Modifying Pilates for Clients With Osteoporosis

Safe Pilates Mat Exercises

Hundred–with head down
Single Leg Circles
Single Leg Stretch–head down
Double Leg Stretch–head down
Single Leg Stretch With Straight Legs–head down
Double Leg Stretch With Straight Legs/Lower Lift–head down
Criss-Cross–head down
Swan-Dive (1 only)
Single Leg Kick
Double Leg Kick
Shoulder Bridge–not too high
Side Kick
Hip Circle/Hip Twist With Stretched Arms–neutral spine
Swimming
Leg-Pull–Front
Leg-Pull
Side Kick Kneeling–neutral spine
Side Support–neutral spine
Push-Up

Contraindicated Pilates Mat Exercises

Hundred–unmodified
Roll-Up
Roll-Over–both ways
Rolling Back/Rolling Like a Ball
Scissors
Spine Stretch
Rocker With Open Legs/Open Leg Rocker
Corkscrew
Saw
Neck Pull
Scissors
Bicycle
Spine Twist
Jack-Knife
Teaser
Boomerang
Seal
Crab
Rocking
Control Balance

Other Important Exercises to Add to the Osteoporosis Exercise Program

Psoas Stretches–adapted from Eve’s Lunge on the Reformer
90/90 Posterior Tilt–modified Hundred
90/90 Lower-Abs Leg Lowering–modified Hundred, lumbar spine flat
Dead Bug–knees straight, lumbar spine flat
Prone Hip Lift–modified from Single Leg Kick
Squat/Plié Variations–done in front of the Wunda Chair, not as mat work
Standing Balance Series
Half Kneeling–“marriage proposal” position
Prone Trunk Extension With Varied Arm Positions
Modified Wall Push-Up
Foam Roller
Thoracic Spine Extension
Prone Spine Extension–modified from Trapeze Table “Swan”
Vigorous walking program

Source for Pilates exercises: Pilates, J.H., & Miller, W.J. 1945. Return to Life Through Contrology. Miami: Pilates Method Alliance.

I had a support group back when the hospitals were notifying people that they had hepatitis C from the blood transfusion they had during surgery…I understand the anger- it was a part of me, too. But if you don’t let it go, you live and steep in that anger. It eats you up. No joy. So many other things to be thankful for. Children. Grandchildren. Life. Even in that moment of giving support, I met people that became lifelong friends. Special people I never would have met. I’m not saying that the anger has no place – it’s just not the place you want to stay.

For ten years, I suffered from hepatitis C. I choose the word suffered carefully. Everyday was a trial. Getting out bed was hard in the morning and sometimes wondered why I was getting up. I kept fighting. I was in clinical trials and spent three years taking drugs that may well have caused some of the problems I’m dealing with today. Nothing worked. Then I went to Holland and was accepted into a clincal study. It was a 7 hour surgery where a machine was used to heat your blood to exactly 41.8C. It caused the proteins in the immune system to unfold (from the heat) and then on the cooling refold back into their natural shape. The hypothesis was that the immune system was defunct. It no longer recognized the hepatitis C as an infection. After the surgery, it sure recognized it. And then I underwent high doses of chemotherapeutic drugs for 52 weeks. I needed blood transfusions (ironic, huh) and had to take shots to build my neutrophils- part of your white blood cells. I still have to take those shots. It was the worst year of my life. But I persisted where my family had doubts. I knew this might be my last chance to rid myself of this terrible disease.

Well it worked. That was in 2004. The hepatitis C is till undetectable. The odds on it returning now are very small. Every day is a good day compared to when I had the hepatitis C. But no one knows what caused my spinal degeneration. Advanced disc disease. Spinal Stenosis. Foraminal stenosis. Secondary scoliosis. Was the drugs? Was it the hyperthermia? Those are questions that can’t be answered…But I had MRIs from 2001 that showed normal degenerative changes for age. Now they read like a book. I have the spine of an 80 year old and the mind of 23 year old. I wouldn’t change anything. That’s how bad the hepatitis C was.

Now I sit before you having had three back surgeries. Being told that I move like a young person and my mind and body are not in sync. I’m used to fighting. Where does acceptance come into play? Do I accept this for my reality or do I continue to think that all will be normal one day? Am I keeping myself in this place the same way that the people did with hepatitis C? I don’t know the answer.

Maybe it’s a half way in between. I was born to fight. I was a blue baby back in 1954. Do learn to stop and accept the changes? I don’ t know….I just don’t know.

If you’re interested in the workout, print it out and take it to your surgeon (assuming he knows what Pilates is). Your best bet is to have your movement specialist have a look at it and let them yeah or nay it. Then you need to find a Pilates Reformer professional that is trained in Stott Pilates and has the Injury and Special Populations certification.

And now the workout:

Warm up for 10 minutes preferrably with some form of cardio.

Stott Pilates based Modified Reformer Workout Phase 1 Post Rehab

Footwork (2-3 springs) using the jumpboard and platform extender over the springs. Allows client to easily position themselves on the reformer.

Keep the feet parallel to the knees. You’ll be pretty high on the jumpboard. Modification: add hamstring extensor straps if additional support is necessary. Also helps to contract the hip flexors.

Watch the ROM when you press out. Keep a little bend in the knee to protect the lower back. If necessary, change the ROM to Mid Range.

Foot positions: parallel, heels together toes apart, Lift heels- press out- return and lower heels, high half toe- lift the ankle to neutral and press out, lower and lift- press out with heel on jumpboard, lift and lower heels twice, return and repeat.

Second Position: 2-3springs. Parallel, Lateral and Medial.

Single Leg: 1-2 springs. Hamstrings extension straps. Table top legs – one side then the other. CAUTION: Alternating legs in TT. Any unilateral work challenges the multifidi. Get hands on to make sure that there is no shearing or rotating. Unilateral work has the benefit of working the rotators without actually rotating. Caution: Bicycle- extending the leg can cause extension of the lumbar spine if the client isnt’t strong enough, Sleeper- side lying with foot high and on the edge of the jumpboard. NO hamstring extension straps.

Midback Series: 1-2 springs. Legs resting on Footbar in top position. May need to go down one level. Legs can also be supported with hamstring extension straps.

Triceps, Straight down, 45 degrees out, out to side, circles in both directions.

Back Rowing: seated on the Long Box. Watch out for counternutation. and tension in the neck. This will translate down the entire spine.

Open elbows, plow, triceps, biceps- start with elbows lowered, cross straps and do punches.

Side Arm work: seated on a block with legs crossed OR seated in Heroes pose ( use a bolster or block if knees are a problem. 1/2 spring

Internal rotation, Adduction, External Rotation, Adduction

Side Twist: Caution. Seated on a block, the short box or bolster. Start moving through ROM. Very small ROM. 1/2 spring. Focus on lengthening the spine up. Absolutley no discomfort in the Lumbar spine.

To be continued tomorrow.

Breast Stroke Prep #3

Originally uploaded by darmorrow

This is the most difficult of the variations. You need to be comfortable doing version 2. You are adding the weight of your arms as you lengthen up.

Positioning is the same with the exception of the arms. You’re going to interlace the fingers and place your forehead on them. Imagine they are glued together because when you move the head the fingers come with it.

Inhale and exhale as you set your core. See version 2. Now inhale and slide the shoulder down to set them. As you exhale slowly move you head and shoulders off the mat. Think about lengthening up maybe 1-2 inches. Breath in at the top and exhale to return to the mat. Lengthening crown and feet in opposite directions.

Again no back pain. As you move make sure that you stay in neutral.

Breast Stroke Head Position

Originally uploaded by darmorrow

You’re going to begin by pulling your belly button in the direction of the spine. That is going to help you protect your lower back.

Next tighten your waist. Suck it in as much as possible without changing your pelvic position. You may find that hard to do at first but we’ll be working on the obliques which are the muscles in this area.

Pull up the pelvic floor. That’s a little bit like Kegel’s. It’s also like you feel like you have to urinate and there’s no bathroom. Not too much of a pull though. Just a little maybe about 20% of what you’d do if you really had to go. Think about pulling up. That’s called engaging the pelvic floor.

Now, let’s move. As you inhale through the nose, roll your shoulers back and the palms will face the body. Slowly start to exhale through the nose sliding the shoulders down as you take the nose off the mat. Notice that the nose is off a few inches. You do NOT want to feel this in your back. If you do, you’ve come too high.

Inhale at the top through your nose and exhale through the nose as you return to the mat. Your feet have not moved. As you lower yourself, think about the feet reaching away (not moving but actively lengthening) and at the same time reaching the crown of your head in the opposite direction. Think length.

What we’re doing here is strengthening the upper back muscles. We spend a lot of time in a rounded forward posture and this exercise will help us get back into neutral without fatiguing. Think about rolling your shoulders up, back and down when you are standing. Ideally, your shoulder, hip. knee and ankle would form a straight line if your dropped a plumb line through the center of the shoulder joint.

Breast Stroke Prep Leg Position

Originally uploaded by darmorrow

Lying on your belly, legs are slightly wider than hip distance and laterally rotated ie the heels are in the toes face out.

You want equal weight on your pubic bone and hip bones. If you are having difficulty with this, the thin pad under the hip bones often helps you achieve the balance.

The arms are at your side. They are going to start with the palms facing the body and the shoulders relaxed.

The nose is on the mat not the forehead. If you put the forehead on the mat, you’re starting out in flexion and we want to start in neutral.

Let’s see the other photos for more about the movement.

Rabbit

Originally uploaded by darmorrow

None of this should hurt. If it does, stop!

Some people will have difficulty with their knees. We don’t want the angle of the knee to thigh to be too tight if you have knee issues. The first thing you can try is to roll up a towel and place it at the back of your knees and then sit back. Next you can place the foam block just under your bum- leave the towel in place. What we’re trying to do is build up the space between the thigh and calf. If it’s still uncomfortable, you can use a bolster or cushion. There should be absolutely NO PAIN in your knees or ankles.

This exercise doesn’t look like you are doing much. But in fact,, you are stretching your thigh muscles (the quadriceps), the ankle joint and the toes.

To get into this position, start out on your hands and knees. The feet are going to start out flat and then we are going to tuck the toes under later. What you need to watch is how much of your body weight you put on your heels. At first, it might just be a little bit. We’re not used to stretching the toes. Count your breathes. Start out doing one breath and work up to three.

Start out by sitting on your heels with your feet flat, that’s a good way to stretch the ankle joint. If you cramp, release the weight off your feet by returning back to kneeling on all fours. If you can manage to stay for three breathes you’re doing really well.

From this position, come back onto all fours and lightly tap your feet into the floor a number of times- first one foot then the other in rapid succession. That is good to get the blood flow going. Then we’re going to tuck the toes under and lean back, gently putting your weight on the heels. Don’t be surprised at how uncomfortable this feels. Not painful, uncomfortable.  Stay for up to three breathes and then come back to all fours and lightly tap the feet again. Lightly.

There are lots of ways to stretch these areas so don’t try to put up with any pain. That’s the body’s signal that you’ve gone too far. There’s discomfort and pain. You know the difference.

And the real reason I did this is because there was a point in my life when I weighed 205 pounds.  I lost it with Weight Watchers which I think is the best way to go about losing weight. It took me one full year.That was such a looonnngg year.

That was in 2001. And I was really ill at the time. The only exercise I could do was walk. And not fast. Shortly after losing the weight, I ended up in treatment and on chemo. I lost my hair. Funny that is one of the first things I remember. The hair. In 2004, I was better and it took me until September to get back into shape.

I decided then that the most important thing in life is to do what you love. And I love Pilates, Yoga and working out.  It took me a year to get certified in all them but all I want to do is share my experience with all of you. Because if I could do it, anyone can do it. I’m not special.
So whatever place you are coming from do what you do out of love for yourself.