RCCB2 Support Material Sample by Merrithew™

SUPPORT MATERIAL

THE MH&F DIFFERENCE Our team of experts strives to provide fitness and rehab professionals with access to thorough, scientifically-based programming, wide-ranging education options, quality equipment, and the ongoing opportunities and support that are important to your success and to the success of your clients, members and patients. Thanks to our uniquely integrated operation, STOTT PILATES Certified Instructors enjoy numerous benefits, including strong post-graduate support and preferred equipment rates, while our equipment customers have access to comprehensive training, instructional videos and manuals, and business solutions. At Merrithew Health & Fitness, our engineers and talented Instructors work together to refine and evolve our equipment so it continuously exceeds and challenges.

RCCB2—PERIPHERAL JOINT STABILIZATION: CADILLAC, STABILITY CHAIR & BARRELS This course introduces exercises that target the upper and lower extremities and enable isolation of the joints while maintaining core stability. Through an

STOTT PILATES MANUALS The following manuals are available from Merrithew Health & Fitness: ◗

RMR1 SUPPORT MATERIAL

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RMR2 SUPPORT MATERIAL

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RCCB1 SUPPORT MATERIAL

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RCCB2 SUPPORT MATERIAL

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COMPREHENSIVE MATWORK

Complete Stability Chair, Complete Arc Barrel, Complete Spine Corrector and

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ESSENTIAL REFORMER

Complete Ladder Barrel technical manuals that list the full exercise repertoire.

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INTERMEDIATE REFORMER

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ADVANCED REFORMER

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ESSENTIAL CADILLAC

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INTERMEDIATE & ADVANCED CADILLAC

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STABILITY CHAIR

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LADDER BARREL

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ARC BARREL

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SPINE CORRECTOR

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INJURIES & SPECIAL POPULATIONS

evidence-based approach to Pilates, the focus is on stabilizing the musculoskeletal structures with a widely varied series of non-weightbearing and weightbearing exercises, to improve functional alignment and core stability as well as progress to return-to-sport and daily activities. This support material guide is designed as a reference for exercises taught in the course along with the Comprehensive Matwork, Essential Cadillac,

This manual is intended for those training at a Licensed Training Center, Corporate Training Center or host site offering STOTT PILATES branded programming, under the instruction of representatives of Merrithew Health & Fitness.

ADDITIONAL SUPPORT MATERIALS To complement our technical manuals, Merrithew Health & Fitness also provides the following helpful support materials: ◗

WALL CHARTS Outlining the STOTT PILATES repertoire for each piece of equipment

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CLIENT WORKOUT SHEETS Our repertoire in handy pads of 100 tear-off pages

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WORKOUT VIDEOS Unparalleled instruction from beginner to advanced level

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ALL AVAILABLE at merrithew.com

RCCB2 Objectives 1. Learn how to apply the STOTT PILATES Five Basic Principles to exercises on the Cadillac, Stability Chair & Barrels 2. Learn the choreography, modifications, indications and contraindications for exercises on the Cadillac, Stability Chair & Barrels 3. Develop the ability to teach, modify, correct and progress each exercise 4. Learn how to integrate the Cadillac, Stability Chair & Barrels into clinical practice through Case Studies and Clinical Reasoning Challenges 5. Develop an understanding of how Matwork, Reformer, Cadillac, Stability Chair & Barrel exercises integrate together. Note: Exercises that are new in RCCB2 are denoted in BOLD.

1705G-1 SUPPORT MATERIAL: RCCB2 PERIPHERAL JOINT STABILIZATION: CADILLAC, CHAIR & BARRELS

Table of Contents Introduction Arc Barrel & Spine Corrector Exercises Supine

Ab Prep

Hundred

Prone

Cadillac Exercises Roll-Down Bar—Springs From Above Seated

Circles

Roll-Down

Side Kick Stretch

Neck Pull

Developé

Port de Bras

Knee Lift

Twist with Pulses

Side-Lying One Leg Pull

Kneeling One Leg Pull

Scissors

Ovals

Single Leg Extension

Standing

Lower & Lift

Facing Side Lat Press

Lower & Lift Heel Squeeze

Facing Side Press Down

Stability Chair Exercises Leg Work

Leg Circles

Unilateral Triceps Lunge

Footwork

Scissors

Isometric Triceps Lunge

Single Leg

Beats

Eccentric Triceps Lunge

Ankle Exercise

Chest Pull

Lower & Lift Standing

Forward Step Up

Forward Step Down

Side Step Down

Inverted Lower & Lift

Scissors

Roll-Down Bar—Springs From Below Standing

Bicycle

Upright Row

Leg Circles

Eccentric Upright Row

Backward Step Down

Windmill

Bicep Curls

Shoulder Bridge

Frog

Eccentric Bicep Curls

Adductor Press

Supported On Hands

Push-Thru Bar—Springs From Above

Crossover Press

28 28

Tricep Dips

Scapula Isolation

Foot Press On Long Box

Push Ups

Push-Thru On Back

Leg Work Supported by Arms

Leg Pull Front

Push-Thru with Feet

Knee Raises

Rotation Prone

Side-Lying Push-Thru with Feet

Knee Raises with Obliques

Arm Press

Push-Thru Bar—Springs From Below

Arm Work

Scapula Isolation

Scapula Isolations Standing

Chest Press

Triceps Press Standing

Leg Presses

One Arm Push Hand on Floor

Hip Opener

Triceps Press Sitting

Spine Corrector & Ladder Barrel Exercises Side-Lying Bend & Stretch

Side-Lying Leg Lift

Scissors

Top Leg Circles

Side Kick

Side Kick Stretch

One Arm Press

Seated

Torso Flexion

Arm Springs Midback Series

Torso Press Sitting Prep

Bicep Curls Supine

Back Rowing Preps Kneeling / Kneeling Lunge

Case Study Clinical Reasoning Challenge Appendices

Front Rowing Preps Kneeling / Kneeling Lunge

A Spine Corrector, Arc Barrel & Ladder Barrel Exercises

B Cadillac Exercises

38 42

Scissors

Arm Springs Standing

Bicycle

Arms Sideways

C Stability Chair Exercises

Lower & Lift

Triceps Press

Leg Circles

Bicep Curls

Ladder Barrel Exercises Short Box Series

Side Arm Work

References 43 Selected Pages from the Intermediate & Advanced Cadillac Manual

Reverse Expansion

Neck Pull

[22] 46

Round Back

Offering

Twist with Pulses

[26] 48

Straight Back

Hug a Tree

Port de Bras

[28] 50

Tree Prep

Butterfly

Triceps Lunge

[38] 52

Punches

Hip Opener

[102] 54

Plyometric Punches

Reverse Expansion

[126] 56

Decelerated Lunges with Punches

Offering

[132] 62 [134] 64

Spine Corrector & Arc Barrel Exercises Standing Decline Squats

Standing Pull Down

Hug a Tree

Decline Single Leg Lunge

Squats

Butterfly

[135] 65

Punches

[136] 66

Arc Barrel & BOSU®* Exercises Standing Balance Squats

Leg Springs 15

Ladder Barrel Exercises Standing

Bend & Stretch

Squats

[140] 68

Lift & Lower

Beats

[142] 70

Leg Circles

Scissors

[154] 72

Beats

Ovals

[156] 74

Standing Single Leg Work

Side-Lying

Standing Terminal Knee Extension

Bend & Stretch

Lunges

Lift & Lower

*BOSU is a registered trademark of BOSU Fitness LLC, used with permission.

Side Kick Stretch

[158] 76

Developé

[160] 78

Barrel Exercises Arc Barrel & Spine Corrector Supine 1. Ab Prep Refer to page 30 of the Comprehensive Matwork manual and Appendix A LOWER EXTREMITY

a. Legs over Arc Barrel or feet on Arc Barrel ◗ Allows muscles to relax and knees to rest in acute injuries, feet on Barrel promotes different hip ranges and levels of support b. Fitness Circle® on outside or inside of knees ◗ Teaches client dissociation of abdominal work from hips ◗ Monitor tensor fascia latae ◗ Monitor segmental stability of spine, especially area of concern c. Legs over Arc Barrel with Terminal Knee Extension ◗ Promotes low load open kinetic chain strength work for the quadriceps ◗ Allows progression of quadriceps setting exercises ◗ Indicated for: extension lag, resolving swelling of knee ◗ Can omit Ab Prep to focus on legwork only ◗ Ensure pelvis remains stable throughout

d. Spine over apex i. Terminal Knee Extension ◗ Introduces open kinetic chain strength work for hip flexors and quadriceps and end-range knee extension ◗ Open chain biases quadriceps group and minimizes input from hamstring and adductor groups – Richardson, Hodges, Hides

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Spinal motion moves from extension to neutral (can also be done into flexion)

ii. Lower & Lift of leg Promotes endurance through isometric contraction of quadriceps ◗ Increases hip flexor and abdominal challenge due to longer lever of leg ◗ Spinal motion moves from extension to neutral (can also be done into flexion) ◗

UPPER EXTREMITY

a. Modification 2. Hold Fitness Circle – add sustained abduction or adduction with Fitness Circle between hands b. Flex-Band® around feet – add bicep curls on spinal flexion c. Holding Toning Ball™ – palm up / down / side or Toning Ball on floor – rolling Ball along floor while pressing down ◗ Works elbow stabilizers isometrically d. Spine over apex – extension to neutral i. Single arm overhead ii. Single arm overhead with wrist flexion / extension iii. Single arm Snow Angel iv. Single arm Tricep Presses ◗ Spinal motion moves from extension to neutral (can also be done into flexion) ◗ Tonic work for the shoulder extensors and triceps and increase loading of the abdominals ◗ Different hand position in space promotes tonic work of wrist muscles ◗ Correct size Toning Ball supports arches of the hand and promotes intrinsic hand muscle work ◗ Challenges latissimus dorsi in a lengthened position ◗ Watch thoracolumbar and mid-lumbar region for gives ◗ Toning Balls, Fitness Circle or Flex-Band to challenge arm strength

1705G-1 SUPPORT MATERIAL: RCCB2 PERIPHERAL JOINT STABILIZATION: CADILLAC, CHAIR & BARRELS

Spine Corrector & Arc Barrel Standing LOWER EXTREMITY

1. Decline Squats Refer to Appendix A ◗ ◗ ◗

Works on quadriceps eccentrically Provides increased eccentric loading to patella tendon Indicated for: patella tendinopathy, ankle instability, achilles tendinopathy

2. Decline Single Leg Lunge Refer to Appendix A ◗ ◗ ◗ ◗ ◗ ◗ ◗

Works on quadriceps eccentrically Provides increased eccentric loading to patella tendon Decreased base of support provides proprioceptive input to entire lower kinetic chain Indicated for: patella tendinopathy, ankle instability, achilles tendinopathy When using the Arc Barrel client can wear shoes or ensure sole of foot to be in contact with slope of Barrel if plantar fascia or arch of foot is compromised Decreased base of support provides proprioceptive input to entire lower kinetic chain Balance control challenge for leg

Arc Barrel & BOSU Standing LOWER EXTREMITY

1. Balance Squats Refer to Appendix A a. On apex of Barrel i. Squat ii. Plantar flexion / dorsiflexion in static squat or standing position ◗

Decreased base of support to provide low level proprioceptive input to ankle joint

b. On BOSU i. Squat ii. Plantar flexion / dorsiflexion in static squat or standing position ◗ ◗

Unstable surface provides proprioceptive input to ankle joint Progresses standing with decreased base of support

c. On inverted BOSU i. Squat ii. Plantar flexion / dorsiflexion in static squat or standing position iii. Rocking BOSU side to side in static squat or standing position ◗ ◗ ◗ ◗

Arms can be forward or down by sides Ensure folding at the hips to prevent tucking of the pelvis and excessive posterior chain gripping and to protect the knees Unstable surface challenges ankle stabilizers Provides mobilization of joint in closed kinetic chain with proprioceptive input

Push-Thru Bar—Springs from Below UPPER EXTREMITY

1. Scapula Isolation Refer to page 62 of the Essential Cadillac manual a. Modification 1. Unilaterally b. Modification 2. Palms toward face c. Modification 3. Full range ◗ ◗

Challenges concentric and eccentric strength of serratus anterior and pectoralis major Watch extension of neck and pressing thorax down into Mat

2. Chest Press Refer to page 64 of the Essential Cadillac manual a. Modification 1. Angle elbow toward feet b. Modification 2. Unilaterally ◗ ◗

Focus on triceps strengthening Cadillac bed provides proprioception for scapular position

LOWER EXTREMITY

1. Leg Presses Refer to page 66 of the Essential Cadillac manual a. b. c. d. e.

Modification 1. Legs hip-distance apart Modification 2. Legs laterally rotated Modification 3. Unilaterally Modification 4. Omit dorsiflexion and plantar flexion Stability Chair at end of Cadillac to decrease required range of motion of hips

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Loaded position of spine and hips Contraindications: symptomatic lumbar disc, sciatica, inner-range hip flexion issues, inadequate ankle mobility to maintain foot contact with bar Indications: hip mobilization, neural mobilization, ankle mobilization, lengthen posterior hip muscles and open posterior hip capsule

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2. Hip Opener Refer to page 102 of the Intermediate & Advanced Cadillac manual ◗ ◗ ◗ ◗

Lateral mobility of leg Watch alignment of knee Encourage folding in the hip socket Encourages gliding of the sciatic, tibial and peroneal nerves

Arm Springs UPPER EXTREMITY

1. Midback Series Refer to page 70 of the Essential Cadillac manual a. b. c. d.

Triceps Press Straight Down Forty-Five Degrees Side

e. Circles i. Unilateral and bilateral ◗

Three hand positions

Case Study Assignment For each of the following case studies, write out: a. Factors contributing to the client’s complaint b. Your goals with STOTT PILATES exercise c. Ten to 15 exercises including appropriate props and modifications d. Progressions for each exercise

1. Terry the Telephone Operator with Thoracic Outlet Syndrome and Recurrent Ankle Tenderness ◗

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Holds phone on left shoulder, right-handed Head forward posture Clockwise rotated trunk which is shifted left Protracted and elevated left scapula Thoracic outlet syndrome on left side Recurrent sprains of left ankle

a. b. c. d.

Contributing Factors Goals Exercises Progressions

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2. Olivia with Osteoarthritis All Over ◗

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Olivia has osteoarthritis of both knees and her right thumb (CMC and MCP) She is an avid gardener who spends hours kneeling while weeding and using hand tools She has no abs, glutes nor scapular stabilizers You have six months until major gardening season begins again

a. b. c. d.

Contributing Factors Goals Exercises Progressions

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3. Type A Trina with Terrible Trochanteric Bursitis and T1 Entrapment ◗

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Trina is a 32 year old who is studying architecture She developed left trochanteric bursitis three weeks ago after running 14 miles in tennis shoes (she forgot her running shoes and could not possibly miss a run) Palpable clicking of ITB over greater trochanter with flexion and extension, and internal rotation Head forward posture Sits cross-legged all day long studying Hikes scapulae all the time; hypertonic levator scapulae and rhomboids

a. b. c. d.

Contributing Factors Goals Exercises Progressions

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1705G-1 SUPPORT MATERIAL: RCCB2 PERIPHERAL JOINT STABILIZATION: CADILLAC, CHAIR & BARRELS

Clinical Reasoning Challenge 1.

Name two STOTT PILATES exercises on each piece of equipment you can use to help a client find a neutral scapular position, and develop the tonic holding function of the trapezius.

2. a. Name two exercises on each piece of equipment to help center the femoral head in the acetabulum for a client who has anterior femoral head syndrome. b. What may have led to the condition in the first place? 3. a. What does a Trendelenberg gait pattern indicate? b. What are the ramifications? c. Name eight CCB exercises you would use to strengthen the gluteus medius in a 60-year old inactive woman with hip pain. 4. a. Name six exercises you would use to help develop midfoot mobility and control. b. What cues could you give to help the client perform each correctly?

Name six exercises you could use to challenge knee proprioception following an ACL replacement.

Name two exercises on each piece of equipment to lengthen a short / facilitated iliopsoas.

Name six exercises where you can develop scapular stability and thoracic mobility simultaneously.

8. a. List five postural factors that may lead to lateral epicondylitis in an inactive woman who works on the computer all day long. b. Name two Cadillac, Stability Chair & Barrel exercises you could use to address each issue. 9. a. What are the functions of latissimus dorsi? b. Name two issues which would result from shortness / dominance of the muscle. c. Name four exercises you could do to get length and proper control of the latissimus dorsi. 10.

How can you use STOTT PILATES exercises to mobilize an osteoarthritic hip, knee, and wrist?

11.

Why is it inadvisable to ‘work through the pain’ when rehabilitating an acute injury?

12. a. How can STOTT PILATES help you achieve excellent clinical results and reduce your clients’ risk of injury recurrence? b. How would you explain what you have learned in an in-service?

1705G-1 SUPPORT MATERIAL: RCCB2 PERIPHERAL JOINT STABILIZATION: CADILLAC, CHAIR & BARRELS

Appendix C

Stability Chair Exercises SHOULDER BRIDGE

2 HEAVY-LOW, SPLIT PEDAL

supine on Mat, heels in line with hips, arches of the feet on the pedals, pedals pressed down, pelvis and spine neutral, arms long by sides in: prepare, ex: extend hip joint lifting the pelvis off the Mat, in: keeping pelvis lifted neutral, allow one pedal to lift, ex: press pedal down to start position, in: allow other pedal to lift, ex: press pedal down to start position, 5-10x per leg, in: keep both feet down and lower the hips back to the Mat

CROSSOVER PRESS standing facing side of Chair so metal frame is in front of feet, foot closest to Chair on pedal, pedal pressed down, pelvis and spine neutral, arms long by sides in: flex hip and knee to allow pedal to lift, maintaining pelvis and spine position in space, ex: press pedal down to start position NOTE: Can move outside leg closer to seat of Chair to increase adduction of legs, can hold handle for balance

FOOT PRESS ON LONG BOX

4. BOX LEG LUNGING WITH BACK LEG STRAIGHT stand facing side, legs straight and parallel, legs staggered with one foot at front of Box, other foot on back pedal as far as pelvis and spine remain neutral, hips level, closest hand holding handle for balance, other arm down by side, scapulae stabilized in: flex Box leg allowing torso to lean forward at the hip joint to maintain pelvis and spine neutral alignment, keep back leg straight and allow heel to lift if necessary, ex: return to start position 5. BOX LEG IN STATIC LUNGE, BACK ANKLE PLANTAR FLEXING OR DORSIFLEXING stand facing side, legs staggered with one foot at front of Box and knee flexed, other foot on back pedal with leg straight as far as pelvis and spine remain neutral with torso leaning forward from hip joint in: plantar flex or dorsiflex pedal leg ankle, ex: return 6. BOX LEG IN STATIC LUNGE, BACK LEG FLEXING stand facing side, legs staggered with one foot at front of Box, other foot on back pedal, both knees flexed, pelvis and spine remain neutral with torso leaning forward from hip joint in: press pedal down with back leg, pelvis and spine remain neutral with torso leaning forward from hip joint, ex: return

1. LATERAL ROTATION ON ROTATIONAL DISK standing facing side of Chair, one foot on pedal, one foot on Rotational Disk on Box, feet hip-distance apart and parallel, ASIS level, pelvis and spine neutral, hand closest to Chair holding handle or arms by sides in: keeping pelvis level and centered over feet, simultaneously flex box leg and laterally rotate hip to lower pedal, ex: extend pedal leg and rotate hip to parallel to return 2. BOX ANKLE PLANTAR FLEXING OR DORSIFLEXING stand facing side, legs straight and parallel, one foot on Box, other foot on pedal, pelvis and spine neutral, hips level, closest hand holding handle for balance, other arm down by side, scapulae stabilized in: plantar flex or dorsiflex Box leg ankle, maintaining pelvis and spine level throughout, ex: return NOTE: Can be done with knee flexed throughout to focus on soleus 3. PEDAL ANKLE PLANTAR FLEXING OR DORSIFLEXING stand facing side, legs straight and parallel, one foot on Box, other foot on pedal, pelvis and spine neutral, hips level, closest hand holding handle for balance, other arm down by side, scapulae stabilized

KNEE RAISES SUPPORTED BY PEDAL hands holding top of handles, supporting body weight, facing away from Chair, torso vertical, imprinted position, legs straight, parallel and adducted, hips flexed slightly to reach feet on pedal, scapulae stabilized in: prepare, ex: flex knees and hips, pulling knees toward torso, in: return NOTE: Can be done unilateral with one leg only reaching to torso

KNEE RAISES WITH OBLIQUES SUPPORTED BY PEDAL hands holding top of handles, supporting body weight, facing away from chair, torso vertical, imprinted position, legs straight and parallel and adducted, hips flexed slightly to reach feet on pedal, scapulae stabilized in: prepare, ex: flex knees and hips to pull knees toward torso, simultaneously rotate pelvis to one side so knees reach up toward one shoulder, in: return NOTE: Can be done unilateral with one leg only reaching to torso

in: plantar flex or dorsiflex pedal leg ankle, maintaining pelvis and spine level throughout, ex: return NOTE: Can be done with knee flexed throughout to focus on soleus

1705G-1 SUPPORT MATERIAL: RCCB2 PERIPHERAL JOINT STABILIZATION: CADILLAC, CHAIR & BARRELS

arm springs standing REVERSE EXPANSION

INTERMEDIATE

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1. REACHING FORWARD

EXERCISE

STARTING POSITION

To prepare, inhale...

Standing, facing away from vertically sliding bar. Pelvis and spine neutral, with whole body leaning away from Cadillac. Feet hip-distance apart, legs straight. Arms straight, reaching down and slightly behind torso. Hands in handles, palms facing forward. Scapulae stabilized.

EXHALE

keep scapulae stabilized and reach arms straight forward, as high as possible up to eye level.

INHALE

keep scapulae stabilized and torso stable in lean and reach arms down and back to starting position.

Complete 4 repetitions.

Reaching Forward

126

1. starting position

2. reach arms forward

3. reach arms forward

4. reach arms down

I N T E R M E D I AT E & A D V A N C E D C A D I L L A C M A N U A L • E X E R C I S E S