Lumbo-Pelvic Pain

Trailer

Chapter 1

Primary Functions of the Spine

Today, we're gonna talk about one of my favorite themes which is the healthy spine and healthy spine movement, as it pertains particularly to Pilates teachers but also the any kind of movement teacher. There's a lot of research out there about spine and motor control of spine and the trend of spine and spine care is definitely moving towards things like motor control, efficiency of spine, positive movement experiences, how we map things in our brain to understand and interpret what we're feeling in our body, how fear and perception can significantly modulate what we feel in our back, in our in our pelvis and how what well we do as Pilates teachers can have an incredible effect on shifting the paradigm of movement equaling pain.

I'll repeat that, the idea of what we do as Pilates teachers is actually shifting the paradigm of movement equals pain to one of movement equals happiness, movement equals health, right? And that's where I wanna start. Joseph Pilates in one of his quotes, he said, "physical fitness is the first requisite of happiness." Our interpretation of physical fitness is the attainment and maintenance of a uniformly developed body with a sound mind. Now, the part that I love about this quote comes up when he says, it's fully capable of naturally and easily and satisfactorily performing our many and very daily task with spontaneous zest and pleasure. Now, when you sort of dissect that quote a little bit, there's a couple of things in there one, we're talking about a formula for happiness, it's being well, right?

It's being fit, it's being able to move and to find that by having this balanced development of our body and our mind. But then he goes further and saying that as we practice these things in this lifestyle, that our goal should be capable of doing our daily activities and tasks naturally with spontaneous zest and pleasure. And so sometimes I think what we've done in the last maybe 10, 15 years, is gotten so hung up on this idea of core control, that we actually interfere with natural and spontaneous. So for example, a kangaroo, since all this stuff comes from Australian law, the research, a kangaroo when it jumps is not thinking about engaging its pelvic floor and transverse abdominis when it jumps and likewise, neither as a child thinking that when they go down to pick something up, those are things that are spontaneous and they come from practice and organization and experience. When those get adulterated with things like injury and fear and sedentary lifestyle, it starts to shift our paradigm and we start to have painful episodes and those are the kind of things we're gonna talk about.

So without me giving you too much information, what are some daily tasks that we encounter as human beings, active human beings? What are the things that we feel we should be able to do every day, sometimes we feel we can't? What are some things that come to your mind? Drive the car. Drive the car.

Go up and down stairs. Go up and down stairs, good, what else? Moving of the laundry basket. Good, laundry is a big one, yeah. Children, grocery shopping, carrying bags of groceries trying to minimize your trips so you got 16 bags in your hands good.

What else? Break dancing. Break dancing, yes, dancing. I do have that in there and pleasure, there's other parts of life that require spine movement that are important. What else?

Running, right? Good. I have a list here and that's why I didn't wanna buy a shoe but take a look at this. So walking, sitting, reaching, squatting, lifting, bathing, toileting, intimacy. We always joke about it in back pain but it is one of the primary complaints of low back pain in adults is that it limits their intimacy with their partners.

Dressing, dancing, playing, sports, sleeping. When your sleep gets disturbed you become a big grouch and nobody likes you because when we don't sleep, we start degenerating faster and become more and more miserable and tired and so these are things like even sleep apnea and those kind of things make a big difference, you'll see somebody that has sleeping problems and they get a CPAP or something like that and they see another become nice people again, right? Sleep is important. Cooking, cleaning, a lot of things you said art, many, many more activities and I think the bottom line is that we have to understand we are built to function well. This has to be an assumption that we have, our bodies are built to function well.

What we do a lot of times is that we put ourselves in a predisposed position for too long, like sedentary positions that go against the way our body was designed to perform. So you think over a period of a million years, we progressed into a nice vertical bipedal, by curve animal to be able to have good dexterity in our upper extremities, balance on our feet and in the last 70 years we choose to become a sedentary animal so our bodies and our tissues are not prepared for it. Watch a child develop up to the age of four so before we started demanding for them to sit down all day long and they had this beautiful, natural spontaneous movement in their body, then we get them seated and they don't like being seated but we forced them to be seated and we punish them when they're not seated and not sitting quietly. And we call them hyperactive when they wanna play and then they have attention deficit disorders when they don't sit down for prolonged periods of time, right? So then we sedate them so they conform to our behaviors.

And we sit down and then we say to the school district, we can't afford physical education and dance and movement and art so we pull those things out of the curriculum because math and English and writing become the priority for us in our schools and our development and we are developing unhealthy bodies is what we're doing. So more so now than ever before, as a physical therapist even 20 years ago, I did not see the number of teenagers and adolescents with problems of obesity and back pain, we just didn't see it and now we see it all the time. So we are shifting ourselves as a species in our society because of the way that we're forcing ourselves to become sedentary animals. And it's hard to get out of it because we no longer are a blue collar society, we're a white collar society in the United States and especially a lot of Western countries are white color, things are automated, we no longer are lifting things and moving around all day and it's almost like we used to think that our back would break down more by being more active in work and lifting and doing labor work but the reality is our back degenerates more by the sedentary lifestyle than it does by the active lifestyle so we're gonna talk a lot about that. So when we look at this to successfully perform our daily tasks, we must have a clear understanding of how the body works and I think this is important for us as Pilates teachers to understand, you know, what are the biomechanics of this, what's the neuromuscular aspect to it and more important what I hope to bring to it today is some of the psychology that ties into back pain and back health more importantly.

So we're gonna start with some biomechanics and the first thing we're gonna look at is just understanding what are the properties of the different parts of the lumbar, thoracic and cervical spine like what is their purpose. So when you look at the lumbar spine, the primary purpose of lumbar spine is weight bearing. It is like these nice beefy solid chunks of bone that articulate very much in the sagittal plane, they have hefty disc and their primary job is to bear weight so as we walk and we move around, they are the big weight transfers from the lower extremities up into the upper extremities. So primary responsibilities, weight bearing. L5-S1 has an interesting relationship so this goes back to those of you who have a little bit of sacro-iliac and lumbosacral problems and the L5-S1 is a very mobile Joint and it's facet sit like this, so open.

So it's almost what we call like a ball or a ball and socket joint that almost creates an L5-S1. So if I wanted to be able to be reciprocate movement that's going on in my hips, it's probably gonna happen in my L5-S1 because it has this kind of relationship but very quickly as I move up into my L4 and L3, the facets become very sagittal and very vertical which means there's no rotation really coming from that part of the spine. So a lot of moving in L5-S1 a little on L4-L5 which are the two places that we have most of our pathology in the low back and then very little movement in L1-L3, okay? Then when you move up into the thoracic spine, you often hear people talk about the T/L junction, if you heard the T/L junction referred to, thoracolumbar junction that junction actually occurs at T11 and T12, not at T12-L1. The reason why we call the T/L junction is because thoracic spine is defined by having a rib coming out of it, right?

And because we have a T12 rib, that floating rib down the bottom is referred to as a thoracic vertebrae but it actually looks and acts a lot more like a lumbar vertebra that has a rib attached to it, does that makes sense? And so that being said, T12 and T11 is where that transition is and what happens is, in the back of T12 are these two bony prominences that come out. And these two bony prominences act like kickstands or brakes because the facet go from being the sagittal vertical facet into a coronal and about 65 degree into a rotational facet and so what happens is, this is where transition of force happens. So as I go into do my merengue, right? What happens is I side bend here at my low back and then my thoracic is gonna side bend the opposite direction because we go from having the lumbar thoracic curve, we also having that transition point that's gonna cause the translation of the force to shift which is how we get reciprocal movement, right?

When we run, that's what should be happening in that transitional force in the spine. So if I don't move from there, that movement is gonna happen somewhere else, often L5-S1 so we blow out L5-S1 out, we then understand where that movement comes from. So when we teach our clients which are looking at, how does that force transfer from that leg up into the pelvis, into the spine and then reciprocate over to the opposite limb, right? So that for us has to go from my right leg out my left shoulder, right? And vice versa as I move through space, okay?

So that's a really important part of the body that transition but know that it happens at T11 and T12. The thoracic spine is interesting because it's sort of broken up into two parts, we talked about the upper thoracic and the lower thoracic and the upper thoracic spine is between T1 to T7 and the lower thoracic is gonna be ta two T8 to T11, T12. Now, what defines the difference there is that the apex of the thoracic spine is about T7-T8 which is right at the base of your shoulder blades, okay? When we look at the function of these parts of the spine, the upper thoracic primary function is rotation, Upper thoracic is rotation and I'll explain why that is. Its secondary function is flexion-extension and the tertiary is side bending, right?

The third one, so that's the least amount of movement there. So first and foremost is rotation, second is flexion-extension and third is gonna be side bending. Now in the lower thoracic spine it's flexion-extension first, rotation second and side bending third. Why do you think it is so important to have rotation as number one in the upper thoracic, what comes to your mind? What sits on top of the upper thoracic?

Even go a little bit lower, what sits on top of those ribs? Your scapula and your clavicle, right? The whole shoulder girdle sits on top of that upper thoracic cage. So the idea is rotation gives me momentum, it gives me a moment arm to rotate around with upper activities, it gives me power that ties into my core because of that movement. So if I have an immobile thoracic spine stuck in kyphosis, now all of a sudden I've lost a tremendous amount of mobility and power that would normally come through the mobility and rotation of my upper thoracic spine.

The kyphosis does not allow the shoulder blades to slide down and maintain congruency with the humeral head so what happens is the humeral head starts compressing and we can do this just as an experiment. If you drop down into a slouch and you lift your arms up, you're gonna feel your arms hitting the acromion very quickly which is where it's interesting in orthopedics often, anybody over 55 years old men or women that are very active in the gym, they have a common pathology that most of them share which is called a rotator cuff tear. And the physician or the surgeon will say that's normal for active adults over the age of 55. But see it's normal, it's common but it's not necessary because if they had good thoracic mobility and good uprightness, they would not have impingement in the subacromial space hence they would not have rotator cuff pathology or a lot of them wouldn't, it'll be a lot less. So the idea is that when that thoracic is stuck in a little bit of kyphosis so a lot of us especially men and women that do a lot of weight training get really strong up in here, they lose the mobility in their upper thoracic because they become a little muscle bound up here and so then what happens when they go to raise their arm up, they can't get back into these positions without subluxation their humeral head and so they have problems there.

So lack of thoracic mobility leads to three types of pathologies, cervical, shoulder and lumbar.

Chapter 2

Primary Functions of the Discs

Today, we're gonna be talking about lumbar and lumbosacral but understanding that the lack of mobility thoracic means that forces are gonna be transferred to other places. Can you think of a sport that has a lot of upper rotation that also causes a lot of low back pain? Golf, right? So if you think of golf and the golf swing when I am preparing to golf, if I'm in this position in my golf swing which a lot of people are, they're fixed in this area, that means my motion has to come from my low back.

So I start feeling in my low back, my hips and my knees because I don't have the thoracic mobility that creates the momentum, right? It's a thoracic mobility that creates that speed and the length of the lever that gives momentum to the head of the club. It's interesting a number of years ago about two, three years ago, I shifted golfing from being right handed to left handed. And it was like, every time I'd go and golf, and I've had some hip pathology, I'd get to the 13th hole and my right hip would start really bothering because the internal rotation of golf. And so I was out with a friend who golf left hand and I tried his five iron, think and hit it, you know, 180 yards straight as it could be.

So I switched clubs because I said that's much straighter than I hit with my right handed clubs and I've been playing left handed ever since. Now, interesting enough, I play a game of about 60% of my rotation, right? So I don't play a full swing game but my game has improved drastically because before I wanted to power the golf club through, right? And now I rely on that thoracic rotation and just allow the club to do its work and my golf game is much better without the stress going into my low back or my hips so it's amazing to me to understand that a little bit of movement in the thoracic spine goes a long way. So going back to the slide, we look at that upper thoracic spine, primary is gonna be rotation, secondary is flexion-extension and tertiary is side bending, all important movements, right?

All of them are important movements and it's just understanding how the upper thoracic primary job is to be able to participate in the upper quadrant movements so the head, the shoulders, the shoulder girdle or the arms, that it supports and provides the movement foundation for that. If we don't have movement there, then we're gonna get stresses that come through those other parts of our body that are gonna exceed the normal stress of those tissues and they start to break down. Note, disc herniations, degenerative joints, hypermobility to shoulder, impingement, rotator cuff tears, et cetera, et cetera. Does extension, you know for you who work on getting the extension of thoracic spine, does it interfere with getting the rotation there? And they're actually are forced couple, they go together, when we're going to we have to go into extension to get good rotation, right?

And that's why I said if we get stuck in kyphosis or flexion posture, we then lose availability into extension and rotation and if we lose extension, the sagittal plane that's gonna cause impingement but even more so when we go into rotational sports like volleyball, swimming, tennis, baseball, any throwing sport and now even a bigger thing is a lot of hanging activities. So if you look at CrossFit and you look at acrobatics and you look at acrobatic yoga and you look at Cirque du Soleil and you have a lot of hanging activities and some of them are active hanging and some of them are passive hanging so there's different activities that go on that. You know, if you're passive hanging on your shoulders, right? And you don't have good thoracic mobility to allow that to be congruent, you're going to actually cause impingement because of strength. Good, the last one is a cervical spine and I like to remind people the cervical spines job primarily is to move our head around to be able to interpret senses to see what's around us and so it has the greatest mobility and the least amount of weight bearing property unless you have a really big head, right?

So the idea is that it allows us to move but what happens if we lose again that thoracic mobility? So go back into the slouch and notice what happens to your cervical range of motion, right? It decreases by over 50%. So if I'm driving a car and I'm in a bad posture and I get hit from behind, the severity of the whiplash is going to be much more severe with a poorly organized body than a well organized and supple body and that's what Joe said, show me a 30 year old with lack of spine mobility and I'll show you an old man, show me a 60 year old with good spine suppleness and mobility and I'll show you a young man. And so there's something true about that, that distribution of movement equals distribution of force.

When we have good properties of movement and we know where that movement comes from, we can significantly decrease the risk of injuries and increased performance. Because just 5, 10 degrees more of rotation in your thoracic spine can be the difference of a 250 yard drive of a golf club and a 300 yard drive of a golf club. It could be the difference of a 80 mile an hour pitch and a 94 mile an hour pitch. It can be the difference between being able to pick your grandkids up out of the bathtub or not be able to pick your kids up out of the bathtub. So whatever we clarify is what our daily tasks are that we perform in, we perform better when we have mobility and that connectedness which we'll talk about motor control and understanding where the movement comes from.

At the very top of the cervical spine is the OA and the AA we call, they also put out less in atlas axis. In these two joints, 50% of our head range of motion is received from there, right? So we have 50% of our flexion extension, 50% of our side bending and 50% of our rotation come from those two joints, the head on the top of the cervical spine and C1 and C2. So again, if we lose range of motion and the other parts of our body and we go into this forward hit, it slides forward and we take up the slack in those ligaments and we lose that OA, AA mobility. So again, a force that comes to us or a sudden movement or sleeping funny, immediately causes pathology and damage or give and deformation to those tissues and that's why we see so many problems in degeneration of cervical spine.

So to me, the healthier thoracic spine is the healthier the cervical spine is gonna be. We're going to move on more to the lumbar spine. So when we look at the relationship with only animals that have what's called a bi-curved spine. So even our closest animals the monkeys, right? The chimpanzee, the primates have a single curved spin so they go right from sacrum up into the cervical spine, has this nice big C-curve.

Now I know some humans that look like that but typically we're supposed to be bi-curved spine, So we have a lumbar lordosis and a thoracic kyphosis and then another cervical lordosis, we call that bi-curve. And we are the only animal on this earth that has that bi-curve and uprightness. And the reason for it is that we have that reciprocal nature for us, right? That's how we move, we don't move like this as an animal, we move like this as an animal. You see the difference?

You think of a horse galloping, right? Right? Or a dog or cat and you see the spine doing this. Our spine movement is different, our spine movement is about rotation. And so the primary amount of rotation comes from thoracic spine, a little bit from L5-S1 and our hips, we need to take better care of those.

Let's take a look at the disc in the picture. So what you'll see is in the disc, you see the bands and Netta does a beautiful job of drawing these bands but those fibers really don't look like that in the typical human being, We can dissect things to look like anything we want to draw them but our tissues adapt to the stresses that are applied to it, this is called Wolff's law, our tissues adapt to the stress applied to it. If I run with a funny gait and I put stress on a ligament or a tendon that comes into my heel bone, it will create a bone spur because the stress that's coming into that bone get irritated, inflamed and create a bone spur. If I don't use something, it atrophies, right? Don't use it, we lose it.

Well imagine that we are a 55 year old sagittal beast. That doesn't do anything but bend forward and sit in chairs all day long. So for 55 years, maybe there's a time I was active from one until five and then a little bit in high school football where I got the notion that I was athletic and then I went to law school and I never saw rotation again in my life, right? So that is called a sagittal beast in my book, right? So now that sagittal beast becomes 55 years old, his kids move out of the house, he has a little extra time, his friends wanna play golf and he decides that he wants to play golf or he decides he wants to do and participate in yoga, right?

Because he heard Yoga is good for your spine. So now you take that 55 year old sagittal spine and we're gonna take them and put them into rotational poses. But the problem is, is the rotation of fibers on that disc are not really there, they look like jelly because there's been no stress to them for 50 years, does that make sense? Our bodies are what we practice. So if we don't practice rotation, I take that gentleman out and I take him on a golf club and he has the notion in his head that he's out athletic because he played high school football and he watches football on TV and opens up a beer can, right?

(laughs) Now he believes he's athletic, he goes out competitive with his friends and he's whacking the heck out of that ball, right? And he's wondering why he starts to have back pain. Now, if he plays any time at all with this poor organization and lack of rotation, he even might do damage to those annular fibers of the disc and lead himself into a disc herniation or a disc pathology, okay? The same thing would be true going to a yoga class and having some young, handsome or beautiful instructor come by and do an overpressure in that rotation when he doesn't have the inert structure resistance to that. See, this was happening in our inert structures of our sedentary lifestyles and he said inert are non-contractile, so we're talking about ligaments, discs, bones, connective tissue that is non-contractile, all right?

So as we become sedentary animals, right? We have less and less rotation that comes to our body when we really should be what? Rotational because we're bi-curve, bipedal and we start losing that rotation and we start walking like a sagittal animal and you see people doing that all the time, they start lumbering, right? They lumber when they walk instead of having a rotation when they walk, okay? Big difference and when we lose that rotation it creates havoc in our bodies and so it's very important to understand that, okay, now that sagittal beast tells me he wants to go back and play golf or she wants to do yoga or play golf, I'm thinking to myself, I need to create normal and healthy stresses to those tissues over a period of four to six months to prepare them to be able to withstand the forces of rotation, otherwise they will break down.

So the question I ask is, how long do you want to play golf for? Do you wanna play golf for the rest of your life until you're 90, then you need to spend six months preparing your tissues before you go out on the golf course to go to the golf pro. Is that a fair trade? Because I can send you out to the golf course and golf pro now and you're gonna be coming all the time with injuries and you won't be able to play longer than five years and probably end up with some back surgery by the time you're 64, 65. What do you prefer?

What do you choose? What's better for you? Lifelong, active, healthy, participating in activities you want or start breaking down and seeing the pathology and the doctors and the surgeries and the medicines that accompany those pathologies. And so it's very important for us as Pilates teachers to understand how do we facilitate normal stresses to those tissues to get them so that they start having the tolerance and ability to withstand the forces that are normal. Golf is normal, yoga is normal, our bodies are meant to do that but when we don't do it for so many years, we lose and we adapt to the sedentary lifestyle and our tissues adapt as well and we need to go back in and tell those fibers that are on the diagonal, hey, it's time to work again.

It's time to start having stress again so you can be strong and condition, I'm just like we had to condition our muscles or our nerves or our skin, right? We put stress on them and they start behaving. When we look at the disc, the disc has a very unique property and it's one that cannot be matched by synthetic manufacturers yet, okay? When we think of what the disc is capable of doing, it is in between the two vertebral bodies and its primary objective is to be able to transfer force so it absorbs and distributes force and allows movement in all planes, I think this is really important, all planes of movement. So that gelatinous jelly in the center the nucleus pulposus pushes up against the annular fibers in the different directions based on where the plates of the vertebra are moving and to your posture or your lateral rotation side to side, okay?

So very cool phenomena. So, we look at what the disc is able to do if you take your hands and you pretend that the top hand is one vertebra or vertebrae and the bottom one is another and in between those two hands is the disc so the property is a movement goes something like this, I can go into flexion extension from above, I can go into flexion extension from below, I can go flexion extension or side bending right and the left from above and right and left from below. I can do right and left rotation from above, right and left rotation from below, I can do an anterior, posterior glide from above and anterior, posterior glide from below, right? And I can go laterally and from below, right? And I can do circumduction to the right and left from above and circumduction right and left from below.

So what that's telling me is I have 12 degrees of freedom, right? 12 directions of movement that my disc allows every one of my 22 segments that have disc to be able to move which is a significant capacity for movement, we don't come close to exercise in that. We see it occasionally in the circ, we see it occasionally with people we call freaks but the truth is, is all they're doing is accessing the movement of their spine that they were given as part of our creation of human beings, we have that movement. Those that are contortionists or circus performers or acrobats that go into these extreme ranges of motion, we sometimes think of them as, you know, being abnormal or going outside, they gotta be breaking bones to be able to do that. The reality is all they're doing is accessing what we already have, it's just they have learned how to get access to the movement and all 24 vertebra, where typically we move from three or four in a typical human race, when somebody comes in there's two or three places that we move from out of 24.

So even when we fuse somebody's spine, they often don't move very different when we fuse our spine at 17 levels, that's what is scary, right? That we have the same mentality or problem solving as average human being as somebody that has a 17 level spine fusion because we just don't move from our spine, right? We sit, okay? And I think that's a great point. So when we think of this idea of the disc.

(speaking indistinctly) What's that? So you can just move it around a little bit and get it going and just appreciate that and I am going to have you stand up for a second so we're gonna do this and I'm gonna have somebody come up in the front with me so why don't you come up with me here? And I want you to assume the posture of a 15 year old that is on her iPhone. Yeah, you got it, okay? And probably their legs are gonna be like this a little bit for balance sake, right?

If you have a 15 year old, you sort of know what that like. (speaking indistinctly) Yeah, Okay. So what I wanna do is create the image, right? That those discs are like balloons or inner tubes, all 22 of them, right? There's two vertebral segments that don't have this as OA and AA don't have disc between them but all the others do.

And I want to also have the ground rule that this is your central axis here. So as you're standing there, I'm gonna pump up the vertebral disc as if they were balloons and I want your body to change into the position that you feel would be the right thing at the disc we're pumping up, ready? Good, put your arms to drop down, the phone drops, good, the phone drops, get off the phone, all right? Now from there what I want you to feel is just go into a gentle rotation of your spine, let it just rotate, right? And from that now stop that and I want you to think of some of the common Pilates cueing that we use.

So I want you to think of hollow in the abdominal wall or drawing the belly button to the spine, lift the pelvic floor up as high as you can like a fountain exploding to the crown of your head, So feel that drowning in the abdomen, lift up the pelvic floor and now rotate and tell me if that feels different than what I gave you with the pumping up of the disc. What did you notice differently? Rigid A little more rigid, right? So sometimes our imagery of time to contract muscles is not as efficient. But here, let's make it a little more complicated, the body adapts to the stresses applied to it, right?

And the anticipation is based on what we've experienced in the past so that was a very easy free flowing thing but let's say that we imagine we now have 10 pound weights in our hands or bags of groceries, as Christy pointed out earlier, right? So we have a bunch of gallons of milk in our hands, right? So we do the same thing. And then you realize I mean, even the change in a posture is drastic, I don't have to say where the bones have to move, it just happens because the spine when it gets actually elongated, everything falls into place, it's pretty amazing. But now you have these 10 pound weights in your hand or even maybe 20 and now rotate and feel the difference, you're gonna feel probably a little more stiffening with the anticipation or pretending that you have weighed in there, right?

Now get rid of the weights, there's no weight in your hands and feel what happens to that rotation, right? Feel free. Now go back to the visual image of drawing in the abdominal wall looking at the pelvic floor and rotating and notice immediately you stopped your rotation. Can you feel that? So we depreciate the value of our spine significantly by overriding a visual image of a muscle contraction and we do that all the time in Pilates and I was guilty of it so I have to confess too.

But as we learn the properties of the body and how the spine actually has made the work, we realize that's why a child moves so well. A chile when it gets that and learns because when they lift something heavy they fell on their face or on their bottom and they learn they had to have a little more stiffness the next time they went and picked up that truck or that doll and by the time they're four or five years old, they sort of got it set and then we put them in a chair, right? Then we screw everything up, okay? And so letting them play outside, learn how to use a monkey bars and those things and only those that are financially fortunate often have that opportunity to take their kids to play gyms that actually allow them to play. The majority of our kids in school is no longer have that, they have after school care that also becomes babysitting and often sedentary and gaming.

So even after school care of 15 years ago was going out play in a playground, now they sit and they play with their phones in that game because they don't want the risk of them being outside, all right? Thanks.

Chapter 3

What is Core Control?

Another component in the next slide is we're looking at this idea of this hydraulic amplifier and I've put a picture up here that is a schematic of the hydraulic amplifier or the core unit. And I think we've also sort of gotten caught up in this poor interpretation of what is core control. I think we've gotten caught up in thinking that it is tied to torque or muscle contraction or muscle strength when in reality, it's about a connectedness that creates the appropriate amount of intra-abdominal pressure based on the anticipated load of the activity.

So if I'm swinging in a golf club, I don't wanna have a whole lot of stiffness because I wanna speed of the golf club. If I'm lifting 300 pounds, I want stiffness because I'm lifting, I don't want movement in my spine. So just as we anticipated 10, 20 pounds in our hands, our body stiffened up naturally based on our anticipation of it, our pretending, right? It would do that if I'm gonna pick up a box that has, you know, paper in it from the office and we know we gotta transport it 30 feet, our body's gonna stiffen up and it's gonna be very little movement, we don't want movement with that. But if I'm gonna go out and play catch with a dog or throw the stick or go swimming or playing or running, I want movement, I want freedom, I want mobility, right?

And so what we look at is this organization of this hydraulic amplifier and it consists of a bunch of muscles that are around the spine and not just muscles but the fascia connections and their relationship. So we're looking at how does the pelvis relate and communicate to the thoracic spine and the thoracic cage and you get the lumbar spine in the middle of it. So we have these muscles that drape around in different angles that are connected through fascia planes that when we organize our spine in the right position, they function very well. When we're in a poor position, they don't function well so I could be nice and strong here slouched but that doesn't give me core control. Core control is found when I have axial length and mobility available to me for the appropriate activity that I'm participating in, right?

It's not about torque, torque comes in long afterwards when I'm starting to build up something that I'm doing that requires a tremendous amount of stiffness, like power lifting, right? Or that I have a job at work that requires me to do repetitive heavy lifting, then I start thinking about torque on top of a well organized rib cage to pelvis. Torque is actually power, power that we generate like torque of a muscle, how much power can a muscle contraction generate, right? Torque could be like you have a torque wrench that you put in but torque really is about the power that goes into the wrench so a torque wrench will break when you get too stiff. Okay.

So a torque wrench says this only handles 40 pounds of torque when you put in on this bolt. If you go more than 40 pounds of torque, you'll break the head off the screw or the bolt so that's a torque wrench, right? But we suddenly say I got a torqued pelvis or I have a torque this or yeah, but I think that's more of a misuse of the word rather than thinking of it's the power, the torque of a car, right? What is the torque of the engine, what is the torque of the gearing of the engine for a big diesel truck, they'll talk about its torque in first, second and third gear to be able to move large weights so the higher torque ratio, the easier it is for them to move the car forward or the truck forward, okay? So torque is about power and we're not really interested in that in this stage of the game, most of us have plenty of torque for our desired activities, we don't have good alignment and we don't have good organization skills because of our sedentary life.

So we look at this cylinder that is in our body here and the top of the cylinder is the diaphragm, the bottom of the cylinder is the pelvic floor and then all the musculature around it are all integrated part of it. So it's beautiful that the diaphragm comes over the front of the lumbar spine and attaches down like L4 and L5 and the anterior longitudinal ligament and the pelvic floor comes up and attaches into that same anterior longitudinal ligament. The psoas goes up on the backside of it and the quadratus also on the backside of it in the medial fibers are very close to the spine even attached to the spine, the more stiffen I fill in the back of the spine and so if I took a cross section of the spine or our bodies we would see these pillars around the spine and then a shell going around the front filled with guts so the shell is gonna be your abdominal wall, it's gonna be your transverse abdominis, your obliques, your rectus and the facial planes that go with them so the rectus sheath and then coming on the back into the thoracolumbar fascia and erector spinae so we have this beautiful tube and what happens sometimes is that we get an imbalance in that tube, in that relationship by either being out of alignment or in poor organization, we don't use the right muscles. Alright, so let's take a look. When we look at the mobility of the spine and one of the things imposter that we often talk about is the ability of articulation of spine and we say distribution of movement equals distribution of force, okay?

And I repeat that, distribution of movement equals distribution of force. So if I have a rotatory force coming through my body from a swing in a golf club but I only move from L5-S1, that I'm gonna have a tremendous amount of torque going through L5-S1 but if my strategy allows me to move from three or four other segments, that's gonna reduce the amount of torque going through and the force going through L5-S1 by maybe 50, 60%. We did a little study at Loyola Marymount in Los Angeles in 1996 and we had a machine that looked at the segmental displacement of the vertebra so from T2 all the way down to the sacrum, we looked at flexion. So we had people stand up, they went down and their flexion, how far down could they go and we repeated the measure looking at where did the movement come from, the total range and then segmentally. And we found that in the pretest that the majority of the people had a significant amount of movement that came from L4-L5 or L5-S1, very little movement from L1 to L4 and almost no movement measurable from T2 to T12.

Now these were healthy people that had never had low back pain and never had done Pilates. We then split them randomly into two groups and we had one group called the control group and they just rested on the table for 45 minutes, came back into the same test again, and had the same result, same thing. So primary movement of L5-S1, L4-L5, very little upper lumbar, almost no thoracic, okay? We took the other group and we did a 45 minute session on the Pilates equipment, on the reformer only. So we did footwork, we did bridging, we did feeding straps, we did roll down and we did a quadruple exercise for them.

We then brought them back in and we had to measure again and we found three significant changes in this small group test. Number one, the total range of motion and movement in flexion increased significantly. And you would say, well, that makes sense because you probably loosened up the hamstrings and the muscles and the joints and you got more range of motion, that's fine. The second one was that the upper lumbar and the thoracic actually had a significant increase in their mobility. So we're very pleased about that to say that, yes, Pilates could increase the movement in the upper thoracic and the upper lumbar but the third and most important finding was that L4-L5 and L5-S1 decreased by an average of 50%.

You see, when our clients come to us and say I got a herniated disc and I got a spondylolisthesis, I have a stenosis and I have chronic low back pain and they do Pilates for three months and they come back and they say, you know, Pilates got rid of my disc problem, Pilates got rid of my stenosis, Pilates got rid of my spondy, it didn't really get rid of the pathology, did it? If I went back in and did an MRI, I would still see the disc pathology, I'd still see the degeneration, I'd still see the bone spurs but what's happened is if I can reduce the stress going through that segment by 50%, right? That's significant because that might be enough to take away that perturbing for us that's irritating that nerve or irritating that joint or irritating that facet that's causing a pain response, right? The inflammation response, I think that's really important for us to understand. And sometimes when we teach the stabilization concept, we actually take away movement that should be there that would distribute the force for our low back patients, does that makes sense?

We got a little too carried away with this idea of core control. Rather than thinking of just good control which goes back to Joe's word of contrology or the science of control, stability is the control of movement, you have to have movement to have control of it, right? Now when I had a cervical fusion about three years ago a lot of you in Pilates Anytime don't know and the doctor came into me right after the surgery and he says, Anderson your cervical spine is stable now. And I thought to myself stable, like hell it's stable, it's fixed, it's fused, there's no movement, how can I control because my vision of stability is control the movement and I know that I don't have movement in those three segments so I can never have stability and C5, six, seven and T1. In my mind, I can never have stability because it's rigid so what do I have to do?

I have to find movement and control that movement above and below in multiple segments to keep the shear force away from T1 and C4 or C5 because those are the segments that will get beat up if I don't distribute that force that normally would go through C6, seven and C7-T1, does that make sense? And that would be true with any of our clients, that's how when they come in they have really good whole body Pilates experience over and over again, they get to that point, they'll say my back problem is gone, right? And let them think that, that's okay because in essence it's no longer a problem so it is gone, right? The pathology could still be there but we don't care, right? As long as they move well and they're doing and participate in activities and they feel good, they have a healthy spine, right?

If you create the image of them having an unhealthy spine which a lot of us do as healthcare professionals, my goodness, that's the worst disc herniation I've ever seen, it's amazing you can walk or man, there's so much bone build up around there, you need to have surgery on that, right? As soon as we create those kind of images or man that scoliosis is so severe it's like over 30 degrees, we create these images inside the head of our clients and all they see is that pathology and they have the fear that's associated with it. And maybe they have experience from their ancestors or their family members who have also suffered severe back surgeries or severe back pain or other problems, right? And so we have to be very careful with the terminology we use. Just like Joe said, hey, the spine that moves when you're 60 is a healthy young person so let's just get the spine moving.

That also doesn't mean we have to say to the person that's not moving well, my goodness, your spine is stiffer than 100 year old dead person, all right? So current trends in spine care. I think this is important for us to know understand because we hear these words and these phrases out in the community, things like stability, things like core stability, motor control has been rising over the last 15 years a lot with Carolyn Richardson and Paul Hodges work out of Australia, there's a lot of Diane Lee out of Canada in Vancouver and so there's a lot of really cool work coming out. And more importantly now, this huge push for us to really get into return to functional activity which really was the mission of Joe, right? He said, we perform these daily activities and we do our exercise so we could perform those daily activities spontaneously and naturally, that's function.

He is not saying, who can recruit the most muscles doing the hundreds and squeeze their butt really tight and hold their guns really tight? He's saying, you know, if we do these exercises, we're going to be able to do our functional activities better and we have less risk of injury and it's gonna be spontaneous and natural and you're gonna feel good about it and that really should be our goal, especially as we have more and more sciences supports what we do which is what I'm here to talk about. And the last one is the psychosocial influence that pertains to what we do as Pilates teachers to shift the way people perceive their spine and their body and how they feel so very important aspects of it. And when we look at spine stability, this principle of control, I mentioned this already, we must have mobility before we can have control of it so let's talk about that a little bit. Have you ever wondered if somebody is hypermobile, we use these terms hypermobile and hypomobile so hypermobile means it moves more than normal and hypomobile means it moves less than normal, can we have stability in both of those scenarios?

Could we have control of hyper mobility? Absolutely. You know, what is normal now versus what is our capacity now, right? That's what we're saying our capacity is really high to be able to move, we could shift normal up, you know, oodles of ranks if we participated in movement, conscious exercise. But because we're sedentary, we've moved normal down to a level that's very unacceptable for human performance.

I guess that's the normal that we are speaking of at this moment. Yes, that is the normal that we're speaking of at this moment, okay? That's a good clarification. So the idea is, when we look at somebody, like for example, I work a lot with dancers and performers and I would bring in orthopedic surgeons and other therapists and other movement teachers to come in and help me do the annual screenings with them and I would get through like 10, 15 dancers and I got one orthopedic surgeon or one doctor, one therapist going like, can you believe the range of motion his hip has and they're like stuck on this person for like 45 minutes because it's so far out of their perception of what normal is. And when I take that patient to them to be evaluated for things like labral, tears and stuff, they look at the range of motion they go, what do they need, I mean they have all this range of motion, they need to be you know, they don't understand what our potential movement is because normal has been brought way, way down of what standard is, right?

In all healthcare. Like I go in and I do a performance and a stress test for my heart and I know that I'm not in the best condition I could be in but my cardiologist says, you're in the top half percent of the patients that come into a cardiologist, I was like, I don't wanna be any part of anything that goes into a cardiologist, I wanna be such an outlier out there so far that I want to be in the point 0000.5, whatever, you know, mathematically way out there and the outlier, right? Because we've accepted disease as part of our lifestyle, right? We've accepted that in you know, we call it healthcare but it's really chronic disease management, we don't have a health care system in our countries, we have a chronic disease management system and we need as Pilates teachers, we are healthcare. We are the true health care and if we follow Joseph Pilates philosophy of restoring people to returning them to life and giving them things that they take responsibility and that is a huge issue psychosocially is that we have neglected the responsibility in us to be healthy and we have created in a system of entitlement.

You owe me my healthcare coverage which really is saying my chronic disease coverage because I'm accepting the fact that I'm gonna have diabetes and I'm accepting the fact I'm gonna have heart disease and I'm accepting the fact I'm gonna have back pathology and because of your pharmacy and because of your insurance and because of I work for you and because I belong this country, you owe me those things but just Joseph Pilates is saying exactly the opposite, he is saying it's your discipline, it's your responsibility, you choose how you wanna live your life. If you wanna return to a high level life then you will participate in these exercises, this nutrition, this balance between work, play and rest, you'll get plenty of fresh air and sunshine and you will keep your body clean, right? And that was that was Joe's formula, that's his first guiding principle of whole body health. You know, it's not complicated but it certainly is completely outside of what we consider normal, right? In our in our society which is that.

So back to the idea of instability and stability. As long as we have control over the movement, we are stable. Is that a fair definition? As long as we have control of the movement, we are stable. Now, what you choose to participate in, can shift that.

So, let's say that I have pretty decent movement for doing things like swinging a golf club but then I wanna go audition for Le Reve in in Vegas, right? And I wanna be able to do single arm weight bearing handstands 40 feet above the water and release myself and doing a double backflip and entering in a small hole of water. All of a sudden, my level of stability and control and mobility is not adequate which means I'd have to do a lot of training to get my body up to that level, right? Now, the problem we have is actually in the word instability and this is where I think the physicians and the surgeons and the therapists confuse that with hypermobility. Instability means you don't have control over that movement, can you think of an incidence where you lose control of movement in your joints?

Can you think of knee injuries or ankle injuries that there has been trauma to them and they're no longer our stabilizing inert structures to keep it congruent and to keep that joint auto kinematically sound? Can you think of some injuries, what can injuries come to your mind? ACL, good. ACL so somebody comes behind me in football, clips me here, takes that leg forward and tears my ACL ligament, right? So now I don't have that inner stability, right?

In there and so my knee is gonna be sloppy and the muscles aren't gonna really be able to take its place, right? It's not gonna be good enough or the sprained ankle, well the same thing happens in the back and that's we're gonna talk a little bit about Panjabi's model of the balance between inert structures, contract out structures and the motor control of them so that's Panjabi's triangle of stability. And so Panjabi says you have to have movement and that stability is the balance control of that movement. We have defined stability as being rigidity,

Chapter 4

Stability vs. Instability

not control of mobility. Yeah and so what we've adopted unfortunately in the Pilates world is how do we interpret powerhouse to be a stabilizer and a holding and a stiffening element, rather than thinking of movement that's going to distribute force and provide better efficiency in our neuromuscular organization and that's really the difference of what we're saying now and that's why I'm purporting to us as a profession is like hold on, we've taken things and bits and pieces of information from research and we might be misinterpreting it as a way that it fits into how we want to create healthy spine as it pertains to Joseph Pilates philosophy, I think that we might have gone outside of what we should have gone outside of.

And so I've got some things up here on the board that sort of help us with that, right? Appropriate amount of stiffness for anticipated low, that's Panjabi's statement, that's probably my favorite definition of stability, right? It's not over recruiting, it is not pulling my abdominals in and holding all day long because my body doesn't require that, right? People who do that often end up with contractions or their abdominal wall, no longer can use your diaphragm and now pelvic floor dysfunction. And we saw that in our little study that we did at the PMA so we ultrasound at 75 pelvic floors as Pilates teachers and we basically took the snapshot of their pelvic floor when they thought they were lifting their pelvic floor up.

50% of the Pilate Tess that were doing this exercise were actually pushing their pelvic floor down when they thought they were lifting their pelvic floor up. So what it tells me is a number of things, maybe over recruitment here, maybe the pelvic floor already is in a chronic contraction up because they're always lifting their pelvic floor up and they don't have the ability to descend the pelvic floor, they increase intra-abdominal pressure and it pushes it down, right? And it might not be so much about us teaching people to lift or lower the pelvic floor as much as the appropriate amount of stiffness that intra-abdominal pressure to be accurate and it will come with it and I would prefer us to be able to do stretching of the abdominal wall and the pelvic floor. Women who had had multiple childbirth vaginally actually had better ability and more displacement of lifting the pelvic floor than the hardcore Pilate data that had over recruit the abdominal wall could not lift the pelvic floor. Did you measure in men?

Yeah, we measured men and all the men that we measured had perfect pelvic control lifting their pelvic floor. Totally true, totally true. Christy doesn't believe me but it's true. How many did you do? About five, we did five men and we did 70 women.

But that's about the ratio of men to women in the Pilates industry but yes, they had very good control. A lot of it has to do with the cueing and so other things we saw, we saw some women doing a vaginal contraction rather than a pelvic floor lift and others doing abdominal contraction rather than a pelvic floor lift so it was just probably in a glute squeeze was the other compensation. So they didn't really know where their pelvic floor was or what we were asking so all I wanted to know, I didn't wanna teach them, I was just asking what you think is lifting the pelvic floor I want you to do and tell me when you're doing it and that's what I would measure. So the next study now is to see as if I can teach that person that pushes down if they had the ability to lift up or start having controlled and having at least an accurate interpretation of where their pelvic floor is in relationship to gravity, right? I think that'd be important because I think a lot of might be over recruited up, some are misinterpreting the vaginal wall, some are doing anal wall, some are doing glutes, they're not really understanding where the pelvic floor sling is, the pubococcygeus muscle elevator if any, okay?

Interesting stuff. Another one that I love this is from a mentor of mine, he says as much as necessary as little as possible. This ties into Joe's concept of efficiency, it is efficiency. We want to be efficient supple movers as we age, we do not wanna be that hard body, over recruited, damaged muscle skeletal system waiting to die because we can keep you alive longer with medicine and with surgeries, right? We wanna be active, we want to be supple and that's what we're looking at.

The rules of efficiency, talking about being unconsciously competent had to point that because we practice these exercises every day, our body is competent in whatever we ask it to do and or we realize that we are not ready to do some of those activities that we are thinking about doing, right? Sometimes the body will tell us, you know, I know you wanna go play Ultimate Frisbee but you are not in good shape today to go play Ultimate Frisbee, it is gonna be too hard on you, you need to do more work before you can, not that you can't do it but your body's not ready for it today. When we can listen to that deep internal whispering in our bodies and our minds, not the negative one but the one that is truly aligned with our body because we practice alignment all the time, we avoid things that are gonna cause us injury, lifting up heavy things when you know lifting that 70 pound TV is going to hurt your back but you're angry and you wanna move it because your kids are watching too much of it and the next thing you do is you, you know, you hurt your back. And so some of the things that I hear patients tell me like, why did you try to, you know, lift up that big TV by yourself? Well, my husband's gone and my 14 year old son can't get off the TV and I just got so angry, I pulled the TV off the wall and took it out to the garage and then my back's hurting about 24 hours later, right?

So when we're in tune, we don't do things like that, we don't make those decisions, we wait till help comes in or we figure it out. And the last thing I have here is the Yoga Bandhas and I think this is important too because our work comes from yoga. And Bandhas are defined by Simon Borg-Olivier as a co-contraction of a joint complex. So that means that we have multiple muscles and fascia connections around a joint complex like the lumbar or pelvic region that we're talking about today, that work together to create an appropriate amount of stiffness for the anticipated load. Yoga would also look at it of controlling the prana or the chi that's flowing through that part of your body so if you're doing a headstand, you would want the shoulder ulna bone to have a certain amount of stiffness to keep all the blood from going to your head as well sending the energy back up towards your hips or your pelvis, right?

And that co-contraction is on a line spine a very powerful tool. So depending on what direction I'm moving, so for example, if I wanna do a roll up, where do I want to have a little bit of extra stiffness so that I have good mobility in another part of my spine? Where would I want that stiffness to be in a roll up? Do I want it to be above or below where I'm rolling up? So I'm laying on my back, I wanna do a roll up, I want to like articulate my thoracic spine, where do I want the stiffness?

Low, right? So I want my lumbar pelvic region, my Mula Bandha to be a little bit stiffer so that my upper body can articulate on it. If I'm loose down here and I don't have any control down here and I try to lift up, this becomes rigid like a big block and can articulate anymore. Now take that and reverse it and say we wanna do a rollover, right? We have somebody to teach, you know, engage that powerhouse at all times, if I engage my powerhouse while I'm preparing to do a rollover, I'm basically creating a big brick here that I actually want to move this and I don't have the right stability appear so I end up going into my neck and compressing my neck.

So in a rollover, I'd wanna have more stiffness up across the shoulders and more looseness and mobility in my lumbar and my lower thoracic spine and my hips, does that makes sense? So the Bandhas move up and down based on where the anticipated load is going to come and speed and mobility have to have a part of the body that has stiffness to be able to accelerate on. I can't accelerate if I'm just all floppy so stiffness is important in our performance but if you are over stiff what happens? Performance goes down, if you're under stiff, what happens? It goes down, that goes back to Panjabi's definition, appropriate amount of stiffness for the anticipated load, that comes from practice.

So if you think of sidekick, I mean sidekick is such a beautiful example of that, right? So here I am, I wanna have mobility in my hip, right? But I don't want mobility up in here so I have to have the right amount of stiffness but if I'm too stiff, then I don't have any movement in my leg. If I'm too loose, then I have too much movement here so to me the sidekick exercise is a perfect example of finding that balance between stiffness and mobility and all movement is about that, right? There's all different grades of how much stiffness I need to carry a big box versus to walk versus to run versus to sprint to run upstairs is a very different, you'll get a lot stiffer in your upper body running upstairs because you need something for your legs to push off of to accelerate you up against gravity, right?

So you get a lot of stiffness here and a lot more work happening in certain muscle groups without telling them you need to be recruiting this muscle. Just by putting your body in the right place where and the right activity will change the amount of stiffness demanded then we practice we become more efficient and we have the appropriate amount of stiffness we anticipate low, we become efficient. Any questions on that concept of stability? It's a shift right? But it's going back to something that we feel intuitively inside of us of what a beautiful mover looks like.

Remember in Pilates look at quality of movement, not quantity of movement. It's the flow, it's the connectivity, it's the transition, it's the alignment, right? These are all are words that we use as Pilates teachers. It's not the torque, it is not the squeeze, it's not the hold, those are words we tend to try to pull out of our of our vocabulary, we don't want those words in there. Hold your pelvis while you do this, right?

Contract this muscle and hold it in, right? While should you do this? No because we don't know how much muscle has to be contracted in that moment. If I do a maximal voluntary contraction of my TA in that moment, I'm probably gonna interfere with what normal movement looks like. So let's take a look a little bit of anatomy here and I won't spend too much time here but I think it's worthwhile looking at.

We look at the relationship with the fashion, the direction that the abdominal oblique muscles and transverse come into that rectus sheath and how they connect, it really is not about any one muscle firing and here's a good time to make a point that if you remove the fascia from around the muscle for sequelae, there is no power in the muscle, the muscle has no torque, it has no contractual ability. So the fascia is an integral part of that connectivity, right? And the fascia is not just around a muscle fibril, it connects the muscle fibril to other muscle fibrils and connects muscle groups to other muscle groups and typically is surrounded by another fascia component like the fascia Lata. So when I stand up and let's all do this, just stand up on your legs for a second, you can stand on your hands but probably better if we stand on our legs and just give yourself a little squeeze in the thighs and just sort of notice how much tone do you have in your legs standing there, right? But then shift over onto one leg and then squeeze your thigh that you're standing on and notice what happen, is it a little stiffer?

Yeah, but now do a voluntary contraction, go ahead and tighten up your quadriceps in your hamstring, that's a different kind of contraction. So one was spontaneous when you put the load on the leg and your alignment, that hypertrophied inside the fashion to give you stiffness so your abductors can work efficiently to hold you up but when you did a volitional contraction it got in the way and that's the same thing I'm saying about the core. When you volitionally make a contraction you get in the way, if you just stand with good posture and you create the demand, the stiffness is gonna increase automatically, right? And the right way and the more we practice it, the more efficient we become to be able to do activities and start having freedoms of moving our body through space on that appropriate amount of stiffness for the anticipated load. If I wanna move faster and do things with force, what's gonna happen to the stiffness in my core?

It's gonna go up. If I'm doing things with less movement, it is going to go down. And the thing is in something like a kick or swinging a bat or something like that with so much force and speed going through, right? That I need to have something that I can accelerate on. My torso has to accelerate on something, there's something happened that I'm accelerating on, if I was holding a muscle and it's happening so fast, that was holding a muscle like you really got to get your abs ready for when you hit that ball and you're stiffening up, you've lost the acceleration, where the image of accelerating in itself creates the appropriate amount of stiffness.

And as we get stronger and stronger and we swing faster and faster, those muscles get stiffer and stiffer at the appropriate fraction of a second. You can't tell that muscle when to be strong, right? Because that volitional contraction is 250 milliseconds, we're talking about 50 milliseconds, right? In a correct anticipated low. So these muscles work in a very cool way because they talk to each other, we think they talk to each other through the fascia and through the proprioceptive system that when there's a torque or a pull, those muscle spindle fibers know about and they go to the spinal cord and they come back and as messages going up and going down in our anticipation is a preparation for it.

There's some who even think that the fascia system is the tubules are filled with light photons, I mean that's been defined but that that light photon is also a communication mechanism that goes into a nerve and into contract our tissues. So the inner anticipation of movement because we have experienced things happen in fractions of seconds rather than a typical neurological definition, neuromuscular could be the fastest is 50 milliseconds but usually 250 milliseconds and usually 1000 milliseconds. So this is the kind of thing that we're starting to understand now is that there could be a whole anticipation communication system going on in our fascia system that travels at the speed of light, not at the speed of a nerve conduction, right? Not a brain to the muscle. Right, it's not gonna be a brain to the muscle, it's gonna be thought to fascia to function, right?

And we'll see, I mean it's coming. Here's another really cool thing, when you slice the abdominal wall horizontally, you can see how the different layers of the other abdominals make up the anterior and posterior fascia of the rectus sheath and I always love that picture because it depicts the divine organization that no matter where my body is in space, there is a fascicle pool or a contraction going on that can provide the appropriate amount of stiffness for the anticipated load on my interior wall and on my posterior wall. And to me, that's just a beautiful thing to think that it's so well designed that these angles and diagonals and crossovers only the fascia communicates and even the depth of the layers that they come in that deepest layer, the transverse plane on the back or the underside of the rectus sheath and pulling on the underside of the thoracolumbar fascia, I mean that is the deepest layer, that's really cool and the fibers are horizontal. So I mean, there's just really cool things when you start thinking about it, it's not that I want to teach my patients to contract their TA, I wanna appreciate the fact that the TA exists and when their body is integrated and moving it's gonna fire at a time that I can't even think of fast enough, I can't tell them when that muscle should fire. All I can do is say if the bones are lined up and we're anticipating correctly that moving because we practice it, it will fire efficiently and more efficiently as we practice it, right?

with good alignment, good congruency, good axial length which is what you brought up earlier Amy, to be able to have that optimal movement experience. If we don't practice it, we lose it. This next picture I love, this is sort of that cutaway of looking at the posterior wall but from the anterior approach and what I love about this is we can see where the diaphragm comes down the front of the spine, literally right in the front of the spine and goes into the anterior longitudinal ligament and those fibers can go down as low as L4 and even L5, you see the pelvic floor and the pubococcygeus coming up from below and going up over that lumbar spine as well through the thoracal, sorry through the anterior longitudinal ligament. And then we see the psoas muscle, right? And the psoas muscle and the tendon coming up and it's behind the apex of the lumbar curve, this is really important.

And it's medial fibers connect to the segments of the upper lumbar and up even into the thoracic spine, it penetrates the diaphragm. Remember I said the fascia communicates between these organs these muscles, right? And then we see the quadratus off to the left of that coming from the iliacus up into the lumbar and it's actually gonna go up right into the lowest rib, right through the diaphragm. So now that you have the psoas major and the quadratus lumborum that pass right through that diaphragm and the diaphragm comes down the front and attaches on the front of the lumbar spine over the apex a lumbar and the pubococcygeus so you started realizing like there's this really cool relationship in the anterior abdominal wall has all these different relationships and it is just this layering and this communication that takes place based on the load. It's based on the load, it's our experience that tells when those fibers should be firing, right?

It's our anticipation of something. So that brings us to a whole other aspect of talking about spine which is where is our anticipation? It's in our thought, right? And our psychology, yes, yes.

Chapter 5

Interpreting Research on Core Stability

One more slide here before we go into some other concepts of this is you know, we look at again from the backside now we see a thoracolumbar fascia that acts like the rectus sheath in the front and it's very thick fascia filled with juicy muscles in the inside of the multifidus and the erector spinae, we look at the angulation of it.

So we see the latissimus connecting the whole upper extremity coming down the top and we see the glute max coming up an inferior angle from below tied into the fascia lot and the gluteus maximus people used to think that it connected into the leg that actually connects into the IT band and so you can see if you ever roll on a roller and you get down about three quarters of the way and you hit a spot that's really painful and really tender, that's actually where the fascia connection of the glute max comes into the IT band, right? And then you have your glute needs coming down and your Tensor fasciae latae so you have this triangle that is sort of organizing that leg, all tied into the low back all tied into the front of the body, tied in to the upper quadrant, tied in to thoracic spine all the way up to the TL junction. You can see that TL junction where the traps come down, the T12 and the thoracolumbar fascia goes up to T11 and you can start seeing the relationship that these things are these guy wires, there's tensegrity model around the spine that when the spines in its position, whatever position I'm moving in, those organizations are gonna start communicating and knowing where my body is in space, whatever sport I'm doing and whatever I'm anticipating so when I've started anticipating acceleration, I anticipate power, I anticipate deceleration landing from a jump, I anticipate endurance, right? And so my body starts to adapt immediately to those anticipations and you think of anytime we learn something new, what does our body do? Over recruit.

The first time you learn to ride a bike, if you've taught a child how to ride a bike or you remember your own it's like this and pretty soon it's like, hey mom look no hands, you know, we become very efficient. First time you learn to drive a stick shift, and then I see my, you know, kids driving a stick shift and they got a, you know, child over here, they're barefoot, they got a phone here and they're gone, it's like they don't even know how they got to work, right? Which is dangerous. So the idea is that we become incredibly efficient through our practice, things become very automatic, we just anticipate that that's gonna happen, and it happens. All right, any questions before I go into a definition of core stability because this is the area we wanted to talk about?

Panjabi, probably to me is the the guru of understanding stability so he's a biomechanist and taught us a lot about this and Richardson's group which consists of Hodges and Hicks he just published 150 juried articles in 2013 and published two books in the same year, he's a machine. And obviously he is a machine but I mean, I take my hat off to him because his content is rich. So if you have a chance to study some of Paul Hodges and the people that he supervises their work, they're really organized, you know, well for us to understand the motor control of what is core, what is stability, what is proper organization and how does it tie into the central nervous system. There's some tremendous work being done on things like the smudging of the motor and the sensory cortex based on painful stimulus that when you have painful stimulus we actually have a neuroplasticity in our brain and things change and so we have to go back in and reeducate that and use the same neuroplasticity that gave it the problem to make it better and so just starting to scratch the surface on that with work from Lorimer Moseley and he has some beautiful work on pain, David Butler out of Australia as well and there's some very cool things out there. Stuart McGill is one whose name has come up a lot in Pilates and not always favorable and I wanna make a low distinguish kind of comment in here as well as you know, researchers do research and we look at things and we try to interpret what we see.

And based on what we look at, we like to think that we could extrapolate our findings to everybody that they fit for everything. So we can say, this is the model for all spine health, this is the model for you know, epidemiologically world health and peace but the truth is, is that it doesn't work that way. Extrapolation is very complex and so when we look at the researchers like Panjabi, Richardson and Hodges Group and McGill's Group up in Toronto, they provide a richness for us of information, how we interpret that information is very important. I think sometimes we get carried away and this is one of the reasons why the PMA wanted me to sort of clarify some of these things is differences between some of the research that's out there. And I think the most important thing to understand is we look at sort of Richardson's Group with Hodges and then his research group is we're looking at things in the beginning of segmental stabilization, transverse abdominis, efficiency of the multifidus, the pelvic floor and the diaphragm all working together so a lot of our work from Pilates really is well supported by the work coming out of Australia.

We recently had been criticized by some writer for the LA Times and the New York Times and The London Times, there's been different articles that have come out, that all have been anti Pilates, somebody out there is anti Pilates. And to me, I don't know why you'd ever be anti Pilates but you might not be pro Pilates but why would you be anti Pilates? And she has used research from Stuart McGill to support her. So Stuart McGill I think has gotten a little bit of a bad rap in the Pilates industry because what he's interpreting is our use of the word core stability. And he's saying, you're telling me that your hollowing of the abdominals is more stable than my bracing of the abdominal wall for core stability and I think you're full of crap, let's test it, right?

And he's tested it and he's absolutely right. If we are measuring intra-abdominal pressure and torque, his method of doing that with this idea of integrated abdominal wall and no separation between deep and global muscles and pushing out into the abdominal wall, he is absolutely right that he is gonna generate more torque. We know that from experience as we don't see power lifters going out hollowing their abdominal wall before they do a clean and jerk. They are big guys and girls and they push into a heavy leather belt to create enough intra-abdominal pressure to do a clean and jerk exercise, right? And so he's absolutely right that if we were comparing apples-to-apples of who produces more torque in core stability, his model is going to win.

But the question is, how many of us are power lifters or doing repetitive movement of lifting heavy boxes or heavy equipment, right? And I think that, you know, even in Stuart McGill's work and my interpretation of it, he talks about the guy wire system and he doesn't discredit the idea of the intra deep abdominal muscles working, he just feels that they have to work together. And because his population tends to be a population doing very heavy lifting, I think he's right, in that population, does that make sense? So that won't be true on anything? Won't be true in anything?

I mean just again only wouldn't be on that. Right, so what what I think happened is we got so excited with the idea that the TA was this magical muscle of helping organize core stability by the definition of some of the research and we extrapolate it to say, if you have low back pain, we teach you to draw your TA end, it's gonna get rid of your back pain because people with back pain don't have good TA activity and people that have back pain have good TA activity. But the TA activity that's good is subconscious subthreshold so if I teach a volitional contraction in the TA, I think I'm gonna be back at the 50 milliseconds that Paul Hodges showed, I'm probably misunderstanding that or not extrapolating that information correctly. And I think that's what we've been doing for the last 15 years is misunderstanding that information, that when we put the appropriate load on a well organized skeleton, these muscles start to work naturally. When we create positive movement experiences without fear, they start to work correctly and then as we train have more and more of these positive experiences, they then condition themselves for the multifidus and these deep muscles to start performing the way they're supposed to perform.

Typically with segmental movement, it's well organized. So when we do our bridging today in the movement class we do a little bit of lateral translation, that lateral translation is there to help us wake up those local stabilizers, deep stabilizers that work at segmental levels, not damaged and I can't tell you, I want you to fire the L4-L5 and L5-S1 multifidus on the right, right now while you're translating, it is really saying, let's get rid of all the big global muscles that are blocking you and allow those local muscles now to start waking up because we find that people in pain over recruit the global muscles and under recruit the local muscles and even when we try to teach them to isolate the local muscles, there was a study that came out in Dubai just recently that showed that they still end up over recruiting the global muscles in their attempt to isolate the local muscles so we just keep producing the same problematic pattern in our education of those local stabilizers, isn't that interesting? That, you know, we think we're doing the right thing by teaching them isolated TA and multifidus contraction and pelvic floor contraction and actually, we're still seeing that there's more engagement of the global muscles of the rectus and the quadratus and erector spinae and the longissimus than the local muscles so we have to be smarter than that, it's one that we're trying to isolate. I think we're better off a little bit with Stuart talks about of integration and I think that Paul Hodges would agree with that, that it is a very complex, integrated system and the heavier the load, the more stiffness is required, the faster the movement, the less stiffness required but that ties into our alignment. So when we look at Panjabi's model which I still think is probably the best model out there, it's the oldest model but I love this model because it lets me know and just always think of this balance between the message coming from above, the inert structures that truly control mobility of the bones and so when those are damaged or stretched out, the neuromuscular has to take over to substitute and the neuromuscular does not have good memory like a ligament does, a ligament doesn't stretch so you tug on a ligament it says, you're at the end of range, you're at the end of range, you're at the end of range stop, right?

Where a muscle has elasticity. So unless we go in and tell the muscle every day, this is your range of motion, this is your range of motion, this is your range of motion, it doesn't know and it forgets. So there's a lot of times we can have an instability, a lack of control and we can go in and reeducate the muscle but we have to do it every day with your theraband out and do our alphabet with our ankle to take the place of losing the lateral tip-fib ligament, right? The tibiofibular ligament, right? And that's the same thing that happens in our back so if I have a ligament that is damaged or instability in my spine, I have to do my bridging and my lateral translation and pelvic clock exercises and my quadruplexes every day to be able to have function in my spine because those muscles will not remember it tomorrow.

And you'll see that people who have back pain, they do their Pilates, they feel great, they stop doing their Pilates the back pain comes back, why? Because the inert structure has been damaged, right? And they have to continue to remind the neuromuscular system that it's okay. And as long as they're having positive movement experiences, the big dominator up above, right? Is okay and it's not trying to protect them by interfering with inappropriate guardian and splinting that happens as a protective mechanism.

That's the battle that we're always fighting that balance between those three corners of that triangle. I put up a little bit of researches up there as far as things that have been out there that sort of support what we do, Gibbons work on low threshold training which is what we do in Pilates, we can get people into nice positions and just let them move low threshold, they're not gonna do any harm to their body, you're not gonna hurt their inner structures, you're not gonna pinch their nerve, you're just gonna have some movement that's going on this low threshold and gradually increase that threshold to be more stiffer and stiffer and stiffer as we bring them into more and more function, okay? Norris with a hydraulic amplifier we talked about a little bit already is that integrated model of how the abdominal wall, the diaphragm, the back, the pelvic floor and the multifidus work together for that. Comerford, another one of my favorite authors Mark Comerford, he uses a lot of Panjabi's work and extrapolates on that in his teaching but talked about local and global retraining and how important it is. Now the new research is out is saying that, if you're trying to do local training that Mark taught us and they still have a pain mechanism, then they're going to be actually recruiting the globals more than their locals the deeps more than ever, yes.

So the idea is we have to create these positive movement experiences without pain which we can do very easily in the Pilates arena, right? Which is why we have so much success by default, right? You don't have to think too much in the Pilates to have a positive movement experience without pain. I love Hyde's work talking about the specific stabilization that when and will a multifidi has been shut off because of a painful mechanism even on one side, we cannot assume that just because the pain goes away that that muscle wakes back up, it doesn't matter, it might actually shown it over and over again. The muscle stays atrophied and even over time will become fatty infiltrated so becomes pretty few tiles as sort of gummy, right?

It's good for steak like you want that in your beef, you want a beef fatty infiltrated because it's more tender and flavorful so a lot of times when you get your Kobe beef, your Kobe beef has a lot of fatty infiltration, right? And they reverse that we go back in and start doing normal segmental movement and increasing the load of that segmental movement so can you think of segmental movement that would be very low load or would be a very low load, segmental movement of our lumbar spine? Pelvic clock. Pelvic clock, good. Can you think of something that would be a very high load of segmental movement in our spine?

I did it with you today in the reformer class. Bridging? Bridge is not real high, it's higher than pelvic floor, I mean the pelvic clock. I could say short spine and long spine. You bet so short spine and long spine have segmental movement but high load, right?

So the idea is that we can move ourselves into higher also up stretch, we did up stretch so the higher load will bring in more of that, will challenge that transverse and multifidi to fire more, you know, and more appropriately so burning up some of that fatty infiltration, the hypertrophy in the muscle. Again, when that muscle hypertrophy is inside of that fascia then it has to work very little to create the appropriate amount of stiffness, right? If your leg is withered away because you haven't done any exercise with your legs for a long time you stand up the amount of work your muscle have to do to create the stability and the fascia sheath is much much greater. Sometimes people say that you don't wanna use your rectus abdominis in work and it's like are you kidding me, it's a rectus, it's your rectus abdominis, it's you're erector spinae, those your vertical pillars, we want them to be juicy and full inside that sheath so that all the TA has to do is just barely tug on it and the tension of the anterior wall becomes very powerful, right? And are a little oblique when I start to turn, it is so full, it is like that hydraulic amplifier, you put a little pressure on the cylinder and it can lift the whole car, a little woman can lift the whole car by the little bit of pressure, we want our TA and our obliques to be like the little woman that's lifting up a car because the hydraulic amplifier is functioning well, right?

If the muscle is atrophied inside the sheath, you can't get enough torque on it. If a woman has a diathesis or somebody obese with diathesis, we can't get enough torque into that rectus sheath to be able to hold you up right. So we can redo all the muscle strength we want but you don't have the ability to keep the intra-abdominal pressure then it's not efficient, you can't maintain that pressure. Fantastic so let's continue to move on with the content,

Chapter 6

Motor Control

now looking at sort of the definition of motor control and looking at where we seem to be in agreement in the different fields that are measuring and investigating motor control and where there still is a little bit of disagreement that might help us understand what's going on in our profession in the science that supports our profession as a Pilates and a movement teacher. So in agreement, we agree that there's an appropriate amount of stiffness for the anticipated load, I think Panjabi's model still continues to be the best model in his statement of what is stability.

Motor control of the trunk is a critical component when we talk about stability and everybody is in agreement with that. So we do think that the ability to control it is much more important even in some of the what we'd often call structural instabilities, the ability to control that stability as most important thing. The disagreement comes in with whether we do abdominal bracing or hollowing or either of them, I'm gonna make a case to sort of slip away from both of those concepts and to think of being a little more natural with it but Richardson's Group was all about the TA isolation in the beginning and they've moved away from there just FYI so Paul Hodges work continues to go into more efficient and more effective motor control. But a lot of rehabilitation programs a lot of the therapists you work with and a lot of the Pilates teachers out there still, in that model of that TA isolation, hollowing the abdominals, connecting the belly button to the spine, lifting the pelvic floor and playing with that hydraulic amplifier model of neurosis. In Stuart McGill's camp where they look at this co-activation of the TA with the superficial abdominal muscles and that there really is no change of position so he's looking at a bracing kind of position and again, when would a bracing type of motor control response be appropriate, what kind of activities?

Heavy and power lifting. Really heavy power lifting things that would really challenge our spine and I still don't really like the word bracing, I think that it's a little harsh and definitely shouldn't belong in anything that we do in Pilates but we do look at this idea of intra-abdominal pressure and how that intra-abdominal pressure changes. So on the left on this slide, you see Paul Hodges study that was identifying the transversus abdominis up in the top left, the black line is the actual contraction of the transversus abdominis 50 milliseconds prior to the lifting of an arm and a flexion, abduction and adduction. So it's interesting that it consistently fired with very precise accuracy 50 milliseconds prior to the contraction of the deltoid which was the primary mover. So what they tell you is that the TA was sort of stiff in the trunk and that connection between the rib cage and the pelvis so the arm could go up, the arm had something to be able to work on.

And they didn't measure things like the rotator cuff which I would bet you it would've also fired about the same time as the TA in preparing the shoulder and the core for the deltoid to lift the arm up, right? And then we see in the white box which represents people with low back pain was all over the place. So we see that they did not have the same firing pattern, which is where the research was extrapolated in by a lot of us that, low back pain doesn't fire TA let's teach them how to fire their TA and we taught them how to do an active volitional contraction which was not the same as a 50 milliseconds subconscious subthreshold contraction and that's sort of where we misinterpreted it. I don't think it did harm to anybody but it certainly is not the same as an efficient 50 millisecond preparatory contraction for lifting the arm. We also don't really understand what the role is and the timing of it pertaining to a lot of really dynamic movement so the faster and more dynamic the movement, the less we understand of when which fibers of the TA will fire, the superior ones that are attached to L1-L2 or the lower ones that are going to be the level of L4-L5 or L5-S1 and we just don't really know that but we can certainly extrapolate from this that there is a sequence of firing in a healthy person where the TA is a preparatory muscle and it's gonna create enough stiffness for the acceleration or deceleration of the anticipated activity.

We teach the hollowing effectiveness we don't call it bracing, they call it hollowing but yet they're doing a volitional, maximal contraction of the TA which is not the same thing as that subconscious of subthreshold contraction that Hodges found in the healthy adult. So I mean, that's really the big differentiator, isn't it? For us to understand the difference. Yep and so if you look at McGill's diagram is on the right. So McGill's diaphragm is saying his guy wires and these muscles connect these different bony landmarks and they compress and create stiffness.

Now, I also don't like that idea of compression because I belong more to the tensegrity model where I see stiffness happening by pushing out and by creating tension by having good elongation of the spine that's gonna create a suspension system, right? It's gonna be like we're suspended and floating in space almost and that's how we feel after a good Pilates class, isn't it? People who say I feel light, I feel space around me, I feel taller, I feel you know, a longer neck and my feet feel more grounded the floor, what they're feeling is when the spine is aligned, the fascia system lifts us up. We're lifted up in our own fascia system and so it decreases the wear and tear, our acceleration and our springiness as humans is significantly increased when we have good alignment so we become like the kangaroo or like the rabbit or the cat. So maybe, just maybe transversus abdominis does not create the greatest core stability, right?

Independently and we should probably stop saying that or trying to make statements of Pilates being the best core exercise out there and then teach somebody to do a belly button to spine or core hollowing. And maybe a guy wire model of lumbar stability is not the most practical strategy for us either, you know, especially not in daily tasks that require a little bit of stiffness here and a little bit of stiffness there. And maybe just maybe, you know, some people would call it blasphemy, all right? They'll say that I'm being blasphemous but let's cover some new rules, let's make some new rules for ourselves, things that I think will make sense to all of us as Pilates teachers. When the spine moves to planes of movement, there's two components we're looking at, we're looking at velocity and we're looking at load.

Velocity and load should maintain an inverse ratio, okay? Velocity and load, load would be the amount of torque needed to do something heavy and velocity would be the speed so the greater the load, the less velocity. So I'm lifting something heavy, I don't wanna be throwing heavy boxes around, right? I could condition myself to be able to do that, if that was truly what I desired to participate in. But rule of thumb is, the heavier load, lower velocity and the adverse would be true as well, the higher the velocity, the lower or less the load so dancing, golfing, acceleration, sports.

As a load increases, segmental movement decreases. So if you're gonna be a power lifter, I don't want segmental movement in your spine, I don't wanna see the lumbar shift, we don't wanna see that at all, right? We want that lumbar down. So what we want to avoid with that is the sheer force that you would see like in a power lifting, you don't want to have shear force you want the multifidi and the erector spinae and the psoas muscle and the in the lumbar quadratus be hypertrophy to their max inside their fascia sheaths and they're creating just with a little bit of contraction, they're creating tremendous stiffness from a fascia standpoint not from a torque standpoint, the muscles hypertrophy in the fascia. One of the things that Stuart McGill discovered that I don't think he really discovered, I mean, he discovered it but I don't think he's defining it well, was that when the power lifters are in their high season of lifting, they don't get hurt, they get hurt in their off season.

So what that would tell me is that when the muscles are hypertrophied and juicy inside those fascia sheaths, there's incredible stiffness for them to be able to protect their spine from sheer force. But any muscle that we don't use starts to shrink in size, it doesn't lose muscle fibers, it's just, you know, for me for example, I've lifted weights heavily when I trained in college and anytime I go back and I lift weights, my arms beef up and my chest really fast and my legs move really fast but I don't really wanna be that big, you know, so it's like, I choose a different way of training but because I've already trained, the muscle fibers are still there, I just don't call on them every day lifting weights, but they're there when I call on them they're going to hypertrophy, right? And this is sort of the idea of those power lifters that when they are in lifting season, the muscles are hypertrophied inside the fascia sheaths so it's so much easier for them to generate torque and stiffness without shear force. And then it could be something as simple as bending over and sneezing in off season that they don't have the right amount of stiffness and those local stabilizers aren't working or awake, boom and they have a herniated disc from a sneeze, yet in high season they can live 700 pounds, okay? The appropriate amount of stiffness again applies for the anticipated load that Panjabi talks about, this is what we're saying as inverse ratio, determine what you wanna participate in and we'll gear you up for that.

And we appreciate the fact that the more load, the less velocity and the greater stiffness you're gonna need and the more velocity you need your activity, the less load it's gonna be. So a tennis club or a golf head is not a real heavy thing to be swinging through space or your own body as a dancer or a swimmer in the water, you're gonna want more velocity and less load. Supported truths about the spine is movement, the spine is made to move in all planes of movement, we know that already. So somebody says you shouldn't move in flexion, you shouldn't rotate, you shouldn't side bend, you shouldn't do combined movements is not accurate. There are people for example, the sagittal beast that should not move in those directions with force because their tissues are not prepared for that force but that doesn't mean that the human body is not built to move in those directions, right?

Our bodies will adapt to the stresses applied to it, we just have to be careful with what we're choosing to participate in and grade ourselves on the way up so that graded exercise becomes really important. Behavior proceeds form, we are all what we practice, what Eric Franklin talks about, you know, if we practice sitting in a chair all day we look like the chair, if we practice being Pilates teacher all the time we look like a Pilates teacher and not a Pilates enthusiast. So the truth is, is we have to practice Pilates not practice being a Pilates teacher, we have to practice walking to be healthy walkers, we have to practice and learn how to run and practice it to be healthy runners. And these are the things that we are what we practice, our behavior proceeds the form. Wolff's law, our bodies will adapt to the stresses applied to them so as we start applying the stresses in gradual graded loads, the body starts adapting, the tendons become stronger, the muscles become hypertrophy, the fascia becomes more connected, the bone becomes more dense, all based on what we practice, our body will adapt to that stress.

And pathologies are a result of deformation of tissues, usually secondary to restrictions and compensations as would Comerford talks about where we have restrictions and then we have compensations because of restrictions and then we have deformation of our tissues. So that's when the ligament starts stretching or the disc tears or the bone gets a spur and we identify that as the pathology and the pathology causes pain, in most healthcare we focus on pathology and pain. Pilates teachers focusing in on restriction and compensation, that's a much more holistic way of focusing on things. Let's not try to be the cheater of pathology, let's be the cheater of the whole body movement, incorporating and removing the restrictions and the compensations to old injuries, bad habits, old patterns, congenital problems and get them being as balanced and as well motivated and movers as possible because that in itself will get rid of this force that's causing the pathology and the pain. That's why somebody will come to us as a therapist or a doctor and they'll say, you know, I have this pain and then nobody gets rid of the pain, they don't wanna do surgery, they find a good Pilates teacher, Gyrotonic teacher or Feldenkrais teacher and they start moving and three months later, they say, yeah, that problem disappeared.

The problem didn't disappear from the standpoint of the pathology but from the organization of the structure, the compensation changed into a better aligned, more mobile distributed fourth body that no longer suffers from that pathology. So we look at things like restrictions of the structure and we know things like tight ligaments or loose ligaments, shortening of muscles like myofascial restrictions from surgeries and old injuries, we have degenerative cartilage from just old age or poor alignment or abuse or lack of use, mal-alignment of joints, neural adhesions and skin adhesions even things like people who've had burns or other surgical procedures often would have these kind of adhesions. And these are all things that might need to be treated by surgery or by somebody with a license to do some of these structural releases. But more often than not, I find that the restrictions are more strategic and this is where I think the Pilates teacher and the movement teacher have great contribution to 100% of the population because even if I have a restriction that is structural, I still need the strategic intervention to overcome even if I'm seeing a myofascial release therapist or I'm seeing a chiropractor or I'm gonna have surgery, I still need to have my strategy reorganized so I don't repeat it and I can heal quickly. So things like dealing with poor alignment, dealing with habitual postures, activity, specific posture so looking at the swimmer and the dancer and the lifter and being able to understand what their body is being demanded on by their sport activity and how we can balance that out with our Pilates training.

Compensation to an injury to re educate them, to remove the fear of pain and to change those false perceptions of their ability, often the internal expectations and the external expectations of their movement, right? So those are the things we do as Pilates teachers, we own these positive movement experiences and they start to believe again that they're healthy and to live and participate in life like they're healthy. And if you've ever experienced it, where you've been down and out with a back problem or a knee surgery and you so look at that knee and you go, that's not my knee or you say my back doesn't let me do those things anymore, that's an external locus of control. We've lost the control instead of saying that, you know, I'm choosing not to participate in that activity because my back is sensitive, you know, we say my back doesn't let me, you hear the difference in the language? So we give that control to the part of our body.

Structure versus strategy. Structure work is not needed all the time but strategic work is needed all the time and for us that's good news, right? Especially to Pilates teachers, they have good job security based on that. Functional movements math or science, is flexion really a taboo? The answer is no.

There's not a taboo. Flexion is a taboo when you maybe have osteoporosis or disease process or a pain process that might be temporary in the pain process or a disk lesion. You know, people talk about Swan and extension killing their back but Swan and extension were the most powerful exercises we can do, we just had to learn to do it from the right place. Where are we getting the extension? In the upper back and mid-thoracic, that's what we should be getting Swan not in the low back increasing the lumbar lordosis.

So a healthy Swan does not increase lumbar lordosis, the lumbar lordosis stays the same and the thoracic matches a lumbar lordosis and the hip extension, they come up in to Swan. Rotation is a culprit of disc herniations and should be avoided. Rotation is not the culprit of disc herniation, it's only when you do rotation and you've been a sagittal beast for a long time and you choose to have all your rotation go through L4-L5 or L5-S1. But healthy rotation through thoracic and the hips and the knees and all the joints together is gonna distribute that force and rotation actually is the kind of animal that we are, we are rotation animals, right? Gyro we are about gyro, we are about spinning around an axis and rotating, everything we do has rotation to it, there's very few things that we do truly that are sagittal in the human body.

Side bending will fracture my vertebra and I asked to process if you are flex and collapsed inside bend, you could put pressure on the vertebral body and cause a fracture. But a well organized body, axial length and body, a segmentally distributed movement body is not gonna have those problems. And so again, we go back to our basics, axial elongations, segmental movement, good breath habits and proper alignment, those are things that are going to allow us to enjoy healthy spine movement in all planes of movement. So deconditioned sagittal beast is gonna have limitations

Chapter 7

Restoring the Healthy Spine

and things like movement in any plane because they're probably gonna have tissues that are vulnerable and they don't have movement awareness into those ranges of motion so they will do damage if they do anything with force or in the end of range. So our goal is to start transitioning them into movements and exploring that they feel more comfortable in.

Lumbar stenosis is a narrowing, so maybe that person has a lumbar stenosis, we don't want extension at the side of the stenosis but usually people with stenosis only know how to move from the side of the stenosis, that's why they have it. So if you teach them how to move from the thoracic and their hips, you can take the stress away, they can stand up straight and never insult the stenosis again. Disc disease and damage, it's prevalent, everybody has it. They did a study that looked at 700 people who had never had back pain, they took an MRI, they send MRI to the surgeons and 70% of them needed surgery immediately. So what does that mean?

What does that mean? How many false positives are there? When people go to their doctor, they say My back hurts which by the way 90% of adults in United States will suffer a serious bout with back pain in their life, at least once, 90%. When I started my PhD about 15 years ago, it was 70% so it's increased 20% in the last 15 years. So what was my question again?

Remember my question? False positives? What does it mean that there's all these false positives? You go to the doctor, you say my back hurts, they send you for an MRI and pathology shows up in the MRI and all of a sudden you need surgery, when in reality 70% of people never had pain had MRI show that they needed surgery. So we don't diagnose the MRI, the MRI must be matched by clinical signs before we ever consider doing surgery, right?

So what happens is when we create the image in somebody's head that they have three herniated disc or fusion taking place in the L4-L5 or whatever they're seen on MRI is usually much more harmful to them than not getting it. Yeah, so I had a patient that came in and he had a true disc pathology and had ridiculous symptoms and neuroscience down his leg so we knew clinically he had that but within three weeks we got the signs and symptoms localized just into his low back which is a very good sign and at three weeks his insurance approved his MRI. So he came to me he goes, do you think I should get my MRI? And I said no, I don't. I said we know you have a disc herniation and we know that it's resolving and that you're doing better and things are centralizing and in probably another couple months you'll be back normal, it might take that long for the disc to heal up and for you to feel better and have different strategy so he did what most of my clients do anyway and he went and got the MRI and the next time I see him, he comes back in and he's dragging his right leg, you know what is in his left hand, right?

His MRI. So I say to him, you know when did this sentence start back up in your leg again? He scratches his hand, he's like, you know I think it was about an hour after I saw the doctor. I was like, well what did the doctor say? And he said, the doctor said that's the worst disc herniation he's ever seen in a long time and it's amazing that I can walk but then he said because you don't have any neurological signs, you're not surgical.

Now, the patient doesn't know how to differentiate that, what he heard was, worst disc herniation I've ever seen. And all of a sudden his symptoms come back, it took me six months to reduce him. Six months, I hadn't reduced in three weeks, that one comment, that one image, that one MRI, set him back another six months because he couldn't get the image of the disc herniation out of his head and to this day still uses those words that he has a slipped disc and that the doctor said, I mean, it's almost like he's proud of the doctor said he had the worst herniated disc he'd ever seen, right? So those are the kind of things that we do they get in people's way, I mean, we really do a lot more damage to them. Rotational sport athletes need to rotate.

So you can't take rotation away from them, they need to rotate, they need to rotate for more segments. Labor needs to do repetitive heavy lifting, they need to be stiff, they need to be strong, they need to have that ability to have the appropriate amount of stiffness. A Cirque du Soleil performer needs to have significant mobility distributed throughout their body and control of that mobility when they become vulnerable. So sometimes with the Cirque du Soleil performers and the elite acrobats, they have so much segmental mobility but they have control of it while they are performing. And then they retire, they get married or have children or whatever and after having children, they get deconditioned and they have all this mobility in their body but they don't have the training or conditioning to keep the control of it and then they start to manifest things like spondylolisthesis, hypermobility, instability problems that become diagnosed degenerative disc disease for set degeneration, all things that are manifested because they lost the control of something that they had.

So in a nutshell, the stability is control a movement but if you stop performing and you have a lot of movement, you do have greater vulnerability of instability, right? Somebody who is stiffer and stops moving has less incidents of instability, they might have the risk of severe trauma because force can be distributed in a car accident or a fall, right? Because your body's not supple. So they're more likely to tear ligaments or those kind of things because of their stiffness. All right so the ICF model is the World Health Organization's model of classifying function and disability and one of the things that they identify in there is highlighted in red is participation.

And this is important because we asked our clients, what do we choose to participate in? That's the question, what do we choose to participate in? Because if you choose to participate in heavy lifting then we need to know that and prepare you to be heavy lifter. If you're choosing to participate in a movement, high velocity activity we have to prepare you for that and to understand there's a difference or somebody who is a jack of all trades that we need to make sure their supple can do all of those things, right? At a certain level, like my weekend warriors, I take the 80% of their range of motion is available to them and train them in the 80%, why?

Because I know they get past that they're more likely to get hurt or tear a ligament or herniated disc. An elite athlete, I'm gonna take up the 95 98% of their available range of motion but they have to train four to six hours a day to have the proprioception awareness of that range of motion, right? And still have the rest and if they screw up just a little bit, they could have very detrimental trauma and injury to their body but they need it to be able to compete at that level. So what do you choose to participate in? You wanna be a power lifter, right?

Or do you wanna be a break dancer kind of thing, right? I love these little hamsters but you know the idea is that based on we what choose and this is where, you know, maybe Stuart McGill is talking more about the power lifters and Paul Hodges is talking more about break dancers and we're saying what matters most of what you choose to participate in. If we understand it, we can create your program to have the appropriate amount of stiffness for the anticipated load and not get caught up in this idea of are we bracing or hollowing but are we creating good alignment and good quality of movement, axial elongation and rise above that argument. The argument is not where we should be spending our time, we should be making it very clear that good qualitative alignment and axial elongation and appropriateness and stiffness of anticipated load is efficiency and that's what Joe was talking about, wasn't it? So Pilates is ideal to create this optimal load and stress to reeducate the new postural strategies.

We have varying basis supports, we have a full spectrum of closed chain to open chain activities and kinetic chain, we have varying degrees of assistance fully passive to fully loaded. We have varying lengths of levers, varying challenge of proprioception and the ability to progress from foreign to familiar environment and most importantly we can create positive movement experiences without pain that exceed their expectation. These are powerful tools that we have as Pilates teachers, they're not to be, you know, thought of lightly, I mean, what we have is a tremendous environment, people who understand movement have to go looking all over the place to find the right kind of environment to facilitate all of these different attributes of motor control and quality movement instruction and for us, it's built into our system, it's built into our reformer in our trapeze table and the barrel and the chair and gravity in the spine correct and all the things we do, it's part of it. So we continue with the strategic intervention while receiving structural intervention always and we always apply Joe's guiding principles of whole body health, whole body commitment and breath. I think it's important for us to understand that our principles as Pilates teachers, and the tools that we have, are exactly the right thing to be able to teach people that healthy spine movement, we just have to be a little more involved and understand the individual of where they come from, how much movement they have, how much movement experience they have, et cetera.

So as we look at restoring the healthy spine, these are a couple ideas that I've written down. Number one, establish client's unique limits and what exacerbates their symptoms. You know, do they have problems with flexion? Do they have problems with extension? Do they have problems with rotation?

What what makes her symptoms worse? Establish what activity client chooses to participate in if their back was not hurt. That's the first question that I asked them, what activities do you believe you should be able to do now that you're not able to do or you believe you're not able to do? So you give me this long list, I can't do dishes, I can't change the laundry, I can't sit in my car longer than an hour, I can't fly in a plane on the two hours, I can't play soccer with my son, I can't be intimate with my wife, I can't do can't, can't can't and then I ask the question, how important is it to you to return to those activities? That's really the question, isn't it?

How important is it? Establish what activities they choose to do and then go into your biomechanical counseling. That's what we do, we teach people how to move and we start off with things like disassociation stabilization. If they hurt when they move into directions, we start teaching them how to not hurt, right? How to move from their hips when they sit down rather than always moving from their back, we teach them how to disassociate that.

We introduce movement with non-destructive forces so how do you know it's a non-destructive force? No pain. So if there's some kind of back pain but we're doing pelvic tilts are doing clock are doing a little bit of bridging or some side to side and it doesn't hurt them or some thoracic extension, then we're probably okay, introducing with non-destructive force. So we don't wanna spend the whole time teaching them how to disassociate and walk around like a wall, right? We just wanna do that long enough to get the severe pain to start coming down and for them to start thinking like, okay, I can sit on the toilet, I can go upstairs, I can take a shower, I can get in and out of bed because they learned good biomechanics but we don't want to stay there, we want them to be able to move their spine.

And then we go into restoring function so we start going to that graded load and the varied speeds and the things that start matching the activities that they choose to participate in, right? We have to know that before we can go on and then we set the internal limits where we're helping them to appreciate what they feel inside, not what we tell them but what they feel, right? This is an awareness work in Pilates, we want them to feel and to be able to say, you know, today's not a good day for me to run more than half a mile. I can feel like I'm not feeling real good, my energy is not good, not a good day for me to do that and the next day they might feel perfectly fine and go out running three, four miles because they listen to their body, their body will tell them they're aligned to their body. When we're aligned to our body and our mind we're less likely to do stupid things that hurt our body, right?

We eat better, we sleep better, we work better, we interact with our loved ones better. The psychosocial factor and again this ties in this idea of fear and bad experiences and painful experiences, perceived ability by Jeffrey Lackner where they said, you know, that basically our perception is the single greatest predictor of outcome of people with chronic back pain, more than anything else, it is over 80% correlation. So strength, flexibility, and those things have almost zero correlation with getting better, isn't that interesting? So we talked about, let's get strong, let's get flexible, let's get balance, they don't have a correlation with people's perception of being better and able to return to their activity. So how do we change that perception?

How do we get there, right? So to change the paradigm from the one of movement equals pain to one of movement equals happiness is really what our work is about and this is why I wanna emphasize in closing that when we provide that positive movement experience without pain, we are changing their paradigm. That's probably more important than how much core control and what torque they can generate and whether they can touch their belly button to their spine or not, right? It's much more important that they're having these successful experiences without pain. Because the more that they have, they start to believe that they're healthy.

If movement always equals pain then they believe they're not healthy, does that makes sense? And then they're not healthy and they don't do the things they wanna do because they don't believe that they can do them and then they're not happy, they're depressed. And when they're depressed, they don't release the right kind of hormones and neurotransmitters so their dopamine levels go down, their cortisol levels go up, they spend time in harmful thought, the biochemistry of that bad thought starts hurting their body, making them sick, slowing down their metabolism and creating a painful modulation system in their brain that's not healthy and it gets tougher and tougher and tougher. So when they come into Pilates and have these positive movement experiences, one after another coming in, it reverses that effect, right? They build confidence, they release more dopamine, their cortisol levels go down, they spend time in positive thought, they start acting and participating on what they choose to participate in and when they see that match, they're healthy and happy, okay?

So sometimes, you know, when I teach a class I'm not so fanatic about the detail of it, sometimes I am but most of the time when I'm teaching somebody, I just want them to move in to notice that when they make little changes, they feel the increase in efficiency. You notice I said when they make the changes, if I make the change on them, they might change but they might not feel or be aware of what happened in their body. And I do believe that our clients would fix themselves if they knew how to, if they knew where to find it, if they knew what they were working with and since we know that information which is guiding them to have these experiences. This leads us to our last slide which was our first slide. And basically says that Joseph Pilates philosophy is that physical fitness is a first requisite for happiness.

We said that we wanna change the paradigm from movement equals pain to movement equals happiness. Our interpretation of physical fitness is the attainment and maintenance of a uniformly developed body with a sound mind fully capable of naturally, easily and satisfactorily performing our many and varied daily tasks with spontaneous zest and pleasure. That's my desire for our clients, especially those in low back pain not to get so caught up in some of the interpretations that are out there in the research but are saying that the most powerful thing we can provide for them is already existing inside the Pilates environment. As we teach sound Pilates, as we understand the individual's unique needs and what they desire to do, we can design beautiful programs to give them those positive movement experiences and to take home messages that strategy is needed in every case, right? Structure intervention is not needed in every case so it means that a Pilates teacher's job, if they're good at teaching movement is always gonna be there, they're always will have even it even if Pilates was to fall out of being popular, teaching good sound movement in a Pilates environment will never be outdated.

Making people feel good and healthy will never become outdated even if the word becomes outdated, all right? And I finish with just our last thing of saying, you know, our sort of goal and our vision and Polestar is impacting the world through intelligent movement, as we understand the sciences, as we understand the applications of movement better, we change people's lives. And the more people that are happy, the more people that are in tune with their bodies, the more people are connected to the universe, the happier we're all gonna be, there's gonna be peace so be that shift will have that critical mass that's needed and I don't know if that's 2% of the world or 5% or 20% of the world but as people move and they find that awareness, they're gonna be less likely to be greedy, they're gonna be less likely to be dishonest, they're gonna be less likely to be, you know, angry and desirous to cause harm to other people and that's where most of our problems exist, around those three or four categories. So when people feel better and wanna be honest and transparent, the world is gonna be a better place. And I believe firmly that it comes from teaching that alignment of the body and the mind which is a fundamental Joseph Pilates work.

I have a funny slide up here at the end just to sort of show this idea of the evolution, you know, that we really don't wanna go backwards, you don't wanna go into that flex posture. So take home, segmental movements, right? We said to get the segmental movement and that the two changes in tissues can take up to six to 12 months so don't feel like it has to happen overnight, also prepare your clients to know that as well. And that takes us to the end.

Chapter 8

Mat Workout

So we're gonna play a little game with our Pilates mat class, today on Pilates Anytime and what I wanna do is have a very nice flowing class for about a half an hour to 35 minutes, we're gonna focus on things that are built on the healthy spine concepts, moving our body, just having a good positive movement experience all the way around and maybe a little different than you would think of traditionally of what is a class for low back or for spine problems.

So I wanna start with this actually laying on our backs, feet towards the center and I wanna start with the legs a little bit extended, not all the way extended, not all the way flexed. And just turn off with a little bit of an oscillation you create for yourself and just feel the wave by flexing and pointing your ankles and feel the pulse through your body. She's feeling like a wave and you're gonna notice there's parts of your body that you're holding, there might be some tension, now's the time to let go of those so this is about movement. Distribution of movement equals distribution of force and as you point and flex your ankles, you can sort of find that the timing typically goes with the song Row, row, row your boat. ? row, row, row your boat, gently down the stream, merrily, ?

? merrily, merrily, merrily, now you're in the stream ? Good, keep it going, keep it going and this time make it a little bit bigger, the oscillations bigger, right? Bigger oscillations on the ankles and then smaller oscillations, the subtle ones, the quiet ones. Just feel the rhythm inside the body, the digestive system, the spine, the nervous system, the skin, everything has been oscillated and relaxed. Bring the feet a little bit closer to you, just like you would be getting ready to do a little pelvic clock.

Let's go right into pelvic clock, tilting the clock towards the feet in a six o'clock and up towards the spine or the head at 12 o'clock, just a gentle articulation. Now appreciate that connection all the way up into the head so as my pelvis reaches down, it's also going to articulate my full spine and my head would be nodding in the direction opposite of my pelvis as it tilts forward and back, see if you can feel that connection. So if the back of the head was stuck on the floor as the pelvis moves, the head would be moving opposite direction. And then now that the pelvis tilt to the right and to the left, there is that bowl of water or a bowl of soup, fill the rotation through the spine, again, just gently waking up those segments, gently lubricating, nothing holding and the less muscle we use, the better in this class. Taking that right to left and anterior and posterior combining it into a diagonal, now tilt the pelvis down towards the right foot and up towards the left shoulder that would be on the clock if seven o'clock in a one o'clock angle, seven o'clock and a one o'clock angle.

And just back and forth with it, feel that connection, down and up, down and up and feel that relationship. Even feeling here and almost here and we got that right there, that's the angle, good. And then let's switch that angle going down into the left or you're gonna find one sides a little friendlier than the other, that's it, there we go. And then let's finish up doing circumduction, nice circles as if I was stirring a pot of soup and just feeling the movement around off, you compare it to the olden days of a Doughboy pool or above ground pool and all the kids in the neighborhood run around in circles inside the pool until we can just float and that's what I want you to feel, it's like that soup is just moving around and let the spine all the way up into your throat, all the way up into your eyes feel that movement. Allowing that movement, switch directions, straining back the other way.

Creating that flow, two more circumduction all the way around and we're gonna go right into our bridging series. With that same relaxation as you exhale just allow that pelvis to continue rolling up to the middle of your back and then take a breath and roll it back down. The least amount of work is possible, feel a little bit of length to the knees reaching one direction and the head reaching the other and the spine just peeling up about 50% of the movement in the spine and down. Two more times on your own speed, up and down. See if you can find a few more segments coming from that lower thoracic spine as you go up and down.

That's right. Last one, coming down, good. Now this time take your pelvis about halfway up in the bridge and let's go right into a lateral shift, side to side waking up those little local stabilizers telling the big muscles to be quiet like a typewriter, side to side, drop down a centimeter and keep going and see if you can get four or five of those lumbar and lower thoracic vertebra to move side to side. Make the movement a little bit bigger and translating, there it is. Be patient feel that shift side to side.

That's right, working your way down. And bring this pelvis back up again one more time, let's go into a figure eight so if you had two shovels in your hips, little tiny hand shells, you drop the right one down and you slid it down into the sand picked it back up and dropped the left one and pick it up. A nice figure eight all the way around dropping one hip down one hip up, bring it up, scoop it out, bring the other one down. And again just looking for the segmental movement really trying to get into this area of movement in our spine, yeah and not just in the low back in the pelvis. See if we can transfer a little bit of that and we talked about rotation, we're rotating animals we wanna feel that rotation come up in our spine.

And this last one, bring it on down and relax. Take your hand sled him out just a little bit away from you knees come together, ankles together, feet together taking knees side to side so take the knees over to right side and then the left side just gentle rotations. And sometimes I go slow, today I want to go a little bit quicker. I want you to feel the oscillation through your body, side to side. Now when you do that, take your hands up towards the ceiling and see if you can keep the same control through your shoulders, you might lose a little bit of range of motion.

And now choose which arm you want to raise over your head with the direction of the knees way without me telling you, it is gonna alternate. This is gonna be happening as you sway side to side, as if you can find the side that feels more natural. Exactly, good. How does that feel? Strangely okay.

Strangely okay? Let's try it the other way and see what it feels like. So try the other, switch the arms around. No, you gotta switch again because this time knees go to the left and your right arm goes up, we'd be switching for you. That'd be switching, yeah you were doing, there you go.

That's just opposite of what you were doing. So just sort of find and discover which one feels more anatomically correct as far as opposing stresses to you and do that one. So make your choice either the first one you did or the second one you did and just pick it because this is what walking is about right? See where you have the best suspension. So you walk like John Wayne or do you walk with a little rotation?

All right, how do you walk? And relax, very good, very good. (talks indistinctly) Don't overthink it, just allow. Just allow and now bring your legs up to a 90, 90 degree at the back of the thighs. That's fine, a little bit of that flexion in the spine.

Use your legs as your levers, they're your springs, your arms are your spring so send your feet away from you and just let the weight of the feet bring your body up into a seated position. Send the feet towards the floor, take a deep breath up and now send the spine back going down the same way using your legs as a counterweight or counterbalance. That's right. And exhale rolling back up. Beautiful, that's exactly what we're looking for, that good segmental movement, you feel the difference?

Yeah. So you can think of is a spine moves they're always move in opposite directions, right? So as you're going down feel the lower one moving back and then for the next one come down and the same thing when you're coming up feel the lower ones come down to the mat is the superior one rolls up. You got it. Good and keep going, that's it.

That's it right there. That was it, that's a new range for you. Excellent. You're gonna come down this time and you're gonna stay down, you're gonna leave your legs up at 90, 90. You're gonna leave your shoulder blades just barely touching the floor, the heads are up, hands are down and then you slide going right into hundreds and in two, three, four, five, out two, three, four, five.

Use your breath to facilitate the movement, right? So if you can breathe into the back of the lungs, feel that take the pressure off of your abdominals, inhale here, exhale from here. That's right, inhale here like you filling up the balloons in the back and exhale from here, yeah. So when you inhale on the back you actually feel the pressure come off of the abdominals for that split second and that gives you more endurance so you can keep the breathing going, let's here a nice loud breath and the last four of them. And inhale.

Three more. Last two. And last one, inhale. And exhale all the way down, very good. Rolling over on your right side, right side, sideline upon your forearm, organizing that spine, this is looking for that perfect balance between stiffness and mobility, stiffness of the body mobility of the leg.

If you're too stiff in the body, the leg doesn't move. If you're too loose in the body, the spine was all over the place. So lifting that left leg up towards the ceiling without losing the body position and halfway down. Let's just go up and down a couple times and up and down, feel that femoral head sinking into the other hip or down into the floor, right? That's what brings the legs up rather than thinking of lifting the leg, think of dropping the femoral head down into the mat.

Half halfway down let's do some circles going forward, two, three, four, five, six, seven and reverse and go one, two, three, four, five, six, side kick and forward and back and forward and back and forward and back and forward, leave it back, take a left hand reach it forward for that length. Taking a deep breath, we'll play our buzz with a bee as you exhale feel the ribs connecting the spine connecting for that life but keep reaching, good little hint here is to push the lower leg into my foot. Yes, feel that push, good? And roll on to your tummy, very good. Let's go with the hands behind your back head turned to the right side, let's go right side, head to the right, head to the right, hands behind your back double heel kick.

And what I want you to think of is rather than lifting up real high, let's just think of reaching real low, okay? So we do the double heel kick, heels are gonna come up, pump, pump those hands reach and think of going into more dark position than lifting up behind extension and head going to the left, pump, pump and reach. Briskly, pump pump and reach. Briskly pump, pump and reach. Pump, pump and reach.

Pump, pump and reach. Pump, pump and reach, last one, pump, pump, and reach. Stay up there, hands released to the side, going into our dart. Hands down the side, yep. So down here, let's start with palms facing down to the floor, yep.

And just pulse the back of the hand up towards the ceiling. Nice and slow pulse, pulse, pulse, pulse, pulse, pulse, pulse, pulse. Now turn the palms up towards the ceiling and go a little quicker. Bah, bah, bah, bah, bah, bah. With your breathing now inhale into the back, inhale into the front, exhale, feel that expansion.

Back to the neck length and as legs are reaching long, feel that connection. Feel the energy make it about energy flowing on this one not about how high you're holding yourself and relax. Hands come to the side of your chest, elbows up to the ceiling push back into quadruped. So back onto your heels and just take a little rest there. Now on this one I want you to do is, you're gonna come up in the quadruped and you're gonna have your knees apart and your feet together.

So you're basically an extra rotation of your hips, sticking your bottom out as you sit back over your feet. So just fill in the hips deep and in the socket and forward again. And back just coming deep into that socket, nice deep socket, trying to keep that pelvis from tilting at the end, right? The temptation is to tilt into a posterior to tilt, try not to do that. Now bring the knees into parallel, right?

Not touching but parallel. Same thing, take the sit bones back only go as far as you can without that pelvis tilting, you notice you're not gonna go as far with your legs in parallel, can you feel that? Good. Two more times, sinking the hips into the socket. Imagine that I'm sitting on top of your sacrum, feel the weight of gravity pushing down.

Now this time bring your knees together and your feet out when you're up in your quadruped, right? Internally rotate it, you're not gonna go very far so just go to where you feel a little bit of a nick of pressure and come back out of it. Let's do that three or four more times nice and easy. Sinking that hip into the socket, it's very important that that hip is deep in the socket for healthy spine, two more times. And go back to your parallel and notice a difference in your parallel depth.

So parallel knees and legs and just feel how much easier it is to go back. Can you feel the difference? So now lay on your other side, let's do sidekick and see if we notice a difference. So left side sideline upon your forearm. Prepare to go here right leg is gonna lift up a couple times and up and up and up, halfway down circles going forward and one, two, three, four keep the hip deep in the socket and reverse to two, three, four, five, six, seven, eight, push down to my foot with that foot there.

A sidekick going forward with one and back and forward and back and forward and back and push into me and back and push and back. Last one and reach right hand forward, deep breath feel that opposition, right? So that pushing down exhaling with a z sound pushing into my foot feel that reach the crown of the head opposite of the left leg. When you're done roll back onto your tummy. Let's come up into quadruped, up into quadruped and there is someone doing little diaphragmatic breathing so we really want to feel the abdominal wall expand and stretch.

So things are sort of warmed up and they're already, keeping the spine perfectly quiet. So the spine is in that neutral lordotic curve. Take a deep breath and pretend that the belly is being drawn down to the floor with a little stone that weighs maybe two three pounds and then as you exhale, you're gonna lift that stone back up off the floor but without changing the position the spine. So belly is gonna deepen as you inhale. Let me fill it, where's it at?

I want more. There you go exhale. So really looking for that Buddha belly expansion. That there we go, good. This is where we break all reverence of Pilates, letting that Buddha belly come down, yes and really fill in that stretch of that anterior wall because the stronger muscles have ability to relax.

Good, that's exactly I'm looking for. Exactly, Good. Now, from that position, we're gonna push up into a squat. So you're gonna go from quadruped, come up onto your heels, put your elbows between your legs like this. So you can take your feet apart a little bit further it's more comfortable.

And now we should be also pretty comfortable in our hips there, lift the chest up if you can and as you take a deep breath now feel the pelvic floor and the belly expanding. When you exhale, just as a spring, right? The pelvis springs back up when you exhale. Inhale. Exhale.

Inhale. One more time and as you exhale, come up into a squat position body leaning forward, we're gonna go right into a swimming exercise, your arms coming up over the head, body's horizontal, yeah? Arms are beating, feel the expansion and take advantage of that diaphragmatic breath now, see if you can also find a little bit of expansion and contraction of the diaphragm here. In this orientation it's okay to have belly breathing going on, you're gonna find some new muscles in your body from here, yeah? And relax.

Now stay in this position, arms are still here in front, bring them down to the side, right? And all we're gonna do is do a little bit of rotation from the upper spine, just like we're doing spine twist in standing, right? So knees are gently bent for the movement coming from the thoracic, staying right on that center axis, side to side. Yep, rotate is good to do with your patients that are pregnant because they can't do all of these exercise about laying on their tummy and also good to do with some back patients that might be able to get in this position that couldn't do a long sit position too, you'd be surprised if they can get in position through their hips. Very good.

Bring the bottom back down and sit on your mat, legs out in front. There you go. That works, that makes it a lot easier for me. All right. So now what I wanna do is go into a little bit of leg pull, right?

But I want bent knees. So bent knees, hands behind you and I want you just to feel your bottom lift up and feel the length through the front because this is what I wanna get in my back patients, get that open up in the front of the hip, right? And drop the hips back down and back up and back down and back up and back down. Now this time come up, stay up. Get the legs together nice and tight, right?

Take the right leg up, lift it off. And you can even just keep it bent, you can just keep it a nice, yep. Good. Now can you get a little bit more height out of the left hip. Bring the right foot down, bring the left leg up without losing that height.

That's it. And down and up. Now here's a question, do you think that you can take one hand the opposite hand off and keep it balanced like you would in quadruped? Can you just disengage it? Can you try?

(talks indistinctly) You can shift your weight, where can you find it? Where's that? There you go, good. Good, Christy found it, that's good. Switch legs, see if you can find on the other side.

See if one side probably gonna be a little easier than the other. You know, we do this exercise on the foam roller, didn't we? Does anybody do the foam roller? Just a little bit harder and bring your hips down. That's fine, very good.

All right, we're gonna roll ourselves back down onto the mat so we have the back of your thighs, take yourself down onto the mat. That's right, legs are gonna be up at a 90, 90, hands are out to the side doing a side to side with your legs now with the feet off of the mat. So take them all the way over. Restoring that rotation as we increase the load, bring it back over to the other side. Use your breath to facilitate this so inhale in your right lung when the legs go to the left.

Exhale, drawing the ribs down to bring it back up from that side. Inhale on the left lungs when the legs are on the right, exhale drawing down the ribcage up high getting that movement up in the thoracic spine is gonna make a big difference, right? This next time you're going to come over to your right side, leave the legs to the right side and now let your left arm come over and go into sideline on your right side. You got it, good. Doing book openings now, you're going to take that left arm, open it up to the side leaving the knees on the ground.

So really look at the upper thoracic, remember primary movement in the upper thoracic is rotation. Take a deep breath and imagine stay there. Imagine have a sandbag of about 10 pounds gently resting on those lower ribs. So just keep breathing. There you go, feel that opening there.

So like we do with our mermaid to get that opening in the spine. Light pressure and beautiful, bring that left arm back up and over. One more time going to the left, the left arm coming out. That's it, there you go. There's a lot more in there, isn't it?

Nice, you are okay? Good, now, what you gonna do is you're gonna bring those legs over to the left and go into a right sideline, we adjust yourself on your mats. Left sideline, sorry. And you can have the right hand on top, that's it, yeah. My bad.

Take that right hand now out and open it up to the other side leaving the knees to the left and just appreciate the difference from side to side, there's always one side, it's a lot easier. Taking a deep breath and feel that sandbag on those ribs really focusing, we'll do the same thing in our mermaid in a few minutes but getting that long sustained breath, opening up those intercostal tissues, giving you that length and bring it back up and close it. We'll open the book one more time to the right and open. That's it. Now from they're coming to the sideline on the left and come right up into a mermaid position, right?

You got it, look at that transition, wasn't a beautiful? Left hand on the mat, right hand behind your head. Take it up and over to the left. Yeah, and don't go down quite so far, I want you to feel this bend but now that's your kickstand to bring this up so we're gonna go over it. Yeah, that's where I wanna go.

Up and over. Give me a little more push that elbow through here. There it is so feel like this rib is lifting up underneath your heart, there you go, good so really opening that space. And then up and over to the right, right hand down, left hand behind the head. A little more restricted in this direction so appreciate that control of that left hip on the floor, reach that left elbow up to the ceiling, breathe into the left lung expanding that space.

Reach in, yes. And let's go like the seaweed in the ocean up and over to the left, gesturing the arm now so add the arm gesture and up and over to the right, long arms, beautiful wave into the ocean to the left. And up and over to the right. And up and over over to the left. And up and over to the right.

And up and over to the left. Last time, take your hands behind your back. Switch your legs to the other side, still facing the same direction to switch legs, you got it and here we go, right hand on the mat, sustained breath up and over to the right, left hand behind the head. You got it, good. Give a little bit that counterforce from that right arm up through that rib like around T5-T6 for that elbow reaching up to the ceiling.

For that gentle pause if I was just taking you up there. Find that space, that's it. One more breath. Give me a little more push with that right arm, there it is right there and then up and over to the left. Same thing to the left, left hand down, right hand behind the head.

Take it up and overreaching again. Now this side is the biomechanical side so it has a lot more expansion to go on. There you go, breathe right there and exhale lifting this rib right here up underneath your heart. There it is, good, good. All right up and over to the right side.

Seaweed, long arm here we go and up and over to the left. And up and over to the right. And up and over to the right. And up and over to the right. You got it and left, beautiful last one and relax.

Good, good, good. Come to the front of your mat, feet in front of you sit at the very end. So make a lot of fun with some movement and some rolling like a ball, yeah? Grabbing those legs, let's start by grabbing the back of the legs first and we'll progress into it and fill the space that you create by pulling away and rolling back with an inhalation and up with an exhalation, finding the balance if you can on that sit down each time, inhale back, exhale up. Inhale back, exhale up.

Now on this next one, you're gonna hold that position so roll back and come back up and stay there. Now I want you to find that position at about L1-L2 in you're back, there's a little bit above like two inches above your belly button that's actually reaching back using your hands as a counterbalance. Can you find that place? And then come back up from there, pull yourself back up and go back down. This is where the teaser comes from, it has to come from that L1-L2 area.

I'm not gonna take into teaser in this class but I want you to start preparing for it and feeling where that word comes from so you can feel L1-L2 reaching back and you can sort of feel your legs, use your legs and assistance to come back up so that balance, yeah? Let's do it one more time. Now there's last time you go down there, you're gonna stay there, release your hands to point up over your legs and right there just straighten your legs out so they're in the same plane. Can you come up an inch from there and back down, an inch up, inch down. That's it, that's the strength that I'm looking for deep inside where that movement comes from, that's going to do more to create that power in your body than none, good.

And then come all the way down, bring your knees in your chest, give yourself a hug. Little legs circle acts in their, release those hip flexors. So just take your knees and just do little circles by giving yourself a little bit of love there. Let's finish up with a couple of roll ups and going into some standing work. So legs are out in front of you straight ahead.

Arms are over your head. We're gonna pretend that you're singing that beautiful song so make sure that the breath is sustained. You can even do like a pursed lip. Or you can count out loud one, two three all the way up, yeah. Inhaling arms overhead, exhaling hands over chest, exhaling rolling up.

Find that much better, I like that. You feel the difference? Very nice. Exhale rolling down the same way. Send one down, then the next and the next just feel that control that same area we were just working in, that's the area, yeah.

Let's just do one more of those, we only need to do a bunch of them, just reeducating us on where that movement comes from, very nice. Good segmental movement, good stacking, good efficiency. Beautiful, now cross your legs in front of you. Stand up from there. Great, now from there we're gonna do a standing roll down and push ups so make sure you're facing the direction that you have room on the mat.

So you can actually come back, back, back, yep, good. And we're just gonna do a roll down from above and feel that same distribution so really notice how some of them get strings on your vertebra from behind and like a puppet we're letting one vertebra drop down at a time, just fill the head the ribcage getting that lower thoracic spine, the knees can soften if they need to as you roll down, get all the way down and feel the weight of the blood and the fluid in your face. Heavy lips, soft face, relaxed tongue and jaw. Feel the energy flowing towards your head, the inverted head below the hearts and then send that energy with your head as you start to stack back up, back into your heart like you're changing the flow by lifting your body up. Arms are just dangling and relaxed.

You come up you're gonna feel a nice rush of energy in your body. Taking a deep breath we'll do that one more time. This time we'll add a push up to it. Exhale, rolling down, segment by segment all the way down and you feel the heart now pumping the head gets below the heart and hands come on to the floor, you're gonna walk your hands out in front of you into a plank position. In the plank position just let the arms come down to the elbows come to the side and then push back up so it's a half push up, elbows go back to the side and back up, that's it and back up.

Let's do two more of those, feel that energy reaching the top of the head, feel the energy reaching down through the hill. Give me some energy here, yeah, good. Walk the hands back, feel the relaxation before you come back up. Faces relaxed and having lips come away from the teeth, the tongue drops away from the mouth, jaws relaxed, ears relaxed. The openings in your ears are opening for the ear wax falling out, your eyes heavy in the socket, stack your spine up one segment of time sending the tailbone down the pubic bone up, the elasticity of your spine brings you back up and stacks that spine.

Now this time, we're gonna imagine a nice big theraband attached to our head and our tailbone and we're gonna go about half the distance but half the time too so just gonna be rolling down and filling the elastic band bring you right back up so nice and easy, nice and fluid. Taking a deep breath, exhale, roll down and back up. Try that gain, so the spine bringing you back up, the flexion is distributed through 24 segments in the hips. No load to grade on any part of the spine, nothing stressful, very relaxed and stand, good. And here we are again in standing the way we started.

Close your eyes for a second. Just notice where your weight is on your feet. Notice what your legs are on top of your feet, your femurs, your pelvis, imagine that your skeleton is just suspended from the ceiling by this heavy elastic band and you're dangling. Create that space, fill your spine stacking up, there's no tension in the buttocks, no tension in the back. As the bone stack up, there's no need for any additional tension or contraction.

Taking a deep breath and notice where the body moves or not. If we're breathing in well, it should stay right in the center. Open your eyes and that was 33 minutes and 30 seconds. That was exactly 33 minutes and 30 seconds. How do we do?

How are you feeling? All right, so the idea is that you could have a class about movement, right? Very quickly in the morning this would be something somebody with back pain could do, you know, or a history of back that just shows really needs to wake up the movement, we moved into flexion, extension, side bending, rotation, from above, from below, right? Some things with strength, some things without strength, side bending so you got a nice exploration of movement in all directions and if it's your morning, it's a good way to start your day. Thank you very much.

We'll see you again the future Pilates Anytime.