Hip and Back Pain

Chapter 1

Anterior Hip Pain

My name is Dr Brent Anderson, founder and president of Pollstar piles. And I'm here with Jia today. And A, we're going to take a look at a hip problem that is not uncommon in the dance world and also in the Palladio's world and often referred to as the anterior hip pain. But I like to do first is asked g a couple of questions and just to get some feedback from her before I start an exercise program for her. So I wanted to thank you geo for volunteering today. Hopefully we can uh, help your hip feel better. Tell me and tell the camera a little bit about sort of what your problem has been, how long has bothered you.

Um, my problem is my right hip flexor tends to grip in, sometimes it causes pain. I've had this problem for probably about 13 years off and on, but for the last month and a half it hasn't gone away as quickly as normal. And are there any things that you feel you cannot perform now that you feel you should be able to perform because of the hip? I'm holding my leg out to the side. Especially, it tends to grip sometimes to the front as well. And then if I'm standing on my leg in a rotated position, if I'm doing things on my left with my left leg, it tends to hurt in a different spot.

Okay. Now are you still dancing? Uh, I haven't for the last month, but I do still feel [inaudible]. And how much dancing are you doing typically other than this last month? How many hours a week are you dancing? Um, probably like four hours a week.

And what type of dancing? Ballet. Okay. All right. So what I like to do is I'm going to take a look at g ah, and do just a quick little assessment to see what's going on in her hip. I am going to combine a little bit of some physical therapy technique with a movement in the beginning and then finish up with the nexus program. So ideally what you would be doing is, depending on what your scope of practice is, you would choose where you would start the intervention along the way with anterior hip pain. So if you are a PyLadies teacher that also is a chiropractor or physical therapist or osteopath, anything that I'm doing is fair game. If you are, applaud these teacher, I'll let you know when we start in with the actual strategic intervention, which is the is exercises and again that's all fair game to you. So, so looking at that spectrum of rehabilitation to wellness.

So I'm going to have Gla on her back, uh, head down this way and I just want to see you lift that leg up on your own. So just do a little dead bug there and see what that feels like. Good. And then lifted up and reached the leg up to the ceiling and bring it up a little bit higher. Good. And take it out to the side and you're just comfortable with that going out there, laying down. Okay, good. Bring it back in and let the knee come down both feet together. We call this exercise the bent knee opening, but I like you just to keep this leg still and let the good slide out to the left and drop it down as far as you can without the pelvis moving and back up. And then this leg, same thing.

So I'm just sort of trying to assess, does she have good movement inside the hip and rule out if there's any kind of pathology in there that might be in the intraarticular joint of the right hip versus just some tendons and yeah, the muscles that are giving her some trouble. Let me see that again. Left to right, left first. Good and back up and the right side. Okay, so what I'm going to start with is I'm going to place Jia in a 90 90 position. We call it impulse star. We're going to use the cuffs and suspend her right leg in the air in a 90 90 tabletop position.

And so I'm going to use the velcro cuffs to be able to make it so she really doesn't have to use any muscles. She's just gonna Relax. The hardest part about this exercise is getting people out of them because they get so comfortable they don't want to, I don't want to get out. Good. Just relaxing. Good. So I'm just gonna connect a long spring to a thigh and a light short spring.

Yeah, we go to her ankle. So the feeling here, how's it feel? Yeah. Okay. Just sort of suspended, right? Let the left leg straighten out for me. Jia? Yep. And the Nice thing here is this, very subtly we can start introducing some movement into her hip joint without pressure, without too much compression or her muscle guarding. And I'm just going to do a little bit of Oscillation in circles with her as we do this. Any discomfort with this? Yeah.

Okay. Now, one of the things that I want her to learn, a very common mistake in dance is that we tend to push the head of the humerus forward. So if you imagine a classical dancer standing up and doing a little bit of a post to your tilt and they actually pushed that hip forward and when that hip goes forward, it actually compresses the labor them. And puts pressure on the capsule and the hip and that's often where they get their pain, particularly this, so as in the ILIAC, this tendon. So I'm going to work a little bit on getting her hip joint to sink into the socket.

So a common cue that I think is a can be a mistake is the idea of reaching out of the hip socket. I would rather see particularly dancers feel the hip seek into the socket. So I want to get that congruency deep in the socket. And the hip is a very, very strong joint. So even though g is tiny and I'm huge, um, me putting my weight through her hip is totally fine and probably feels pretty good. Good to feel that sink into the hip. Yeah.

And I'm just going to stay here for a little bit. I'm finding sort of the angles that are little more comfortable for you and just relax that down. Yeah. That's where the attending comes in. So what I'm doing basically is placing my hand on the insertion of the Iliopsoas tendon. That's where the, so that gunky feeling the dancers complain of in front initiates.

So I've sunk the hip back into the socket. How are you holding up there? Okay. Yeah. Yeah. Is the smile hard to maintain while I have my hand on that tendon? Okay. Actually push into me a little bit. Jia out to the side that's going to push into me, not up just down.

There you go. Good. And let's just get that release. So I'm going to do a little, a mild fascia release on this tissue just in this position. So she's pushing into me, she's actually creating a reciprocal inhibition. So she's using her abductors and external rotators to push out and that's allowing her add doctors, which I'm on to release and they're releasing just fine. And again, our goal is that Jia can stand up and she can stand on her leg without a problem at the end and can also pass a develop by her leg without a problem. Right.

That's what you're having troubles with. Yeah. Good. All right. Just come back up, Eh circles again. Yeah. What do you fill in there? Okay. More internal rotation, right? More crossing over. Good. So what she's feeling is that I can cross the femur over a little easier.

And that's one of the, one of the signs that the hip is actually sinking nicely into the socket. And that's exactly what we want. All right, so let's have you come out of these springs here. All right. And I'm a big believer in treat and tests treat and retest. The idea is that we keep trying to, uh, find out what helps her, what makes her feel better. So let's bend both knees up again.

Let's just look at that abduction to begin with. So let this knee drop out. Good. And now she goes further now too, just by treating the right side, they feel different on the right. Good. All right, so now let's bring this up in that dead bug arc, right? And see if that feels a little easier to bring up. Go ahead and extend it. Good. And take it out to the side. Now here I want you to think of sinking that hip into the socket.

There we go. That feel different. Good. So work in that range a little bit. Let me hit assist you with that. Yeah, just coming around sync. There you go. Good. And around. So rather than reaching it, this is gonna be important as you stand up, but we're going to do excellent. Good. So what I want you to now is you're going to turn onto your left side facing that way.

And I'm going to use one of these cuffs again, just the ankle cuff. There's an exercise that I learned from Eve gentry years ago and everybody says that I'm big enough to do it on the, on the little folks. But the truth was eve Jenn, who was around five foot tall, she did on me. So I think that anybody can do it. It's just learning how to maybe scoot back towards me tier.

Put your arm along there. Yep, that's it. And rest there. Good. Let's take back and again, we're going to go for that idea of sinking the hip into the socket. So I'm just going to give her some pressure there. You okay? Good. And bend the knee and reach the leg.

Reach it up straight. There you go. Good. And then the, let's get rid of this hand over your head and reach and bend and reach and band and reach. So what I'm trying to do with her is to start getting the nervous tissue as well to respond, taking her through the circles. And I'm using the springs to assist me so I don't have to do quite as much work and Jia can trust, I'm not going to drop her legs somewhere. So now I'm gonna take her around the back. I'm gonna do a little dance with her and what I'm going to do is hook my hip onto her hip. Okay. And bring her here. I'm going to protect her knee.

And what I want you to do now is let your knee bend gently. Does that feel okay? And a lot of times the area that actually they feel the pain is in the tensor Fascia. Lots of right here. This flexor? Yes. That's one of the areas. So I'm going to work in this area gently as I'm keeping her control.

She is doing a good job of keeping her connection between the rib cage and the pelvis and you get them to come in and try to free that up a little bit. Oh, you're doing okay. Talk to me. Okay. Yeah. All right. What are you feeling? Little tightness. Yeah. Yeah. So what are the key things to do is to try to keep the leg parallel and to protect the knee.

So I'm using a little bit of forest back on the ankle to try to prevent the knee from popping up or being pulled into internal rotation and just really working on opening up the anterior wall here in her hip and I was paying it back again. I'll go one more time with the deep sinking into the hip. Good. Okay. And bend the knee in. Yeah, I'm gonna take this off. Okay. So let's have you lay on your back one more time. And again, like I said, I like to always test, suite, retest.

So we're going to retest and just see how this is feeling for you now. Okay. Okay. So let's do a little lift of the leg first. See if it's even going better. Yes. Good. Straighten the leg up and simple circle around keeping it something that feels better. I can feel the difference inside the hip.

Yes. Like sometimes it grinds a little bit. Yeah. Yeah. When it grinds. So gs talking about the hip grinding. That grinding is typically because she's lost congruency inside the hip. So typically of ballet dancers and classical dancers, they're going to shift that femoral head, a little interior of the socket. So the grinding, their feeling is along the edge or the border of the Acetabulum.

And that's what's probably causing some of her discomfort. And in response to that, the muscles have been going into spasm and the spasm continues to pull her out of congruency. So it's this vicious cycle. And so our goal is let's get that femoral head deep into the socket, try to get it back working its normal orientation to the pelvis. Okay. So now what I'd like to do is I'm gonna have you go hands and knees so we can go quadro pet position, head down that way. And this is a great exercise for home that a lot I use with a lot of uh, dancers, golfers, soccer players.

And we're going to start with the knees a little bit wider gea and stay parallel with it. And I want you to feel the hinge inside the hip. So as you come back, we're gonna just imagine a lot of weight on here. Go back as far as you can without the back curling. Perfect. And come back forward again ahead. Let's do that a couple times. Nice and easy. Hinge right through the hip flexor. Yep. And back up. And let's do that again. Good. Now see what happens when you take your knees apart a little bit.

So a little bit of an extra rotation. Bring the feet together, do the same thing, and notice how much more range there is. Can you feel that? Okay. Now we know you have range and external rotation. So where's the difficulty? Typically internal internal rotations, right? So typically the internal rotation is going to be the most challenged, but the internal rotation actually drives the head of the femur back into the socket, which is exactly what we want to do. So everything I just did with her on her back, she could do for herself before she dances and also in the evenings to try to get that hip in a good place. So let's bring the knees together.

Bring the feet out now. Still keeping that relationship. Don't expect to go back quite as far. We're going to shift the weight back and notice when right there, it starts flexing, right? So this is a great little place for you to do little oscillation and sinking the hip into the socket. Can you feel that? Just very gentle. You don't have to force it. Don't expect it to go back as far.

I take them on that one. I can see it on the left one. Yeah. Which those of us that danced and had hip problems, you know, we beat up one of our hips and by the time we're in our forties and 50s the other hip is in pretty bad shape too. So sort of par for the course that left hip should start freeing up a little bit as well and probably need some of the TLC that we give the right one. Right? Okay. Go back to parallel form a Jia. Yup.

And let's just see how that feels on both sides. Going back nice. Much, much deeper. Good. So you get the idea that even with a home exercise program, being able to oscillate and get that again, that can grow NC in that hip deepening into the socket becomes really, really important. So now we're going to shift gears. I'm going to have you stand up on the table and we're going to use the tower bar as our friend and I think we're going to use a red. All right. So what I want you to do, move this out of your way. Yeah. And right hip. You're actually going to face me with your right hip.

So hands are going to go on the bar and I'm going to have you place your right foot here. Yup. And I'm going to hold that foot. So a lot of times when you're working with the actual tower bar, the safety is not just to hold the bar, but to hold the foot to the bar when it's sprung from above. More importantly than protecting her, I'm protecting my face. So that's why I'm holding onto it. So here in that nice standing position, I want you just to push this out and then allow it to come up. So bend the knee, bend the hip, let the spring bring it up at the spring, do the work up as high as you can and then bring it back down.

And what I you to think of is that femoral head is actually spiraling in and down towards the pubic bone. So the femoral head, if you watch my hand is going to be spiraling this way in the Acetabulum as her knee comes up. So she's going to be dropping this down. So this dropped down into my hand. Yep. Keep dropping down, down, down, down, down as the knee comes up, up, up above, and then take it back out. And again, bend it up. Knees spirals, spirals, spirals, spirals, lovely and back down. And I'm going to add a little bit of a bone rhythm to her right here.

And what I want her to think of is when the knee is bending, the femur is going to be spiraling out, but the pelvis has to be spiraling in, right? Don't let go that bar. I'm going to be a little dangerous here. That's the spiral right there. Good control that. Now when you push back down, the femur is going to spiral in. Pelvis spells out good. And as you bend up, the femur spirals out. Pelvis spirals in and down. Okay, let's let that come up a little bit higher now Jia higher, higher, higher, good and back down. Now let your foot come off of the bar and I'm have you step another foot to the left. Good. So we're going to go for a little bit of a passe on this now. Okay, so same idea. Let the foot come a little further forward.

So we have nice square hips. Bend the knee up, passe. Let it come up, up, up, up, up. It's gonna keep coming up. And can we get it into a developer? That's it right there. Now pull it back down. Yeah. Poor, poor, poor, poor for, and for us. Back out. Good. Let's do that again. Femur spirals out. Pelvis spirals in. Follow the bar. Follow the bar, pressing it out. Beautiful. Fill that. Now, right here, drop this down into my hand. There. You just went into that socket.

That's where I want you. If you could think of like what we were doing, rocking back and forth, that's what we're looking for. So one more time, pull it down and press it up. Very nice and up. A little less work. A little less work. Let it go. Let it go. Just think of the femoral head moving. That's it. And again, down and relax. I have the bar. You can take your foot off. All right, so now let's turn around and face the camera.

And with this sigh, let's just do a simple passe. Yep. And just see how that passe feels to you. Nice. Can you feel the difference in that? Good. So again, we're looking at not ready to take her into a full developer, but the key thing is is that her hip is actually dropping nicely now, so she's not doing a hiking up of the pelvis to be able to get that position. Okay, so let's shift gears again. You're going to stay right? You are, and I am going to hook you up again with this. So again, the velcro cuffs become very handy facing the camera and I want to work a little bit of her drawing in with that right hips, a little bit of abduction. So I'm going to have her turn out with this leg. Yep. Good up, nice and tall and just, let's put this a little forward.

Draw that heel into the left leg all the way up. Good and back out. Now when it pulls you back out is more important than drawing it. So when it's pulling you back out, think of that hip sinking into the socket. Okay. So pull it in. And as you're slowly letting it come out, feel the hip sinking down that femur sinking down into the palace. Good.

Do that again. And that's how I want you to imagine the leg moving through space. When you're doing a passe, develop, pay, or around the genre under. There you go. Good. Okay. Let me give you a little more height on it. Okay, so we're going to come up here. Same thing. Draw it down.

Good. Now slowly one and take 10 counts to come up. Dropping down into my finger, my fingers right underneath the hip socket. Five, six fillers dropping down. Seven good. Eight, nine, 10 bring it back down. So again, I want to see that femoral head dropping down in the socket in her thinking and moving the bone rather than getting into her hip. So right now there's really no activity happening in these muscles and that's exactly where we want to keep the muscle strain out of, right? We don't want the muscle strain in there. So moving from the bones, that's it.

Let's go a little bit quicker now. Ten nine, eight, seven, six, five, three, two, one and pull down 10, nine, eight, seven, six, four, three, two, one. And pull down. One more time. 10, nine, eight, seven, six, five, four, three, two, one. And relax. So now, once again, just see what that passe feels like to you. Even better. I can feel that. Yeah. So I'm liking that a lot more. Good. All right. So what we're going to do now is we're going to take a little break and we're going to switch the equipment and bring, uh, the a box up onto the table that I want to use to work on her having control with a little bit of extension. So the next, uh, set up that I wanted to create was using the box with the tower bar sprung from below with the blue spring. I'm going to have gla on her belly over the box to hips are going to be here.

Your head's going to be there and at the hips come off the box so the knees come all the way down. Good. And then just have your hands come down to the side. Good. Now what I'm looking for is to get the anterior hip to open up, but through a reciprocal inhibition. So I'm going to take her right leg. I'm going to have her place it just underneath the bar. Okay, so again, we're sprung from below. Always use your safety strap in my office. If I catch any PyLadies teacher ever using the tower bar sprung from below without a safety strap, it is grounds for instant termination. They can pack her bags and walk out the door.

Never ever assume that you can pet string a tower bar from below without that safety set. So of course I followed my own advice before she got up here and here we are. So what I want you to do now is press this bar up towards the ceiling, gea precedent. And that's high enough. So right when I get her to about neutral position is all she starts to go into her low back. So that's where we're going to play with that range. Pressing it up and yeah, and press up and down.

Now what's going to happen to her is as she gets to about the sixth or seventh one, and besides being a little fatigued and the hip extensors, she's actually going to be a little more inhibited in the front of the hip, so she's going to have a little more freedom in particular. There she goes. She's just now starting to let go of that to get a little more extension coming through the hip. Not because she didn't have the extension before, but because the muscles were guarded because they'd been injured and they'd been protecting her, trying to keep her from doing that. How's that feel to you? A little bit easier to get up, right? Good and relaxed. Now while I'm here, we should do the other side because there's no sense in being an asymmetrical, so we're going to hook her left heel on there. Again, I like to hold the foot to the bar. I'm going to have her press up and we're going to see that limitation right there already. So this is going to feel good to hurt, to get it to start opening up and press and keep your hand on the small of her back or the sacred so that you can feel when she starts to go into back extension rather than hip extension. There she goes, and that's plenty high enough. But let's do two or three more there.

Exactly. Two more. And the last one. Very good. All right, so let's swing off the table for a second. I want you to just to feel what it feels like in your hip again, to be able to move so you can use the table as your bar or whatever and just sort of feel what that right hip feels like too. There you go. Good. I like that. Now let's try a low derriere right? So let's try just moving in the back and see how that feels.

Yeah, a lot looser. A lot looser, right? Yes. So the exercises for you are going to be pretty simple. We didn't really have to do a lot of manual therapy for go and have a seat here and let me just sort of capture what's going on. So that an to your painful hip, clicking, clunking, snapping tendonitis, grinding in the hip, the clunking that a lot of dancers get really comes down to poor congruency, not, let me define congruency. Again, congruency is that optimal alignment between the two bones of the joint. So if I lose that optimal alignment and that hip comes forward a little bit, that femur comes forward in the, in the Acetabulum, that's where the cracking popping and the grinding kind of sensation comes from and the hip doesn't like it. So what does it do?

The muscles around it go into spasm to protect it. So you can imagine trying to lift the hip when it's not in its socket. Those muscles in the front, particularly the tensor Fascia Lata are going to be bunched up and that's sort of a common description of these muscles that they feel bunched up. Okay. So what we did today is we did a very simple 90 90 to get the hip to sink into the socket. We've got it to relax, get the muscles around the hip to relax. I put a lot of weight through it and I remember the hip just in normal walking, just standing on your leg is about eight times your body weights for us going through that hip socket. So if I think Goa is a hundred pounds, eight times as she can handle 800 pounds, just normal walking and she's a dancer.

So when she jumps in does those kinds of activities, it is much greater the amount of force that goes through that hip. So I'm not worried about too much force going through that hip joint. What I really want to see is that hip drop into the socket. The second thing we started doing was getting her just to do the rocking back and forth in that quadrupled rocking with internal rotation does the same thing as me putting force through her. So that's something you could do at home to try to get that hip to sink into the socket. And to have better alignment in every exercise we did.

You can see you're starting to get a little more range of motion and a little more freedom in the hip and less grinding, popping and guarding in the muscle. The last one we did, or the last two media one was standing on the trapeze table. You could stand off of the tragedies table, but using the spring to be able to draw in and then using the tower bar with the ability to start doing the past days. So that sort of assisted lift of the knee and the hip into a passe and eventually a developer. So once she knew and felt that range of motion normal without the popping, it became much easier for her. And another little tip here, when you're moving into these ranges of motion against gravity, a lot of times when you think of using your muscles to lift them up, the muscles work so hard that they get in your own way. So a nice idea and, and is using the bone rhythms, right? A lot of Eric Franklins work.

He works with a lot of dancers to get the bone rhythms themselves, the bones to articulate and understand how they move. So I'm thinking of lifting the leg up, think of sending the head of the femur down, which is the same thing as a leg coming up, but it's so much easier for them or the muscle system to figure that out than just to lift the leg out. So those are a couple little advices for that. So what I want to do now is just sort of bring this to a close. Um, Jia, how are you feeling? Yeah, if I get some movement in there and the left hip, a little bit of advantage of that as well. Right? And these are just a couple little tips that you can do with your clients that are having some anterior hip pain. This is Brent Anderson from Pollstar PyLadies bringing you a little bit of help to those hip, anterior hip pain on Palladio's anytime.

Chapter 2

Low Back Pain

And Meredith has been struggling with some movement restrictions in her low back that are quite common actually in the pilates world in the world who out. So I just want to ask her a couple of questions and have her give us an idea of sort of what's going on and then we'll do a little assessment and see if we can come up with some exercise prescription in the piles environment. So Meredith get, tell me a little bit about um, sort of what's going on. What kind of things are you feeling, what kind of things do you feel that that gets in the way of doing or performing on a daily basis? Um, my chronic pain, if we're going to call it that is in [inaudible], you don't have to call it a pain. You can just be restricted. Okay. I have a chronic feeling of chronic restriction.

It's not really actually restrictive because I'm able to move around it and go around it. But um, I feel discomfort in more, not like my real low back, but more of like my middle back. Like, yes, it is low back. Okay. And the lumbar here, but the lower thoracic and upper lumbar. Yeah. Okay. And you said it doesn't really stop you from doing things, you sort of figured out how to get around it. Um, does it create any kind of symptoms? Are there times of day or certain activities that it seems to be a little more annoying? Certain, uh, even movement patterns, whether you're going into a swan or going into a roll up or a mermaid or any of those more challenging than another movement? Um, I can usually feel that side of my body working harder when I'm in extension.

It doesn't limit me inflection. A rotation like mermaid stuff feels great to me. It just feels, it feels very tight. Okay. And more so than it limiting movement. I feel discomfort or pain or like a heaviness at achiness there after movement. Okay. Like at the end of the day. In the beginning of the day. All right. So what I'd like to do with Mary is, um, it's something that actually happens quite common.

This is a neuromuscular phenomena that happens in our bodies and for whatever reason, the global muscles or the large muscles. In her case probably the quadratus lumborum and maybe some of the erector spinae muscles are over recruiting. So she feels this stiffness and restriction and when she moves she feels better. She gets some movement in there, but the local stabilizers often are, are asleep or not working too well. So what I want to do with her today is see if I can really facilitate some segmental movement in her spine and give her some tools that she can use throughout to keep the sense of mobility rather than stiffness.

The other thing you'll notice today when I talked to Meredith is that I'm not going to be using any kind of queuing to recruit or hold muscles. I think this is really important as we talk to our clients that suffer from low back pain or low back restrictions is that they already are over recruiting. So when we give them a cue and there's some good research out now, this shows that somebody who already has a faulty alignment or fall organization, that they're over recruiting the global muscles. When you try to teach them how to move correctly and to recruit, even things like transverse abdominis with pelvic floor, they tend to recruit five to 10 times more than they need to recruit of these global muscles rather than the deep local muscle. So I'm going to try to use a little bit of an indirect technique with Meredith to get some movement on the reformer and even up here with somatics or sizes and integrate a little bit of some manual therapy as well to see if I can understand what's going on with your back and see if we can get you feeling better and get you feeling better if you're suffering from some low back problems as well.

Okay. So Mary, let me have you just lay on your back head down this way. Yup. And I just want to see a couple things. So I want to see a simple bridge. I want to see what happens when you roll your spine up. And one of the things that we want to do is, is look for a segmental movement. In pilates, we talk about qualitative movement, not quantity, so it's not how high she goes, it's really how many segments in her spine is she able to articulate from the laying down position up into a bridging position. And just to give you an idea, there are five lumbar vertebrae in about five or six thoracic vertebra that are in that region. And if a motion segment is two vertebrae with a disc, we're talking probably about five or six possible segments that she can move from. So Meredith, go ahead and just do a simple bridge rolling up with that idea of articulation.

So I get a nice movement. There's probably three or four segments moving. Come on down right now. Do the same thing with half as much muscle. So just sort of float it up like you're rolling up like a jellyfish. Oop. And take a breath in on top and soften and relax it back down. All right.

The next thing I want to look at is to see how she organizes from side to side. So with her feet together, we're going to do a bent knee opening exercise and I want you to keep this neat up and just let this knee go down. But keeping the pelvis quiet. So even if Meredith, you want to put your hands there and just feel that and observe what happens. Okay, and back up and the left side, right side down. And so the like the left side had a little harder time dropping out from the right side. So let's try this and the and the bent knee opening.

If she pushes into my finger a little bit here, as she pushes out, it's actually going to create the stiffness I want on the opposite side, on the right side so we can push into my finger. Just open that leg up and just feel you feel that stability in there and that control. Keep pushing, keep pushing, keep pushing all the way out and then back up. Let's try that again. Push into my finger and said all the way out. Keep going. Keep going. Keep going and back up. Now this time, pretend you're pushing into my finger and open up that leg and see if you can feel the same thing. Same late. Yeah, that's right. Good. Can you feel how much quieter the pelvis is? Good.

And then try the right side again and see if it feels similar. You can't even imagine pushing into my finger on the right side and I'll give you some stability. Good. Okay, so the next thing I want to look at is to see what's actually going on with her pelvis and her leg. She did complain of a little bit of right sided hamstring pain up really high close to the issue of tuberosity. So I'm going to have a straightened her legs out on the table and I want to look. Now when I look at the legs, one of the things I look for is I come underneath the Malleoli with my thumb and I just bring them right next to each other to see if there's any leg length discrepancy between the right and left. Now in in Meredith's case, her left leg is relatively about a quarter of an inch longer than her right leg, which might explain why she's having some of the pain up in her, in her pelvis. And when I come to the pelvis, I do the same thing on the anterior Iliac spine and it shows the same discrepancy of about a quarter inch. So that's telling me is that she has a little bit of a pelvic torsion.

I don't know if you've been treated for a pelvic torsion before or not have you known. And that pelvic torsion is usually a pretty simple fix. But a lot of times at asymmetry, if she's trying to be symmetrical and our pelvis is rotated like this, it actually makes that right hamstring work harder and might also make that left quadratus lumborum work harder. So that might be that relationship cause she has really good awareness of her body and watching her do the segmental movement and even the knee openings, the Benny openings, she actually was able to have control very quickly. So she's a skilled mover as are many of you. So what I'm going to do is a little simple muscle energy technique to correct it. And before I do that, I want to do a little oscillation. So to me, oscillation is a technique I teach my PyLadies teachers because it gives them an idea of where is movement coming from in the body.

So what I'm doing is supporting the leg in my hand and I take that fifth metatarsal. And as I place my thumb on there, I'm just going to do a simple push and pull and a little bit of an internal rotation as I push on the fifth metatarsal. Now what I'm looking for in Meredith is to see if I can get a ripple effect all the way through her body and out through that left shoulder and even a little bit of movement in her neck and in her head. And so it looks pretty good here. I can see a couple areas that are a little sticky in her lower thoracic on the left. I can see that. And then on this side we'll do the same thing and see what, and this actually moves really nice. Okay. So it's telling me that she probably has some lower thoracic restrictions on the left side. And then of course the pelvic tour.

So I'm going to go in and see if we can fix that. You're right. If I tried to fix it, you're sure. Okay, so what you're going to do is, remember I said the left side was relatively longer than the right side is not a true bony leg length discrepancy because the Iliac crest is also the same asymmetry. So it's just telling me that things are talked a little bit. We call it pelvic torsion. So I'm going to use her own muscles to be able to correct it. So I'm going to have her push down with the long leg and push up into my hand with a short light. So go ahead. Just match my resistance, push into my hands.

We'll hold it for three seconds and then we'll relax and let's do that again and push and relax. One more time and push. Relax that the feet come down just like that. Good. And open the knees. You're going to give me a squeeze using the inner thigh muscles. And break my arm. Go for it. Squeeze hard, hard, hard, hard, hard, and relax and squeeze a little bit harder each time.

What do you feel? Yeah, there's if like something's gonna, maybe make a noise or something or pop. Are you? No. Okay. And they come in with the legs together. Clothes. Squeeze my hands. Close, squeeze, squeeze, squeeze and relax. And one more time. Squeeze and relax.

So now let's let the ladies come back out and see if we're barking up the right tree. So they do line up. Okay. They do line up in the leg and they do line up in the pelvis. So that's good news and had to go hands behind your head, lock your fingers. And now I'm going to look at that area that I said was a little restrict on her right in here. So I'm going to open that area for her. And again, this is a manipulation technique.

So it's going to be done by a therapist or a chiropractor. Breathe in. And as you exhale, relax into my hand. And I don't know if you heard that on the microphone or not, but she was a little 4th of July fireworks and inhale and exhale. Good. And one more time. Good. Good.

Okay, let's see how we shake out now. So remember the right legging was the one that was stiff at the hands come down to the side. You can feel the difference there, right? Moving right through that lower rib cage. So that's, I think maybe your whole problem along was probably some restriction as lower ribs on the left side and that could even have led to the legs being different length now the same length. And I would imagine even that this is probably going to be less of a problem in here. Okay. Alright. Yeah. So let me have you go into quadramed position for a second. Head down this way. So the other thing is I want to look at is I want to see how forced transfers through Mary's spine, because this is, again, her complaint is not really pain, but just some restriction regarding, I want to see if I can teach you some ways to loosen things up and have her own tools for these joints to work correctly.

So we're going to do a little of the famous cat and horse, just articularly in the spine, up into flection in the head, be part of it and use less and less muscle for me. Meredith, just get the body moving. Come up into the saggy horse and up into the cat. Nice. Good. And down and up. Less muscle again. Last muscle. Some more movement. Good. There you go. Good. That's right. And now we're going to go into what's called circumduction.

So you're going to do circles with the pelvis and the head. So the pelvis and the head are going to go around and opposite of each other typically. Yeah. Good. Great. And how does that feel in the back? Is it okay? Uncomfortable. Feels good. Okay. And then let's reverse the direction. That's right.

So again, just simply having fun moving. And I think again, we sometimes get so rigid you need about two more of those and we're trying to hold and use muscles to stabilize or to solve the problem. Sometimes we just need to let go and to move. So what we're gonna do now is I'm going to prepare a couple things I want to do with her on the mat and then I'm going to switch into the reform and do three or four exercises and reformer as if this was a single session or the first session that I would do with Mary. So let's have you lay on your back. Okay. And what I want to look at now is I'm going to have you do the bridge again and I want you to see if it feels a little bit easier just to peel up and just floating it up. It definitely looks easier.

Um, now from here, let's let go of some of this tone in the glutes, in the hamstring and think more of the length, sorta Ho yes. Good, good. And roll down through that new area. They're good. That's what I'm looking for. So did you feel it's in this area here? Right. And now it's starting to articulate down a little bit better rather than coming up as a block. That's what it was doing is coming as a block. Let's try it again.

Now she gets to this point. I want her to do a little lateral translation. So I want to start waking things up by her. Shifting to the right and shifting to the left and we want to keep it real horizontal. So it's like your bottoms on a and you're just sliding it back and forth. Right to left and then come back to center and dropped down a centimeter right here, Meredith. And then shift to the right and the left. Yep. Can you give me a little more movement? Yeah, there you go. And fill those.

If you're taking the vertebra and you're actually articulating them, they're talking to each other. Drop down another segment. We're coming into the area that's restricted, right? A shift side to side here and see if we can wake that up. Did you see how it's like [inaudible] yeah, that's because it's not used to moving through there. So this is going to be a really important exercise for you to wake that up.

There it is and you'll learn it. And as soon as you learn that it calms down and its muscles work correctly. So again, this is that idea. Go down and then just work your way all the way down. This isn't the idea that the big global muscles cover five or six segments or even 10 segments.

And when they're in a spasm or a contracture holding or restricted, they don't allow segmental movement, which means those deep local muscles aren't working. And so what we just did was doing the bridging, and more importantly, that lateral translation for Meredith told the big muscles to turn off. And as soon as we turn the big muscles off, particularly in that one area, so around l one l two she got a little shaky as she was shifting to the left in that area because those muscles have not been awake. As you wake those muscles up, the big muscles will chill. And you'll actually re-educate that pattern. So if you don't do anything, those big muscles will come back and take over again.

But if you do this a little bit, a lot translation, it might be enough to really keep that, keep that open up for us. All right, so you can do the bridge and the bridge and Mulatto lateral translation at home and in your exercises. Okay. So what I want to do now is going to take a little pause and we're going to bring a reformer out and we're going to do some reformer exercises with Meredith. So we're back with Meredith and in the second part of getting on the reformer, so I'm going to have Meredith lay on her back. I have three red springs on it and I'm going to start with doing a little bit of footwork and I just want to look and see how she loads, uh, in the footwork. So just in a nice parallel position I ever had up for a nice, comfortable a that can thoracic. And let's just start, go ahead, start pressing out. And again, I'm not a real picky person in the first four or five repetitions, I saw like people to get loaded and get uh, their body organized and adjusted to what they feel is good. Before I would make any corrections and let's slide the feet down or onto the balls of the feet and see what happens when we go down a little bit lower. Same thing.

Okay. And I'm going to gradually bring in her feet down, lower and lower because what I want to see is when do her hip flexors start to battle the back extensors. And that's going to be a little bit of our program today. See if we can figure out how to keep her spine nice and mobile. Yeah.

And still she's doing fantastic. So come on down and let's lift your feet up for me. I'm gonna take you down a little bit lower even. Yup. There we go. Same thing. Send the hills underneath. There we go. Okay, so now we're getting closer to her being in standing position. And let's just repeat that Meredith, go a couple of times.

So you feel comfortable with that. Height hills underneath. Now, one of the things that I want her to focus on is not so much the position of the pelvis, but more of the position of her ribs, especially the lower ribs. So as you press out, just sort of get a feel for it and not necessarily associating a breadth to it, but feel it how it actually gets lifted up at that last little bit of extension of the legs. Can you feel that? So let's see if we can sort of anticipate a little bit and using as little as possible. Keep that back from lifting up on the very end of the extension. Now stay there that the hills go underneath. That's it for the back of the neck going the opposite direction.

So what I'm working on is if you could imagine the Fascia posterially as like a fabric and so that fabric, I want her to feel that fabric opening up because I know that some of the things in her hamstrings her calves, I want to know where there might be some restrictions in her low back or thoracic, her neck. And just to stay there for about 30 40 seconds and enjoy that position. Now coming back home with the carriage, I want you to leave the hills down, right? Initiate the needs to come back home. Press the hills out to initiate, pressing out. So seeing the hills underneath and control. Good. That's what I'm looking for. Let's do that a little more naturally, a couple more times and a little quicker. So we'll see if we can feel that. So it's a little more spontaneous rather than premeditated.

That's right. Do you see that feeling, knowing that as those hips extend, the upper back is going to have to prepare? Yes. Good. You got it two more times. Good. And the last one, so again, you notice that we lowered the feet way down. I think a lot of times in PyLadies we keep the feet up so high that we don't ever really get a realistic alignment of what it's going to be like when we stand up.

And one of the biggest problems with us in our vertical posture is that our hip flexors are relatively too stiff or too short compared to our abdominal wall and our spine stabilizers. So as we practice this, make sure you take your clients, get that foot bar down low. You can even go off of the word if you need to wear the heels on the word of the frame to be able to get a really nice extension on that. And I'll show you nothing. We're going to do in just a little bit with the feet and straps exercise, but right now we're going to go into bridging to feed her up on the bargain and I think I might even bring the Barlow closer to you while I'm doing that. Why don't you knock your head rest down.

Okay. Yeah, and that looks like a good height for you there. Now the advantage of doing bridging with the foot bar versus what we did on the mat is that it is a higher position, which means it's going to be greater movement segmental in the spy, which is nice for our clients because they can actually feel it a lot of times on the mat. They can't feel enough separation between the segments to know if they're moving from two or three or four segments. So the beauty of the foot bar is it's up high enough now at home.

If you want to do this at home, put your feet on the bottom of the couch or a chair or a bookcase that's sturdy enough to hold your weight but about a foot or two feet off the ground to give you that height. So let's take a look at your bridge here and again, same ideas we were doing on the mat. Rolling this vine up, take in a breath and then allow the sternum to soften down and the ribs move back. Now here I want to share with you a little bit, we call it the rule of the ribs when she's going into flection. If she understands where the ribs move, it will reduce a tremendous amount of muscle, unnecessary muscle contraction. So what I want you to think of, Meredith, is when you are rolling down flection, the ribs are going to go back, but the front of the ribs are actually going to come up underneath your heart. Can you create that image? So let's roll up into the bridge again and I see how her body organized the idea of the ribs coming back and up underneath your heart. So fill that dry. Yeah, there you go. So right away I got three or four more segments of movement in that upper lumbar and that's the area that we're having the trouble with. Right? Let's try that again so you can initiate that with the ribs.

So ribs are going to soften down into the mat and move up towards the heart. Yes. Good, good. All right, so now we're going to do that second variation. We did the side to side, but now we have more movement because you're up higher. Let's see how that feels.

And I expect to see a little bit more of what we call a cliff or a drop going into the areas that she has a hard time with. So we're just going to drop down just a centimeter in the chest and now shift right and left. Yup. Back and forth and come back to center. Drop down another centimeter and shift. Stay at that height right there. That's a good one for you right there. Keep going to that left side to repeat that left.

So if you could see really closely and there's a little bit of a shake and a little bit of a drop to the left when she goes to the left. And so that's just telling me that she's waking up those muscles, those local stabilizers that maybe haven't been working in that area for awhile. And that's why those big globals had been taken over, dropped down another centimeter and you can see she smooths it out. She's a smart enough mover that she figures it out pretty quickly to get that movement back in that area. And the same thing here at this segment. Can you feel the difference going left and right.

That's it. Good. And dropped down to center. And last one. There you go. And relax all the way down. So let's do that bridge back up again. Rolling it back up all the way out.

Nice and easy. Nice, good. And Roll it back down and seeing if we feel that same fluidity, particularly in the lower thoracic and upper lumbar. There you go. Open it up and just keep sending it down. Good. So we just finished doing the bridging and the sagittal plane. And what I want to do now with Meredith is I want to start waking up those local stabilizers. So we were able to get some more movement, but I'm still not confident that she's really waking up those deep local stabilizers. And we're going to do that by doing the bridge with translations.

What I want you to do now, Meredith, is initiate with a bridge rolling up and then go ahead and let this drop down. Just a centimeter. Good. And then we're going to start shifting to the right to the left as if your bottom was on a hydraulic skateboarder. You are a typewriter and just going back and forth side to side, drop down a centimeter and just keep working your way down. Yep. Each segment, and what we noticed is that when you get to that area, it's a little bit sticky. On that left side, you'll feel maybe a little bit of shaking or you might even feel a little bit of restriction just to work through that and do enough repetitions of it that it starts to become normal and easy for you. Drop down again and work your way all the way down.

So this is a great exercise and a great way to really wake up those local stabilizers, not by thinking of contracting a muscle, rather by thinking of letting go of muscle and actually facilitating the movement in that translation side to side. So the more segments that move and the more they move with control, the less likely you already have some of the spasms in the garden from the global muscles, which is what's been Meredith's problem all along. I want to do one more little exercise in bridging, which is with rotation. So our marathon and have you go up into your bridge at the hand, come to the side so I can slip in here and I'm going to get my left knee underneath her right knee. Now I'm putting pressure through her foot to keep her onto the foot bar and I'm also hanging onto her leg here.

You're just going to roll down like your normal bridge, but you're going to fill my pressure blocking and allow that left hip just to keep dropping all the way down. That's right. All the way down. Now as you do this, start thinking more of that central access to see if you can find that central axis of your spine and then roll back up. That's right. Good. Take a breath in and exhale. Dropping again through the spine and trying to keep yourself in that spiral. Letting the hip come down and let's keep this knee here.

Keep dropping down around that hip. Yeah, good. Now bring this knee up. There it is. Good. So again, now adding a rotatory component, that segmental movement, trying to wake up those local stabilizers and really get into Meredith spine. And I say get into the head of her spine and get those segments starting to work again. Now I'm still seeing a little bit of extension as she's going down. So what I want you to feel is that rule of ribs. So you're going to go down, ribs are going to go back up underneath and then spiral.

So just sort of let it drop. Not, there we go. So now we're moving the segments. Keep going down. Yeah. All the way down. All the way down there. Now bring it back up, bring it back up, bring it back up and back down. So now I'm giving it some resistance to actually work through that range.

Finding that good. Last one and back up. I'm also keeping her on her central axis. Good. So I'm going to sneak out. Roll down. Nice. Nice, nice, good. So we're getting some more segments moving there. So now this time Meredith, easy as can be. You're laying on the beach, you're a jellyfish and that little one foot tide comes in and rolls your gelatinous body up off that mat. No bones, just gelatinous jellyfish. Beautiful. Taking a breath.

And as you exhale, it's like that wave is now pulling you back out into the ocean. So just let that body rain come down. One segment, one gelatinous cell at a time. Beautiful. Good. So what I want to finish up with with Meredith in this little session is feet and straps. And what I want to do now is I want to work a little bit more on that relationship between the anterior hip muscles that actually come up across into that lower thoracic is my gut feeling is that the hip flexor, this, so as major coming up through the diaphragm and into the t 11 t 12 area is what might be restricted because she's overcompensating that area and then the global muscles in the back of the quadratus and that's why she's feeling that stiffness on that left side. So I want to make sure that she has that opening of the anterior as well as the opening of the posterior and lateral and the rotation.

So where we've addressed all three planes of movement of her lumbar and lower thoracic spine. So we're going to do now is lower this springs to a red and a blue and I'm going to have her press out into her straps. So press out and slip in. There we go. Excellent. Now just to go up and down a couple of times. Again, nice and easy looking for the disassociation and the hips. I want to see sort of how she organizes.

Similar to what we did with the footwork, with her feet being with football really low. And what happens when you go a little bit lower Meredith? Yeah. Okay. All right, so let's just get a little fixation on how far down she goes. So she comes down, she gets to about 30 degrees. She starts to feel her ribs coming up off of the mat. Okay, so I need her to be at least at zero to be able to stand up straight without having that force pulling her ribs up. What's pulling her ribs up? The SOS major, maybe the anterior wall pulling those ribs up off the mat.

So this is how we're going to do it. Roll your bottom up a little bit. Meredith and us. Get this underneath your sacrum. Good. Right there. Good. And now feeling this part of your ribs drawing down into the mat. Yep. Good. Now take the legs down as far as you can without losing that position.

Wherever you can go. There's no right or wrong right there. That feels about it. Good. So now just gently with your leg. He's a little bit of a beat. Beat, beat B. Three, two, one. Lower down a few inches and beat. One, two, four, five, six, seven and lower.

And again, one, two, three, five, six, seven. Can you go down one more? Can you do it good, nice. And Go. One, two, three, five, six, seven and relaxed at the legs. Come up. Let's take the block out and let's just see what happens. Now with your regular, how low you can come without feeling the ribs pulling up. Trust it. Keep going. There it is.

Okay. So getting closer to that horizontal position or line that we want and vertical. If she was standing up, do it a couple times and see if you can create the ease of it. I might even bring you back up on the block one more time to get to all the way down. That's better. Good, good, good, good, good. So again, I want to get her so that she doesn't have that conflict ID pulling and togging.

This is what Shirley Simon often talks about. It's not so much that the hip flexors are short, is that they are stiff relative to the trunk muscles. So if they are stiffer than the trunk muscles in that moment, they will create sheer force in her back. If she has sheer force in her back, the deep or the big global muscles like the quadratus and the erector spinae will over recruit to protect her. And that's what this battle that I think she's been having over and over again. I know many, many people that have this and it creates that chronicity.

So that idea of why does this keep, why is it always stiff there? Right? So what we want to do is give her a series of exercises that sort of balance her out. And this is just a review. We had the bridging at home, just the regular bridging. The bridging and lateral translation and then if she has help or even if the the studio, she can get up on top of the foot bar and do the single side rotation. We also did the footwork with the bar very low. That was another important one. And the third one is to have her doing her feet and straps, but bring her bottom up on top of that yoga block and have a work gain as low as she can, keep it in the ribs low and have her opening and closing the legs to be able to really start to open a length in that interior wall relative to that lower thoracic spine. Okay. How are we doing? Go ahead. All right, so let's finish off the very last thing with a little bit of mermaid because we want to get our lateral flection.

Okay. And our springs are good. I'll let you come up and transition into your mermaid posture. [inaudible] excellent. Good. So let's go ahead and place your right hand on the bar and left hand behind your head.

And what I look at in the alignment is I want to make sure that she's not so far back to the side that she loses her alignment through here. So we're going to go up and over to the right. I'm going take off that blue spring. So I'm now just one red spring and I'm going to grab this elbow and give her the sense of coming up. I know it's that left side is bothering her and what I want you to do now is send that breath into this yeah, area here. So as you breathe in, and as you exhale, you're going to send it from underneath here.

Ah, in hell into here. This is where we want to open up. That's why you like it so much, right? And exhale from the right side. Good. Now rotate it around. Bring that left hand down onto the bar. Slide your right hand over a little bit. Yup, go ahead and press away through your body without the carriage moving. So we're going to move this back, opening this area here.

Inhale, expanding this area here. That's it. Exhale from underneath. Inhale, expand, keep expanding. Excellent. Now from here we're going to do a combination of extension and flection. So without the carriage moving, inhale, bring head and chest and sternum. Okay. And exhale, send it back. Polling through here, opening this space, fill this space like a cell of a boat. There it is.

And inhale. That's it. And exhale. Nice. You doing okay? Is this delicious or painful? Okay. All right. Should it be delicious? And I'm just taking that lower rib down on her because I know that's the, as we say in my clinic, the Mama Jama that I think is getting in her way. Last one, just taking it. Yeah. Down and flash it one more time. Bring this hand behind your head.

Scooch your right hand over a little bit. Open that up. Yep. Gun and come up. Now I would obviously take time to go to the other side, but I knew this was a side that needed more work. The story concludes what I wanted to do with Meredith today. So again, just to recap, we did some bridging in Matt. We did some quadriped edge, just getting things loosen and moving around.

We wanted to make sure that she had good oscillation and good articulation of that spine to ease up that stress that she felt on the left side. We also balanced out her pelvis, so if you see somebody that a leg length discrepancy, send him to the therapist or to a chiropractor osteopath to work with them and getting that balanced out, but make sure that you're laying the strategy on top of that structural correction within 24 hours. So anytime you refer out, make sure that you make arrangements to have them coming in to learn the movement strategy with that new structural organization as quickly as possible. Then we got on the reformer and we did footwork with a football really low. We did the bridging again with some lateral translation rotation with a higher bar. You could also do that at home on the base of the Sofa or a chair. And then we went into the feet and straps and the feet and straps.

We looked at the only get that opening of the anterior wall hearse particularly that left. So as an Iliacus and we used the yoga block with a little bit of beats coming down as low as he could and then coming back to be able to see how low can you get those legs without those ribs feel like they have to pop up off the table eventually getting so that we could stand in a vertical position without the adverse effect of those hip flexors. And then in the end we worked on uh, the mermaid getting side, bending our lateral flexion and rotation into that same area, putting special attention into the area that we know is restricted and these are all things that she can do on her own, which is why I'm going to encourage you to do on a daily basis to reeducate that strategy of getting those deep local muscles to work with segmental movement and get the big global muscles to relax and chill a little bit so they're not always clean or stiffness. That concludes the session again, my name is Brent Anderson and Pollstar Palladia. It's a pleasure to be on plots anytime and look forward to seeing you in the future. And thank you, Meredith, for participating.