Mat for Hip Replacement

Hello this is Brent Anderson at Pilates Anytime and we are here for a special class that we designed specifically for Mindy. Mindy recently had her hip replaced as little as four weeks ago and we did an assessment with her in a workshop that we did. If you're interested you can always go to Pilates Anytime and see that workshop. But the class is designed for people who is a growing population everyday of those who received total hip replacements. It's going up by 25% per yer, the number of people over the age of 40 that are now having total hip replacements with success returning to full able-bodied movement.

Now this particular case, Mindy had an anterolateral approach. And what I want to just make sure everybody understands is that you need to get clearance from your doctor and your therapist before you attempt to do a class like this. But this is based off of our assessment however she is doing physical therapy. She does come from a strong movement background, from dance, pilates, and gyrotonic and so this class is designed for her. It is good for anybody that wants to participate in this class and if you fit those particular parameters, boy we'd love to have you join us on Pilates Anytime.

So let's get started. I want to begin just in standing and you'll notice that Mindy does have a walking stick with her, which she has been told by her physician or therapist that she should be using for another couple weeks. Just for safety and for her assurity. So that's why I asked her to use it here just like I would ask you to do the same thing at home. And so having this awareness on your legs what I want you to do is just close your eyes for a moment and with that assurity that you are safe just notice how the pelvis sits on top of the femurs.

So you're really observing, you know, is there any tightness or restriction in the front, the side, the back or the groin. And if you just shift your weight side to side right to left, just notice as well, is there anything that you notice different about one side versus the other. And I can guarantee you Mindy's noticing a difference because of the leg just operated on still is going through its reawakening stage and she's starting to take ownership of that leg again. That usually takes anywhere from four to 12 weeks to feel ownership of the leg after having a total hip replacement. Now just resting in that standing position again just make a mental note of it and take a snapshot as if you had a camera inside your body of what you feel and record it and have that recording inside to come back and compare after we do the class.

Everybody with me? Eyes open, we're going to go down onto the ground and we're gonna start laying on our backs with knees in a hookline position. And we have this down to a science here. You got it, I'm gonna take this away from you. Alright, you good?

Yes. Fantastic. So what I want to start with and I do this almost with every class is just a little bit of awareness of the pelvis. We're gonna go into a little more detail because our goal really is to wake up the relationship between the pelvis and the femoral head especially the new femoral head and to start increasing that awareness through movement in all directions and angles so that those proprioceptive fibers inside that hip can now start being awake and give her the sense of ownership of her leg. So with that being said, imagine that your pelvis is that beautiful large bowl of soup that is half full, it's a smooth warm soup, let your feet be spread apart about hip width apart as if they lined up with your sit bones.

And just very gently anteriorly and posteriorly tilting that pelvis. We can incorporate our breaths so the inhalation tilts the pelvis forward the exhalation tilts the pelvis back. And each time using less and less force to get that movement. It's almost like the soup is sloshing and the pelvis is moving around the femoral head, that's exactly what we're looking for. Just a very gentle movement, anterior and posterior.

And again any time that you would feel discomfort would be worth checking to see why you're feeling discomfort. These exercises, they are particularly indicative for this particular circumstance that we're working with. Now come back to that quiet place in the middle and let's take the pelvis and tilt it to the right and to the left as if your legs were on a coat hanger and I was, maintain the legs up vertical just sort of holding them, allow the pelvis now to rotate around the femoral head. Alright, so we're getting that nice side to side, this rotation of the spine, and we're looking for the ability to keep the knees vertical and allow the pelvis to roll around the new femoral head. So let's do that for a couple repetitions.

The tendency is to want to hike the hip. We really want to keep it so it's just rocking side to side, you all have very nice rocking side to side. And each time try to see if we can increase that movement again with efficiency. Using as little force as possible to be able to get that movement successful. And again let the pelvis rest back into the central position.

Now we're gonna combine those two movements to do a diagonal and this is a very important move for this because this represents walking. So for her to have that diagonal walking. So what we're gonna do now is the anterior tilt and rotation towards the right foot and then a posterior tilt and left rotation towards the left shoulder. If you're thinking of the pelvic clock or Feldenkrais clock, we would be going towards seven o'clock in the morning, towards that right hip and up towards one o'clock in the left, alright? Left angle, so we're just going on a diagonal, side to side.

And that's a funny one isn't it? But what you'll find is this is actually walking. And back to the left, and down to the right. And this is often a range of motion that is lost following a hip replacement because they don't have a lot of adduction or internal rotation. Is that easing up a little bit?

Mm-hmm. Good. And just when you learn that diagonal it's time to do the other diagonal. So we're gonna take it down towards the left foot and up towards the right shoulder, you got it. And again just feel that sink and up, and sink and up, you can still use your breath for this.

So inhaling down towards the left foot, exhaling towards the right shoulder. And again just try to allow the pelvis to move around the femoral head in all of the angles. This increases the awareness inside those hip joints and that's exactly what we're looking for. And when you're ready let the pelvis become quiet again. We're gonna go into a full circumduction now as if I was stirring that bowl of soup with a large spoon and that there was a current.

So imagine the current going around clockwise and the pelvis and being able to get that fluid moving and the pelvis now moving around the femoral head. So the femoral head is quiet and the pelvis is moving around massaging that femoral head. Waking up the proprioceptive fibers around the hip socket itself. And again let the movement just start happening, less and less thinking more and more moving. Alright, just allow it to happen.

And if you want a little more movement you can take a little soup out of that bowl and make it so the movement is a little bigger. If it's a little uncomfortable you can put more soup in the bowl and decrease that movement. And we're ready to go back the other direction. So when you're ready start stirring that soup in the counterclockwise direction. Less work, less muscle, more flow.

Imagine the current, let the breath be part of it. Inhale as you come down towards six o'clock, exhale as you come up towards 12. (deep breath) Moving around. Waking up those hip joints, beautiful. Alright, and relax.

Now what we're gonna do is we're gonna use our hands and we're gonna bring the knees up to a 90 90 position and place the fingers on top of the knee. So you're gonna hold it with this hand and hold that with a hand. And we're gonna do a gentle circle roundabout. Just a tiny little circle, imagining the femoral head dropping down into the pelvis, and sort of opening up the back of the capsule, that's right. And just gentle circles, I think more of the opening of them coming around here.

That's it, there yeah. And then reverse that circle. And what I like to do in this part is just really trying to get away from anything that's pinchy, anything that feels like it's bunched up. Just sort of allowing the femoral head to drop down, let gravity be some of the source of the movement that wants to open the legs, that wants to move the legs around into the circle. So very gentle, reversing the direction of your circle, same thing going back the other way.

And again feeling like the pelvis itself is being massaged now, remember we massaged the pelvis around the femur the first time with the pelvic circles. Now we're massaging the pelvis with the femurs from on top. And relax, let the legs come back down. And we're gonna go right into our bridging. So the feet about hip width apart.

And this is a very good exercise to be able to start waking up the posterior fibers of that pelvis. And I'm gonna ask you just to go right into a simple bridge. So hands down to the side as you exhale rolling the spine up and then take a breath up on top, exhaling dropping through the sternum. Down through the ribs one segment at a time all the way down until the tailbone comes down. And go ahead and appreciate the inhalation letting it tilt forward a little bit.

So we're just getting that massage around the hips and then exhaling and rolling back up. So we're keeping that movement all the time around that femoral head. Again, waking the femoral head and that socket up. So let's do about two more of those simple bridges on your own pace, rolling up, take a breath up on top, and segmentally roll down. Again thinking of the ribs, gliding and sliding down until you're all the way back down.

Now this time we're gonna go into a single leg bridge. So we're gonna roll up with both feet, come up until you're parallel. Drop the sternum down just a little bit. Right to give yourself a little bit of control there. And then see what happens when you shift your weight to the left just disengage the foot a little bit off the ground and then bring the right foot back down, disengage let the left foot come up just a little bit.

And shift back to the other side. Nice and easy shifting side to side, gently lifting that foot off, disengaging, back down. For a more advanced variation we would be doing some gestures, maybe an advanced class, being able to lengthen the leg out or do circles with the legs. At this stage of the game we're happy as can be to just switch the weight into that movement. We'll do one more on each side and then roll your spine back down.

Now another important factor for coming off of a hip procedure like this is getting spine mobility. So we're gonna do the bridge one more time. And this time we're gonna do a little bit of lateral shifting side to side to be able to wake up the spine muscles. Because a lot of times what people will complain of after a hip procedure is their hip feels a lot better but they actually might have some back pain. And that was a case with Mindy that we want to try to get that back feeling a little bit better.

So sliding that pelvis to the right and to the left as if the pelvis was on a skateboard. So you roll up into your bridge, shift the pelvis to the right, shift the pelvis to the left, and then come back in the center, drop this down a centimeter, good, and shift. So we're just gonna slide, and slide. Come back to center, drop this down, slide, slide, drop it down again, slide. And down again, slide.

Each segment, so we're trying to get multiple segments of that articulation, very nice Mindy. All the way down 'til the bottom comes to a rest. Side to side. So just a quick note on this. If you had 10 or 12 vertebrate that we're going to move between the base of the shoulderblades and the sacrum, you're looking at the ability to slide from T8, T9, come back to center drop down a centimeter or two, T9, T10, slide side to side.

Come back to center drop down another segment, slide side to side until you finally get to the bottom. So let's try it again and see how many segments you can actually create a smooth translation for at each level. Okay, so roll it up. And let's try that again. And sliding to the right, sliding to the left, drop down through that sternum, slide again to the right, slide to the left, come back to center and drop down.

Right, left, you got it. This looks great, and again. And you should be able to get at least five or six segments that you're able to translate through successfully to wake up those local stabilizers, to get rid of any kind of cramps or spasms that are in the back from all the change and deviation after having a surgery like that. Very good. Bring the back of your hands together and rest them on your sternum like this.

So fingertips are pointing down towards the pelvis, elbows are in front of you, and we're gonna do a modified chest lift here. So as you exhale you're gonna reach your elbows forward as you roll the head neck and shoulders up. And if you can create the image that from the elbows is a hammock that comes around and supports the head, that it actually is lifting the shoulders off of the mat. And then come back down onto the floor. I'm gonna be your lift, okay?

So here we go. I'm gonna pull the elbows, just relax, don't work so much. There. You feel how the head can relax there? Mm-hmm.

Good, so the idea is that we use that as a hammock, if you think of the trapezius muscle close to the shoulders and we draw that forward to articulate the spine up from above down towards the base of the shoulderblade. That's as high as we need to go. And then roll back down. Last one, and exhale roll up, and come down. Take the hands behind the head, going into a real chest lift, elbows are in the peripheral view, right?

So you can see the elbows out the side of your eyes. And then draw the back of the neck a little bit longer. Imagine your hands are still on your sternum, and as you exhale begin to slide up around those top ribs. And from here, stay there, inhale, release the hands long arc, let them come behind the knees. Exhale lift a little bit higher using your arms.

Right, not the hip flexes but the arms. Now stay there, inhale bring the hands back behind the head. And then exhale and roll back down. That's the whole chest lift. Let's repeat that three more times.

And exhale roll up, inhale arc, grab the legs, exhale, lift a little bit higher. Inhale arc, and exhale and roll down. Really use the arms to bring that challenge to yourself to come up a little bit higher. Arc the arms, grab the back of the legs, and lift up a little bit higher. Get up off that shoulder blade a little bit.

Stay there, bring the hands back. So you should really be feeling it here, not here, okay? Last one, here we go. Exhale roll up, inhale arc, exhale lift. Good stay there, bring the hands behind the head, stay there, right there, stay up.

Take in a deep breath three times up in that position. Expanding the ribs. (deep breath) Two more breaths. Deep in expanding, exhale. We didn't say it was gonna be an easy class we're just gonna be sensitive to the hip, right?

Exhale and relax on down. Excellent job, okay. Going from here what we want to do is bring the legs back up into that 90 90 position. And put your hands, both hands, behind the right leg. Okay, or the leg that's affected, whichever leg had the hip replacement.

And we're gonna do a modified version of the single knee stretch, right. So roll yourself up using your hands behind your leg so you can push into it to come up in that position. And what we're gonna do is we're gonna keep holding on to that right leg, okay, that's gonna be our safety. And what you're gonna do is reach the left leg out and bring it back in. Pushing into the right hand.

Reach it out again, the left. When you return with the left push into the right hand. So inhale exhale. (exaggerated breathing) and relax, now what we're trying to do is create the sensation of what it would be to push that leg out if we had those privileges. Now I've, you can rest your heads.

I specifically gave Mindy sort of the idea that we don't want her doing any long lever out from her body for probably six months after the surgery but we can prep the tissues and the load by having her push into that. So why don't you try that one more time, roll up using the assistance of the right leg. And again if you had a left hip surgery you would do it on the opposite side. Exhale reaching that left leg out and inhale pushing into the hands, exhale out, push into the hands. Push out and in, out, in, out, in, one more time.

And relax, hands behind both knees. And rest your head and shoulders down but keep the hands behind the leg. We're gonna go into a modified roll up. Alright so we're gonna use the weight of the legs and the mobility of the spine to be able to come up into a seated posture, alright. Now the challenge here is not about thrusting, it's not about pushing or pulling or jerking.

Very gently, just be patient, start sending the legs away and down while you're holding on with your hands, let the arms lengthen as your head, neck, and shoulders roll up in the position to come up. That's right, good. And just come up in that position, right? You don't have to sit up all the way, just sit up here and deep breath. Exhale, roll back down through your spine.

Use your legs as your cantilever and roll back down. We're gonna do that two more times. And exhale rolling up, send the legs away, roll the spine up into a seated posture, very nice everybody. And again inhale, exhaling rolling back down. Now we're gonna try something a little new, we're gonna combine the corkscrew with this.

In the sense, we're gonna keep it simple as the modified roll up but we're gonna roll down on one side, come up on that side, and then roll down the other side, come up on the other side. So roll up into your seated posture. And this time we're gonna weight the left hip and roll down on the left ribs going into your roll down. So that side, just sort of feeling the side on the left rolling down on the left all the way down. And then roll back up on the left.

Very good, now shift the weight over to the right side. And rolling down through the right side. Same idea, very nice. You guys got it right off the bat, I didn't have to demonstrate it or anything, this is awesome. And roll back up on the right side.

And now let's go a little more fluid so you'll come up and shift to the left rolling down to the left. And continue to come up on the left shifting over to the right, rolling down onto the right. Using your legs all the time to help you. You push in, it takes the stress out of the hip flexers and allows the oblique and the tummy muscles to work and organize appropriately. So as little work as possible.

One more time on each side. I'm liking that. That feel okay Mindy? Yes, that's good. Yeah get some movement in that spine, that's awesome.

Alright and come on down and rest. We're gonna let your legs come down to the floor for a second, give them a rest. And let's just take the hands to the side as we sort of get ready to do a modified hundreds as well. So again, we're teaching an intermediate course or class with the modifications for the hip replacement. So this is sort of, you know it's not a beginning class, it's an intermediate class where we're doing some work that we would you expect you to have a basic knowledge of the pilates.

So that said, I gave you a long enough break, roll up into the hundred position. Bring one leg up at a time into the 90 90 position and you're ready to go. Pulsing the arms, deep breath in, focus is on the breath. And let's go in two, three, four, five, out, two, three, four, five. And in and out.

And if at any time you get tired of holding that leg up you may let that right leg come down to the mat but keep the left leg up. And keep going, we have a few more breaths to go, four as a matter of fact. And out, you know the brisker we go the easier it is. If we were to slow it way down it would be really hard and challenging. Last breath, here we go.

And in and out. And relax, beautiful, let the legs come down. You rest down, rolling over onto your left side. We're gonna go into book opening. So you're gonna bring your hands on top of each other laying on your left side.

Arms are out in front. And we're gonna take that right hand and we're just gonna slide it across the body opening up into a little bit of rotation. And remembering that hip is about rotation, right? The hip has rotation. The spine has rotation.

So if I don't have rotation in my spine I put too much stress of rotation on my hip. So gradually bring that hand back across your body and roll back into side lying. And let's repeat this three or four times nice and easy. Just rotating that upper body, opening that spine, releasing any restrictions that might be in the upper back. Which again, distribution of movement equals distribution of force.

So if we get that move in the spine we can decrease the stress on the hip with your normal movements on a daily basis. Let's do one more time to that side. Using your breath to facilitate that movement, take it all the way out to the right and now bring your legs up and over to the right side. And you can adjust yourself on your mat. But we're gonna go over onto the right side, left hand on top of the right hand.

And do the same thing on the opposite side, rolling back through that part of the body. Opening up the chest, the thoracic cage, rotating the spine, and bringing it back together again. Let's do that book opening three more times to the left. Feel good to get movement in other parts of your body. This is what happens, a lot of times after following a major surgery we think we can't participate in the activities in other parts of our body and support and then we make sure that they have a whole movement experience in their body.

Not just focusing on the site of the injury or the site of the surgery. Last one. Alright now from that side lying position what we're gonna do is we're gonna push up into a side sit position so it actually looks something like this. Where we'd come up from here, just come up into this position here. Almost like a Cleopatra.

So you're gonna come up in that position and we're gonna use breath to help us move the ribcage into a side bending. So as you inhale we're going to expand into this rib, and getting tall. You can let it come down, you're gonna actually work on getting something similar to a mermaid, right there you go. And just getting that opening up in that side for the side bending. Again remember distribution of movement is distribution of force, we expect the femur to be able to have that movement of side bending or adducting, if we can get that in the spine we actually can decrease the amount of load on the hips.

So let's just stay there for one more second using a nice deep breath into the lung, the right lung, and when you're ready slide back down. Roll over onto your left side, slide back up and let's stretch out the left lung, the left ribcage. So that Cleopatra position, legs are safe. Deep breath in to the left lung. So filling this space out here, right?

Get that nice long curve, almost like that opposite curve to the right of your body. Good, nice deep breath, beautiful. Alright and when you're ready from there we're going to go into side kick position. So just lay straight down on that side. Notice your right leg is up, right.

So we're gonna come up on your forearm, up on your forearms, intermediate class. But what we will do is we will bend the knees. Exactly, and we're gonna start off with like a clamshell where the feet stay together and we're just going to work on a little bit of opening that right knee up off of the left knee. So just bring that right knee up towards the ceiling and back down just to where you feel comfortable. The body long, we still have that axial length.

We still have that relationship between the ribcage and the pelvis. If at any time you feel uncomfortable make sure that you relax, come down, and we'll try that exercise later as your body continues to heal. Now from there bring that right knee down, take the whole leg, and lift the whole leg up just off of the leg, just disconnect, come back down. Let's do three or four of those. Now remember you only lift the leg as long as you can maintain the ribcage in a quiet place.

So we don't want the ribcage dropping down every time the leg lifts up. You want to keep it pretty pure. And then from here straighten that top leg out. Again just a small little lift, turn the toes down towards the mat a little bit and work on that posterior part of that hip. So lifting the leg up and down.

Just tiny little pulses. Tiny little pulses. Three, four, five, six, seven, and relax. Now we're gonna do a little bit of side kick. We don't want to move too far so it's gonna look something like this.

That leg will straighten out, it's literally gonna be six inches forward and maybe back to neutral position. So it's a very small range. So lifting the leg up into that nice position and we're gonna take the foot forward and the foot back just, perfect, just enough. And forward, use your breath with it, inhale forward, exhale back, add the foot gesture, flex the foot, and point the foot as you reach back. Flex the foot as you come forward, point the foot as you reach back.

We'll do one more of those now it's plenty to start out in the first time. And relax, very good. We're gonna roll onto your tummies. Right, and we'll get over to that left leg in a little bit. And what we want to do now is go into our dart position.

So bring the hands down to the side, your forehead is resting on the mat, lift the hands off the ground a little bit, take your head, neck, and shoulders and just barely disconnect them from the ground. So you're length and long like an arrow or a dart. Legs hover a little bit off of the floor, pulsing the arms we'll do a reverse set of hundreds. Inhaling in two, three, four, five, out two, three, four, five, use your breath to expand the lungs into the side and into the back. Head can come up a little bit higher, boom, right there, good.

Keep it going we got a hundred of these to do, you're at 60, and in two, three, four, five, out. And again the stronger we are in the back side of our body following a hip surgery the stronger we are in our standing our posture, and we're gonna see how good Mindy feels after the class of getting these muscles to wake up. Last one, and relax rolling over onto your other side. So on your other side, we're on that right forearm, knees are bent, feet together, left knee comes up as a clamshell opening, and back down. Keep that body nice and straight so we get that long so we're not going to move the pelvis when you open, so go, that's it.

That's right, good. Stay on top of that right arm, that looks great. Exactly, let's do three more of those. And again make sure that you keep those ribs lifted up. If you think of sending those ribs from below up towards the ceiling that's gonna give you a lot of stability there.

Now the whole leg lifting up with a bent knee. Coming up just a little bit, again, when the leg lifts up the ribs should lift up at the same time. Leg lifts up, rib lifts up. Up, and down, good, up and down. And that's gonna keep that ribcage from collapsing and the pelvis from collapsing, last one, straighten that leg out.

Lift that straight leg up, toes inclined towards the floor. Just give me four of those nice and easy, two, three, and four, side kick four with a flex foot and forward and reach back. And forward and reach back. Now if you were uncomfortable laying on your side of the surgery, you can always put cushions or padding or pillows down to protect you just from the soft tissue tenderness that you might have following the surgery. No real precaution, just nice and easy.

Last one, release the leg back and then roll over again onto your tummies. This time go onto your forearms, your hands together. We're gonna go into single heel kick. So we're gonna get up nice and tall onto the front of the pubis, or even onto the thigh a little bit lifting the belly button off of the mat. And we're gonna start off with the uneffected leg, so the left leg just to get an idea of the exercise.

And we're gonna pulse the heel towards the bottom with a flex foot two times. And then you're gonna reach it out back like we did with the dart. Just a little bit of suspension reach in the back and let it come down okay. Effected leg, let's go to the right leg and try the same thing. So we'll do this together.

So it's flex flex and reach. Left leg, flex flex and reach. Back of the neck is long. Flex flex and reach. And flex flex and reach, keep it simple.

Flex flex and reach, feel the lift in the tummy when that leg comes in, right? So it's lift lift as you pump. Lift the belly lift the belly as you reach. Lift lift and reach. Lift lift and reach.

One more on each side. Lift lift and reach. Kick kick and point. And relax, excellent job. Coming up into quadruped now, you're gonna go right up onto your hands and knees and we're gonna have a little bit of a relaxation here.

So this is a great place for the hips to be able to be nourished, to be able to be fed, right? The blood's pumping now, we're just gonna move the pelvis gently around the femur. So we can start off with a very simple sort of cat and horse movement and really enjoying the extension in this, where let the bottom stick out a little bit, you're in a safe place. Nice and easy forward and back. And then we're gonna go into our circle, so we're just gonna go around and sort of massage those hips, that's right there it is.

And really trying to get that massage. Now let the head be part of that as well. I just want you to become aware of it that we have that full integration of the movement through the spine, so the whole spine's articulating. We're communicating cell by cell from the knees all the way up to the crown of the head that there is a connectedness in the body. So one of the big problems, as I mentioned earlier is you sort of feel like who's leg is that attached to me after a surgery like this.

And this is a way to wake it up and say no no you're part of the body, you know, we're all friends and we're communicating. Reverse the direction of that circle. And you might notice one direction's a little bit easier than the other and that's very typical as well. So a nice smooth playful rotation of the spine around the pelvis, around the femoral heads, giving it nutrition, giving it plenty of fluid, getting that synovial fluid working making sure that it's lubricated and moving nicely. Now come to that neutral position that you can find.

So the neck comes reaching, the tailbone's reaching long, the ribs are in a good place, feel the abdominal moving a little bit as you breath in and out without the spine moving. It's almost how you feel the belly dropping down when you inhale and lifting up when you exhale but the spine stays quiet. Feel that connectedness. Now from here we don't have to lift the arm and the leg up too high, all I'm looking for at this stage of the game is a weight shift and disconnecting the limb from the floor. So we're gonna shift the weight over to the right knee a little bit and just pick up the left knee.

So sort of slide it back a little bit and then bring it back in, just like we're doing the alternating but we're not going as far. Shift to the left knee and just reach the right leg back a little bit and again, getting the hip extension and getting the leg out straight is a great exercise in this orientation of gravity. We can't do it in the other direction because of the load on the front of the hip. So let's gradually increase the reach of the leg without moving the pelvis. This is very important, the temptation is to move from the spine and the pelvis and we're gonna keep that control.

So I don't care how high the leg goes. I really just want to see the organization of the pelvis and start having the awareness of how much extension do you really have in that leg as we go back and forth. Now let's add our arms to it, alternating arm and leg. So as you reach the right leg out the left hand goes out, bring them back home, inhale. And switch reaching the left leg and the right hand.

Inhale back home and exhale reaching back out. Excellent. Now I failed to mention earlier that in this class we need to have the box, and we'll be heading into some box work real soon to help us understand how we can modify some of the more advanced exercises after a hip procedure like the one that Mindy had. Last one on each side. And we're ready to use our boxes.

So what we're gonna do is bring your box to the center of your mat and we're gonna sit on that box. Here, you're gonna sit here facing that way. How you doing, okay? Yes. You got it, beautiful.

And, actually that's not a bad idea, sit with your feet facing the center, that way you can see me. And we're gonna start with spine stretch. So the idea is that when we're seated on the box her hips now in a pretty safe place, you don't have to worry about that long sit position for her which was a little challenging. She has plenty of mobility to sit in that position but she didn't have the strength to really hold that position. So this is a much safer place.

Hands down to the side, and feel like the fingers are sliding down towards the floor, or down to the box a little bit. Head going up towards the ceiling. And at that same time we're going to then reach the arms out to the side. Right? Hug the imaginary tree, and now send the lower ribs up underneath your heart as you flex over your knees and let your hands come down to the front of your shins.

That's far enough, okay, that's plenty good. Take in a deep breath there, exhale, slide the hands up the shins as you stack the spine back up into a tall seated position, the arms should come back down towards the side of the box. You got it, send the hands down, send them out, hug the tree, ribs come up underneath your heart, as you come around that imaginary ball. Hands will come down to the middle of the shins, take in a deep breath, relaxing the back of the neck, and stack the spine up. The hands just drag the leg, and then down to the side of the box again.

Send the hands down as the head goes up, take the arms out, hug the imaginary tree, ribs come up underneath the heart sending that way high really supporting that hip as you bend over the hip. And notice each time that you're gonna get a little more flexion and again we want to avoid any kind of impingement, alright. So we don't want to feel anything pressure in front of the hip so that lifting the heart or lifting the ribs and the heart is really gonna prevent that. And just go to where you can go through the upper spine to start realizing that you're flexion's coming from the spine, not as much from the hip. This time bring the hands across the chest.

So we're gonna go into our spine twist. And we'll start here really pure, vertical rotations. So you're gonna feel the weight on your sit bones. You're gonna find that your spine twist is much better sitting on a box than sitting on the floor, okay. And you're gonna rotate to your right.

And rotate to the end of that range of motion where that left sit bone does not glide or slide so you're still in that nice vertical axis you've rotated around. And then come back to center. Rotate to the left as far as you can. Staying on that vertical axis, feeling that weight equal and here's a little trick with the ribs. If you're rotated to the left, feel like that left rib, lower rib is gonna reach down a little bit towards your hip and the right lower rib is gonna lift up underneath your heart.

And notice that you'll actually get a little more rotation. Because what happens is when you can create the connection between the lower rib and the pelvis the top ribs can start to slide on each other. Come back to the right side and rotate to the right. Same thing now, so here that right lower rib is gonna reach down towards the hip and the left rib is gonna lift up underneath the heart and then rotate a little bit further. And let's go again back to the left.

Appreciating that relationship, rotating to the left. Axial length, come back to the center. And to the right. And we'll do one more to each side. And we're gonna ready to combine them into the saw, right?

So let's take the arms out to the side now, we should have plenty of room between us. And we're gonna start with a spine twist so we're gonna rotate to our right. Now take that left hand and feel the ribs coming up underneath your heart as you bring it down to the middle of the right shin. Stack it back up through the spine. Bring it back up and rotate to the left.

So we're going into the saw in a seated position reaching the right hand over towards the shin, towards the toes. Stack it back up through the spine, bring it back out to the right, rotate to the right a little bit quicker. And up and over, and stack and open, and rotate, and up and over. And up and rotate, one more time to the right. And reach left, and stack up, and reach left and reach right hand, you got it.

And up, beautiful, and relax, very good. Now spin around so you're facing the front of the room, still with the box. Place your hands on the box, yeah. And you're gonna put your feet out straight in front of you. And all we're gonna do is lift the bottom up off of the box.

So it's a leg pull exercise. Your heels are anchored on the floor. If you want to modify it you can do it with bent knees. Let's try with bent knees first. And just feel that control.

So with bent knees we're just gonna lift bottom up off the box. That's it, and back down. So it's almost like you're going in to, you really want to feel the opening of the hips by using the posterior part of the body to lift the bottom up. Okay, you got it? Lift the pelvis up, that's it, and back down.

Bring these in a little closer, there. And up, there we go, and down. That feel a little safer? Mm-hmm. Worried that your feet were gonna go sliding out.

Make sure that you have non-skid. Here's a little push for toe socks, non-skid socks. You pay me later, Joe. Here we go, now let's straighten the legs out and do it from the heels. I'm gonna give you that safety there, and then we go up and down.

How you doing? Shaky. A little shaky? I would expect you to be a little shaky. Shaky just means it's working, no discomfort?

Mm-mm. Okay. And she had her physical therapy already today so I know she's a little tired. And down, one more time, and up and down and relax, fantastic. Alright we're gonna get rid of the boxes and continue with the class.

So we're gonna go into plank position. So we're gonna go back into our quadruped. Head toward the center of the room. How you doing, give me your hand. You got it? Yeah.

Alright. She's way ahead of her time. Alright so we are going to go into our plank position. Now I love plank for the hip. So what we can start with is just going from the quadruped position into plank and then back into quadruped position.

So we're just gonna lift up into a plank, slide your legs back, hold for 10 seconds, nine, eight, seven, six, five, four, three, two, one, the knees come back down into quadruped. We'll do that two more times, okay. So rest it up. And again what's important about this is we're actually getting the strength in the interior wall without loading gravity onto it. So it's a reverse load.

And here we go into plank. And hold, 10, nine, eight, seven, six, five, four, three, two, and rest. Now come down onto your forearms. Ready? Same thing, plank position here we go.

If you get too tired you bend those knees down. 10, nine, eight, seven, six, five, four, three, two, and rest. How are we doing? Come back on in a little bit if you need to. You want to come up onto your hands?

No, I'm good. You good? You got one more. Alright here we go. And plank, 10, nine, eight, seven, six, five, four, three, two, and rest.

Put your hands into push up position. Now with your knees down or your knees off you're gonna do one full pushup. If you can do it off. If she's doing it off then everybody should do it off. One pushup all the way down and come back up.

Walking the hands back towards your feet you can soften your knees if you need to. Soften your knees, and I'm coming to help you out here. Thank you. Yup. And roll your spine up.

And we're gonna do a roll down and a roll up one more time just to where you feel comfortable, alright? Now the key thing here is I don't really want so much hip flexion as I want the spine to be able to move in its place. So the more spine mobility you have the more you can do the daily activities without going so much movement into the hips. So let's do the spine roll down just down to where it really is all about the spine and then soften the knees when you get down to the low back. And then stack it back up from there, right.

Beautiful. And let's do that one more time. Segment by segment, articulating the spine down. Find that place, knees soften a little bit forward, tailbone goes down, pubic bone lifts up, ribs lift up underneath the heart. Effortless roll.

All the way up and take a nice deep breath. Now once again in this position we go into assessments. So the class is over, where are we? Eyes closed if you feel comfortable. Do you want your walking stick?

No I'm good. You feel good? No walking stick, I like that, okay. So now standing in this position just notice how the pelvis feels on top of the femur. Is there a little more awareness?

Shift the weight to the left and to the right and just notice if the body's able to receive that weight equally on both sides. How do you feel when you're on the right and the left side. And then just even do a little bit of a circle around the hip and just notice if you feel a little more control, a little more safety all the way around the hip joint. Because that's what we want to do is wake up all those little mechanical receptors inside the hip that have been turned off and wake them up again so that we feel like the leg is ours and we have control of it in this range of motion. Open your eyes, alright.

And that's the class. (applause) How do you feel? Thank you, alright. So at home, again, I just want to encourage you to make sure that if you did recently have a hip replacement that you would have talked to your doctor, your surgeon, your physical therapist. They're welcome to look at this class with you and make sure that it's adequate.

Again we tried to deal with an anterolateral approach. So again different types of hip surgeries have different types of precaution. This class was specifically designed for Mindy and many other who have anterolateral approaches that could benefit from this class. We hope that you'll join us on other classes that will continue to evolve and prepare her to return to all of her activities in the pilates world at Pilates Anytime.