Pilates Essentials manual

A L L - A M E R I C A N

P I L A T E S

TEL: 561.795.1219 / FAX: 561.790.3781

C E R T I F I C A T I O N S

I N C .

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Pilates Essentials

Engage Your Core Like Never Before

101

All-American Pilates™ Cross Training

Pilates Essentials Foundations Course All-American Pilates™

Designing Fitness That Fits Your Clients Lifestyle

All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

This material, including photographs, may not be copied or used in any form without express permission from All-American Pilates Certifications Corp. 3-05

A L L - A M E R I C A N

P I L A T E S

TEL: 561.795.1219 / FAX: 561.790.3781

C E R T I F I C A T I O N S

I N C .

E-MAIL: info@PilatesEducation.com / WEB: AllAmericanPilates.com , Pilates-Equipment.com, PilatesEducation.com

ALL-AMERICAN PILATES CERTIFICATIONS INC

Pilates Cross Training Joseph H. Pilates (1880-1967)

All-American Pilates Education PILATES CERTIFICATIONS

PILATES CROSS TRAINING

Pilates Mat Fitness

Pilates Essentials

Chair Pilates

Pilates Equipment

Golf Pilates Mat

Gym Pilates

Pilates Studio

Golf Pilates Equipment

Pool Pilates

Ball / BOSU Pilates For More All-American Pilates Courses Visit

w wAll-American w .Pi la te sE duc a International ti on.c om Pilates™ PGA National Resort & Spa / Palm Beach Gardens, Florida 33418 Toll Free 877. 487.1575 • Fax 561.337.6715

Web: www.PilatesEducation.com e-mail: Info@PilatesEducation.com • Certifications: www.AllAmericanPilates.com

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A L L - A M E R I C A N

P I L A T E S

TEL: 561.795.1219 / FAX: 561.790.3781

C E R T I F I C A T I O N S

I N C .

E-MAIL: info@PilatesEducation.com / WEB: AllAmericanPilates.com , Pilates-Equipment.com, PilatesEducation.com

CERTIFIED ALL-AMERICAN

Owner Administrator Susan Santisi

Director Classical Pilates Master Pilates Trainer Dawn James

Director All-American Pilates Master Trainer Bonnie Hubscher

"What is balance of body and mind? It is the conscious control of all muscular movements of the body. We should recognize the mental functions of the mind and the physical limitations of the body so that complete coordination between them may be achieved. Not mind or body but mind and body! My method develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind and elevates the spirit."

--Joseph H. Pilates

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ACKNOWLEDGEMENTS

The owners of All-American Pilates Certifications would like to specially thank Bonnie Hubscher, (Pilates Educator, Fitness Instructor of over 20 years) who demonstrated her vast knowledge, tireless effort and tremendous heart in putting together this comprehensive manual. Bonnie made sense of the reams of research materials and sources to compile and complete on schedule, this comprehensive manual, and to keep true to All-Americans vision, goals, and standards. We are very grateful for her association, integrity, dedication to quality and for her friendship.

We also owe sincere thanks to Dawn James, Master Pilates Instructor and true professional in every sense of the word. Dawn has provided All-American with valuable direction, guidance and input in all aspects of this project. From selecting exercise sequencing, to modeling for the photos, to skillfully interfacing her knowledge of classical Pilates with today’s contemporary approach to Pilates. Throughout this journey Dawns honesty, integrity, professionalism and genuine love for people has shown through.

This manual is a culmination of many influences: from Joseph H. Pilates himself to our associates as well as the students and clients we work with. They have blessed and inspired us to step outside the box in order to bring All-American students a learning experience that will last a lifetime.

Joe & Susan Santisi

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Table of Contents ACKNOWLEDGEMENTS........................................................................................III MISSION STATEMENT..............................................................................................1 HISTORY OF PILATES...............................................................................................2 WHAT IS PILATES?....................................................................................................4 PILATES PRINCIPLES...............................................................................................5 ANATOMY AND PHYSIOLOGY.............................................................................23 POSTURE ANALYSIS...............................................................................................35 CONTRAINDICATIONS...........................................................................................48 GLOSSARY..................................................................................................................60 PRONUNCIATION GUIDE.......................................................................................67 REFERENCES.............................................................................................................69

All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

This material, including photographs, may not be copied or used in any form without express permission from All-American Pilates Certifications Corp. 3-05

Mission Statement All-American Pilates Certifications, Inc. The All-American Pilates Certifications team is dedicated to providing its students with a solid foundation in Pilates-based exercise. The All-American Pilates student will then be prepared to carry their knowledge on into many different avenues of personal or group service.

Our team of instructors and administrators have created a comfortable learning atmosphere which respects the vast backgrounds of each student. Current healthcare providers and seasoned personal trainers attending our workshops are educated about Pilates exercise along with the novice student newly embarking upon the fitness/wellness industry.

All-American Pilates students are future instructors with a desire to make a difference in someone else’s life. AllAmerican Pilates instructors are inspired with a professional and caring attitude which is passed along to the students and then to the clients along with the exercise instructions.

All-American Pilates’ unique educational program, which combines the original work of Joseph Pilates, the classical approach and the contemporary approach, lays the foundation for the student to continue into many other facets of the fitness/wellness industry. Personal Trainers may continue training their clients in the gym, but with new information and techniques to balance their program designs. Pilates instructors may choose to become specialized and continue their education with our Golf Pilates or Senior Pilates programs. Yoga instructors may blend the principles of Pilates into their yoga sessions. The possibilities are endless.

The controversy about what is and isn’t “real” Pilates exercise may rage on, but the All-American Pilates vision is about stepping outside of the box, exploring how the Pilates principles can be applied to any form of physical activity, from rehabilitation to sports, and then integrating them into existing programs. Pilates is the future for the fitness/wellness industry and the All-American Pilates instructors are at the forefront of that movement.

Joseph Pilates’ “Contrology” wellness program was also an amalgamation of many different disciplines that Pilates studied and practiced; to name a few – yoga, martial arts, tai chi, gymnastics, swimming, acrobatics, ballet, modern dance, jazz, circus performance, kinesiology, anatomy, physical therapy, imagination therapy, and mind-body-spirit therapy. Joseph Pilates’ work was always a work in progress. It was then. It is now.

Today the Pilates service industry has continued to evolve the work of the man Pilates. The essence of his vision always comes through when the exercise principles he set forth in his book of 1945, “Return to Life through Contrology,” are applied to any fitness program.

All-American Pilates has a unique educational series which takes the student instructor and intern from the fundamentals of Pilates-based wellness to several other fitness avenues. All-American Pilates is the first certifying body to offer an educational format that encompasses the original 34 floor exercises to every standard piece of the apparatus, both small and large.

Borrowing from the instructing techniques of group fitness the exercises are taught in a layering format from most fundamental movement patterns to complex. The Pilates instructor will want to use a similar approach when teaching Pilates exercise to their clients. All-American Pilates has provided education in Client Program Design since its inception, and has set the pace for other certifying bodies.

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D E S I G N

C U S T O M I Z A T I O N

History Of Pilates Joseph H. Pilates (1880 – 1967)

Joseph Humbertus Pilates lived to be a robust and vital 87 year old icon. Had he not succumbed to the effects of smoke inhalation during a fire, in the restaurant below his studio on 8 th Avenue in New York City, he potentially could have demonstrated an incredible level of physical fitness for many years to come. Looking at photographs of Joseph Pilates, even well into his eighties, it may be hard to imagine that he did not always enjoy such vitality.

Pilates was born near Dusseldorf, Germany in 1880. His unusual last name is actually derived from his Greek heritage and would have been Pilatos. Much controversy surrounds the correct pronunciation of his name; however, nearly all publications show it as (Pi –LAH – teez). All instructors crack an amused smile at the mispronunciation of his name by those outside the Pilates loop. Living relatives of Joseph Pilates say that the name was not pronounced as it is popularly known today. Mary Pilates LaRiche, the niece of Joseph Pilates, and a long time resident of South Florida, says her family name, as best she can recall, was pronounced (Pi – LOTTS).

Mary Pilates LeRiche qualifies as an expert and probably was Joseph’s earliest disciple as she had worked in her Uncle Joe’s exercise studio as a young woman in her 20’s. A now famous photograph of Pilates’ exercise studio at 939 8th Ave., NY, NY displays a long rectangular room with at least four Reformers (the original group sessions?) in a line. Joseph stands between two, his wife, Clara, in her nurse’s uniform, by another, and his niece Mary at yet another Reformer. Mary relocated to South Florida in the 1960’s and continued teaching fitness as her uncle had taught her. Even today, well into her eighties, she will demonstrate the “only way” the exercises should ever be done; that would be just the way Uncle Joe taught her in the 1940’s!

“People won’t understand the brilliance of my work for 50 years.” That is a quote from Joseph, himself, about 50 years ago. Mary LeRiche says that her uncle would be quite happy and surprised at just how much impact his work is having on the world. Today, healthcare professionals are studying and implementing his work into their healing therapies. Medical doctors are writing prescriptions for their patients: Pilates. His clever exercise apparatus designs are virtually the exact designs used by today’s equipment manufacturers. How many of the exercise machines found in today’s traditional gym setting can accommodate hundreds of exercises on one single piece the size of a twin bed? The Wunda Chair doubled as a small livingroom side chair that when flipped upon its back becomes a gymnasium with two bedsprings. Pilates felt that every home should have one.

As a child Joseph Pilates had suffered with asthma, rickets, and rheumatic fever. Even as a young adolescent he made a life-altering decision that he would restore his own health. He studied the Eastern disciplines of yoga and martial arts and blended them with Western forms of physical activities such as bodybuilding, gymnastics, boxing, and recreational sports. At the young age of just fourteen years he had sculpted his physique so well that he was posing for anatomical charts.

As a young man Joseph Pilates moved from Germany to England where he became a boxer, circus performer, and self-defense instructor. When World War One erupted he, and other German nationals, were incarcerated in Lancaster as “enemy aliens.” Pilates influenced the other detainees to follow his exercise regime which he called, “Contrology.” His fitness program was so beneficial that he and his fellow compatriots survived the 1918 influenza epidemic that took the lives of thousands of people. He attributed their survival to their physically fit lungs! Hence, the Pilates Principle of Diaphragmatic Breathing!

Pilates was later sent to the Isle of Man to work as a nurse orderly caring for the hospitalized detainees. One can imagine the condition of many of these patients; some had grown weak from lingering in hospital beds for months, their muscles atrophied, further inhibiting their potential for recovery. Unable to participate in Pilates’ floor exercises, these men benefited by Joseph’s cleverly designed apparatus to rehabilitate them right from their hospital beds and wheelchairs. Looking at the Cadillac one can see the table as the hospital bed; plumbing pipes create the canopy and borrowed bedsprings become first assistive and then resistive exercise tools. Despite whatever injuries the wounded may have had, Pilates was able to strengthen their muscles and restore them to their potential good health.

After the war Joseph returned to Germany but became disenfranchised with the political direction his country was taking. He decided to immigrate to the United States of America. He met his future wife, Clara, on the ship. Clara was a nurse and they realized that they shared the same interest of wanting to restore the good health of others.

When they arrived in New York they decided to open up a physical fitness studio.

Joseph Pilates’ method of physical and mental wellness has been a best-kept secret of the dance and entertainment world since the 1920’s when his studio was discovered by Martha Graham, the mother of modern dance, George Balanchine, the artistic director for the New York City Ballet, and Rudolf von Laban, founder of Labanotation.

Dancers such as Hanya Holm and Romana Kryzanowska, along with prizefighters, actors, actresses and traveling circus performers embraced his methods both for the total body conditioning needed for the rigors of their work and also for rehabilitating the injuries that often plague dancers, performers, and athletes.

Dance companies all over the world use Pilates’ exercises to keep their dancers in top form. Many dancers go on to become Hollywood celebrities; Patrick Swayze and Madonna to name only two. Due to the attention the mainstream public gives to Hollywood celebrities the name Pilates is now a household word. If Madonna does it, it must work.

Romana Kryzanowska entered Pilates’ world as a young dancer in New York. Pilates regarded her as his disciple; she had absorbed and could express the essence of his work as if it were coming from him. She continues his legacy today in New York and has generously shared her knowledge with the world through her students, books, videos and lectures.

Joseph’s obituary, appearing in the New York Times in 1967, reads like an advertisement for his methods. He is described as a white-maned lion with steel blue eyes (one was glass from a boxing mishap), mahagony skin, and as limber in his 80’s as a teenager.

Joseph and Clara operated their exercise studio for over 40 years. He had dedicated his life’s work to restoring the health and vitality of others. Gone now for more than thirty-five years, the essence of his work continues on into the 21st century.

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What is Pilates?

Pilates is a seven-day a week lifestyle. Joseph Pilates developed his program to create a healthy body, a healthy mind and a healthy life with balance.

Pilates is much more than an exercise method. Joseph Pilates blended many disciplines together to restore harmony and balance on three levels; physically, mentally, and spiritually. Originally, he referred to his work as “Contrology,” because he believed that the mind controls the body and the spirit builds the body.

The following is an excerpt from his book, “Return to Life Through Contrology.”

“The ancient Greeks probably knew better than anyone else: the true meaning of balance of body and mind, as tangibly expressed in terms of supreme physical health, is supreme mental happiness combined with supreme achievements along the highway of human progress. They even believed that the soul itself is inextricably bound to the physical functions and mental manifestations of the human body. They fully understood that the nearer one’s physique approached the state of physical perfection, the nearer one’s mind approached the state of mental perfection.”

Joseph Pilates’ methods are borrowed from eastern disciplines with contemporary western fitness methods. Pilates emphasizes balancing strength with flexibility for more efficient movement to enhance performance from simple daily activities to sports. He dedicated his life’s work to helping others achieve their full potential in life; he passed his methods on to his students and disciples to be carried into the 21 st century impacting the lives of people all over the world.

Benefits

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Unites the mind with the body Enhances mental acuity Restores proper functioning of the internal organs Replaces muscular imbalance with youthful posture Replaces faulty movement patterns with bio-mechanically correct movement Boosts the immune system Lengthens tight muscles; strengthens weak muscles Improves the performance of any sport Eliminates or reduces aches and pains and reduces the risk of injury Enhances sexual fulfillment Changes how others perceive you Raises self-esteem Improves balance, stability, and agility Streamlines the body Easy on the joints – low stress exercise Can be enjoyed by all populations and complements other methods of exercise Is never boring

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Pilates Principles Joseph Pilates’ book “Return to Life Through Contrology” describes a set of guiding principles that would result in gaining complete mastery of your mind over the complete control of the body. Although both Classical and Contemporary Pilates have modified his original set of guiding principles we wish to share with our students and clients the roots of today’s Six Principles of Pilates.

Joseph Pilates’ Guiding Principles of Contrology 1. You must faithfully, and without deviation follow the instructions accompanying the exercises and keep your mind wholly concentrated on the purpose of the exercises as you perform them.

2. Patience and persistence are vital qualities in the ultimate successful accomplishment of any worthwhile endeavor. Perform your Contrology exercises ten minutes without fail; you will subconsciously lengthen your sessions to twenty minutes or more.

3. Contrology exercises guard against unnecessary pounding or throbbing of your heart. Performing Contrology exercises in a recumbent position does not aggravate any possible undetected organic weakness.

4. To breathe correctly you must completely exhale and inhale, always trying very hard to “squeeze” every atom of impure air from your lungs in much the same manner that you would wring every drop of water from a wet cloth; almost as free of air as is a vacuum.

5. Do not sacrifice knowledge to speed in building your solid exercise regime on the foundation of Contrology. Concentrate on the correct movements EACH TIME YOU EXERCISE, lest you do them improperly and thus lose all the vital benefits of their value.

6. Bulging muscles hinder the attainment of flexibility because the over-developed muscles interfere with the proper development of the under-developed muscles.

7. Vertebra by vertebra try to “roll” and “unroll” your spine exactly in imitation of a wheel rolling forward and backward. If your spine is inflexibly stiff at 30 you are old; if it is completely flexible at 60, you are young.

8. Never fail to get all the sunshine and fresh air that you can. Let the life-giving ultraviolet rays reach and penetrate into every skin pore of your body. Do not fear the cold of winter.

9. Eat only enough food to restore the “fuel” consumed by the body and to keep enough of it on hand at all times to furnish the extra energy required on occasions.

10. Never repeat the selected exercises more than the prescribed number of times.

11. For a good sleep at night a quiet, cool, well-ventilated room is best. Do not use a soft mattress.

“Firm but not soft” is a good rule. Use the lightest possible bed covering consistent with warmth. Do not use large bulky pillows—better still, use none at all.

12. When bathing use a stiff brush with no handle which forces us to twist, squirm, and contort ourselves in our attempts to reach every portion of our body. A good stiff brush stimulates circulation, thoroughly cleans out the pores of the skin and removes dead skin too.

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THE SIX PRINCIPLES OF PILATES AS TAUGHT BY ALL- AMERICAN PILATES CERTIFICATIONS The Six Principles of Pilates are inspired by the work of Joseph H. Pilates during the turn of the 20th century. All movement is made more bio-mechanically efficient and safe when these techniques are followed in and out of the fitness/wellness industry. Intensity builds and safety is insured when the Mind - Body Connection, Dynamic Alignment, Diaphragmatic Breathing, Core Control, Oppositional Lengthening and Precision & Fluidity are employed with every movement of our current fitness/wellness programs.

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THE MIND - BODY CONNECTION DYNAMIC ALIGNMENT DIAPHRAGMATIC BREATHING CORE CONTROL OPPOSITIONAL LENGTHENING MOVEMENT TECHNIQUE: PRECISION & FLUIDITY

1. THE MIND - BODY CONNECTION The nervous system is the informational link between the mind and the body. The brain sends messages to the body and the muscles through nerves which originate in the spinal cord, the most important structure in the back.

Joseph Pilates believed that the mind controls the body. Learning new movements well can only be achieved through focus and concentration. Pilates exercise trains the individual to correct posture, faulty movement patterns, etc., via neuromuscular re-education. In layman’s terms neuromuscular re-education is referred to as muscle memory.

Thoughts are processed by the brain and transformed into powerful electrical impulses that travel through the nerves to all parts of the body. The mind generates an average of 600 - 800 thoughts every minute. That’s an average of 366,912,000 thoughts per year! These thoughts are converted into numerous electrical impulses that will directly contract the muscles throughout the body.

When a muscle is stimulated by the electrical impulse in a nerve the muscle contracts. This results in a shortening of the muscle, which causes it to tighten and move one bone closer to another bone. The greater the stimulus, the greater the muscular tension and force of contraction.

Mental focus on which muscle to contract in a specific pattern of movement and with purposeful technique will more likely produce quality in the movement desired via the electrical impulses from the brain to the muscle. With an attention to technique with every single repetition the electrical impulses deepen the groove along the neurological pathway to the muscle. The deeper the neurological groove the better the re-education of the muscle movement thus replacing faulty movement patterns with bio-mechanically correct engrams.

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Only with concentration can the remaining five Pilates principles be effective. To get great results one must concentrate on alignment, diaphragmatic breathing, core engagement, lengthening the extremities away from the trunk, and proper movement technique (precision and fluidity) for a safe and effective workout.

New clients will often remark that it is just too much to remember! However, the role of the All-American Pilates Specialist is to facilitate the mind - body connection with an attention to detail, truly “training” their clients until the six Pilates principles are unconscious habits in all of the clients’ daily activities. Neuromuscular re-education has occurred when the brain perceives eminent exertion and the deep stabilizers engage in anticipation of the physical action thereby stabilizing joint positions.

TOOLS TO ENHANCE THE MIND-BODY CONNECTION Imagery is a powerful tool used by the All-American Pilates Specialist to facilitate the mind - body connection.

Suggesting a specific mental image or picture to the client will trigger the electrical impulses from the brain to the muscles before the actual movement has begun. In Oppositional Lengthening the instructor can request the client to reach their hands to the opposing walls and the client will abduct their arms in the transverse plane. Or, the instructor can request the client to reach their hands to the opposing walls “as if a river of energy is flowing through the fingertips!” The intensity of the exercise and the results for the client will be far better with the latter suggestion.

Tactile cueing is a tremendous tool, especially for the new client. The power of touch has the ability of increasing an infant’s mental development, of soothing physical as well as mental pain, and many other profound benefits too numerous to site! Tactile cueing directly sends a message to the brain that the spot being touched is the muscle group that must be recruited for the success of a particular movement pattern. Now the brain has a target of where to deliver the electrical impulses to stimulate the muscle fibers into action. Simply touching the back of the client’s hands to guide the hands in the precise track the arms must follow to complete the movement pattern can mean the success of the neuromuscular re-education. Soon the instructor no longer needs to guide the client’s hands; the muscles of the arms “remember” the correct track to follow.

Appropriate touching of the client would include using “ski-jump” fingers or an open palm rather than poking with one finger. When it is necessary to cue the client while being physically close please stand or sit to the side of the client; initiate physical contact by first placing an open palm on the client’s upper back or shoulder before using tactile cueing elsewhere on the body. Note: Some state laws prohibit personal trainers from touching their clients.

Positive verbal cueing will quickly reinforce movement patterns that follow the Pilates principles. Avoid speaking in negative terms unless absolutely necessary. Think instead of making corrections by asking the client to perform the movement pattern in a “different” way and then always follow with praise or acknowledgement of the corrected movement as reinforcement.

Auditory cues would include snapping fingers, slapping the side of your thigh or abdominals, exaggerated breathwork, etc., to keep the client moving at a specific pace or to reestablish the correct breathwork pattern.

Also, voice fluctuations will cue the client to speed up, slow down, raise or lower the intensity, or bring the set to a close—not to mention liven up the workout!

Visual cues refer to using the client’s image in a mirror to point out corrections in alignment. The instructor can also use a handheld mirror over the client when the client is supine and cannot see their lower extremities. The instructor can also demonstrate the incorrect movement pattern that the client has the habit of doing and then demonstrate the correct movement pattern. Another example of visual cueing is to reinforce proper eye gaze; asking the client to maintain eye contact on a focal point has tremendous impact on the alignment of the axial skeleton (skull, spine, ribs).

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MUSCLE INNERVATION The stimulus for a muscle contraction comes from a specialized nerve cell or motor neuron.  

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One motor neuron and all the myofibers that it stimulates are called a motor unit.

Recruitment refers to the number of motor units that are stimulated for a specific muscular response.

To allow for smooth muscle contractions and to avoid fatigue, all the motor units will not contract at the same time.

Activities requiring power and a high degree of force generated quickly will recruit more motor units to fire simultaneously o Fatigue will occur more quickly During voluntary contraction the brain sends a signal through the spinal cord to the motoneurons to stimulate the motor units o The order of motor recruitment is usually from small to large o To recruit more motor units it is necessary to increase the workload of the targeted muscles o When a muscle is overloaded or fatigued, assistor muscles will be recruited to help accomplish the task.

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2. DYNAMIC ALIGNMENT Dynamic Alignment represents the never-ending resistance to forces of gravity. When the muscles are well balanced around the skeletal structures, there is an efficient system capable of performing any given task. Internal organs also have better mobility when the musculoskeletal alignment is sound.

Ideal postural alignment is essential to restoring muscular balance. Attention to alignment must go beyond the position of the joints while standing, sitting, or lying down. Dynamic Alignment encompasses the importance of joint position during movement as well as when the body is static. Pilates exercise retrains the body to move more efficiently because of the attention to joint position during every exercise, every repetition, with every inhalation and exhalation, without exception! The client must have their bones in the right places to get the right muscles working!

Before every action the body must be aligned properly but must also be as tension-free as possible. However, a slight activation of the stabilizing muscles will be necessary to maintain the proper neutral alignment of the head and neck, scapula, vertebral column, thoracic cage and pelvis. Attention to the alignment of the extremities must not be forgotten! Fingers, hands, wrists, and elbows, as well as, toes, feet, ankles, and knees impact and are impacted by the rest of the body!

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Standing • • • • • • • • •

Head evenly between shoulders; chin retracted and level with the floor; back of the head follows the line of the spine; crown lifted to ceiling Shoulders retracted and depressed gently; sternum softly lifted; thumbs facing forward Vertebral Column ideally follows the “S” curves: Lordotic (concave) in the cervical and lumbar spines and kyphotic (convex) in the thoracic and coccyx spine; generally, all postural types should strive to lengthen the vertebral column from the coccyx to the cervical spine Lower abdominals held in behind the ASIS; anterior ribcage softly funneled in and down Neutral Pelvis: ASIS and the Pubis Symphysis should be in the same plane; coccyx gently pointed toward floor; iliac crests level; engage the lower buttocks and upper-inner thighs Knees aligned directly under the ASIS and directly over the center of each foot and two middle toes Bodyweight evenly distributed on both feet Feet support bodyweight as tripods: weight distributed over the metatarsal pads evenly, down the lateral arches, and on the center of the heels Eye gaze to the horizon

Seated • • •

Same as for standing Ischium evenly in contact with the seat (a small cushion, box, etc., may be placed under the buttocks for clients unable to sit in neutral pelvis; also, tailor-crossing the legs or bending the knees may be helpful) Knees aligned directly in front of ASIS and directly over the center of each foot and two middle toes (placing a “spacer” between the knees and feet will activate weak adductors; placing both thighs inside a Magic Circle will strengthen weak abductors)

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Supine and Prone • • • • • •

Same as for standing Chin gently tipped toward throat Eye gaze: When supine, eyes to knees; when prone, eyes to floor Crown of head and coccyx lengthening to opposing walls Supine: either palms to ceiling or thumbs to ceiling Prone: palms facing in or down

Side Lying • • • • • • •

Same as for standing Level One: Head rests on folded arm Level Two & Three: Elbow and/or hand supports head directly in line with shoulder joint Eye gaze directly ahead versus down the body toward legs and feet Underside of the ribcage engaged away from the floor Upper ASIS stacked directly above lower ASIS Top ankle, knee, hip, shoulder directly aligned with crown (bottom leg bent or straight) or both legs straight with a 30 degree flexion at the hips (creates stability); legs may also extend in direct line with trunk

Head & Cervical Spine Alignment The cervical spine is ideally lordotic (concave) and is referred to as neutral cervical alignment. This neutral alignment is best maintained with the chin gently retracted and tipped toward the throat. However, cue the client to avoid jamming the chin to the throat or chest; there should be enough space between the chin and throat to gently hold a medium sized tomato.

Imagery Cue: “Press your throat through the back of your neck; feel how that simple movement impacts the alignment of the entire body!”

The posterior skull should always follow the line of the thoracic spine whether in flexion, extension, lateral flexion, or rotation. When seated or standing place a wooden dowel along the vertebral spine of the client and cue him/her to retract the head against the dowel.

Should the client have thoracic hyperkyphosis it will be difficult for him/her to maintain the ideal cervical alignment.

When supine the client will exhibit chin jutting and their eye gaze will be toward the ceiling: Place a small rolled towel, foam cushion, or pillow under the head to facilitate positioning the head so that the chin is tipped down and the posterior neck is lengthened. On the Reformer the headrest can be placed in the up position.

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Scapular Stabilization & Mobility The scapula (shoulder blades) have a great deal of mobility due to the lack of direct bony attachment to the thoracic cage and spine. To enhance the mobility of the arms the scapula can glide up toward the neck (elevation), down toward the hips (depression), in toward the spine (adduction/retraction), away from the spine (abduction/protraction), and can rotate upward and downward.

Scapular stabilization should be maintained with every movement pattern whether upper or lower extremity and with spinal articulation. The shoulder blades are gently pressed down toward the hips by engaging the middle and lower trapezius, rhomboids, and anterior serratus muscles. Of course, some scapular movement will occur with upper extremity movement, but the instructor watches for a lack of control and cues the client to maintain scapular stability (“Shoulders back and down with armpits to hips!�).

The shoulders should be maintained behind the clavicles with the shoulder blades gliding over the ribs during arm movement. Squeezing the shoulder blades toward the spine tightly should be avoided.

The upper trapezius and levator scapula tend to hyperactivity and may result in hypertonus. The faulty movement pattern of firing the upper trapezius and levator scapula with every arm movement and deep breath can result in muscular tension in these muscles as well as surrounding neck and back musculature and can be the root of headaches and neck pain. The act of gently engaging the scapular stabilizers (mid and lower trapezius, rhomboids, and anterior serratus) and elongating through the cervical spine will greatly reduce this troublesome muscular tension of the neck and upper trapezius.

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Shoulder Disassociation A common faulty movement pattern is unnecessarily elevating and protracting the scapula. Many individuals do this with every movement of their arms; ask them to take in a deep breath and the shoulders raise up around the neck. This hyperactivity of the upper trapezius and levator scapula creates muscle spasms in the surrounding neck and back muscles that can even lead to tension headaches. This faulty movement pattern is Shoulder Association. Of course, the scapula is designed to move with every arm movement which enables the arm to circumduct. However, the muscular imbalance (overactive upper trapezius and weak anterior serratus and lower trapezius) cause the scapula movement to be exaggerated due to the lack of shoulder stabilization.

Shoulder Disassociation teaches the individual to stabilize the scapula back and down which then enhances the mobility of the arm and shoulder. Why? A common postural deviation is medially rounded shoulders (scapula are protracted/abducted because the anterior chest and shoulder muscles are overtight and the mid trapezius and rhomboids are stretch weak) which places the acromioclavicular joint in a poor position impeding shoulder flexion, extension, and rotation (can also cause impingement of the brachial nerve plexus).

Thoracic Cage Position The thoracic cage or ribcage is part of the axial skeleton and attention to its stabilization and mobility is important for many reasons.

The thoracic cage houses and protects the lungs, diaphragm, heart, and other internal organs. Due to the numerous muscular attachments to the ribs the stabilization of the thoracic cage must be maintained while exercising. This engagement also facilitates the stabilization of the lumbar spine and pelvis.

The diaphragm is a dome-shaped muscle which is attached to the lower ribs from the front to the back. During diaphragmatic breathing the lower ribs will expand (upon inhalation) posteriorly and laterally to facilitate the diaphragm as it moves down while pulling the lungs down pulling oxygen into the deep lung bases.

A loss of core control during inhalation will result in the thoracic cage deviating from proper alignment resulting in a lack of stability in the thoracic spine and the anterior ribs over-lifting. During exhalation the engagement of the “powerhouse� musculature (scapula stabilizers, tranversus abdominis, internal and external obliques, rectus abdominis, external hip rotators, and pelvic floor muscles) facilitates the complete elimination of the carbon dioxide from the lungs. The lower ribs are compressed toward the center of the trunk and then down toward the hips reinforcing proper alignment of the axial skeleton, scapula, and pelvis.

With poorly controlled upper extremity movement the engagement of the musculature attached to the ribs may cause the misalignment of the thoracic cage. During supine exercise the instructor must be mindful of the posterior thoracic cage lifting away from the mat or table/carriage (the mid and lower back will be excessively arched.) When the client is standing or sitting the instructor should watch for over-lifting or sinking of the sternum, lumbar hyperlordosis, and protruding of the anterior-inferior ribs.

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Lower Extremity Alignment The alignment of the lower extremities acts upon the alignment of the lumbopelvic region and on up the kinetic chain. Positioning and recruitment of the big toe can mean the success of an exercise movement. The instructor must cue for proper feet, knees, and thigh position during every movement pattern.

The femur neck and head position within the hip socket (neutral, external rotation, internal rotation) will affect the range of motion of the legs, the lengthening and shortening of leg and hip muscles, and the ability to extend the lumbar spine safely.

• • • • • •

To encourage alignment of the ankles, knees, and ischium, items such as small balls, foam cushions, or styrofoam blocks, can be used as spacers between the knees and feet. The client may squeeze the items to engage the adductors to avoid the knees falling apart.

To recruit lateral hamstrings and gluteus maximus, externally rotate the femur in the hip socket To recruit medial hamstrings and less of the gluteus maximus maintain neutral alignment of the femurs (knees and toes pointing directly forward and aligned directly under the ASIS) To prevent overuse of the external rotators and piriformis work in neutral alignment To recruit the iliopsoas more than the rectus femoris, externally rotate the femur To recruit the rectus femoris work in neutral alignment

Feet as Tripods Never underestimate the impact that the feet have on the alignment of the body! The tripod position is essential to achieving overall balance of the body. The feet should be placed directly under the hip joints to evenly support the body. The body’s weight should be evenly distributed over the three points that form a triangle on the foot: • • •

The ball of the big toe The outside edge of the foot (lateral arch) The center of the heel

There should be no pressure forward on the toes or backward on the heels. By also placing an equal pressure the outside edge of the foot the medial arch is reinforced where it should be. Attention to the alignment of the feet during all the exercises will influence positive changes in the body from the bottom up.

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on

Lumbopelvic Stability The lumbar spine ideally is lordotic (concave) and is referred to as neutral spine. Lumbar stability is best achieved during lordosis for greater weight-bearing and shock absorption. The lumbar intervertebral discs bear weight evenly across their surfaces when the lumbar spine is in neutral position (thus reducing the risk of herniating a disc and causing compression against the spinal cord or nerve roots).

Imprinted lumbar spine refers to the lengthening of the lordotic curve toward flexion. Imprinting the lumbar spine can be achieved one of two ways: First attempt to lengthen the lumbar by engagingor funneling the anterior-inferior ribs down toward the center point. The less desirable method is to posteriorly tilt the pelvis; however, during imprinting the pelvis should not be tilted to the degree that the sacrum and buttocks curl up away from the mat or table/carriage.

Imprinting the lumbar spine via a posterior pelvic tilt is valuable when the client is de-conditioned and unable to maintain lumbo-pelvic stability during supine lower extremity movement patterns. Clients with lumbar hyperlordosis should exercise with an imprinted spine during open kinetic chain movement patterns until sufficient functional skill has developed.

Also, imprinting is initiated during many exercises implementing spinal flexion as in the Roll Up or Bridge.

When exercises are performed with one foot or both feet secure on the mat or equipment, in a closed kinetic chain, the lumbopelvic position is best done in neutral. However, when both feet are elevated in an open kinetic chain and the client has not yet mastered control, imprinting the spine is recommended.

Neutral Pelvis refers to the alignment of the pelvis. When standing or sitting the pelvis should be directly under the shoulders with both ilium level. The ASIS (anterior superior iliac spine) and the pubis symphysis are parallel to the wall. While seated the ischium should be evenly in contact with the seat. When supine the pubic bone and the ASIS are level. However, during imprinting the pubic bone may be slightly higher than the ASIS. Instructors will cue their clients to place the heels of their hands on their ASIS and their fingertips on their pubic bones to form a level triangle with their hands so that the client may understand neutral pelvic alignment, posterior pelvic tilt (ASIS lower than pubis), and anterior pelvic tilt (ASIS higher than pubis).

During supine lower extremity movement patterns the weight of the legs, lever length, and overtight lower extremity muscles pull on the pelvis.

When the movement is performed without control, the pelvis is pulled out of the desired alignment. Upon exhalation, with core engagement, the deep functional core stabilizers, which are attached to the ilium, the lumbar spine, the pubis symphysis, and the lower ribs, all work to maintain the joint position of the lumbopelvic region, countering the weight of the legs.

Posterior

Neutral

Anterior

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Hip Disassociation To understand Hip Disassociation requires an understanding of the opposite, Hip Association. Hip Association means that when there is movement from the legs there is also unnecessary movement from the lumbopelvic region. Hip Association results in faulty movement patterns which can be caused by muscular imbalance: Tight hamstrings pull down on the ishial tuberosities, which pull the pelvis into a posterior tilt, which then pulls the lower back into flexion and out of lordosis.

Hip Association in an individual’s daily life is demonstrated in walking: Every step taken produces unnecessary muscle recruitment from the lumbopelvic region. One can appreciate the precarious condition of many peoples’ lower backs. And it doesn’t stop there! Due to the human kinetic chain the problems may radiate up into the neck and shoulders.

Hip Disassociation recognizes that the femur head should move with great mobility (which requires flexible muscles and an open joint capsule) and solid joint stability (which requires functional conditioning) within the hip socket. The thigh bone ought to be able to move freely within the hip socket without causing movement in the hips and low back.

Without the ability to disassociate the shoulders and hips, the ground and trunk forces moving through the kinetic chain place damaging stresses on the musculoskeletal system. The importance of alignment cues cannot be stressed enough to clients. Determining where the muscular imbalances are occurring and then addressing the flexibility and stability issues for the client is the cornerstone of good program design.

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3. DIAPHRAGMATIC BREATHING “To breathe correctly you must completely exhale and inhale, always trying very hard to ‘squeeze’ every atom impure air from your lungs in much the manner that you would wring every of water from a wet cloth.”

Joseph H. Pilates

of same drop

Diaphragmatic Breathing is a most important physical principle to master when learning Pilates exercise. Joseph Pilates emphasized the importance of keeping the bloodstream pure as a result of proper breathing during exercise. Proper breathing oxygenates the blood and eliminates noxious gases (carbon dioxide: waste product of energy combustion on the cellular level, where true respiration occurs).

first

the

Pilates determined that the best technique eliminating the bad and breathing in the is to exhale with force from the “powerhouse” muscles and then a deep full inhalation from the bottom of the lung to the top. This describes Diaphragmatic Breathing.

for good and bases

The principle muscle of respiration is the diaphragm which is responsible for 75% of respiratory effort. It is a dome-shaped muscle that seals the inferior thoracic aperture airtight. It contracts during inspiration and relaxes during expiration. diaphragm arises from the xiphoid process, lower six ribs, and the lumbar vertebrae; left and right parts of the muscle insert into other at the broad central tendon.

the

The the the each

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Based on the principle that volume and pressure are inversely proportional when one goes up, the other comes down. Inspiration: By increasing the size or volume of the thoracic cavity (chest expansion) the pressure within that cavity decreases. When the pressure within the lungs drops because the thorax has expanded, it drops relative to the outside air pressure. Thus we have two areas of unequal air pressure. Air from the area of higher pressure will immediately diffuse into the area of lower pressure; more specifically, air from the atmosphere outside the nose will be drawn into the respiratory conducting tubes (bronchi, trachea, etc.) and into the air spaces of the lungs.

Expiration: By decreasing the volume of the thorax (core engagement), the pressure within the lungs will momentarily rise relative to the outside air, and air will diffuse out through the respiratory passages to the outside.

During inhalation the diaphragm flattens (contracts) and increases the vertical dimensions of the thorax. When it relaxes during exhalation it is pushed up by the underlying abdominal organs into a slight dome shape and decreases the vertical dimensions of the thorax. During forced (or active) expiration, the abdominal muscles contract and press the abdominal organs upward against the diaphragm, further decreasing lung volume and increasing the pressure which drives the air out. Thus, the abdominal muscles provide important assistance in proper breathing during exercise and in all daily activities.

During physical exertion the employment of diaphragmatic breathing facilitates axial elongation and then trunk stabilization. (Axial elongation is achieved when the ribs expand causing the vertebra of which they are attached to move lengthwise, thereby decompressing the spine.) The transversus abdominis fibers attach to the lower ribs from the front to the back, to the lumbar spine, to the iliac crest, and to the pubic bone (the only abdominal muscle to completely wrap the waist). During forced exhalation with the transversus abdominis (core engagement) the ribs move in toward the lumbar and down toward the pelvis to stabilize the trunk, providing a strong central foundation for physical exertion of the extremities. Without this strong center (the powerhouse) the trunk is unstable (like a weak link in a chain) and the individual is at risk for injury, or in the least, will perform the physical movement inefficiently (poor sports performance, dance movement, etc.).

There is a great deal of controversy and confusion about when to inhale or exhale during exercise. All experts are in agreement that one should never hold their breath during physical exertion. Even within the Pilates world there is disagreement concerning how best to breath. In through the nose and out through the nose? In through the nose and out through the mouth? In on the relaxation phase and out on the exertion phase or vice versa? In when extending the spine and out when flexing the spine?

We can agree that the most important time to stabilize the trunk is the split second before physical exertion. And that the best method for trunk stabilization is to exhale forcefully while engaging the “powerhouse;” thus, we can conclude that exhaling at the start of exertion and during exertion is the best approach. Now the Pilates instructor has only to determine when a particular movement requires stabilization.

As a general rule, breathe in to prepare for a movement and breathe out as you execute it. However, even during the relaxation phase of a movement, when eccentric contraction is being employed (which is a form of exertion) the “powerhouse” musculature should never completely relax or “let go” of its role in trunk stabilization. (The breathwork may be cued differently when working with a deconditioned client versus the breathwork of a classically trained individual.)

The Pilates Specialist will teach the client to inhale deep into the lung bases (“direct your breath into your lower back”), flaring the lower ribs laterally and posteriorly. Upon exhalation the instructor cues the client to engage the core muscles and funnel the lower ribs in toward the lumbar spine and down toward the pelvic bowl.

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4. CORE CONTROL Imagery Cue: “Imagine an old-fashion corsette around your waist. As you exhale feel the laces of the corsette tightening and your waist being cinched in toward your center.”

Joseph Pilates referred to the muscles of the waist (transverses abdominus) as a “girdle of strength!” Pilates believed that every action should emanate from the “powerhouse”: mid and lower trapezius, anterior serratus, all the abdominal muscles, muscles of the low back, deep gluteals (external hip rotators), and the pelvic floor muscles. The second before exertion the client will stabilize the scapula back and down, engage the pelvic floor up, engage the lower abdominals in behind the ASIS, draw the navel to the spine, and compress the lower ribs in and down. The efforts of movement, force, balance, and strength come from this Core Control.

Joseph Pilates referred to the trunk as “the box.” All-American Pilates outlines the “box” from shoulder to shoulder and hip to hip (from greater trochanter to greater trochanter). Trunk stability means that everything inside this box, from the scapula to the pelvic floor, is engaged toward its center point.

The center point is the intersection of the three lines that halve the body: The sagittal line separates the right and left sides of the body equally. The coronal line separates the front and the back. The transverse line equally separates the top from the bottom. Where these three lines meet, which is approximately in front of the sacrum, is referred to as the body’s center point and one’s bodyweight is ideally balanced around this point.

Teach: Core stability for and before distal mobility. Every exercise, every repetition, without fail, is performed by first engaging the functional muscles of the powerhouse. This attention to Core Control stabilizes the scapula, spine, and pelvis, allowing for more fluid and precise movement from the extremities.

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STRUCTURAL MUSCLES VERSUS FUNCTIONAL MUSCLES Structural muscles are the superficial muscles which lie just beneath the skin. These are large muscles designed for power and are referred to as dynamic movers (fast twitch fibers)—they move the body through space or the body uses them to move something through space. The functional muscles are much smaller and are deep to the structural muscles (close to the bone) and require endurance (slow twitch fibers). Functional muscles are also referred to as functional core stabilizers. Their function is to stabilize the skeletal system, maintaining proper alignment and joint position so that the structural muscles may perform their tasks with more accuracy and less chance of injury.

Pilates exercise may also be thought of as Functional Core Training: The conditioning of the deep core stabilizers for optimal functioning for daily tasks as well as sports performance.

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5. OPPOSITIONAL LENGTHENING Everything outside “the box” is referred to as the extremities: the head, the arms, and the legs.

During all movement patterns the extremities must lengthen away from the trunk; in other words, the arms, legs, and head are lengthening away, in opposition, to the drawing in of the muscles of the trunk via Core Control.

Example: The Rotator Cuff (musculotendinous cuff) of the shoulder is a set of four functional muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.

Their function is to prevent the humerus from dislocating at the glenohumeral joint (shoulder socket or glenoid cavity) by forming a cuff around the humeral head and holding it into the socket. These four muscles originate from differing points of the scapula and insert on the humerus and also assist in abduction, internal rotation, external rotation, and adduction of the upper arm.

When the arm is lengthened away from the shoulder the proprioceptors (Golgi Tendon Organ and the Muscle Spindle) sense the potential for dislocation of the humerus from the glenoid cavity and cause the myotatic reflex or stretch reflex to shorten the muscles as a protective mechanism. The shoulder stabilizers do not lengthen toward the directional reach of the arm but rather engage working to pull the humerus in, preventing dislocation.

Oppositional Lengthening is a valuable tool to enhance the conditioning of all the stabilizers of the trunk (as well as the structural muscles). Lengthening the crown of the head away from the neck promotes decompressive length and stabilizing strength in the neck and along the vertebral column. Lengthening the legs away from the hips promotes the strength in the muscles of the hips. Lengthening the arms away from the shoulders promotes the strength in the muscles of the shoulders and upper back.

The joint capsules of the limbs are opened up increasing joint range of motion.

The limbs are lengthening to both stretch the short, overtight muscles and strengthen the long, weak muscles, improving their length-strength balance. The intensity of the workout is increased due to the recruitment of more muscle fibers therefore burning more calories and bodyfat!

The Pilates Specialist will cue the client to lengthen bodily landmarks in opposite directions. In the Single Straight Leg Stretch the leg and toes are reaching toward the ceiling while the pelvic stabilizers are drawing in toward the center point. In Spinal Twist the arms are reaching toward the opposing walls while the shoulder blades are pulling into the trunk. The crown reaches toward the ceiling while the tailbone reaches to the floor, and so on.

Imagery Cue: “Reach your heels to the walls as if a river of energy were flowing through your legs and out of your heels! Lengthen your legs out of your hips as if magnets were pulling your legs to the ceiling!”

Caution: Should a muscle be previously injured it would be wise not to stretch it to its fullest length as it can place more load on the fibers and cause additional trauma. Do not lock the elbow or knee joints! When these joints are hyperextended the bones are pressed together and the muscles or tendons become strained. Lengthen the limbs out of the sockets while keeping the joints “softened.”

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6. MOVEMENT TECHNIQUE: PRECISION & FLUIDITY “Concentrate on the correct movements EACH TIME YOU EXERCISE, lest you do them improperly and thus lose all the vital benefits of their value. Correctly executed and mastered to the point of subconscious reaction, these exercises will reflect grace and balance in your routine activities.”

Joseph H. Pilates, “Return to Life Through Contrology,” 1945 Pilates enthusiasts gain the results of improved posture and bio-mechanics due to neuromuscular re-education.

Pilates exercise must always be performed with precision and fluidity. Proper movement technique is a result of focus and concentration. The Mind – Body Connection is evident when the exercise is performed well from the first repetition to the last.

Precision is essential to neuromuscular re-education because the electrical impulses must follow the exact same neural pathway from the brain to the working muscles for every repetition so that the neurological groove can be deepened. If the first three repetitions are performed in one manner and then the last five are performed in another manner the result is two separate neurological pathways! And neither will have a deep enough groove to facilitate re-education!

Joseph Pilates expressed, “NEVER TO REPEAT THE SELECTED EXERCISES MORE THAN THE PRESCRIBED NUMBER OF TIMES since more harm will result than good by your unwittingly or intentionally disregarding this most important advice and direction. Why? Because this infraction creates muscular fatigue – poison. There is really no need for tired muscles.” The client is not to be encouraged to push to muscular failure. Instead, the client is advised to listen to their body! A particular exercise should be stopped once muscular fatigue, burning, or shaking is experienced. The value of the movement will be lost to poor movement technique when someone persists in doing more despite the body’s warning system to stop. Different muscles will be recruited to finish the set for those muscles too tired to continue, therefore, the neural pathway will change, diminishing the neuromuscular re-education.

Fluidity describes the graceful, flowing movement of Pilates exercise. Thrusting, tugging, or throwing the body or body parts into exercise movement will never produce great results, and at worst, will result in injury. There can be no precision and neuromuscular re-education without fluid motion. Pilates movements are intended to be performed under the control of the mind and never from the thrust of momentum. When instructing a novice the movement is to be performed slowly; once good technique has been established then speed may be added to increase the intensity, if necessary.

Fluidity also describes a flow of energy through the body and out through the extremities. Breathing in oxygen is breathing new energy into your body on a cellular level. Converting the breath into muscular activation upon exhalation begins with the powerhouse muscles and then flows through the muscles of the arms, legs, and neck and leaves the body through the fingers, toes, and crown of the head. “Imagine a river of energy flowing from your center and out through your extremities!”

Fluidity can also be regarded as a tool in designing the workout session as in choreography. One exercise should logically follow another so that there is a pleasing transition and the postures complement one another.

Always reinforce the Pilates Principles with every client during every session—repetition is the power of learning. Never assume that having said something important only once will do. Pilates exercises are not simply a list of exercises to be performed. Pilates, through the diligent employment of the Principles, is an integrated experience of mind, body, and spirit, that is more “felt” than simply “done.” Should the movements be performed without the application of the principles the results would be poor and possibly injurious.

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Anatomy and Physiology SKELETAL SYSTEM The skeletal system is composed of the bones and cartilage in the body whose basic functions are: • To provide a supportive framework for the body • To protect its vital organs • To act as levers in conjunction with muscles to cause movement • To produce red blood cells • To store minerals such as calcium and phosphorus Bones have an outer shell of compact bone encasing spongy bone which surrounds a medullar cavity which is filled with bone marrow for the production of red bone marrow (hematopoiesis). Like other organs bones also contain blood vessels, lymph vessels, and nerves.

Bones have both tensile strength and compressional strength and, therefore, have a combination of elasticity and rigidity: • Living bones are approximately 25 – 30% water • 60 – 70% mineral salts o Inorganic minerals (calcium and phosphate) give bone its hardness and rigidity; compressional strength o Small percentage of collagen to provide elasticity and resilience; tensile strength The skeleton consists of 206 bones divided into 2 sections • Axial Skeleton o 80 bones o Cortical bone o Head, vertebral column, thoracic cage, sternum o Provides the framework for the trunk • Appendicular Skeleton o 126 bones o trabecular bone (faster turnover rate than cortical bone) o Upper extremities, scapulae, clavicles, lower extremities, pelvic girdle

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VERTEBRAL SPINE Vertebral Column is divided into 5 groups and comprises all 33 vertebrae with 26 movable joints • Cervical Spine contains the first 7 cervical vertebrae; lordotic or concave • Thoracic Spine follows with the next 12 thoracic vertebrae; kyphotic or convex • Lumbar Spine continues with 5 lumbar vertebrae; lordotic or concave • Sacral Vertebrae are 5 fused vertebrae referred to as the sacrum; convex • Coccyx forms the last 4 fused vertebrae referred to as the tailbone;convex Wolff’s Law Bone increases or decreases its mass to adapt to functional stresses; continual remodeling allows bones to become thicker and stronger in response to resistive activities; bones will become weaker and thinner without any stress. However, if the exercise is excessive, stress fractures may develop.

Osteoporosis A pathological decrease both the collagen fibers and the salt crystals; the rate of bone replacement (osteoblastic activity) gradually becomes slower than the rate of breakdown and the bones become less dense, brittle, and thin and may fracture easily. Factors that may contribute to osteoporosis include decreased levels of estrogen, calcium deficiency or malabsorption, and inactivity. (Please to the chapter Contraindications.)

in

refer

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JOINTS Joint Articulations The point at which two or more bones meet and where movement occurs.

Two General Categories •

Synovial / Diarthrodial Joints o o o o o o

Freely movable joints Most common type of joint Small space between the articulating bones allowing a greater ROM Cartilage covers the weight-bearing surface of the bones Entire joint is enclosed by a joint capsule Six types of synovial joints      

•

Plane joints glide, such as those between the carpal (wrist) bones Hinge or ginglymus joints found in the interphalangeal joints of fingers Pivot joints permit rotation such as the atlantoaxial joint of the neck Condyloid or ellipsoidal joints flex, extend, abduct, and adduct such as the metacarpophalangeal (knuckle) joints of the hand Saddle joints flex, extend, abduct, and adduct (carpometacarpal joint of the thumb).

Spheroidal or Ball and Socket joints are highly mobile such as the shoulders and hips

Nonsynovial Joints are classified according to whether they are held together with fibrous connective tissue or cartilage: o

o

Fibrous or Synarthrodial joints  Immovable  Joints between the bones of the skull  Joints where the teeth fit into the mandible Cartilagenous or Amphiarthrodial joints  Slightly moveable  Intervertebral joints

Joint Capsule Comprised of two layers: • Outer fibrous capsule which is reinforced with ligaments • Inner layer referred to as the synovial membrane o Secretes synovial fluid  Acts as a lubricant for the articulating surfaces  Provides nutrients to the avascular (no direct blood supply) cartilage  Contains phagocytic cells which remove debris from the cavity

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LIGAMENTS Dense bundles of parallel collagenous fibers: • Derived from the outer layer of the joint capsule • Connect bone to bone but may also connect nearby nonarticulating bones • Provides joint stability (prevents joint dislocation with the aid the joint capsule) • Cannot actively contract stretch (a few ligaments do contain a high proportion of yellow elastic fibers) • Contain numerous sensory nerve cells o Respond to speed, movement, joint position, stretching and pain o Transmit information to the brain which signals to the muscles • When injured or sprained due to excessive or continuous stress, ligaments can become permanently elongated and the joint becomes less stable.

of or

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CARTILAGE Two types found at joints: • •

Fibrocartilage o Thick and heavy and forms structures such as the menisci of the knees Hyaline or Articular Cartilage o Found on the articular surfaces of mobile joints o Reduces friction between the bony surfaces o Lessens impact of the applied force occurring during movement

Cartilage is avascular (no blood supply of its own) and aneural • •

Depends on synovial fluid for nutrition o Synovial fluid distributed to the cartilage during full ROM movements o Lack of full ROM can lead to degenerative changes Hyaline cartilage has no nerve supply (aneural); however, the bone directly beneath it has many nerves o Chondromalacia of the articular cartilage of the patella exposes the nerves of the periosteum covering the femur causing pain

Range of Motion (ROM) The amount of motion available to a specific joint ROM determined by • Shape of the articular surfaces • Musculotendinous connections • Ligaments and joint capsule Hypermobile joint has an available ROM which exceeds normal limits • Joint Laxity is a greater ROM without joint stability (pathological) • Can lead to injuries Hypomobile joint has an available ROM which is less than the normal limits • Can lead to injuries • Factors resulting in hypomobile joints o Scar tissue o Arthritis o Lack of flexibility o Exercise o Aging  Ligaments and joint capsule which are constantly remodeling are slowly replaced with less and less collagen

Key Aspects of Musculoskeletal Function A.

Static • Alignment • Stability

B .Dynamic • • • • • • • •

Joint Mobility Flexibility Strength Coordination Endurance Cardiovascular Fitness Alignment Stability

•

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MUSCLES There are over 600 muscles in the human body with three types of muscle tissue: • Skeletal or Striated Muscle Tissue o Attaches to bone via tendons and allows voluntary movement o 44 – 51% of total body weight in men o 35 – 42% of total body weight in women o Composed of contractile tissue including muscle fibers o Connects to tendons surrounded by fascial sheaths  Tendons are noncontractile and connect the muscle to the periosteum of the bone or cartilage  Fascia is the thin, translucent covering that forms a sheath around a muscle or group of muscles o Types of Muscle Fiber  Type I Slow Twitch or Slow Oxidative (SO) • Slow twitch fibers are designed for prolonged, submaximal aerobic activities • Slow to fatigue • Large amount of myoglobin (reddish color) • High number of mitochrondria to generate ATP • Used for long-term, low to moderate intensity activities o Maintaining posture o Long distance running  Type II Fast Twitch or Fast Glycolytic (FG) • Generate quick, high intensity contractions • Easily fatigued • Anaerobic metabolic system for energy • Less myoglobin • Less mitochrondria • Used in short spurt activities o Sprinting o Powerlifting • Smooth (nonstriated) o Found in the walls or organs (abdominals and intestines) o Involuntary muscle (does not require conscious control to contract) • Cardiac o Forms the walls of the heart o Striated in appearance but does not require conscious thought to contract o Pumps blood throughout the body

Types of Muscle Contractions 28 All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

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•

•

•

Isometric o No joint movement occurs o Muscle will only be strengthened at the specific joint angle used in the exercise o Increases blood pressure Isotonic o Concentric  Muscle fibers are shortening and positive work is done against gravity or an external source of resistance  Require the most energy o Eccentric  Muscle fibers are lengthened and negative work is done by moving the bony levers into the direction of gravity  Require less energy  Associated with delayed onset muscle soreness Isokinetic o Can only be done with specialized equipment which varies the resistance so that the speed of the movement is constant o A spotter is not needed

A muscle has at least two points of attachment on the skeleton: • Proximal (nearest to the center of the body) is called the origin • Distal (furthest from the center of the body) is called the insertion • Conventionally, a muscle is said to bring the insertion closer to the origin during concentric contraction because the insertion is often on the most movable bone while the origin is located on the most stable bone • The least stable end of the joint will move toward the most stable end • A straight line drawn between the centers of the proximal and distal attachments will indicate the direction of the muscle’s line of pull Most muscles are arranged in opposing pairs so that when one muscle contracts, called the agonist, the other stretches, the antagonist. At most joints, a combination of muscle groups work together to perform an anatomical function which are called synergists.

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PROPRIOCEPTORS Proprioceptors exist in the muscles and tendons and sense the degree of tension, length, and movement speed of the muscle •

•

• •

Muscle Spindle attaches to the sheaths of the surrounding muscle fibers o Sends afferent information to the central nervous system about changes in muscle length and the speed at which the changes are occurring o Stretch Reflex When stimulated the spindle relays a message to the central nervous system to cause a contraction in the muscle without any conscious thought  During ballistic movement the muscle spindles sense the quick changes in muscle length and cause the muscle to contract to prevent a tear Golgi Tendon Organ Located in the tendons o Protects the muscle from excessive contractions or stretches o Senses tension caused by muscular contraction or extreme stretching o Inhibits contraction of the muscle from which it originates Reciprocal Inhibition: The nervous system precisely regulates concurrent muscle contraction and muscle relaxation to produce smooth movements with the desired degree of force and speed; relaxation of the antagonistic muscle(s) while the agonist muscle (primary mover shortens) performs a given task.

Reciprocal Innervation: A stretching technique in which an individual intentionally contracts the complementary muscles of the muscle he/she wants to stretch.

EXAMPLE OF RECIPROCAL INNERVATION TECHNIQUE Active – Isolated – Stretching: Flexibility work which bypasses the proprioceptors which trigger the stretch reflex. AIS method of increasing flexibility involves actively contracting the muscle opposite of the target muscle thereby relaxing the target muscle so it may lengthen. The AIS method instructs holding the stretch for no more than two seconds and then releasing the stretch before the muscle reacts to being stretched by going into its protective contraction (stretch reflex).

Cue: “To stretch tight hamstrings: Inhale ‘off stretch’ (allow the knee to bend) and exhale ‘on stretch’ while contracting the quadriceps (knee extension); hold the stretch for the length of the exhale.”

THE IMPORTANCE OF LEVERS 30 All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

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The body’s skeletal structure is comprised of a series of levers. A lever is a handle with a fixed point around which it can rotate when external force is applied. The turning effect of a force operating on a lever is called torque.

Movement occurs through the use of a lever system which is the skeleton. Levers are rigid rods that move about a fulcrum or pivot point. There are three basic types of levers classified according to the placement of the fulcrum (pivot point), the effort or applied force (muscle) and the resistance force (gravity) on the lever.

It is important to note that the muscular force is applied where the muscle inserts on the bone and not in the belly of the muscle.

•

First Class Lever o The fulcrum is in between the effort/applied force and the resistance  see-saw  skull and the first cervical vertebra

•

Second Class Lever o The fulcrum is at one end of the lever, resistance is in the middle and the effort/applied force is at the opposite end.  Wheelbarrow  Push-up from the floor

•

Third Class Lever (most common in the human body) o The fulcrum is at one end of the lever and the effort/applied force is the middle and the resistance is at the end.  Forearm during a Bicep Curl  Requires more muscle force to move the body  Allows for greater speed and range of motion.

in

Levers: Exercise Regression -- Progression in Program Design There are three factors an instructor or individual can change to modify an exercise to the appropriate level of intensity: 31 All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

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  

The resistive force can be decreased which makes the lever system more effective.

The effort force applied by the muscle during contraction can be modified. A slower, controlled movement is often more intense.

The length of the lever can be changed. o Roll-ups performed with arms extended over head is more challenging o Push-ups performed from the toes (more challenging) versus the knees o Arm or leg exercises that use extended levers, i.e., straight arms in the transverse plane versus flexed elbows (shorter lever) will increase the workload or intensity of the movement due to the amount of force required to move the lever—the arm against gravity. o It is more difficult to control movement without momentum through a full range of motion and maintain proper body alignment with the use of longer levers (leg arcs versus thigh arcs).

Long lever movements (extended arms and legs which are reaching away from the center point) should be regressed for basic clients with short lever movements (flexed elbows and knees held closer to the center point) in sequencing patterns as a means of controlling intensity.

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Anatomical Position When describing motions of the human body, it is common to assume that the movements are initiated with the body starting in anatomical position: Standing erect with the head, eyes and toes directed forward, the heels and toes together, and the upper limbs hanging by the sides with the palms facing anteriorly.

Motions are also named by the movement occurring at the joint rather than the segment that is moving (“flexing the elbow” is more accurate than “bending the arm”). Movements may be further described by the planes in which they occur.

THE THREE CARDINAL PLANES • Sagittal • Frontal (Coronal) • Transverse (Horizontal) The center point should lie along the intersection of the two lines, Sagittal and Frontal, and a third transverse (horozontal) line which is found in the section between the lower abdomen and sacrum. The base of support (the two feet when standing) should be directly beneath the center point.

FUNDAMENTAL MOVEMENTS FROM ANATOMICAL POSITION •

•

•

•

Sagittal o Flexion (decreasing angle between two bones) o Extension (increasing angle between two bones) o Dorsiflexion (moving top of foot closer to shin) o Plantar flexion (pointing the toes) Frontal o Abduction (away from midline of body) o Adduction (toward midline of body) o Elevation (moving to a superior position) o Depression (moving to an inferior position) o Inversion (lifting the medial border of the foot) o Eversion (lifting the lateral border of the foot) Transverse o Rotation (internal and external) o Pronation (palm down) o Supination (palm up) o Horizontal Flexion (abducted arm flexed toward the midline of the body) o Horizontal Extension Multiplanar o Circumduction (describes a “cone”) o Opposition (thumb movement unique to primates and humans)

Sagittal

Transverse

Frontal

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Joint movement occurs in differing planes: • One plane as with uniaxial joints (hinge joints) such as the knee and elbow • Two planes as with ball joints such as the wrist and ankle • Multiaxial joints have at least 3 planar movements and are either ball and socket joints (hips and shoulders) or saddle joints (thumb) Two types of movement: • Angular Movement o Increases or decreases the angle between the bones  Flexion in the sagittal plane  Extension in the sagittal plane  Abduction in the frontal plane  Adduction in the frontal plane •

Circular Movement o Rotation is the motion of a bone  Medial or Internal (inward toward the midline of the body)  Lateral or External (outward away from the midline of the body) o Circumduction  Sequential combination of flexion, extension, abduction, and adduction  Occurs primarily in the hip and shoulder joints o Supination  Describes forearm motion in an outward rotation (palm up) o Pronation  Describes forearm motion in an inward rotation (palm down)

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Posture Analysis Normal posture occurs when there is a balance of forces acting on bones and joints. Normal posture permits an efficient and effective use of the body to produce the desired motions.

To effectively assess posture a clear understanding of muscle balance lays the foundation. Every muscle in the body is balanced by an equal and opposite muscle. Muscles are paired to work in a complementary manner to synchronize movement or maintain stability. These pairs of opposing muscles are referred to as agonist (the shortening muscle) and antagonist (the lengthening muscle). While one muscle may act as the prime mover, the opposing muscles have to lengthen out to allow the movement to take place, and others are involved to fix the bones in the right place (stabilizers) or to add subtle variation (synergists).

Muscular Imbalance Poor posture results from an abnormal relationship between the forces that act on an area. When a body is in bad posture, the joints and muscles are already under stress and activity increases that level of stress.

Muscles must work harder to produce desired motions and are not as efficient or as effective. Bad posture can also restrict muscles from performing optimally.

Usually, the source of muscle imbalance is a loss of motion or flexibility in a muscle or muscle group, as well as lengthening and weakness from prolonged or sustained stretch of the opposing muscle or muscle group. If a muscle is shortened, its opposing muscle must be lengthened to compensate.

When a lengthened or shortened position is sustained, a muscle’s resting length changes over time. The sustained shortening of one muscle causes a loss of flexibility and strength, and the sustained lengthening of the opposite muscle causes a loss of strength and tone.

Muscle imbalance occurs when one of the muscles in a pair is either too weak, too strong, or too tight. This causes unequal pulling from the muscles. Muscle imbalance can cause wear and tear on the joints, leading to chronic conditions such as osteoarthritis, bursitis, and tendinitis. Properly functioning joints need healthy and balanced muscles to facilitate efficient movement.

35 All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

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Muscle imbalance is commonly caused by overuse or repetitive action of one muscle and the absence of flexibility work of that muscle. Typical muscle imbalance involves muscles whose function is to stabilize joint position and muscles whose function is to mobilize. Common patterns will emerge whereby certain muscles tend to hyperactivity and will display hypertonus.

Muscle imbalance can also result from joint abnormalities. These abnormalities run the spectrum from hypermobility to hypomobility. When joints are hypermobile, displaying an excessive amount of motion, the muscles must work harder to provide joint stability. Joints that lack normal mobility—hypomobile joints—have lessthan-normal motion and place additional stresses on muscles and joints. These conditions can also add stresses to other body segments.

Injuries can also cause muscle imbalances. Scar-tissue adhesions following a ligament injury can cause the joint to become hypomobile. Muscle strains, if not properly rehabilitated and normal strength not regained, can become a site for adhesions limiting flexibility and causing increased stress to the site or adjacent sites.

Often the hypertonic muscle will be easily spotted as more developed or shorter in length causing a misalignment of the affected joints. The upper trapezius will often be thicker on one side than the other due to overuse of the corresponding arm or shoulder, such as carrying a briefcase with that arm. The misalignment is apparent from the posterior view. Often the shoulder is higher, closer to the neck, and the scapula is higher. The client may also experience neck and shoulder pain on that same side.

In the above example, the muscles responsible for stabilizing the shoulder joint (mid and lower trapezius, anterior serratus, and the rotator cuff), are inhibited (made weak) by the hyperactive upper trapezius. Poor joint position of the shoulder results in a faulty movement pattern or inaccurate muscle firing sequence.

The essence of Joseph Pilates’ work is to restore muscular balance, putting symmetry back into the body for optimal functioning.

Factors Influencing Posture • • • •

Genetics: Inherited conditions determine an individual’s height, type of bone structure, and body type (endomorph, ectomorph, and mesomorph) Habit: Repetitive movements result in restricted muscle function which alters joint position Disease: Muscular or structural disease alters one’s stance, and limitations are then imposed on one’s normal activity Self-esteem/mental health: Good posture projects good health, vitality, and confidence. Poor posture can imply weakness, feebleness, and self-doubt

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DEFINING CORRECT POSTURE Imagine a plumb line running vertically through the body and transverse lines (horizontal plane) parallel to the floor: 1.

Lateral view: The plumb line should pass from the top of the skull through the center of the body to the floor, through the center of gravity. It passes through the ear lobe, the center of the tip of the shoulder (acromioclavicular joint), the center of the hip joint (the greater trochanter), behind the patella of the knee, and midway between the heel and the balls of the foot (slightly forward of the lateral ankle). The transverse line should pass through from the ASIS to the PSIS which defines neutral pelvis.

2.

Anterior view: The plumb line should run through the center of the forehead through the middle of the sternum, the navel, to the midpoint between the feet. The transverse lines pass through the acromion processes of the shoulders, through the anterior points of the pelvis – the ASIS, and the patellas parallel to the floor.

3.

Posterior view: The plumb line should fall through the center of the scull, following the line of the spine, the hips (vertical gluteal line), and on to the floor with the lower limbs equally placed on either side of the line, and the knees and heels directly below the hips. The transverse lines of the knees, pelvis, and shoulders should also be parallel to the floor.

The vertebral column should have four distinct curvatures: • kyphosis (convex) of the thoracic spine and the sacrum • lordosis (concave) of the lumbar spine and the cervical spine Exact form of these curvatures varies between people. Problems arise when the normal curvatures become hyperlordotic or hyperkyphotic and the surrounding musculature is impacted.

37 All material copyright All-American Pilates Certifications Inc. 1999-2005. All rights reserved.

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DEFINING CORRECT POSTURE Lateral View Ideal Plumb Line Transverse Lines

Anterior View Ideal Plumb Line Transverse Lines

__________________________________

__________________________________

Posterior View Ideal Plumb Line Transverse Lines

_________________________ _________

__________________________________

__________________________________

__________________________________

__________________________________

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POSTURAL DEVIATIONS 1. Postural deviations in the lower limbs: • Foot pronation or supination, inversion, or eversion o Genu valgum (knock knees) o Genu varum (bow legs) o Hyperextended or hyperflexed knees o Leg length differences o Tibial torsion (feet are parallel but the knees roll inward) o Achilles Tendon deformities o Ankle eversion and inversion 2. Postural deviations in the trunk: • Pelvic and spinal alignment o Anterior (forward) or posterior (backward) tilt of the pelvis o Lumbar hyperlordosis o Thoracic hyperkyphosis o Cervical hyperlordosis o Scoliosis (lateral curvature of the spine) o Rotoscoliosis (rotational curvature of the spine) 3. Postural deviations of the scapula (shoulder blades): • Elevation (shoulders pulled up toward the neck) • Adduction (shoulder blades squeezed together tightly) • Abduction (winged shoulder blades) • Protraction (foreward rotation of the shoulder blades) 4. Postural deviations of the cervical spine (neck): • Anterior Head Carriage (head forward of the plumb line) • Lateral Flexion (muscles short on one side of neck) • Rotation (muscles short on one side of neck) A brief visual inspection of a client may often reveal the most obvious asymmetry and dysfunction of individual muscles. This information can be used as the starting point to determine which areas of the body should receive initial focus for Program Design.

By inspecting the standing posture from the side, back, and front the vertical plumb line and the horizontal (transverse) reference lines will convey where the muscular imbalances are occurring. Due to shortened muscular attachments the bony landmarks are closer together with a prominence of the contours due to increased tension or hypertonus. Often a compensatory reaction elsewhere in the body occurs to restore balance. When there is a weakened muscle between two points of attachment there will be increased distance between them and a flattening of its contours due to atrophy or hypotonus.

DO NOT DIAGNOSE! When assessing posture the instructor is seeking obvious asymmetry. Do not make the mistake of diagnosing medical conditions or attempting to determine the exact cause of the misalignment. Simple notation of what is discovered is the basis of Program Design later. Avoid pointing out every single misalignment to the prospective client; share only the information that is pertinent to the client regarding goal setting, etc.

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Muscles which tend to hyperactivity (overactive; short and tight)

Muscles which tend to hypoactivity (inhibited; weak and elongated) Posterior Body

Calves Hamstrings Erector Spinae of the lumbar Quadratus lumborum Upper trapezius Levator scapulae

Gluteal muscles Lower/middle trapezius Serratus anterior Supra- and infra-spinatus Deltoids Anterior Body

Adductors Rectus femoris Tensor fascia latae Psoas Oblique abdominals Pectorals Subscapularis Scalenes Sternocleidomastoid

Tibialis anterior Toe extensors Peronei (everters) Vasti (quads) Transversus abdominis Deep neck flexors

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UPPER QUARTER ASSESSMENT: Segment Head & neck

Scapula

Fault

Criteria

Impairment

Normal

Head erect in neutral with concave cervical curve

Extended Anterior Head Carriage

Head forward with increased cervical curve (lordotic)

Intrinsic neck flexors— long; extensors—short

Forward

Head forward with straight cervical spine

Degenerative disk cervical spine disease

Flat

Decrease in cervical curve

Neck extensors—long

Normal

Horizontal, situated between T2 – 6, flat on thorax, vertebral border parallel to and approximately 3” from spine; Rotated 30 degrees in frontal plane

Downward Rotation

Superior angle farther from spine than inferior angle

Upper trapezius—long Levator scapula & rhomboids—short & stiff Serratus anterior lower fibers—long Deltoid & supraspinatus—short

Depressed

Lower than T2, A-C joint is lower than sternoclavicular joint

Upper trapezius—long

Abducted

Vertebral border is more than 3” from spine. Rotated in frontal plane more than 30 degrees

Serratus anterior—short Rhomboid & trapezius—long Scapulohumeral muscles—short & stiff

Adducted

Vertebral border less than 3” from spine

Serratus anterior—long Rhomboid & trapezius—short

Winging

Vertebral border or inferior Angle protrudes from thorax

Flat thorax Serratus anterior—weak Pectoralis minor—short Scapulohumeral muscles—short & stiff Rib hump

Elevated

Higher than T2 and acromion high

Upper trapezius—short Levator scapula & rhomboids—short

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UPPER QUARTER ASSESSMENT: Segment

Fault

Criteria

Thoracic spine

Normal

Convex curve

Kyphotic

Increased convexity

Rectus abdominis—short Paraspinals—long

Flat

Absent convexity

Thoracic paraspinals—short

Swayed back

Shoulders more than 2” posterior to greater trochanters

External obliques—long Rectus abdominis—short Internal oblique muscles—short

Normal

Concave curve—20 – 30 degrees

Lumbar spine

Paraspinal symmetry

Impairment

Lordotic

Concavity greater than 30 degrees

Flat

Absent concavity

Normal

Left & right regions from lumbar spinous processes to 2” lateral are less than ½” different in prominence

Asymmetry

One side is more than ½” larger than other side

Scoliosis

Rib hump

External obliques—long Iliopsoas—short lumbar paraspinals—short Pain - Confirming Test: Flattening lumbar spine decreases pain Paraspinals—long Iliopsoas muscle—long

Paraspinals—hypertrophied Spine rotated toward most prominent side Ribs more prominent on one side Lumbar paraspinal asymmetry

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LOWER QUARTER ASSESSMENT: Segment

Fault

Criteria

Pelvis

Normal

Line between ASIS & PSIS within 15 degrees of horizontal line

Anterior Tilt

Asis is 20 degrees Lower than PSIS

Posterior Tilt Lateral Tilt

Rotation

Hip Joint

Normal Flexed Extended

Knees

Impairment

ASIS is 20 degrees higher than PSIS One iliac crest is more than ½” higher than other; lateral lumbar flexion toward high side ASIS on one side is anterior to ASIS on other side; Hip on side to which pelvis is rotated—medially rotated. Other hip—laterally rotated Neutral position; no angle at hip Peak of iliac crest to greater Trochanter (axis) in line along thigh Hip angle of flexion is more than 10 degrees Hip angle of extension is more than 10 degrees

Normal

Neutral position

HyperExtended

Bowing of knee joint—backward; Tibia may be posterior to femur

Flexed

Forward angulation of knees

Varum Valgum

Bowing outward of knee joint Non-structural—hyperextended knees with hip medial rotation Knees directed inward; Knock knees Non-structural—hip medial rotation

External obliques—long Hip flexors—short Pain - Confirming Test: Posterior tilt decreases pain Abdominals—short Iliopsoas—long High side hip abductors—long Low side hip abductors—short TFL—short on side toward which pelvis is rotated

Hip Flexors—short Iliopsoas—long

Quadriceps—weakness Gastrocnemius —short

Hip lateral rotators— long & weak Tight IT Band

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LOWER QUARTER ASSESSMENT: Segment

Fault

Criteria

Tibia

Normal

Shaft is perpendicular

Bowed

Posterior curve in sagittal plane

Varum

Lateral curve in frontal plane

Torsion

Rotation of shaft of bone in horizontal plane

Normal

Longitudinal arch—neutral

Pronated

Longitudinal arch—flattened

Posterior tibialis—long

Rigid

Increased height of longitudinal arch; Does not flatten during hip and knee flexion

Dorsiflexion range— limited

Hammer

Joint flexion

Toe flexor & extensor muscles—short; tendency to keep weight line posterior during sit to stand

Hallux valgus

Lateral deviation of big toe

. Ankles

Toes

Impairment

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Posture Deviation One: Kyphosis – Lordosis UPPER CROSS SYNDROME • Anterior Head Carriage o Weak neck flexors o Short and tight neck extensors (suboccipitals) • Thoracic Hyperkyphosis o Upper thoracic spine is overly convex (rounded) o Anterior deltoids, subscapularis, and pectorals are short and tight o Thoracic back extensors are stretch weak • Scapular Elevation o Tight upper trapezius, levator scapula, and scalenes o Weak serratus anterior • • • • • •

LOWER CROSS SYNDROME Anterior Pelvic Tilt o Lumbar hyperlordosis o Short and tight lumbar musculature Overtight Hip Flexors o Iliopsoas short and tight (contributes to lumbar hyperlordosis) o Rectus femoris tight (contributes to Anterior Pelvic Tilt) Weak abdominals Overtight Hamstrings o Hyperactive due to compensating for the weak gluteals Weak Gluteus Maximus o Inhibited by hyperactive hip flexors Hyperextended knees o Joint position affected by hyperactive hamstrings

Notes

PROGRAM DESIGN PRACTICE Corrective Stretching

Corrective Strengthening

Expected Outcome

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Posture Deviation Two: Swayback • • • • • • • • • •

Anterior Head Carriage o Weak neck flexors o Short and tight neck extensors (suboccipitals) Thoracic Spine o Long and weak thoracic back extensors o Posterior displacement of upper trunk (sways back) Abdominals: upper short; lower abs weak Posterior Pelvic Tilt o Anterior displacement of pelvis (sways forward) Lumbar Spine flat o Strong but not short lower back muscles Hip Flexors long and weak Hamstrings short and strong Tensor fasciae latae short Weak gluteals Hip and knee joints are hyperextended and locked

Notes

PROGRAM DESIGN PRACTICE Corrective Stretching

Corrective Strengthening

Expected Outcome

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Posture Deviation Three: The Flatback • • • • • • •

Anterior Head Carriage o Weak neck flexors o Short and tight neck extensors (suboccipitals) Thoracic Spine o Upper section is rounded o Lower section is flat Posterior Pelvic Tilt Hamstrings short and tight Hip Flexors o Long and weak Abdominals, upper are often short Knees usually hyperextended but occasionally flexed

Notes

PROGRAM DESIGN PRACTICE Corrective Stretching

Corrective Strengthening

Expected Outcome

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Contraindications Not every exercise is suitable for every individual. Although it is beyond the professional scope of this program to diagnose the ailments of the clients, it is advisable that the Pilates/Fitness instructor be well-versed in common medical conditions, their contraindications, and the best selection of exercises suitable. Without playing doctor.

The following compilation can only touch upon the most common human conditions affecting Program Design.

Continuing education, research, professional consultation, and hands-on client interaction will mould the student into a competent and wise instructor.

Gathering information during Client Assessment will guide the instructor in Program Design. A good base of knowledge and good common sense will safeguard the client and safeguard the instructor’s liability. Protect yourself professionally by requiring the clients to sign the intake form which must include a Liability Waiver, a completed Health History, and information regarding the client’s goals and expectations.

Instructors are encouraged to network with other healthcare professionals to either call upon with questions or to refer their clients to, for a diagnosis and proper treatment. Communication with a particular client’s healthcare practitioner would be valuable in providing the client with the safest and most effective program. Keep in mind the laws governing patient confidentiality; it may be necessary to have your client put in writing permission for their healthcare providers to share information with you.

Key Points • • • • • •

Pilates exercise should never cause pain or discomfort The “set” is over if there is pain, discomfort, burning, shaking or fatigue The number of repetitions is never the focus; the principles are always the focus The resistance from the springs is light to moderate The client must be cautioned and taught to listen to their body and intuition Instructors must listen to and communicate clearly with their clients

Post-Injury Fitness Program Design The All-American Pilates/Fitness instructors must be prepared to design an exercise program for the client recovering from or have a history of, an orthopedic related injury or other medical condition. The instructor is encouraged to seek a healthcare provider’s approval prior to the implementation of any post-injury/illness training protocol.

The format for each program design is as follows: • •

•

Identification of the injury or illness Avoidance of initial and/or long term contraindicated stretching and resistive exercises o Contraindicated stretches and resistive exercises should not be performed for the first 4 weeks or 8 – 10 visits; time line may be adjusted based upon the client’s progress through the appropriate lengthening and strengthening program.

Implementing appropriate stretching and resistive exercises o When the client is able to perform the suggested lengthening exercise without discomfort they may progress to performing strengthening exercises. o If any physical signs of re-injury occurs the exercise participant’s healthcare provider should be notified

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NECK Cervical Sprain / Strain (Whiplash) An over stretching or partial tearing of the ligaments (sprain) or the muscles (strain) of the sides and back of the neck; the joints (facet) in the neck may be forced out of their normal location.

Causes Neck sprains occur frequently in contact sports and auto accidents when a single violent force is applied to the musculotendinous units of the neck; poor muscle conditioning is also a contributing factor.

Stretch Principles • Avoid stretching posterior soft tissue structures of the neck that are already overstretched.

• Effectively stretch / elongate spasmed or tight upper trapezius and levator scapulae muscles Strength Principles • Avoid strengthening into a flexed posture • Re-establish natural cervical curvature Cervical Radiculopathy A cervical nerve stretch resulting in an electric, burning or weak sensation felt in the shoulder and down into the arm and hand.

Causes A stretching of the brachial plexus (bundle of nerves in the lower lateral neck and upper trapezius). The head and cervical spine are forced laterally away from the injured side, usually a result of a shoulder trauma or fall; “slumping” or “rounded” posture for a prolonged period of time is also a contributing factor.

Stretch Principles • Avoid stretching already overstretched nerve.

• Actively elongate cervical muscles without stretching effective nerves.

Strength Principles • Avoid eccentric loads which may potentially over elongate nerves.

• Stabilize cervical spine in retracted position and strengthen contributing scapular muscles SHOULDER GIRDLE Thoracic Outlet Syndrome A compression of the blood vessels (subclavian artery and vein) and nerves (brachial plexus) between the scalene or pectoralis minor muscle and the first or cervical rib when the clavicle is in a depressed position; these nerves and blood vessels supply the shoulder, arm and hand.

Causes: Pressure may be caused by an extra rib in the lower neck. Most often this syndrome is seen in individuals with overdeveloped neck muscles. Sleeping with an overextended arm or shoulder for a prolonged period of time puts the neck in an abnormal position; muscle weakness and drooping in the shoulder may contribute.

Stretch Principles • Avoid promoting compressive cervical flexion and scapular protraction movements.

• Effectively stretch anterior / medial neck muscles and pec-minor, eliminating compressive forces to nerves.

Strength Principles • Avoid movements creating downward clavicular compression upon nerves and rounding of shoulders.

• Promote back and together scapular motions with pulling orientated motions.

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SHOULDER JOINT Impingement (Rotator Cuff Tendinitis) An inflammation of the rotator cuff tendons due to the entrapment of the tendons against the undersurface of the top of the shoulder blade (acromion process of the scapula).

Causes Commonly seen in athletes whose activities involve repetitive use of the arm above the level of the shoulder; seen in people who weight train when the number of vertical and horizontal pressing exercises for the chest and shoulders exceeds the number of pulling and rowing exercises for the back and posterior shoulder; barbell upright row often leads to injury due to the degree of internal shoulder rotation with abduction.

Stretch Principles • Avoid extreme overhead stretches which potentially entrap the supraspinatus tendon beneath underside of acromium process.

• Promote stretching with upper arm below shoulder height.

Strength Principles • Avoid raising arms from sides of body with hands below elbows or shoulders in an internally rotated position.

• Promote strengthening upper / mid-back and posterior rotator cuff musculature.

Subluxation / Dislocation A full or partial displacement (typically anteriorly / inferiorly) of the ball of the upper bone (humerus) from its socket.

Causes Occurs due to a direct upward blow to the shoulder or backward force on an extended arm such as catching yourself when falling; usually seen in contact sports or any activity that involves forceful throwing, lifting or twisting.

Stretch Principles • Avoid overhead stretching movements with upper arms behind ears.

• Promote stretches with upper arm below shoulder height and in front of body; active range of motion preferred versus passive stretches.

Strength Principles • Avoid eccentric loading with upper arms above shoulders and behind ears.

• Promote movement down and in toward midline of body while emphasizing inward rotation.

Adhesive Capsulitis (Frozen Shoulder) Formation of scar tissue within the capsule of the shoulder, forming adhesions, resulting in decreased freedom of shoulder joint movement.

Causes Typically the result of an immobilization of the shoulder for one week or more due to conditions such as acute bursitis or tendinitis; following 2 -3 weeks of inactivity the tendons and ligaments around the shoulder joint “freeze,” drastically limiting movement of the shoulder.

Stretch Principles • No stretch is a bad stretch; assess needed ranges of motion.

• Promote extreme overhead ranges of motion; passive stretching proves most effective.

Strength Principles • No resistive exercise is a bad exercise.

• Promote extreme overhead resistive exercises immediately following a complementary stretch.

Acromioclavicular (A/C) Sprain A severe stress, stretch or tearing of ligaments which hold the top of the collarbone against the top of the shoulder blade (acromion process); typically classified as a first degree shoulder separation.

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Causes The A/C sprain occurs due to a forceful downward stress on the shoulder that temporarily forces the acromion process away from the clavicle; typically occurs when falling on an outstretched hand or on the point of the elbow; seen in contact, throwing and racquet sports.

Stretch Principles • Avoid stretching above shoulder height.

• Promote stretching / elongation below shoulder height • Address overhead ranges actively prior to performing any overhead resistive exercise.

Strength Principles • Avoid upward movements which promote compression of A/C joint.

• Promote backward movements below shoulder height.

ELBOW Lateral Epicondylitis (Tennis Elbow) An inflammation of the common wrist extensor tendons along the lateral epicondyle of the forearm of the elbow.

Causes This is most commonly seen in sports that require strenuous, repetitive forearm movement, such as the backhand stroke in tennis and racquetball; injury may also occur due to incorrect grip or hitting position, using a racquet that is too heavy or using an oversized grip.

Stretch Principles • Avoid over-elongation of wrist extensor muscles.

• Stretch stronger shorter wrist flexor muscles.

Strength Principles • Avoid resistive and postural eccentric loading into full wrist flexion.

• Promote open hand and supinated forearm motions.

Medial Epicondylitis (Golfer’s Elbow) An inflammation of the common wrist flexor tendon near the medial epicondyle of the forearm at the elbow.

Causes This is most commonly seen in sports requiring strenuous, repetitive forearm movements such as throwing, golfing, and forehand or serving motions in a racquet sport.

Stretch Principles • Avoid over-elongation of wrist flexor muscles.

• Stretch weaker wrist extensor muscles.

Strength Principles • Avoid resistive and postural eccentric loading into full wrist extension.

• Promote flexed wrist and pronated forearm motions.

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WRIST Carpal Tunnel Syndrome Entrapment of the median nerve at the wrist within the carpal tunnel by the flexor tendons of the wrist and/or transverse carpal ligament.

Causes Entrapment causes inflammation of the wrist tendon sheaths, commonly caused by any sport or activity that requires repetitive gripping or squeezing; may also be caused by repetitive wrist flexion when performing typing related activities.

Stretch Principles • Avoid passive wrist extension which compresses median nerve into carpal tunnel.

• Promote open hand motions.

Strength Principles • Avoid active wrist flexion which also compresses median nerve into carpal tunnel.

• Promote wrist deviation and open hand resistive movements.

LOWER BACK Posterior Disc Protrusion An advanced protrusion of the nucleus of a lumbar vertebral disc upon its corresponding nerve root; results in radiating discomfort into the buttock and, potentially down the leg.

Causes A herniated disc may be caused by extreme overload to the vertebral discs when lifting an object or as a result of performing repetitive, flexion-orientated activities with poor mechanics; movement involving simultaneous spinal flexion and rotation further increases the risk of injury; obesity is a contributing factor.

Stretch Principles • Avoid hip / trunk flexion movements.

• Promote hip / trunk hyperextension movements.

Strength Principles • Avoid all supine, seated, standing static and dynamic flexed postures / movements.

• Promote isometric / active hip and back hyperextension movements.

Coccydynia Pain in the coccyx (tailbone); also persistent pain and tenderness just above the rectal area.

Causes Most often occurs as a result of trauma, usually a direct fall on the buttocks, sometimes resulting in a broken tailbone.

Stretch Principles • Avoid sitting directly on the tailbone • Promote stretching of other nearby muscles to relieve spasms Strength Principles • Avoid sitting directly on tailbone or rolling onto tailbone • A cushion or a donut-shaped cushion may be used to relieve pain

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Degenerative Osteoarthritis / Lumbar Strain A chronic degenerative disorder primarily affecting the articular cartilage with eventual bony overgrowth at the joints; articular cartilage changes cause lumbar impingement, sprains and inflammation.

Causes Repetitive hyperextension is the predominant mechanism leading to the development of this injury; in older populations also results in painful contact between vertebrae.

Stretch Principles • Avoid hip / trunk hyperextension movements.

• Promote hip / trunk flexion movements.

Strength Principles • Avoid all supine, seated, standing static and dynamic hyperextension postures / movements.

• Promote isometric / active hip and back flexion movements.

Degenerative Disc Disease The soft, central portion of the disc loses some of its water content and begins to dry out and shrink, cracks develop in the annulus resulting in the escape of fluid from the nucleus which can press against the spinal cord or a nerve root (ruptured or herniated disc).

Causes Not a disease at all but a term that describes the wear-and-tear associated with aging.

Stretch Principles • Avoid hip / trunk flexion movements.

• Promote hip / trunk hyperextension movements.

Strength Principles • Avoid all supine, seated, standing static and dynamic flexed postures / movements.

• Promote isometric / active hip and back hyperextension movements.

Scoliosis Curvature of the spine which occurs in several different varieties; rarely causes low-back pain unless severe; a small percentage of scoliosis in the lower back is progressive and needs treatment through exercise; usually occurs in the thoracic area.

Causes Functional scoliosis is a result of a muscular imbalance between the right and left sides of the body; congenital or structural scoliosis is a deformity from birth.

Stretch Principles • Promote balanced elongation of both sides of the spine; unilateral stretching of each side of the torso.

Strength Principles • Promote spinal extension and hyperextension with bilateral and unilateral movements.

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Spondylolisthesis and Spondylolysis Spondylolisthesis literally means “slipping vertebrae” and describes a condition in which one of the vertebrae “slips” over another; Spondylolysis is the fracture or crack in part of the vertebrae.

Causes Often due to degenerative changes; often results from trauma occurring over a period of time during teenage years; sports activities that involve repeated hyperextension.

Stretch Principles • Avoid hip / trunk hyperextension movements.

• Promote hip / trunk flexion and stability movements.

Strength Principles • Avoid all supine, seated, standing static and dynamic hyperextension postures / movements.

• Promote isometric / active hip and back flexion movements.

Lumbar Spinal Stenosis A narrowing of the spinal canal that causes compression or “pinching” of the nerves that go to the buttocks and legs; seen more frequently after age 65 due to aging of the spine.

Causes Disc bulges; wear and tear change that creates boney spurs; overgrowth of the facet joint; congenital.

Stretch Principles • Avoid hip / trunk hyperextension movements.

• Promote hip / trunk flexion and stability movements.

Strength Principles • Avoid all supine, seated, standing static and dynamic hyperextension postures / movements.

• Promote isometric / active hip and back flexion movements.

UPPER LEG Hamstring Strain An overstretch, overexertion or overuse of the hamstring muscle fibers, typically where the muscle attaches to its tendon, approximately one-third of the way down the back of the thigh; infrequently, the tendon will partially tear away from the bone of the pelvis, or at the back of the knee.

Causes Hamstring strains may be caused by over-striding during sprinting; commonly caused by overuse of the hip extensors and knee flexors during sports requiring explosive and sprint-related movements; overdevelopement of the quadriceps, ballistic stretching and poorly conditioned muscles.

Stretch Principles • Avoid static lower body with active upper body trunk flexion.

• Promote static upper body with active lower body hip flexion movements.

Strength Principles • Avoid bent leg resistive movements.

• Promote active straight leg hip extension working toward hyperextension.

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Hip Adductor Strain An overstretch, overexertion, or overuse of the upper hip adductor muscle fibers, typically where the muscle attaches to its tendon and, less frequently, where this tendon attaches to the pelvis.

Causes Overstriding during lateral movement; commonly caused by overuse of the hip adductors during sports requiring explosive or quick, lateral movements (includes planting the foot and quickly changing directions); ballistic stretching and poorly conditioned muscles.

Stretch Principles • Avoid static lower body with active upper body trunk flexion.

• Promote bent leg seated / kneeling active lower body hip adduction movements Strength Principles • Avoid straight leg resistive hip adduction movements and eccentric loading with hip in hyperabducted position.

• Promote static / dynamic squatting and bent leg hip adduction movements.

Hip Flexor Strain An overstretch, overexertion, or overuse of the hip flexor muscle fibers typically where the muscle attaches to its tendon and, less frequently, where tendon attaches to the bone.

Causes Forceful flexion of the hip during sprinting, running, hills and kicking; hyperextension of the hip, ballistic stretching, and poorly conditioned muscles.

Stretch Principles • Avoid excessive knee flexion orientated movements.

• Promote passive / dynamic hip hyperextension movements.

Strength Principles • Avoid straight leg hip flexion or standing straight leg eccentric hip hyperextension movements.

• Promote hip extension / hyperextension and progress to bent leg hip flexion movements.

KNEE Medial Collateral Sprain A severe stress, stretch or tear of the medial collateral ligament which crosses the medial (inner) side of the knee joint and prevents excessive lateral shifting.

Causes Blow to the outer portion of the flexed knee while the foot is planted, typically seen in contact sports; planting the foot and quickly changing directions.

Stretch Principles • Avoid excessive straight leg hip abduction movements.

• Promote bent leg hip abduction movements.

Strength Principles • Avoid straight leg hip abduction movements with resistance around lower leg / ankle and standing eccentric loading with hip in hyperabducted position.

• Promote static / dynamic squatting and straight leg hip adduction with resistance at or above the knee.

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ACL Sprain / Reconstruction A severe stress, stretch, tear or surgical repair of the anterior cruciate ligament, which attaches to both the femur (upper leg) and tibia (lower leg) and is found inside the knee joint itself; restricts the amount of front-to-back and twisting motion between the two bones.

Causes Blow to the outside of the flexed knee while the foot is planted; may occur when tremendous muscular force is required to extend the knee (powerlifting, wrestling and football).

Stretch Principles • Avoid all knee hyperextension orientated positions.

• Promote knee flexion orientated positions.

Strength Principles • Avoid excessive knee extension.

• Promote static / dynamic squatting, hip / knee flexion and ankle / lower leg resistive movements.

Patellofemoral Dysfunction (Chondromalacia) A softening or roughening of the joint surface cartilage behind the kneecap (patella).

Causes Commonly caused by instability of the kneecap which causes it to move out of its groove; direct blow to the front of the kneecap; overuse of the knee extensors when engaging in the activities of running, jumping and stair climbing; utilizing poor mechanics when performing lunges, presses, step-ups and squats.

Stretch Principles • Avoid excessive knee flexion positions • Promote elongation of lateral muscles of upper leg Strength Principles • Avoid initiating knee extension movement from beyond 90 degrees knee flexion • Promote static / dynamic squatting and knee extension movement above and below any existing pain free ranges LOWER LEG Achilles Tendinitis An inflammation of the gastrocnemius (calf) tendon, typically where the muscle attaches to the tendon about two-thirds down the back of the lower leg.

Causes Trauma to the tendon when the calf muscles contract hard or suddenly; commonly occurs in sports requiring quick bursts of speed or gradually from the wear and tear of endurance running; lack of flexibility with the tendon, inward or outward heel strike, lack of shock absorption in the heel counter of the shoe and running on hard surfaces.

Stretch Principles • Avoid weight bearing ankle dorsiflexion positions.

• Promote partial or non weight bearing ankle dorsiflexion positions.

Strength Principles • Avoid excessive eccentric weight bearing ankle plantar flexion.

• Promote static straight leg stability activity and dynamic bent / straight leg plantar flexion working toward pain-free eccentric loading.

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Posterior Tibial Tendinitis (Shin Splints) An inflammation of the posterior tibial tendon, found on the back of the lower leg bone (tibia), and its adjoining interosseous membrane located between the tibia and fibula bones of the lateral lower leg.

Causes Over development of the calf muscles (plantar flexors) versus the shin muscle (dorsi flexors); commonly seen in athletes with flat feet, distance runners, walkers, sprinters, and those involved in jumping sports; running on hard or uneven surfaces.

Stretch Principles • Avoid plantar flexion movements.

• Promote dorsiflexion movements with and without everted foot position.

Strength Principles • Avoid bent / straight leg plantar flexion movements.

• Promote static straight leg stability on an unstable surface and dorsiflexion / inversion movements.

ANKLE Inversion Ankle Sprain A severe stress, stretch, or tear of the ligaments on the outer part of the ankle as the ankle is rolled (inversion) Causes Inversion sprains typically occur when wearing shoes with insufficient lateral support which promotes sideways displacement; running or walking on uneven surfaces, poor muscular strength or joint laxity.

Stretch Principles • Avoid ankle inversion positions • Promote ankle dorsiflexion / eversion positions Strength Principles • Avoid ankle inversion / plantar flexion movements • Promote static / straight leg stability on an unstable surface and dorsiflexion / eversion movements FOOT Foot Pronation The arch appears to be flat because it is compressed when the foot rolls over; but, when the weight is taken off of the foot the arch reappears.

Causes The pronating foot is a result of muscle imbalance in the lower leg and loose ligaments of the ankle.

The inward roll of the foot causes the entire leg to rotate to the inside with the kneecaps pointing inward. The alignment of the lower back, pelvis, hips, knees and ankles is thrown off. The pronating foot can be the root cause of many other ailments, such as, heel pain, Achilles tendonitis, shinsplints, bone stress syndrome, stress fractures, and disabling kneecap pain.

Stretch Principles • Promote ankle dorsi and plantar flexion in proper knee-ankle alignment Strength Principles • Promote ankle dorsi and plantar flexion in proper knee-ankle alignment • Promote medial arch development with plantar flexion oriented exercises Foot Supination The cavus foot is the opposite of pronation. The ligaments in the ankle are tight and the foot is rigid with a high arch causing the client to walk on the lateral arch.

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Causes Because the arch is rigid it does not collapse as it should when the foot hits the ground and is unable to absorb the shock which is sent straight up the outside of the leg. The shock transmission leads to pain on the outer side of the leg causing bone stress syndrome or a stress fracture in the fibula. Pain in the outer side of the knee and even up into the outer part of the hip may also be a result of the imbalance.

Stretch Principles • Promote ankle dorsi and plantar flexion in proper knee-ankle alignment • Promote ankle mobility with ankle circumduction patterns and foot adduction Strength Principles • Avoid plantar flexion with heavy resistance or in poor ankle alignment • Promote plantar flexion with an emphasis on weight distribution upon ball of the first toe

Plantar Fasciitis The classis symptom is heel pain with weight bearing upon rising in the morning or after prolonged sitting. Often accompanied by a heel spur. Particularly common among athletes and sedentary middleaged individuals who suddenly increase their level of activity. The plantar fascia is the thick aponeurosis that covers the plantar foot from the calcanus to the toes. This elastic connective tissue runs the length of the foot and holds up the arch.

Causes Poorly fitting shoes or a weight gain of 10 to 20 pounds can contribute. Overstretching the shockabsorbing layer causes pain and inflammation along the length of the arch. Common injury for clients with rigid arches or excessive foot pronation and is also seen with restricted dorsiflexion from tight Achilles tendon or calves.

When the arch comes down the plantar fascia is stretched and pulls on it fibers. The torn fibers may go into spasm and shrink. With every step the plantar fascia tears a little more and causes pain.

Stretch Principles • Avoid weight loaded dorsiflexion while inflammation is active; arch support in shoes is recommended to avoid a pull from the overtight Achilles tendon • Promote non-weight bearing ankle dorsiflexion and first toe hyperextension to stretch the Achilles tendon and plantar fascia once the inflammation is under control • Massage soul of foot with a rolling pin, etc.

Strength Principles • Promote strengthening of ankle inverters • Promote strengthening of intrinsic and extrinsic toe flexors

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OTHER CONSIDERATIONS Muscle Spasm A muscle that is continually contracted due to tension or trauma (injury) which results in a lack of blood flow and oxygen through the muscle; unable to remove waste, a build up of lactic acid occurs with burning and cramping; cells are deprived of oxygen and suffocate, toxins accumulate resulting in inflammation with swelling and congestion; muscles chronically in spasm become short and weak.

Causes Muscle spasms caused by hyperactivity are the result of overuse or repetitive movement over a long period of time; overexerting a muscle; improper bio-mechanics; sudden or extreme directional change in movement; trauma from an accident; protective mechanism of the body to keep the spine from moving to safeguard the spinal cord; made worse by stress or tension in the mind.

Stretch Principles • Avoid forward bending; lengthen the affected muscle but notice how the stretching affects the pain – if it becomes worse the muscle is already overstretched.

• If in excruciating pain, practice relaxation and start by slowly and gently stretching the muscles of the body that are not painful; supine in Constructive Rest Position.

• Promote stretching the affected muscle elongating before the pain of overstretching develops; stretch a muscle to its “edge,” that zone of “pleasurable discomfort” that exists before the pain of overstretching develops Strength Principles • Avoid loading the affected muscle with body weight, as in forward bending, or with props, such as dumbbells or weight machines.

• Promote gluteal squeezes while lying supine with knees bent; perform “angry cat—playful dog” exercise while in quadruped; modified bridge from supine.

Osteoporosis Porous bones that once were strong and have now become fragile; because there is no physical sensation, osteoporosis has been labeled a silent disease and can cause bone fractures during normal activities; 1.5 million fractures occur yearly due to osteoporosis of the hip, spine and wrist.

Causes Mineral metabolism disturbances and nutritional imbalance; not a result of natural aging; fractures can occur during normal activities such as bending over or during exercises where flexion of the spine is a common movement.

Clients with osteoporosis should maintain a straight trunk, paying attention to keeping the thoracic spine straight and stiff and flexing through the hips. If necessary to facilitate hip flexion, the client should simultaneously flex the knees. Clients with osteoporosis should avoid flexion forces on the thoracic spine or at the thoracolumbar junction because of the danger of compression fractures. Forward bending should be limited to flexion at the hips while maintaining extension of the thoracic spine.

Stretch Principles • Avoid upper trunk flexion movements, and rotations • Promote hip / trunk hyperextension movements.

Strength Principles • Avoid all supine, seated, standing static and dynamic upper trunk flexed postures / movements.

• Promote isometric / active hip and back hyperextension movements.

• Promote weight-bearing activities to facilitate bone calcification.

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GLOSSARY 1. Abduction A movement in the frontal plane which takes a part of the body away from the median plane; 2. Achilles Tendinitis A chronic overuse injury characterized by inflammation of the Achilles tendon resulting from small tears in its fibers.

3. Adaptation The continual process of changing physically, mentally, emotionally and spiritually to adjust to a continually changing environment and set of circumstances.

4. Adaptive Shortening Shortening of muscle fibers and decreased range of motion due to inactivity.

5. Adduction A movement in the frontal plane which takes a part of the body towards the median plane.

6. Agonist The muscle which produces a particular movement; the prime mover.

7. Anatomical Position Standing erect with feet and palms facing forward 8. Angina Pectoris Chest pains caused by insufficient supply of oxygen to the heart muscle.

9. Annulus Fibrosis The tough fibrous outer portion of the intervertebral disc.

10. Ankylosing Spondylitis A progressive inflammatory disease of the spine that is more common in men.

11. Antagonist The muscle which produces the opposite movement of the agonist.

12. Anterior Facing toward or located at the front.

13. Anterior Pelvic Tilt / Anteversion Pelvic position whereby the ASIS (anterior superior iliac spine) is forward or pronounced of the pubis symphysis.

14. Aponeurosis A broad, flattened tendon 15. Arthritis Inflammation and irritation of the joints that often includes swelling and pain.

16. Articulation Moving the torso up and down in a smooth and gradual way rolling the spine one vertebra at a time; the act of segmenting or putting space between the vertebrae.

17. ASIS Anterior Superior Iliac Spine; bony prominence of the hips 18. Atrophy A reduction in size or wasting away of any organ cell, resulting from disease or disuse.

19. Axial Skeleton The bones of the head and the trunk: skull, vertebral column, thorax and sternum 20. Ballistic Bounce or explosive movement, unsustained.

21. Bilateral Affects both sides of the body equally.

22. Bulging Disc / Protrusion An intervertebral disc that sticks out only slightly from its normal space without breaking through the annulus fibrosis. It may or may not cause any symptoms.

23. Bursa A fluid-filled sac or cavity, located in the tissue at points of pressure or friction, mainly around joints.

24. Bursitis Inflammation of the bursa sac, can be an overuse syndrome.

25. Box Drawing a straight line from shoulder to shoulder and down to hip to hip forms a rectangular box which Pilates regarded as the torso requiring stabilization during movement with the arms, legs, and head.

26. Breathing The principle which emphasizes the importance of keeping the blood pure as a result of proper breathing during exercises. This oxygenates the blood and eliminates noxious gases; full forced exhalations followed by a complete inflation of the lungs; breathe in to prepare for a movement and breathe out on the execution of it.

27. Cartilage A shiny, whitish connective tissue covering the articulating surfaces of bones 28. Center of Gravity An imaginary point around which the masses of the body segments are balanced.

29. Centering The human body has a physical center, the “powerhouse,� (abdomen, lower back, hips and buttocks) from which all motion emanates from; focus is on strengthening this center to support the spine, the internal organs and alignment; torso stabilization.

30. Cervical Regional term referring to the 7 vertebrae of the neck.

31. Concentration Focusing full attention to movements; engaging the mind with every movement; visualizing the movement to facilitate the central nervous system to choose the right combination of muscles to perform the movement; key element in connecting the mind with the body.

32. Contraindication Any condition which indicates that a particular movement, activity or treatment is improper or undesirable.

33. Chondromalacia Softening of condral cartilage on patella (backside); first symptoms usually clicking or grating sound in knee.

34. Chronic Back Pain Pain that persists for a long time (usually more than three months); pain beyond the point of tissue healing.

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Circumduction Movement in which the extremity describes a 360 degree circle.

Coccydynia Pain in the coccyx or tailbone area.

Concentric Contraction Isotonic movement in which the muscle shortens Connective Tissue Primary tissue characterized by cells separated by intercellular fluid that supports and binds together other tissues and forms ligaments and tendons.

Control It is fundamentally important that all physical motion be completely controlled by the mind; motion and activity without control leads to a sloppy, haphazard and counterproductive exercise program.

Coronal Plane The vertical plane perpendicular to the median plane; divides the body into anterior and posterior parts; frontal plane.

CNS (Central Nervous System) The brain and spinal cord receive, transmit, and direct all information to and from the muscles and joints to initiate, control, and monitor all human movement.

Closed Kinetic Chain The condition of an arm or leg where the distal segment of the limb is fixed (i.e., a foot on the floor bearing bodyweight; both hands on the floor for a push-up) and movement occurs on both sides of the axis of motion; facilitates normal proprioceptive feedback.

Cyanosis A bluish tinge frequently observed under the nails, lips, and skin, caused by a lack of oxygen.

Deep Internal; intrinsic; inside the body or a particular bone or organ.

Degenerative Disc Disease A condition in which disc degeneration, usually at several spinal levels, causes pain; progressive process during which discs lose water and shrink in size; may or may not cause symptoms and commonly occurs as part of the normal aging process.

Discectomy The surgical removal of all or part of a disc (usually herniated).

Distal Further from the trunk or a specific major joint.

Dorsiflexion A decrease in the angle between the superior (dorsal) surface of the foot and the anterior leg.

Dynamic Flexibility Having responsive muscles which are conditioned for their elastic properties in order to move a joint throughout full range of motion at varying speeds and forces.

Dynamics The study of motion resulting from forces acting on an object; the energetic output with which one performs a movement.

Eccentric Contraction Muscle lengthens while contracting, developing tension as when the muscles oppose the force of gravity.

Engram Continuous, repetitive movements over a period of time which become set in the memory of the muscle; muscle memory; neuromuscular pattern.

Eversion Foot position or movement where the lateral border of the foot is lifted; common with fallen medial arches; combination of foot abduction and dorsiflexion.

Extension A movement in the sagittal plane which takes a part of the body backward from anatomical position; increasing the angle between two bones.

External Rotation See Lateral Rotation Fascia A fibrous membrane covering, supporting and separating muscles; unites skin with the underlying tissue.

Fast Twitch Fibers Large muscle fibers which when enervated have fast contraction times; subtypes: low oxidative / high glycolytic , and medium oxidative / high glycolytic; high anaerobic capacity best suited for intensive, short duration activities.

Faulty Movement Pattern Deviation from a normal movement pattern; commonly caused by an injury or repetitive movement performed while in poor joint position; incorrect recruitment of muscle fibers to produce a particular movement.

Femoral Torsion Rotation of the femur inward relative to the tibia.

Fibromyalgia A clinical syndrome defined by specific points of muscle tenderness as well as sleep disturbance, diffuse pain and fatigue.

Flexion A movement in the sagittal plane which takes a part of the body forward from anatomical position; decreasing the angle between two bones.

Flowing Movement Fluidity; moving smoothly and evenly through the movement patterns in a controlled and flowing manner; avoiding stiff or ballistic movements; energy flowing from the powerhouse out through the head, arms, and legs; grace of motion.

Functional Training Designing an exercise strategy where the repetitive performance of movement patterns improves an individual’s performance of a specific activity. The application in a rehabilitative 61

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environment may be enabling someone to walk again; in a sports environment the exercise prescription would enhance the movements required for that particular sport.

Functional Movement Pattern A specific change in joint position resulting from recruitment of specific musculoskeletal components controlled by the central nervous system.

Genu Valgum A condition of the leg alignment where the space between the knees is abnormally close together and the ankles increased; “knock knees.”

Genu Varum A condition of the leg alignment where the space between the knees is abnormally large and the ankles decreased; “bowlegs.”

Girdle of Strength The deep abdominal muscle transversus abdominis.

Golgi Tendon Organ A sensory organ within a tendon which, when stimulated, causes an inhibition of the entire muscle group.

Hyperextension The extension of body parts beyond their normal limits.

Hypomobility Restricted or limited range of motion (<ROM) at a joint.

Hypermobility Increased range of motion (>ROM) at a joint; joint laxity. May result in degenerative joint disease.

Hypertension High blood pressure; readings as low as 140/90 mmHg are considered a thresh-hold for hypertension by some authorities.

Hypertrophy Increase in size of tissue, organ, or cell, independent of general body growth.

Idiopathic Back Pain Back pain that does not have a well-known or identifiable cause. Investigations indicate that most back pain is idiopathic even though practitioners give some type of diagnosis.

Insertion The place or mode of attachment of a muscle; the moveable part of a muscle during action.

Impingement Syndrome Irritation of structures above the shoulder joint due to repeated compression as the greater tuberosity is pushed up against the underside of the acromion process.

Inferior Facing toward or located at the bottom; further from the head.

Integration The ability to see the body as a comprehensive whole; the use of every muscle simultaneously to complete a movement pattern; uniformly develops complementary muscle groups.

Intensity Degree of strength, energy or difficulty.

Internal Rotation See Medial Rotation Intervertebral Disc The fibrocartilaginous cushion between each vertebra; shock absorbers and weight bearers; allows movement between the vertebra.

Inversion Position or movement of the foot in which the medial border of the foot is lifted; combination of foot adduction and plantar flexion.

Isokinetic Contraction in which the tension developed by the muscle while shortening at constant speed is maximal over the full range of motion.

Isometric Contraction When a muscle strains against a resistance but does not change in length; the length stays the same but the force changes.

Isotonic Contraction The force of the muscle contraction is constant and the length of the muscle changes; the muscle origin and insertion are drawn together.

Joint Capsule A sleevelike structure which encloses the joint, prevents loss of fluid and binds together the ends of the articulating bones; composed of dense connective tissue and represents a continuation of the periosteum.

Kinesophobia The irrational fear of movement; often part of the development of chronic back pain.

Kinesthetic Awareness An individual’s conscious awareness of body and joint position in space.

Kyphosis The convex rounding of the thoracic spine.

Lateral Further from the median plane; to the side.

Lateral Flexion Side bending of the trunk or neck.

Lateral Rotation A movement in a transverse plane which takes a part of the body outward; turning the arms or legs away from the median plane; external rotation.

Ligaments Dense bundles of parallel collagenous fibers derived from the outer layer of the joint capsule to strengthen and stabilize the joint in a passive way; non-elastic and non-contractile; contain numerous sensory nerve cells capable of responding to speed, movement, joint position, stretching, and pain.

Limit of Stability The outermost range in any direction that an individual can lean from the neutral position without changing the base of support (i.e., taking a corrective step to prevent a fall or needing a prop to balance during exercise).

Lordosis The concave curve of the vertebral column 62

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96. Longitudinal Ligaments (Posterior and Anterior) Ligaments extending the length of the vertebral column attached to the front and back of the vertebral bodies acting as brakes to extension and flexion; absorbs the thrust from the disc nuclei during articulation.

97. Lumbar Regional term referring to the 5 vertebrae of the back between the abdomen and the pelvis.

98. Lumbar Stenosis A narrowing (stenosis) of the spinal canal in the lumbar spine.

99. Medial Closer to the median plane.

100. Medial Rotation A movement in the transverse plane which turns a part of the body inward toward the median plane; internal rotation.

101. Meniscus Tear Acute injury to the crescent-shaped fibrocartilage (lining the top surface of the tibia) within the knee either medial or lateral .

102. Mobility Movement controlled by muscular contractions, muscular flexibility and the potential range of motion at a joint.

103. Momentum The force with which one exerts movement; all movement momentum should initiate from the powerhouse and not from â&#x20AC;&#x153;throwingâ&#x20AC;? the body into the movement.

104. Motoneurons Neurons that carry impulses from the brain and spinal cord to the muscle receptors for enervation of the muscle fibers.

105. Motor Control The science of how the CNS interprets sensory information from the environment and the body and then controls the individual muscles and joints to produce coordinated movement patterns.

106. Motor Learning The act of making the mind â&#x20AC;&#x201C; body connection; the mind teaching the body conscious control of a new movement or motor program; motor performance.

107. Multifidus Vertebral column muscle subdivision of the transversospinalis group; chevron-like muscles which run superomedially from transverse process to spinous process; assist in extension, lateral flexion, rotation, and alignment of the spine 108. Muscle Spindle Functions as a stretch receptor monitoring the length of the muscle in which it is embedded; its greatest density is near the belly of the muscle; rapid, ballistic stretching stimulates the muscle spindle causing an involuntary contraction of the muscle being stretched (stretch reflex.)

109. Myositis Inflammation of a muscle.

110. Navel to Spine Making the distance between the navel and the lumbar spine as small as possible; engagement of the powerhouse whereby the navel pulls back into the back.

111. Nucleus Pulposus The inner part or center of the disc 112. Neuromuscular Pertaining to the relation between nerves and muscles 113. Open Kinetic Chain The condition of an arm or leg where the distal segment of the limb is free to move (i.e., both feet off of the floor during leg exercise); no direct correlation between open-chain movement patterns and increases in functional performance.

114. Osteoarthritis A degenerative joint disease associated with aging; caused by a degeneration of the cartilage of the joints; improved with exercise and synovial fluid production.

115. Osteopenia Osteoporosis risk factor; exists in those who never reached peak bone mass; a condition of low bone mass; may or may not be a precursor to osteoporosis.

116. Osteoporosis A weakening of the bones as they lose some of their density; porous bones resulting from mineral metabolism and nutritional imbalance.

117. Overuse Injuries Injuries caused by excessive, repeated stress to an area of the body; common overuse injuries include: shin splints, tendinitis and bursitis.

118. Pilates Stance Pilates First Position; modified Ballet First where the angle between the heels is approximately 45 degrees; V position of the feet; toes and legs turned out with straight but not locked knees; squeezing the back of the upper inner thighs stabilizes the pelvis.

119. Plantar Fascitis Inflammation of the plantar fascia, a broad band of connective tissue running along the sole of the foot.

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120. Plantar Flexion An increase in the angle between the dorsal surface of the foot and the anterior leg; pointing the foot; extending the foot through the toes.

121. Posterior Facing toward or located at the back.

122. Precision The principle which facilitates neuro-muscular re-education. Pilates said, â&#x20AC;&#x153;Concentrate on right movements each time you exercise or else you will do them improperly and lose their value.â&#x20AC;?

123. Prone Lying face down Pronation Palm of the hand faces backward; shifting the body weight to the inside of the foot.

124. Proprioception The cumulative neural input to the CNS from receptors (proprioceptors) in the joint capsules, ligaments, muscles, tendons, and skin.

125. Proprioceptive Neuromuscular Facilitation (PNF) Statically stretching a muscle after maximally contracting it.

126. Proximal Closer to the trunk or a specific major joint 127. PNS (Peripheral Nervous System) All the branches of nerves that lie outside the spinal cord. The peripheral nerves primarily responsible for muscular action are the spinal nerves that enter on the posterior or dorsal side of the vertebral column.

128. Q-Angle The angle formed by the longitudinal axis of the femur and the line of pull of the patellar ligament.

129. Range of Motion The scope of movement within which a muscle can comfortably be exercised; the number of degrees that an articulation will allow one of its segments to move.

130. Rehabilitation Restoration, following disease, illness or injury, of the ability to function in a normal or near normal manner.

131. Reciprocal Inhibition Relaxation of the antagonistic muscle(s) while the agonist muscle(s) performs a given task.

132. Reciprocal Innervation A stretching technique in which an individual contracts the opposite muscles he wants to stretch.

133. Recurrent Acute Back Pain Episodes of back pain that are of varying duration and are separated by relatively pain-free periods; most common type of back pain condition.

134. Regression Teaching a complex movement pattern by first reducing it to isolated movements of one body part at a time and progressing the intensity by layering the isolated movements into the advanced or integrated movement pattern.

135. Resistance Anything that opposes the contraction of muscle when drawing its origin and insertion points closer together.

136. Rheumatoid Arthritis An autoimmune disease that causes inflammation in the connective tissues in the joints.

137. RICE Immediate injury treatment: rest, ice, compress, elevate.

138. Rotation Movement around the central axis of a lever.

139. Ruptured Disc / Herniated Disc Extrusion, most commonly a result of chronic flexion movement, during which the nucleus moves toward the back (posteriorly) and fluid from the disc escapes; fluid may compress the nerve roots causing pain.

140. Scanning Teaching technique of observation/assessment; looking for incorrect body alignment or faulty movement patterns.

141. Sciatica Pain in the buttocks and the back of the legs due to irritation of the sciatic nerve or nerve roots.

142. Scoliosis An abnormal curve of the spine to the side; often very mild and usually does not cause symptoms.

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143. Scoop The act of pulling the navel down into the spine by engaging the transverse abdominals to create concave lower abdominals.

144. Sensory Neurons Neurons that carry impulses from the receptors in the body into the central nervous system 145. Slow-Twitch Fibers Small skeletal muscle fibers innervated by the alpha-2 motoneuron, having a slow contraction time; high aerobic capacity; high oxidative and low glycolytic; endurance muscles 146. Softening The point at which the legs or arms can be straightened without locking the joints.

147. Specificity A principle of training that states that physiological adaptations are specific to the systems that are overloaded with exercise.

148. Spinal Canal The “tube” through which the spinal cord passes; formed by the opening at the back of each vertebra as they are stacked upon one another.

149. Spinal Nerves The 31 pairs of nerves that arise from the various levels of the spinal cord.

150. Spinal Stenosis An abnormal narrowing of the spinal canal. Stenosis is classified as developmental (genetic origin), congenital (from birth), and acquired (developed after birth); Acquired stenosis is the most common due to degenerative changes in the spine; spinal hyperextension movement should be avoided.

151. Spine to Mat Also referred to as “imprinting the spine;” supine: removing the space under the lumbar, lengthening the lordotic curve; strongly suggested for individuals with lumbar hyperlordosis or at risk for lumbo-sacral injury.

152. Spondylolisthesis Anterior displacement of a vertebra on the adjacent lower vertebra; slipping forward of a vertebrae; usually L4 over L5.

153. Spondylosis Degenerative changes of the spine, including the vertebrae, the discs, and the facet joints; a fracture of the vertebra facet.

154. Sprain Wrenching or twisting of a joint in which ligaments are stretched past their normal limits 155. Stability Is the active muscular control exerted on a joint by working muscles.

156. Strain Muscle pull; a stretch, tear or rip of the muscle or adjacent tissue, such as fascia or muscle tendon.

157. Stress Related Back Pain / Tension Myositis Syndrome (TMS) Back pain that is thought to be caused and maintained primarily by emotional and psychological issues; 158. Stretch Reflex When stretching to the point of pain the muscle spindle receptors signal the muscle to shorten or contract to prevent the muscle from being torn from the bone.

159. Subluxation Dislocation or disarticulation of a joint.

160. Superficial External; on or near the outside surface of the body or a particular bone or organ.

161. Superior Facing toward or located at the top; closer to the head.

162. Supine Lying face up. Supination Palm of the hand faces forward.

163. Syncope Fainting; temporary loss of consciousness due to insufficient blood flow to the brain.

164. Synergetic The cooperation of different muscles to produce the same action 165. Synovial Fluid The body’s natural lubrication for the joints; slow, controlled movement increases production keeping joints flexible.

166. Synovial Membrane The inner layer of the joint capsule composed of loose connective tissue; secretes synovial fluid which fills the articular cavity to lubricate the joint and provide nutrients to the cartilage and contains phagocytic cells which remove debris and microorganisms from the cavity.

167. Tachycardia An increased or rapid heart rate, usually above 100 beats per minute.

168. Tendon The strong fibrous cord forming the termination of the muscle and attaching to the periosteum of a nearby bone; minimum of elasticity.

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169. Tendinitis Inflammation of a tendon; commonly caused by overuse.

170. Thoracic Regional term referring to the 12 vertebrae between the neck and the abdomen; thorax or chest 171. Tibial Torsion Twisting of the tibia, usually associated with supinated or pronated feet.

172. Tonus A slight, sustained muscle contraction.

173. Torque Amount of twist around an axis.

174. Traction A treatment in which pressure is applied to the spine in order to pull articulations away from one another.

175. Transverse Plane To cross the body with a line parallel to the floor; horizontal plane; to divide the body into superior (upper) and inferior (lower) parts.

176. Trendelenburg Sign The Trendelenburg Gait is one in which the affected hip goes into adduction during each weightbearing phase of the gait; indication of hip abductor weakness as evidenced by the hip going into adduction when standing with full weight on the affected leg with the other foot off the floor.

177. Valsalva Maneuver A dangerous condition that can occur if an individual holds their breath, causing the glottis to close and abdominal muscles to contract, forming an unequal pressure in the chest cavity, reduced blood flow to the heart and insufficient oxygen supply to the brain. Dizziness, temporary loss of consciousness may occur.

178. Ventral Towards the abdominals; anterior or front; palmar regarding the hands.

179. Vertebra or Vertebrae A bone of the spine; a vertebra has three parts: the vertebral body, the transverse process and the spinous process; vertebrae is plural.

180. Vertebral Column The backbone or spine; 23 intervertebral articulations.

181. Vital Capacity The greatest volume of air that can be forcibly exhaled after the deepest inspiration.

182. Wolffâ&#x20AC;&#x2122;s Law Injured bone heals according to the stress placed upon it during the healing process; bones become stronger in response to increased stress; bones react to mechanical forces applied to them by adapting in size and internal structure.

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PRONUNCIATION GUIDE

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References Aerobics and Fitness Association of America Fitness Theory & Practice. Stoughton, MA: Reebok University Press, 1997 Aerobics and Fitness Association of America Mat Science Educational Workshop. Sherman Oaks, CA: AFAA, 2000 Brownstein, A. Healing Back Pain Naturally. New York, NY: Simon & Schuster, Inc., 2001 Calais-Germain, Blandine Anatomy of Movement. Seattle, WA: Eastland Press, 1993 Calais-Germain, B., Lamotte, A. Anatomy of Movement Exercises. Seattle, WA: Eastland Press,1996 Catalano, E., Kimeron, N. The Chronic Pain Control Workbook. Oakland, CA: New Harbinger Publications, Inc., 1996 Esquerre, B., Lang, A., Stoehr, G., Wooldridge, J. Beyond Sets & Reps: Reebok Reactive Neuromuscular Training. Reebok University Program Implementation Team Franklin, Eric, Dynamic Alignment Through Imagery, USA, Human Kinetics, 1996 Gallagher, S., Kryzanowska, R. The Joseph H. Pilates Archive Collection. Philadelphia, PA: BainBridge Books, 2000 Gallagher, S., Kryzanowska, R. The Pilates Method of Body Conditioning. Philadelphia, PA: BainBridge Books, 1999 Houglum, Peggy A., Therapeutic Exercise for Athletic Injuries, USA, United Graphics, 2001 International Sports Conditioning Association Personal Trainer’s Manual. Miami, FL: ISCA, 2000 Kapit, W., Elson, L. The Anatomy Coloring Book. New York, NY: Harper & Row, Publishers, Inc., 1977 Karter, K. The Complete Idiot’s Guide to The Pilates Method. Indianapolis, IN: Alpha Books, 2001 McKenzie, R., Kubey, C. 7 Steps To A Pain-Free Life, How to Rapidly Relieve Back and Neck Pain. New York, NY: Penguin Putnam, Inc., 2001 Menezes, A. The Complete Guide to Joseph H. Pilates’ Techniques of Physical Conditioning. Alameda, CA: Hunter House Inc., 2000 Niederlander, G. Post Injury Fitness Manual. Nike, 1995 PhysicalMind Institute Osteoporosis Exercise Protocols, Awareness & Prevention of Osteoporosis using The Method Pilates. New York, NY: Public Relations, 2001 Pilates, J., Miller, W. Return to Life Through Contrology. Incline Village, NY: Presentation Dynamics Inc., 1998 Robinson, L., Convy, G. Pilates Workout. New York, NY: Sterling Publishing Company, Inc., 2000

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Robinson, L., Fisher, H., Knox, J. The Official Body Control Pilates Manual. New York, NY: Barnes & Noble, 2000 Sahrmann, Shirley A., Diagnosis and Treatment of Movement Impairment Syndromes, USA, Mosby, Inc., 2002 Siler, B. The Pilates Body. New York, NY: Random House, Inc., 2000 Sinel, M., Deardorff, W. Back Pain Remedies for Dummies. Foster City, CA: IDG Books Worldwide, Inc., 1999 The National Alliance of Fitness Professionals Personal Trainer Certification Course.

Wharton, J., Wharton, P. The Whartonsâ&#x20AC;&#x2122; Stretch Book. New York, NY: Random House, Inc., 1996 Yessis, M. Kinesiology of Exercise. Chicago, IL: Masters Press, 1992

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