better control around your low back and pelvis, you will have more energy and less pain, therefore you will be able to play with your baby and give baby the time she/he needs with you to develop.

Your baby gets to see you exercising from early on, which gives a positive message about exercise and can help them choose healthy habits themselves. You are also able to breastfeed and tend to your baby during the class as needed, so you can exercise whilst your baby is still very little.

What should you expect from a class? Most Mums are able to join our classes after their six week check. Our classes are informal and you can bring your baby. We have babies aged from six weeks through to toddlers (although the older babies tend to come to the post-beginners/intermediate class). The class is relaxed, a few Mums worry if their baby will be disruptive, but are quite relieved when they arrive to see that everyone is in the same boat!

Pilates is relaxing in itself – as you concentrate on good alignment during the exercises, your mind can switch off from the millions of little thoughts which occupy it at other times. There is the opportunity to stretch and release through tight areas throughout the class.

The classes are taught by physiotherapists trained in ante- and postnatal Pilates so specific problems can be addressed. Any split in your abdominal muscles can be monitored and exercises modified as required if there is a split.

If joining a class is not for you, you may prefer to come for one-to-one sessions. These sessions will address your personal needs and can either be a regular session or infrequent sessions where you work on an exercise programme at home in between. Some Mums who attend our classes come for occasional one-to-one sessions to work on individualised exercises or to discuss any problems they would rather not bring up in class. Babies are welcome to the clinic too!

This month, we are launching a postnatal exercise guide. This will be for sale along with your first block of postnatal Pilates classes, and also available separately. The guide contains a series of exercises which are presented week by week, with gradual increases in challenge through the weeks. It is designed to be used alongside our classes and will help you get the most from the weekly class. For great results, do the exercises three times a week between classes.

Psst!… Week eight’s exercises are all about stretching, so if you feel the need to stretch out after your exercises, you can dip into week 8 at any point in the programme.

If you have any questions about the exercises in the guide, please see your Pilates instructor.

 

 

 

 

 

Please get in touch if you would like to know more.

Images thanks to Darroch Photography

One to one Pilates sessions – the benefits

We are often asked in our classes, why would I want to attend a one to one Pilates session? For those who have done it, they will tell you that the personal attention you get as well as the focus on health or injury issues can be incredibly helpful and beneficial to their Pilates practice and also performance in other areas of life.

Who can benefit from a one to one session? Really everyone can, we get clients in who have chronic pain, recovering from an injury or operation through to sports people. Women who are pregnant and into the postnatal period often find they need a personalised approach to help them move effectively as their body goes through rapid changes. Other Pilates instructors come to us for feedback on how they are moving or to progress to more advanced levels. Our clients are any age, from young teenagers through to people in their eighties.

Everyone is motivated in different ways. Some people respond to being in a class – the social aspect of meeting the same people every week, exercising alongside people of the same ability as you. Others prefer a more personal approach, with the direct relationship with the instructor a key driver to turn up and make improvements. Some say that people who train in small groups are more likely to stick at exercise than those who are part of larger groups where they feel more anonymous. The smaller the group, the more accountable you feel. In a one person group, you can’t hide at the back or get away with not turning up one week!

Many people, especially those new to exercise, can feel a bit shy in a class, thinking that everyone around them is a) an expert and b) laughing at their novice efforts. Of course, the reality is that everyone else is a) only a few weeks ahead of the newbie and b) too busy trying to do it right themselves to judge anyone else! However, the perception can be a powerful one and our emotions often over-ride our good sense. So a one to one environment can feel more supportive and build skills and confidence to the point where you would feel fine about going into a class. Equally, many people choose to stick with personal tuition.

Every one to one session is personalised to the client’s needs and wishes; regular classes, a programme to work on at home or a combination of both. Some people come three times a week, others come once a month to fine tune their programme and make it more challenging as they are able. Every session is different and tailored to individual’s needs. In the private environment of a one-to-one session a client can also discuss more sensitive issues which they would not want to raise in a class setting.

A client of ours had struggled with neck and shoulder pain for years and been to various Physios, chiropractors and osteopaths before giving Pilates a go. We have given her a programme of one-to-one Pilates sessions twice weekly as well as a few key exercises to work on at home. In the one-to-one sessions she has very close supervision of her positioning to ensure she gets the best out of the exercises. She has found that each session’s effects are lasting longer as she continues working with us, and we have been able to progress her to challenging exercises. Her posture has improved, pain reduced and movement in her neck and shoulder is now much better. She reports that Pilates has been much more beneficial than any previous treatment.

Another client who runs regularly and suffers from back pain from time to time came to see us to check his alignment in the exercises. We incorporated various pieces of equipment into the exercises and encouraged him to work in front of a mirror to help him to monitor his own alignment. He is now making great improvements knowing what to look and feel for, and his back pain has not recurred.

What about those with longstanding chronic conditions? Sometimes the level of a class can be too demanding and people find they need a level that is easier than beginner. In the one to one setting we can look very closely at the positions that are causing discomfort, and start to find positions of ease. These positions are then used to very gradually build up the challenge of the exercises within their abilities. It is a slow process and demands patience from the client while they make steady improvements, usually over months. We focus more on activity than pain as often people find they improve in everyday activities before pain starts to decrease. The strong foundation that Pilates builds means that the person can function better with everyday activities.

We can be versatile in our approach to a one to one session, so if you’ve got something in mind, why not give us a call and talk through your ideas?!

 

 

Pilates for men

I was flattered to be asked to be a guest blogger by Pilates Plus. The subject I was let loose on was why men should do Pilates. Here are my thoughts…

–o0o–

There are two groups of men who would benefit from doing Pilates. These groups are:

1) Sportsmen
2) All Other Men

Which group do you fit into?

SPORTSMAN: As a triathlete (and endurance athlete for 15 yrs), my training week has to cover swimming, cycling and running… but it’s also really important to me to include sessions that improve my core strength, flexibility and balance. For me, that means Pilates.

It’s hard to come up with a single sentence definition of what sport is, but here goes: a rule based contest of physical skill, where a trained physiology is crucial for good performance. 

Let’s break that definition down a bit and see where Pilates comes in. Remember this applies to your sport, not just mine. Often sports have one (or several) ideal postures – and the top performers mostly display textbook alignment, think of Bradley Wiggins’ flat back time trial position, Rory McIlroy’s torque generation at the tee, Mo Farrah’s stride length on the track… the list goes on. You don’t often see slouchers on the medal podium, and that’s because poor posture kills technique and impairs breathing, which in turn deadens concentration. By becoming aware of posture as Pilates teaches, you are putting your body into a better position to perform your skill.

Now let’s look at physiology. Endurance sport often refers to the engine – that is the capacity of the heart and lungs to deliver oxygen rich blood to the muscles. It could be said that your limbs are like the wheels of a car, converting the energy of the engine into movement. But there are a lot of unseen components connecting the engine to the wheels. If any of the cogs loses a tooth, if a seal doesn’t quite hold, if a chain gets gunged up…. the machine’s efficiency will suffer.

Pilates works on maintaining, strengthening and controlling the wee interconnecting and stabilising muscles that allow the power and speed to pass more efficiently from the heart and lungs to the major muscle groups. More speed / power with no additional effort? Yes please!

Lastly, I find that Pilates is great for injury prevention, and an excellent antidote to overuse. As a former rower, I had a very strong back but sometimes found myself immobilised by spasms of pain due to my lack of mobility. My hips and lower body in general were also really tight, not helped by increasing running and cycling volume.

Correcting this with a series of simple exercises (some shown at the bottom of this article) has really made the difference in my athletic abilities as well as normal life.

ALL OTHER MEN: Just because you’re not in pursuit of silverware doesn’t mean you’re not pushing your body hard. In fact, some of us put in as much sweat over the course of a normal working day as some people do in an evenings workout. Work in a coffee shop or pub? You’ll be on your feet all day. Postie? That’s a lot of weight shifted a lot of miles. And that’s without mentioning professions we naturally think of as hard physical graft. They key points about posture, overuse (especially of the back via heavy / repetitive lifting) and efficiency made above apply here. If you work with your body, Pilates can help safeguard the most valuable tool you have, and make it even more fit for purpose.

Those of us who do our work behind a desk might be thinking ‘none of this applies to me, all I need for work is eyes to look at the screen and hands to operate the keyboard’.

Honestly, I’d say this group needs exercise like Pilates most of all.

If overuse can break you, UNDERuse is guaranteed to corrode you to dust. As more of us earn our daily crust through sitting at a desk, we are exposing ourselves to a dangerous piece of equipment every day; the chair. Humans are simply not designed to sit down for long periods of time. Like sharks, we have to move or die. Unlike Jaws, however, sitting still kills us by inches at a time, day after day. Pilates acts to reverse the damage that slumping over a keyboard causes, strengthening and opening joints that are locked up for the working day.

And I’m assuming that you do something in life other than work, right? How about running for a bus, gardening or DIY, playing with your kids? I’d say it’s worth a Pilates session a week to make sure that you can have a kickabout with your grandchildren. Stay strong and flexible long after most of the guys you went to school with are surgically joined to their sofas.

SO, MEN, WHAT ARE YOU WAITING FOR???

The good news is that a Pilates class is suitable for just about anyone, and it’s not something that would reduce you to a sweaty mess. Some movements are physically and technically hard to do properly, but there are progressions so there will be a level everyone can do, even if you are just returning to exercise.

I suspect the reason some men are shy of going to a Pilates class is because they are scared of being the only guy there (the polar opposite of a normal exercise scenario), and, horror of horrors, all the women there will be way better then they are! Men who have a pair are not troubled by such trivial distractions.

I don’t worry about being in a minority and can happily admit that some people who are better than me at some things happen to be women. So start something with the humility and determination of a beginner, stay the course and FACILITATE YOUR MANLINESS!

–o0o–
Supine spinal twist. Arms in a crucifix, legs one way, look the other and relax into it. I love this one for getting mobility back into my spine. A nice variation is to gently pull the top knee down with your arm.

 

Squat: Get your ass to grass and your body between your knees and hang out here for a while. We have lost the squatting habit in the west due to sitting down (esp on the cludgey), and our hips are not lasting longer because of it.

 

Pigeon Stretch: Great for runners with tight ITBs. Leading shin at right angles to your trailing leg, and ease yourself down.
Foam roller: A great bit of kit to have. Not too pricey and easy to have to hand (mine lives beside the bed so I can have a quick roll – ooer! – before bedtime). There are a ton of exercises, I like rolling down the spine through the length of the ribcage (and counting the cracks and pops on the way), and rolling down the outside thigh to massage the ITB. Either support your weight with the top leg as shown or go full side plank for an extra joyous stretch!
With many thanks to Niall for composing his thoughts on how Pilates has benefited him.

Pilates for neck and shoulder pain

As the image above shows so well, pain in the neck and shoulders can be closely related, so we’ve grouped them together for this post. There are many muscle, nerve and fascial connections between neck and shoulder, so pain in one can easily lead to pain in the other. In addition, as we will see, Pilates exercises tend to be focused on the mobility, conditioning and alignment of both together, because anatomy-wise, it is very difficult to make a change to one part without influencing the other.

The neck consists of seven vertebrae, with joints between the bodies of the vertebrae (through discs) and between the outer points of the vertebae as well. The spinal cord runs through the middle and nerve branch out to supply the shoulders and arms and also affect the head.

There is also an artery running up each side of the spinal column in the neck (marked in red on the diagram) which supplies blood to the brain. Problems within the joints, caused by wear and tear, posture, prolonged static positions or muscle imbalances, can cause pain around the neck area but also refer pain to other parts of the body. This is usually due to the distribution of the nerves as the run from the neck.

So pain arising in the neck can be manifested in different places, lower and middle neck problems can cause hand and shoulder pain, while upper neck pain can cause jaw pain and also headaches. This can be difficult to make sense of but we can get great results  when we identify that the problem has arisen from the neck and treat the cause.

Problems with neck and shoulder posture are frequently seen together. People who work at computer screens or spend a lot of time sitting will tend to have a bit of a forward head posture, compressing the back of the neck, and the shoulders will begin to round forwards. This is called upper crossed syndrome and causes tightness in the front of the chest and back of the neck, and weakness in the upper back and front of the neck:

Look around you, does the posture above look familiar?! It can be the source of a lot of discomfort.

The shoulder and shoulderblade form a very mobile and complex joint system. The only joint connection to the rest of the skeleton is where the collarbone meets the sternum (the sternoclavicular joint below). The remainder of the shoulder relies on the support of the muscles around the shoulderblade and around the shoulder (glenohumeral) joint itself to remain in good shape and continue to provide the mobility that a  shoulder is capable of. Take a moment to reach overhead, to the side, behind you – if you have no shoulder problems you should be able to get an incredible range of moments from your shoulder, all of these supplied by groups of muscles working in combination. Sorry to get a bit geeky about this, but I think it’s a pretty incredible feat of engineering!

 

Shoulder problems can arise when an imbalance occurs in these complex relationships between muscles, with dysfunction of a nerve or if there is a problem within the joint itself – tightening of the capsule that surrounds the shoulder joint  for example. Anyone who does repetitive tasks or sits in sustained postures can be affected by shoulder problems. Within sport, swimmers and cricketers are a couple of examples where shoulder injuries can occur.

Pilates exercises work to balance the muscles around the shoulders, but also work the shoulders in different positions to achieve the dynamic stability the shoulders need to support them through the full range of movement they can achieve. The shoulders and neck are encouraged to work together to achieve improved posture throughout the upper body. This is great for preventing as well as treating neck and shoulder problems.

Some Pilates exercises use body weight to encourage correct control around the shoulders whilst maintaining good neck alignment. Specific movements encourage good coordination between muscles and allow muscles to switch on in the correct sequence which is vital for good shoulder function.

A Pilates client of ours had struggled with neck and shoulder pain for years and been to various Physios, chiropractors and osteopaths before giving Pilates a go. We have given her a programme of one-to-one Pilates sessions twice weekly as well as a few key exercises to work on at home. In the one-to-one sessions she has very close supervision of her positioning to ensure she gets the best out of the exercises. She has found that each session’s effects are lasting longer as she continues working with us, and we have been able to progress her to challenging exercises. Her posture has improved, pain reduced and movement in her neck and shoulder is now much better. She reports that Pilates has been much more beneficial than any previous treatment.

So, what can you do to help prevent neck and shoulder pain? Move, little and often. If you have to sit in a static position for a period, sit well supported with good neck and shoulder alignment (chin tucked in, length in the back of the neck and shoulderblades slid back and down into your mid-back) and take frequent rest breaks. During a rest-break you could try a couple of simple exercises to improve the mobility and dynamic stability of the neck and shoulders:

The V-W. Lying on your front with a cushion underneath your forehead, your chin tucked in and you belly button drawn up and away from the floor/mat. Start with the arms beside your shoulders in a W shape, then hover the arms a couple of inches and exhale sliding them overhead into a ‘V’ shape. Inhale and return to the start. Repeat 10 times. To make this exercise more challenging, lift the forehead a couple of inches, keeping the chin tucked in and continuing to look down.

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Upper back extensions: with your hands either on the chair behind you or on your low back, keep the chin tucked in and length through your neck, feel for the stretch between your shoulderblades, not in your low back. Hold for a breath and release. Repeat 5 times.

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Spine twist exercise (which can be done with or without a band or towel). Inhale, lenthen through the spine and exhale, rotate to the side, inhale hold and rotate a little deeper, exhale release back to the centre. Repeat 5 times each way.

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Please see your instructor if you have any questions about the exercises described here.

Enjoy the benefits!

 

Pilates for Office Workers

This is the first of our blog posts written whilst experiencing the subject matter – I am writing this on a computer at a desk so feeling all the problems I’m about to write about! So I consider it an interesting mindful practice.

Firstly, we know that sitting in static positions is not great for us. Joints stiffen, muscles are generally underactive. In the case of sitting whilst working at a computer there are some muscle groups which are overused, leading to imbalances and potentially discomfort. Blood pools in the feet and flows poorly through the areas where there is pressure (numb bum anyone?!).

Joints stiffen up in the spine, all the way from the neck, down through the ribcage and into the low back and pelvis. All the joints in the legs can stiffen up – hips, knees, ankles. Shoulders stiffen due to the muscles surrounding the shoulder being under tension as you use your mouse and type. Think of the feeling you get when standing up from your aeroplane seat after a long flight, it takes a moment to feel able to stretch up to your full height. Sitting at a desk is doing this to a degree every day. This is why us physiotherapists are always talking about those breaks, little and often! Set a timer on your computer to get up and move every 20 minutes, if only for 30 seconds.

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How often do you catch yourself with your phone sandwiched between ear and shoulder? I’m sure you know it’s not a good idea, but here’s a nice way to gently stretch your neck out after the deed is done, go gently into the stretch:

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Pilates takes your spinal joints and the joints in your arms and legs gently through their available motion and can help to counteract the problems encountered from sitting all day. Stiffened joints slowly start to release and improve joint range when doing Pilates. Core control improves and supports the joints. Joints are moved frequently into the range where they are stiff, they gradually ease out, creating more supple joints which move fluidly. However, you do not need to wait for your Pilates class to make a difference, there are things you can do during the day to help as well. Make every excuse to get up and stand or walk – to the photocopier, the water fountain, even when you answer a phone call.

Image from unitedhealthkent.com

The static sitting postures can cause typical patterns of  tightness in the muscles – the hip flexors and hamstrings are kept in a shortened position and if not stretched out can tighten over time. Poorly supported sitting can cause the upper back to become kyphotic (rounded) and the shoulders to round forward with the head poking forward. This posture can cause tightness in the pectoral muscles across the chest and the upper trapezius across the tops of the shoulders and back of the neck. Becoming absorbed in what’s on your screen certainly doesn’t help!

Image from livewellchiro.com.au

(Just caught myself in the posture above!) Why do we crane our necks to get closer to the screen, even though we can see fine?

A nice exercise you can do at your desk is to extend through the upper back, with your hands either on the chair behind you or on your low back:

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Of course your set-up of your desk can make a big difference and if you have someone who can help you get your workstation set up well it’s great to have that. Of course, in these days of hot-desking it’s not always possible. Even if you hotdesk, work on having your keyboard in front of you so you don’t have to reach far forwards to use it. Regardless, even sitting in perfect posture for a long time can be a problem!

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These are all exaggerations, but look around you, I bet some of them look familiar in your office!

Image from varierfurniture.com

Using a mouse and typing can cause overactivity in the arm muscles, especially in your wrists and forearms and around the shoulder of the hand you hold the mouse in. This doesn’t necessarily lead to strengthening of the muscles. As the muscles are held in a relatively static position, they can develop areas of tightness, called trigger points, which can cause a lot of discomfort especially when doing the same activity again. Your Pilates class will gradually move these muscles through their full range, dynamically stretching the muscles to ease discomfort. The strengthening aspect of your Pilates class will then work to build balanced and coordinated muscles through the whole chain from neck, shoulder and upper back, right down to the tips of your fingers, preparing you for next time you have to sit at a computer. Tess demonstrates a spine twist exercise (which can be done with or without a band or towel):

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Whilst some muscles become overused, others are very much underused. In slumped sitting, low back and core muscles are completely switched off, some of the deep stabilising low back muscles are held in a lengthened position and they can then take a longer time to switch on properly when returning to standing. As the shoulders round forwards the muscles across the upper back which stabilise the shoulder blade switch off, weakening and lengthening. Pilates specifically works on strengthening and building control of these muscles, so that they switch on when required.

Laura demonstrates a side bend to loosen the spine:

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Finally, Pilates requires focus on the exercises to execute them correctly. This focus and concentration has been found to reduce stress hormone levels in the body so your Pilates class is the perfect way to unwind at the end of a long day in the office!

If you do these exercises at home or in your office, please see your Pilates instructor if you have any discomfort or any questions about the exercises.

Images thanks to darrochphotography.com unless otherwise specified