Advanced Screening Skills

Chapter 1

What is a Screening?

It's a pleasure to be here in such a beautiful day. I was telling somebody, I was traveling a lot the last couple of weeks, but it was up in the corridor was in Indianapolis, Chicago and New York. And so everything was served 32 degrees everywhere with it seemed like this, you know, at home is 69 degrees and beautiful. I know when I go to California it's going to be beautiful on. So I'm sure enough, we have a beautiful day. So what I like to do is years ago we were trying to figure out this idea of giving politesse teachers tools to be able to assess.

If you think about what the pies method alliance accomplished in its domains, it has three domains for the politest teacher. Anybody remember what those domains are by any chance? Three domains. The first one was that we are able to assess and design, assess a person and design a program for them. So that's a skill set and a knowledge base that we as politesse teachers not apply to teachers that are physical therapists, not applies, teachers that are massage therapists, not plies teachers that are chiropractors, but politely teachers that we have our own set of tools to assess and to design a program. The second domain was our knowledge of Joseph and Clara Palladio's work, the history of their work, the exercises, the repertoire, all of the apparatus including the mat, how to teach individual how to teach groups.

So that was that big middle one that most of us have accomplished in our training. And then the third one, interesting enough was reassess and modify. There's an interesting that two of the three domains have to do with assessments. So this was back in 2002 2003 and we're certainly thinking like we really don't have an assessment tool for pilates teachers. And that's where we came up with the Pollstar fitness screening that we've been using for about the last 14 years, almost 14 years. And that's what we're going to practice today.

And so what we want to be able to do is give you tools, tools to help you manage, um, your ability to assess, reassess, and modify everybody in the right place. Cool. All right. So if we take a look at this, another word for is critical reasoning skills. And that's really what we're trying to do is to increase the professionalism of our profession, of a pilates teacher that we actually have some skillsets. So we're not just following recipes, right? And a lot of times when we were taught, we were taught recipes, we were taught sequences, we were taught stagings, but we didn't take into consideration the individual.

And I've heard people for years say things like, well, you know, I only want to teach pilates to healthy people. It's like, well, what does that mean? I don't know healthy people anymore per se. Um, in our society, we all carry something that can be improved, right? We all have something that could be better or something that might be a restriction in the way of us fully appreciating the work of Joseph and Claire Pilati. So that's really what we're looking at. So what we did is we introduced the concept of screening. So if you think of the word screening, what comes to your mind and you can answer these questions. What comes to your mind? The word screening. Can I ask? Sorry, an x ray actually actually is a test getting close, but what's a screening?

What's that? An overview. Okay. What kind of a scan? Okay. Of what? Give me an example. What are some screenings you as women in this group? What are, what are some screenings that you're supposed to do? Every so often?

Breast exam are screening out. The screening would be basically doing the test on yourself would be a screening and then going in and getting a mammogram would be also a screening test. Those tests in themselves do not tell you you have breast cancer or do not have breast cancer. Does that make sense? They're screenings that would tell us, you know what, you might need to have a more in depth test to be able to see if you actually have a cancer or if it's a cyst or something that's very benign. But that's part of the test that we would do that way and actually it would be a test. A screening I might do is might take a tuning fork and put it on a bone and if they have pain, when I put the tuning fork on their bone as a physical therapist, they would, I would say is a very likely chance that you have a fracture.

So now I would go do the test that would verify that yes, in d there as a fracture of his radius. So screening is what we do on a very global, inexpensive way to be able to find out when and who we need to do further testing on. So blood screening, somebody mentioned blood screening, what types of things would we have screening for? For blood? So types of blood screening, looking at everything from a blood tests that are out there now, markers for cancers, looking at things for diabetes markers, looking at things for high cholesterol markers in and of itself does not say that there is disease. You could have a high markers, a man for prostate cancer, but that doesn't mean that you have prostate cancer. You can have a high marker for breast cancer, but in itself does not mean that you have breast cancer. So again, a lot of these are screenings that we partake in on a regular basis. Colonoscopies are screenings, pap smears are screenings.

When you go to a health fair, they take your blood pressure, they take your pulse, they look at a lot of different things, but typically very easy, very cost kind of ideas. And the purpose of a screening is to identify, we call a red flag. So what does a red flag mean to you? What do you think when you hear the word red flag or so? Okay, and anomaly. What else would we think of as a red flag? Danger, right? So we think of dangerous. See a red flag on the beach.

What does the red flight to it tells you there's a riptide. Don't go out diet your own risk. I mean swim at your own risk, right? So a red flag is something, it's not always so critical, but it tells us it's something that needs to be evaluated and possibly referred out. So just this weekend I was working with the Miami City Ballet. We take care of them and one of the dancers on Saturday injured his back and I just took him through a couple of quick screenings. They didn't have time to really do a full evaluation, but I realized that there was enough of a red flag that I pulled him out of the piece.

And this morning the doctor called me up that I sent him to and sure enough he had a hernia, he had herniated disc and had an acute injury. So we had to take action on that. And that's the kind of thing that that is happening in a screening. We look at things and we find things that don't fit and the things that we need to take care of. So number one purpose of a screening is to identify red flags, red flags we send out. Okay, that's rule number one. We identify a red flag, we refer it out. And I do that all, we do that in all forms of medicine, all forms of healthcare, fitness care.

When we see something that doesn't fit into our box, we send it out. Okay. Um, so when we take down, we break down the component of screening, we start looking at things like what position and orientation of gravity. So on piles we look at quality of movement, quality of alignment. So it's not just quantity. Have you ever been frustrated with somebody that goes into a quadrupedal position? Hands and knees and their body is just like all over the place. The backs collapse, the shoulders are up, the heads down, the bottom tucked, and they are completely misaligned and they're doing the exercise that they told them, but they didn't have the quality.

So the other thing that we look at is the quality of movement in the positions, right? And then we look at the positions as they relate to many of the pilates exercises. So now it sort of gives us an idea of what do we have to modify for them to have a successful movement experience when they're actually performing. The pilot is exercises. Okay, y'all with me on that? Perfect. So we'll look at these and we'll also go through a couple of case studies at the end and we'll do some real cases, uh, today that we have come in and that'll be our day to day. So what is the screening and what information can we get from the screenings?

We've talked about that a little bit, right? And what do you do with the information you get from the screening? So let's say that we see this poor alignment right in this quadrupled position. What might be running through your head as ways that you can use that information that might help them have a better or more positive movement experience? You see the poor organization? What would you want to know?

Okay, so there might be some alignment problems like scoliosis. What else would you like to know? That's some, the grand juries of surgeries could be any. Okay. So there there medical history, surgeries, those kinds of things that they might've had in the past. Injuries. Good. What else would we want to know? You mean awareness? Awareness is the first thing, isn't it?

So a lot of times we are always comparing the difference between structure and strategy. Strategy is the awareness that you talk about. And when we talk about strategy, it's things like if I give them the right queuing, can they make the alignment in quadrupedal more quality based? And if they can't, and we do all of this queuing to get them to go that we still can't get them to make that correction, then we might start thinking of some structural alignment problems. So we might be looking at like maybe they do have some restrictions in their spine, maybe they have a fusion, maybe they have a scoliosis, maybe they have some other types of problems that do not allow them to align even with good queuing. But I always try to get the correction with queuing first to see if it's strategy versus structure. So what are the components of these exercises?

So let's go through this a little bit. So in a screening I was mentioning to you that working with the dancers, we look at the dancers and we want to know is the answer specific, do they have problems with their technique? So I might look at how they actually do their plea a, are they able to disassociate the hips and maintain that alignment over the knee, over the ankle, over the second toe? Or do I see them start to collapse? That might be a technique issue. Like we just talked about awareness, right? We also can look at the conditioning. Do they have the power, they can do a beautiful play with two legs.

Can they do a beautiful play with a single leg? So they might have enough power to work off of two legs, but they don't have enough power of one leg and for sure not landing on a single leg with to that leg collapse sense. So we had another might be a power problem for them. They might not have the endurance. So when I look at the dancers performing, I want to know can I go up and down a step test for a minute, full intensity without really being too winded because that's how the dance activity is. It's very functional. They have explosive movements for a minute and then their band, the wings sucking when and then they come back out and they dance again for another minute. Okay. In a medical professional screening, we mentioned already where identify dysfunction, so as a physical therapist, I use screenings all the time to be able to see what types of things might be going on. I'll give you a really good example.

Many years ago I had a patient sent to me as a workers' compensation patient. He worked on high rise buildings and he had severe low back pain and so he came for an evaluation for a muscle skeletal problem. During that evaluation I was listening to him and he said that his pain woke him up in the middle of the night with severe sharp pain, throbbing pain. So those are things that we call red flags. We started identifying that maybe there's something else going on here. I started to pow pate around his abdomen where he was complaining to pain wrapping around. And sure enough, just touching out here to this side of his body reproduced a severe pain, his severe pain. So I called the physician, the physician was gone, I believe it was this holiday presents holiday back about 1718 years ago.

And I called them up and I said, um, I think we all have to message, we have a problem that's not muscle skeletal. And I'd really like him to be evaluated. So he's at a time, so send him to Er. So we sent him to Er and er does not want to take him because he does not have insurance and it's not related to emergency room, I mean, to his worker's comp. So I call him back and I said, look, I'm, I'm just a physical therapist, but I put my stethoscope about four inches away from the central line. And I heard this sound and I don't know what that means, but to me that's what's causing his pain.

Of course I knew what it was. It just wasn't my place to diagnose it. Just like many times, you will know of things that are alignment issues that are out of our scope to practice as applies teacher. But you have seen them in, you identify them so you're sending them out. So I was trying to be politically correct. He went back to the Er and in the Er, the identified yet is stage four aortic aneurysm. It was ready to burst. Turns out he was a coke head, so he was using a lot of cocaine, which is not very good for a stage four, three inch, almost a three inch bubble in his descending aorta. So was only 37 years old. So the pieces didn't fit, but the signs manifested and we identified that this function was not muscle skeletal. He went in for emergency surgery and survived.

But the idea was that it was something that if I would have tried to do my physical therapy techniques like manipulation or myofascial release to the, so as right there on that aorta or had gone too deep, he could have had a serious problem right then and there. And that's why there is a seriousness. We say often professional, we say the more I know, the more I know. I don't know. The reverse of that is just as dangerous. The less I know, the more I think I know, right? And so that's, we have to be careful. So people become Plati certified or fitness certified and they know a little bit, but they don't know enough to know how dangerous things are. And that's why the screenings help us just to be able to say, this is outside of my scope. I'm going to send this out.

This is inside my scope. I can definitely make a difference in here. So things that have to do with awareness, alignment, consciousness, quality of movement, all fit within our scope is plot. As teachers, when we start dealing with structural problems, they need to be referred out and then they often will come back to us because everybody needs strategy. Not everybody needs structured intervention. So we're in a good place as polite as teachers cause everybody needs us. Right? But not everybody needs to have structural intervention. Does that help at all?

To sort of look at how screenings have been used in other professions and that's how we're going to use it in our profession. Similar way. So we mentioned the red flag already and we know that the red flag identifies

Chapter 2

What Can You Get From a Screening?

abnormalities that are out of our scope. But what is the yellow flag? What do you think a yellow fagus are? That hurts might be a, might even be a red flag, right? So when somebody says, oh that hurts, I might say something like, have you seen anybody for this before? Have you ever had a diagnosis of this before? Right? And so those, the type of questions that we might ask because if they say, oh yeah, I have a chronic shoulder impingement pro problem. I've been seeing a physical therapist and chiropractor for years and it just is, you know, it's an awkward position.

Do you have as much worry about that scenario as somebody who said no, I've never seen anybody for it. There's a first time I felt it right. That would be more of a red flag. What else would be like a yellow flag? What's a common population that comes to do PyLadies that is great for them, but we have to be careful with them. Seniors. And what do seniors often carry with them?

Especially females asked your porose is very good. So osteoporosis would be a perfect example of a yellow flag. Is Polite is good for them? Absolutely. What is our precaution with them? We avoid flection with compression. Right?

So the idea is that we're looking at understanding that precaution. So that's our yellow flag. We're still going to treat them. We've got clearance to work with them. Their doctors know that they're coming. They might have some scoliosis and have different things. As a physical therapist I prescribed to the applies teacher all the time.

I'll come and say I got a patient was to gnosis. They're getting a lot better now. They need conditioning. Are you comfortable with stenosis? Precautions? Yes. Fantastic. I trust you'll design a beautiful for them, have fun with them, great person. Right?

Because your work with them is going to be more valuable and more effective than the cost of them having to go to physical therapist for five, 10 minutes for $140 they can come and see applaudise teacher take a class that's going to respect their precautions. Right. So that's much more valuable. Can you think of any other possible precautions that would be out there? Well during your placement, perfect joint replacements, so knee and hips and depending when the hip surgery was done, those are the things that we want to know. So yes, that varies and we have things that we avoid, things that we do specifically to work with that. Right. So again, it's polite, is good for people that have just had total knee and total hip replacements. Yes it is. It's fantastic for them. Is there a precaution? Yes.

So that's the yellow flag. So just to make it real simple, red flag, we send out yellow flag, we modify. Okay. Simple, right? And then the next one is limitations. I think limitations, important limitations, not a disease. It's not a problem necessarily. A limitation might be things that they have difficulty in long sitting, right? Or they have difficulty sitting in a z set.

So they go into the Z set position and they're like, they're like this, right? They can't get up into a position. Right? And so we might say that they have a limitation. It's not even a precaution, but what are we going to do as a result of this type of limitation? What might we do? We might modify the position. So we might use props to be able to help them have a positive movement experience.

So if their hamstrings are a little tight or the posterior chain's a little tight, we could bring their bottom up. Right? If they can't get into a set position, we could have them do a cross legged sit position or also bring their sit bones up on some yoga blocks, those kinds of things, or even a chair if we need to. Okay, so the idea on the next one, the limitations is we can know that we're going to focus on those things. Here's the beauty of this one, in that third category of limitations. I don't want to have to use props forever. In some cases we do.

People that have been paralyzed waist down, I have to use props and I can get power back necessarily, but some of that has restrictions in movement. I'm inclined to continue to progress them until they need less and less and less and less and less props. So we also don't want to be satisfied of saying, oh, the guy that has tight hamstrings over there, we always just put them on a box. It's like we want him working actively to increase his mobility and to have that ability to do the exercises without props eventually. Okay. And the last one is aligned perception with the ability. Now, this one is an emotional one. Have you ever had the really excited athletic guy that comes in that believes he is all that?

No, you're probably that person, aren't you? I know. Um, anyway, um, when we think of that person coming in and we talk often have a malalignment so their perception does not match their reality. So the other thing that is screening does is it helps us align reality with their perception. So if they think they're all that and you take them through and testing them for an extension mobility and they're thoracic for a swan and other, uh, prone extension exercises and they're really, really rigid or you're testing them to see if they can long set and they're so tight and sprung so tight to their body, they can't long set without having to use their hands and you show them that they don't have the ability to roll up. They've just been doing, excuse me, the hinges for their abdominal work, right? All of a sudden alignment comes in and white, maybe you shouldn't be in that level three class with your friends. Maybe you need to be starting a level one class and so a lot of times we found our teachers were having a hard time with that malalignment with the students and for us to give them a test and you could take them through a test and say, well, you know you scored ones at a three on eight of the 15 tests and that really indicates to me that we need to be focusing on the basic fundamentals and get you some coordination that you would need to be able to do a level two in a level three class.

Would that be a helpful tool to you to have something where you could actually have a measure that says, hey, look, I know your ego is this big, but this is your mobility. This is your strength, this is where we need to start and you're going to be so glad we did it this way in six months. Okay. The same thing I do with my golfers, they're 55 years old, 60 years old. I decided, hey, I heard, you know, golfing is a great activity to do when you're not running anymore. Not that I ever ran before, but you know, I'm this 55 year old sagittal beast that sits behind a desk. My kids are all out of the house. I now have a little bit of supposedly income. I want to play golf. So for 30 years there's been no rotation in that spine other than maybe going to the bathroom. All right? Very little.

Mostly I spent pretty much sagittal and so they go and they pick up a golf club where they go and take the yoga class. Right? And they go into a rotation and what happens to them? They get hurt. Does that make yoga and golf bad? No. No. And I think this is a very important thing for us to understand.

It makes us understand that they don't have enough mobility to enjoy the sport safely. So if they participate in those activities with this type of a body, they're probably going to injure themselves. So for you to be able to have a tool that you can say, here's some limitations and we're going to be working on preparing you so that you can participate in Yoga. You can participate in golf for the rest of your life if you take these things seriously. Does that make sense? So a lot of times that alignment of perception is a very powerful tool.

We often forget about it, but a screening can help us align perception with reality. Okay. Any questions up to this point? We're good. Perfect. So what we're going to do now is we're going to go right into the screenings. I'm going to explain sort of how we test. You have the handouts in your hands and we're going to go through 15 tests and this is an older version that we had proved over and over and over again.

Um, we have been developing a new one that we call the F mom, no relationship to mother or creator, but um, movement, uh, observation and movement assessment that we do that's a little more technical. And so we've been working on getting it for interact test and inter test to reliability still as a tool for politesse teachers. But this one we've been using forever and we really appreciate this tool. So we'll go through that. Each test has a maximum of three points that you can award in the screening that we're gonna use today.

So zero means that you could not attempt or that I don't let you attempt. So for example, if I have somebody that just had a hip replacement, there are tests that I would not tests like z sitting as one of the tests. We're just not going to test. And I put a note to the side. Would that scare the heck out of you? Yes it would. And they scared me too. So on the side now we just put, you know, recent hip surgery zero is a score. It doesn't mean they did badly.

It means that there's a zero. We would do the same thing if we had some of the osteoporosis, we would not do the flection or the roll up test or the hundreds tests. Okay. We would do a different variations of things that we would look at to see if they have the power and the alignment that we would measure without doing harm to them. Okay. Does that make sense? And so zero means we didn't attempt it.

K One is where we did attempted, but there were a number of things that were not in place. Remember, we're looking at quality of movement, not quantity of movement in these measures. So we're looking at alignment when they go into their squat activity, are they still able to keep their spine vertical, keep their legs aligned well, and be able to hold that position without their heels coming up? Okay, so I want to know, can they do that for 30 seconds? If I see the ribs coming forward, right when they go down their squat or that they go forward like this and their squat, then I know that they're having a hard time making that transaction so they're not going to get all of their points or three points at the end of the test. We just add those points up divided by 15 and then it gives you an average score. That average score actually correlates fairly well to the level of they participate in. So somebody with a very low score, an average of 1.2 is going to really be a good candidate for a beginning class, right?

Because they're gonna need to work on certain things and then you could go back and do what in three months? Great retest. That's exactly right. So we test, we treat or we take them through programs and then we retest again. Okay. We reassess. And that's the beauty of having something that sorta shows are we making a difference? I was talking to somebody about business the other day of politeness and they were saying, my practice is so full. I have this waiting list just a mile long.

It's like three months out. I'm like, really? I said, how many politesse teachers do you have in your studio? It's just me. Okay, that's good. That's nice. I'm glad you're busy. How many of your students actually fall out because of she has a long list and she's replacing them and you can wait. That means a lot of them are not staying and you're having what we call attrition. So one of the things that prevents attrition is having objectives and measures that show that they're actually making progress. If we don't do that, and you just do the same thing all the time, which is what I believe this one woman does, she never changes her program. It's always the same.

People either fall out because they get bored or it's too hard for them or they have special needs. And so none of those were met. They weren't stimulating them by making it more challenging. They weren't bringing it down a little bit to make it so they had a successful movement experience and they weren't changing it so that there was some excitement and progression on it. So again, the screening gives us a good chance to be able to have objectable objective measures and looking and saying, here's where you started, here's where you are now. This is where we want to go, this is where we're going. Does that make sense? And so that allows us to be able to have these really clear objective measures of where they're at. And I think that significantly decreases attrition and attrition will kill Your Business.

I would much rather hear that your fault and you had to hire two more pilates teachers to handle the volume that's coming through because you're not having a nutrition. You shouldn't have a long waiting list. You should just keep growing and letting more people participate in the benefits of plots. Right. And so that's the, that's the idea that we want to have in the society of polite is teachers. Right. Good. All right.

Chapter 3

Half Squat, Full Squat, and Heel Raise

So we're ready to move on to these scoring on these exercises. And so what we're going to do is I'm going to have one of you come up and volunteer each one of you.

We'll do a different test and then at the end we will all do it together with partners and then we'll take a break. After that break we will have a person, a volunteer come up that has something we want to look at and I'll do the full screening on them and you'll help me by going through and grading it yourselves at the same time that I am. And then we'll have a discussion about the differences. Cause what we're trying to do is build that intra test to reliability between us so that you can actually see am I in alignment with this program? And that's, that's the power of what we're trying to do. Okay. Everybody good on that? Perfect. All right. So who would like to be the first volunteer?

Don't all jump at once. Come on. Okay. So again, when we do screening, yes we remove all of our junk clothing and the more that we can see the better. So it allows us to be able to look and understand what kind of things we're looking at. So if you open up your handouts, your handouts, you'll see each of the measures test by test and you can sort of go through with me as I look at her in her different positions. So we're gonna look at her from the side and then we're going to turn it the other way and look at her from the front, right? So we'll pick up both views so that we're very clear on what's going on. So what I like to do is I like to demonstrate what I'm asking them to do, right?

So what I'm going to ask you to do is just to have your feet about shoulder width apart, relatively parallel. So I don't insist that it has to be parallel, but relatively parallel. I don't want him turned out like a duck and I don't want him to turn in like a pigeon case, no birds, and then we're just going to come down into a squat, keeping the body straight. There'll be a little bit of a lumbar curve. The hips come down right over the feet, the knees bent in front, and this is the position of the half squat. The heel stayed down and things that I'm looking for are going to be, am I able to get enough flection in my knees and ankles and hips and can I avoid pitching forward? Okay, so let me have you come here in the center facing me. Yeah, good. You're in a good position there. And let's just start with dropping down, keeping the heels on the ground, and then bring the arms out.

And we're going to hold this for 30 seconds. You'll actually hold it for two 30 seconds cause I'll have you face the other direction. So what I look at from here is I'm looking from the side, is she able to maintain the spine vertical? And she is, I look at the ability to get some movement in the knee and reciprocal movement in the ankle and hip. So the ankle and the hip should add up and equal the movement of the knee. Does that make sense? So you can see that that relationship, if she had one side that was real tight, I would start seeing her shifting over and not able to stay on both legs equally. Okay. And come on up. That's 30 seconds. Now let's face forward to the group and now we're looking at it as alignment. So let's do that same thing.

Dropping down. Yep. Hands in front. And now I'm looking at alignment of hip over knee, over the ankle, over the second toe. So now that becomes important to me. To see what's happened. Does she go into a rolling the knees in, are rolling the knees out? Does she go into pronation on one side, supernatural one center. The feet change, they look the same to you. And this is also where I can pick up things like, wow, when she's coming down and waiting into her feet, she actually is getting, you can see the forest coming onto the big toe or onto the little toe or those kind of things and come on up. Okay. So for me, I would give her three, right? She had the death, she had the power and she had the alignment. So it was the three things I'm looking at.

One last thing I mentioned throughout everything we do turn sideways here is I'm looking at the position of the head in relationship to the rib cage in relation to the pelvis. So what I want to avoid going into a forward head posture, I want to avoid having a loss of alignment with the head going forward or the ribs poking out, right? So the ribs go in front of the pelvis or the pelvis tucking under or hyperextending. Right. So any of those things where I lose that alignment of head, rib, cage and pelvis, even when we're articulating the spine, we still can have that relationship in harmony. So as soon as I see that we lose that articulation alignment with the head to the thorax to the pelvis, I take off point. Okay.

Are we good for a sexercise? Perfect. Thank you very much. So Reece in a resume. In summary on that basically coming down, can they maintain the alignment? Can they maintain the vertical wholeness? Can they maintain the relationship of head over thorax over pelvis? Right.

And can they then hold it for 30 seconds? Each of those is worth a point. If they'd miss it, you take a point away. Okay, excellent. So if somebody pitches forward, how many points did they get? Two points now. Right? So the lower the points they need more work. Okay, so the next test, what they do with my little thing. So the next one is a full squat. So the full squat, the heels can come up.

And again, you don't have to be perfectly parallel. That can be turned a little bit still vertical, but coming down, able to come down and then come back up, come down and back up. Oop, long, high. Should we fall down? Okay. So what I'm looking for, a couple of things I want to know. Do they have the ability to get down to the ground? So the number one differentiator between a frail adult and a healthy adult is the ability to get down to the ground and back up again.

So if an adult over 70 can't get down, then they're considered frail. Okay? So let's give it a try. And I'm going to give you a hand the first time and just go down for balance. Good. And back up and try it again and back. Yup. Okay. And then I want you to face the front. Do the same thing.

Okay. And you'll see a little of a wiggle on her, right? So she keeps the alignment nice. She goes all the way down. So functionally I'm happy with that, but I'm seeing a little asymmetry. I also had a little one myself.

I know mine comes from an old ankle and hip injury. And so when I get through in certain ranges of motion, you'll see my body shift a little bit going side to side, right? So I'm trying to get around my stiff ankle or around my stiff hip and I go through a range. Okay. So let's try it one more time and just see how smoothing come down, connect and then come right back up. And that was better. Okay. So a lot of times if they can do it better with practice, then I know that it's what type of a problem and awareness problem. Right?

So it's a strategy problem and we're focusing on the strategy of the movement, not just the structure of the movement. Okay. So that was pleasing to me. All right. Thank you. So I would give her, um, two points maybe because I did see that and it gives me a red flag and I wrote for the yellow flag that I'm going to come back and focus on that. Right. There's some areas that I saw in her hip or her knee or her ankle somewhere. I'm going to come back to a screening. I'm thinking there's something I gotta make sure smooths out in that, in that area. I didn't take her medical history yet, right?

I would do that with any plans that have come in and health wise. But she had a metal taken out of her ankle less than a year ago, right? Or a year ago, a year ago. So that would make sense. And we even know, but we saw it right in the screening. It popped out and it's like, oh, something here we need to pay attention to. When we look at the alignment of the squat, we still want to see the ability to stay in that nice vertical position coming down and up. Now what will happen a lot of times because the heels come up, is the knees will come forward and you'll see a little bit of a posterior tilt to engage the quadriceps. Um, the more powerful you are easily go down. Now something's happening now in running is to be able to get the hills all the way down and to be able to come all the way down with your arms up and maintain the ribs over the pelvis. So that's a screening we're working on. It's a little more advanced, a lot more challenging to get the arms up without losing the rib cage and having the pelvis rolled back.

But we're finding that that's necessary for running to be healthy runner. Okay. How are we doing? Two down, 13 to go next volunteer. And you can see the faulty went on the right, correct? Yes. All right, so this is looking at it come to me as sort of like a dance. So we're going to do, um, when we look at the ability to heal race, um, I just want to see that they can do five heel raises on each side. I'm looking at power and I'm looking at balance, right?

So if I see that she can maintain herself and good alignment, right? I'm going to give her a finger touch to start and she's going to go up five. And I'm looking at her alignment through the leg. Right. You don't get, we don't take points off for clicking. Okay, that's good.

And relax. Okay, now go the other leg and I'm not going to give you hands of course, because that's the one they sprained. And again, I'm not interested in the ballerinas version of going up into irrelevant, but I do want a significant clearance of the heel off of the floor. Great. Okay. So there's compensations. I'm gonna have you do the same thing facing them so they can see you from the front and as you come up now pick your leg. Um, what I'm looking for is what kind of compensations does she make when she loses her balance? Right. So she might do more of a hip strategy going side to side kind of thing. She might do pelvis forward and back, right.

To find her balance or she might be sort of wiggling all over the place. Right. So I would prefer it to be unidirectional then sort of all over the place. Right. Why do you think I would prefer it to be Uni Directional? Like she sort of does this kind of thing to catch her balance versus all over the place. It's much easier to solve. So when we know that it's a unit directional, we can start working on their awareness and balance in that one plane as they go up and down on their heels. Okay, so a five on each side. Thank you.

And even with her history of an ankle problem, right? I can tell that you've been working on that ankle for a number of years. So when her case, even with an ankle history, I can tell that she's worked on that ankle a lot over the years because she was able to have balance. And I actually find that I had better balance in the ankle that I broke than the one that I didn't because I have rehabbed the one that I broke so much in focus on, which is more of what kind of a problem. Okay.

Awareness and then structural. Right. And so we started finding, you'll hear me say this to you and asked you because as plies teachers, your focus needs to be on awareness and you're going to find out a lot of these problems are not structural restrictions. They are strategic restrictions and that's going to be a good thing for us. Alright, the goalposts. So I have a volunteer for the goalpost.

Chapter 4

Goal Post, Long Sit, Seated Hip Abduction, and Z-Sitting

So the next screen test that we want to do is the goalpost and I need to use the wall for that and I need a volunteer. So all right, come up this way. So what we're going to do is on this one we're looking for the relationship of the shoulder girdle to the thorax in relation to the pelvis.

So I'm going to have her stand against the wall and your feet can be actually about a foot away from the wall. So one of your own foot with away from the wall. Yeah, good. Both feet out in front and then resting the sacrum back against that, you're going to just feel the thoracic, the head in the sacrum. So we're going to respect natural curve of the lumbar spine. And we're going to respect the natural curve of the cervical spine. Okay?

So what we want to know now is when she lifts her arms up and we call it a scarecrow or goalpost position, does that change the nice posture that she has right now up against the wall? And just to back up a little bit, let's say that I have my 80 year old friend that comes here. Who's head's way forward? Let's say that she's in this posture here, right? And she really can't get her head back to the wall. Now what I'm concerned about is would I even go into the test for the shoulders?

Probably not. So what I would do is I would mark her as maybe a zero or a one if I can't even get her up against the wall. Right? So she goes against the wall just fine. So now we want to see is if she brings her arms into the goalpost position, does that change the relationship behind the back here and the lumbar? So do the ribs jet out a little bit. Does the Chin change position as she does that initially able to get that nice align across the front of the shoulder.

So those are the things I'm looking at is to see can she maintain alignment when I put the load on her shoulders. Now from here you're going to slide your hands up into a v position and still keep the elbows against the wall. And I'm still looking to see how does that effect the rib case. So for her, she's having to use a lot more tone to be able to maintain the ribs down based on the pool of the pecs pulling the ribs up. So for me, she gets a three cause she can get in that position. But I picking up, I'm going to write a little note on the side that I'm going to want to open up the pex a little bit more in relationship to the ribs. So it's a little more natural for her to be able to bring her arms up in this position and to move in that range of motion without the ribs feeling this. Now you might ask why would that be important? Right? The thing, if she wants to play tennis and she doesn't have this mobility, where is that movement going to take place when she goes to swing overhead?

Okay. She'll pick it up in her shoulder joint. Where else might she pick it up? Yes, in the low back. Right. So what she'll do is she'll go here to get that arm up in space because she doesn't have that space here to do that. Right. So the majority of injuries to neck, shoulders and low back are a result of rigid thoracic spine. Rib Cage.

Alright, thank you. Good job. Any other questions regarding the goalpost positions and the relationships between the rib cage and the pelvis? I use this one a lot because to me it gives me a lot of information. It's vertical related. It tells me if people are really restricted in the soft tissues of the chest or if they're more restricted in the intercostal tissues or maybe even in the back.

So just by watching where the movement comes from as they slide arms up. And again, you know, I'm preaching to the choir, so you are the healthy teachers and movers. But if you imagine if we were working with some of our clients and we were putting up against the wall, what would that look like? And that's where we come in and you'll see some differences whether I am queuing the client as they're going through each test versus just giving them instructions of movement versus the actual queuing or correcting. Right. Um, I use it in a way that I typically, if I really want to be objective, I'm just going to give instructions.

So my consistent instructions would be I demonstrate, I tell them what I'm looking for and now you repeat it. Okay. If I really wanted an objective measure, the reason why is because I also want to know how they interpret the instructions. Right now I have one plot, his teacher who uses it as a teaching tool all the time. So he is actually teaching them while they're going through the screening of how to improve and how to improve their alignment. And then he'll teach them exercises that will improve that test and measure. Right.

I think the important thing is for us to be consistent with how we administer the test more than um, exactly how we do it. It's each person's heard, develops their own skill set with that second question in the question is, is if they cannot get their head back to the wall on the goalpost, would I still look at range of motion in their shoulders and the relationship? And it just depends on their activity levels. So what I might ask them is, you know, are you participating in overhead activities and if they are participant over activities, even things like putting suitcases up in the airplane or getting coffee cups off the second shelf, those are all out overhead activities, getting dressed, blow drying your hair. If I had hair. Um, the idea though is that if they're doing over activity, then I want to see how they strategize to do that. So I would look at that in particular. And that's, that's a great comment. Okay. All right. Next test is the long sets and I can, I have a volunteer come up for long set. Beautiful.

So I'm having to sit up on the table and let's have you sit with your legs in front of you. Good. Now this is one that, um, is controversial in a lot of different, uh, worlds of looking at movements and tests and measures is, are we really looking at hamstring length and shortness? Are we looking at the relationship between the pelvis and the Femur, the hip joint? And those are the things we look at. Now, what I want to know really from a practical standpoint is are we able to resemble something that looks like a neutral lumbar spine? Now the big question is how do we define a neutral lumbar spine? So to me, it's where we move from the easiest. So if I looked at her and standing and I saw that she had a pretty flat back, which I saw, I would want to sort of repeat that same amount for her. If I saw someone that had a lordotic curve, I would probably want to have her be a little bit more in a lordotic curve, right?

What I'm looking for is it because in Long said activities when she goes into forward bending, right? And what I want to know is does she start already in a disadvantage? Right? So for example, let's pretend that you are this person. Okay. Now for her here, if I'm going to do spine stretch, if I'm going to do rotation activities, right? Spine twist saw any of those activities from this relationship, I'm in a very bad starting place. Okay?

So what I would wanna do is let the bottom up high enough to get her up at least into a vertical position that I know she can start her movement from here, right? If I can get her even to hinge a little bit forward like she did from the very beginning of more from the pelvis, right? So I know she has oodles of hamstring length, right? So without a doubt, she's a three. And the way that I sort of measure this is I put my hand on the sacrum. If the sacrum has any inclination at all forward, that's a three.

The sacrum is vertical. That's a two. If the sacrum is posterior, that's a one right now, why would I say that? Why would I say sacred interior is a three? What is the sacred neutral position in the human body? Which direction does it inclined? Anterior. Right? So it's always anterior. So some when I go to Brazil is more anterior.

When I go to Japan, it's less anterior. Okay. But the idea is it's still anterior because it determines the Lord dotted curve of the lumbar spine coming off of the angle of the sacrum. Okay? So if she has really tight hamstrings, but I see her with a lordotic curve and she comes up here and I see her back here. Now I know she's compromised. So if I have her doing rotation from here, I know that I'm going to be having too much movement in certain segments that are not going to be happy. They're already inflection. Okay. So how would you modify that? That test?

You could bend the knees if you wanted to, or you could raise the bottom up. Right? So what would you tell some, would this be a limitation or a yellow flag or a red flag limitation? Right, so the limitation, we're going to correct with some kind of modification or prop. So for her, she gets a three because the sacrum's anterior, she's relaxed in the front of her hips. That's another thing I look for. If I see the front of the hips and that tensor Fascia Lata is tense, right? And it's pulling forward, then I often take a point off from that. Okay. So the idea is just again looking, can I get that pelvis sitting up straight so that she has freedom of moving her body up above? Right. If I take that away from her, now I don't have that freedom anymore. Okay.

Can you feel the difference of that? And then here, so the idea of the x is right. This is what I tell people is the exercise is not about long set. The exercise is about the relationship of the rib cage over the pelvis in a long set position. If you can't get into a long sit position, then you defeats the purpose of the exercise. Of being the differentiate the movement in the thorax in rotation flection side, bending in other long sitting activities. Okay. Any questions on long city? Perfect. Thank you.

All right. The next test is also long sitting, but it is with the legs open. So I need another volunteer. Yup. And let's see. Do you think you can open wide enough this way towards the camera or you that flexible? Okay. There I knew I got the right person. But now on this one, I don't double Dang people points.

So what I mean by that is, let's say that she had tight hamstrings in the long set and I brought her up to the height of the yoga block and the tension in her hip flexors went away, spine went to neutral. I would probably use that same yoga block in this test. Not taking away points from her because I already measured it. I'm not gonna, I'm not gonna say, man, those hamstrings get in the way of everything you do, don't they right. Now, the other thing you'll notice is when you go into abduction, it also takes some of the stress off of the hamstrings. So you might find they couldn't sit up perfectly straight with long set, but when they had flexibly opened up into abduction, they could. So that tells me a little bit more too physiologically of where things are happening. Instruction. Okay. So here what I do is I look from the top down.

So if you think of your trigonometry and your angles, right? So or geometry, even simpler angles, 90 degree angle is what we see in the wall and the floor. Okay? So I want to know that she's more than 90 degree angles. Okay? So what I'm looking for is I want to see as much as 65 degrees precise and you say, well how do I know it's 65 degrees is okay. So what I do is I draw a line that goes right down the center of her and I have the line that goes here. If she is beyond the middle point of that, which would be 45 I'm going to give her three points, which she is. Okay. Does that make sense?

So you don't have to get a measuring tool out in a protractor and go, she's 62 she's not getting three points just to know that if it's over the 45 point, right? So again, remember straight line down the front and then the coronal plane. If she's more than halfway on each side, she's going to get three points. She's right at the halfway point. I tend to go two points and if she's less than that, I'll go one point. What am I really looking for here?

Any ideas? Thank you. Symmetry. That's right. Or asymmetry, right? So if I see one leg, for example, if I'm looking at somebody with a hip problem, right? They might have one leg that goes out 25 degrees and one that goes out 60 degrees. So I'm thinking there's probably some arthritic change going on in that hip that I need to be aware of this limiting that movement. And that might be something that I consider a red flag and we'd send out as a place teacher to get evaluated. If I saw that type of asymmetry, it could also be a labeled tear. It could also be an impingement.

It could be a flared up capsule. It could be as so as inflammation could be a lot of different things that somebody like me would rule out. Right. But if you pick up that asymmetry and then you put them in feet and straps are, you have to do some of the other exercises, you're going to see that it's not going to be the best exercise for them. And narcan, you get a really nice benefit from it. Okay. So let's just again give you an idea. Thank you.

Do I look at the rotation of the femurs in relationship to the abduction of it? And typically, I don't know, I didn't look at chores, but typically I like to see if we can keep the toes up towards the ceiling. So just the way we would teach the exercise. Alright. Alright, good. So let's move into the next one, which is the z setting. So can I have another volunteer come up here and we'll finish up our city and exercises. All right, so let's face the camera, pick a side, either side and use Isa. Okay.

And we'll look at it from the front and then we'll look at it from the back. So in the Z set, what I want to see is can she maintain the shoulders horizontal and can she maintain the spine relatively vertical. We used to look at the height of the sit bone coming off the floor. The problem is if you had a lot of redundant tissue, it looked like it was touching the floor, but it really, you were still tilted. Right?

So what I'm really looking at is the spine and I want to know is that spine relatively vertical in relationship to the sitting posture. Okay. And then we want to look at the other side as well to see if there's an asymmetry from right to left. So anytime that we have two sides of an exercise, we're going to take the measure and whichever one is less is the score that I give, I don't average them, I just take the score that's less. So if she had something different, go to the other side and that's it. She goes to this side and she has to be over here using her hand.

That's a one if she has used her hand, so I would give her a one. But in the side of the note I would put in right z setting, she was limited. Left sitting was clear. And now where I might be looking specifically at something going on in the right hip, what might you see as we go through the test now you're trying to see some of the tests, the, the long sitting, the abduction, the z sitting. Do you think you might, somebody had a hip problem, you might see a pattern. You bet you would. Right? And so that pattern would come out. What about the ankles? Right between the squatting and the heel lifts, we would see a pattern coming out. If it was an ankle problem, would you see a knee problem come out in some of those different ones?

Absolutely. Just like this. And knee problems. Not gonna like sitting like this and disease [inaudible] and they'd say, ah, it's really uncomfortable for me. Great, let's not do it. Right. So she said she couldn't get in this position. Well, how else could I measure her in a sitting position? How would I modify this? I can raise your bottom up or I can, yeah, I can straighten the legs.

I can even have her cross legs cause that might take the torque off of the knee. So when we go into some of the z city positions, I can tell her for now she can go into cross-legged sit and for some of my patients I let the legs dangle off of the reformer or off of the trapeze table or the chair. Right. So they can still do the exercise. I have a patient in a wheelchair, does all of his sites sitting activities in the chair. We just hold onto the one of the wheels and do the movement side to side. Okay. So it's not so much, and again, I think this is really important.

A lot of times it's not the position that you were in. It's the movement ability from that position. So we often, we get so fixated on, you know, can I get them to get their bottom all the way down in a z set when in reality what I'm looking for is a thoracic lateral flection or spine lateral flection. So if they're so obsessed with the knee and ankle and the foot being in the position of the set, that they can't get the benefit of going into a mermaid, right? Because the, they can't get their legs there. Then we made too much stress on the wrong thing because what we really want is to be able to find this, right? It's a z sitting that allows us to have the freedom of really getting focusing on that.

So I might have to come over and anchor her hip down to give her the same sensation of being in the z set if she can't be in a z set. Okay. Both sides, we give the score of the lowest side. Make note to the side. Okay, now here's my grading on this one. Go back into your z set position. It doesn't matter what side, if she can stay vertical. And I want to actually have you spin around to the camera. Let's go with you facing me all the way. Yeah. So if I were to look at her spine, I would see that the spine is very vertical.

I'm not worried about the height on the sit bones with her. Right. And I can see that the shoulders are very level and her eyes were very level. Okay. If I see anything tilting, are those things moving side to side? I know that something's pushing her off. So let's say that she didn't have that much internal rotation. Okay.

So right there she can still maintain her uprightness, but we know that the spine now is curved. That's a too, okay. Okay. If it's curved up so high that she has to put that hand down, that's a one. So that's how I differentiate it. Okay. And then if I have to modify it to be able to get her in position, like having the legs to the side or something like that, I'll put knee pain on the ride or you know, poor hip internal rotation on the right, whatever I think is causing that. And then I modify it. Okay. To see if we still have the ability to, to sit up straight. Okay. So what would you score? Would you give her if you had to change your leg position?

Zero because she couldn't get in the position. Right. Does that make sense? Because it's going to, it's telling me right away that if I'm going to do mermaid with a class and she can't get into a z set position, I need to modify. I'm not going to force her to get in that position right now. That modification will change as she gets better and better and better and better. Right. So we might start where she has her lace crossed this where dangling, and then we progress her to a block with it and z set to where she eventually can do it in z. Say, okay, cool. Thank you.

Any questions on z setting? That one sometimes gets a little confusing, but again, keep it very simple. It's about the position alignment of the spine, and if the spine gets taken off of its center and the hand doesn't have to go down, that's a to, if the hand has to go down, that's a one. If you have to change the legs to be able to get in the position, then you really can't test the z setting. So it's a zero volunteer.

Chapter 5

Roll Up, Hundred Position, and Side Lift

The roll up while one of you is being brave and ready to come and do the roll up. The roll up is not about testing somebody technique because typically these are people who have not done a roll up yet. Okay, so what I want to know is do they already have a preconceived notion of muscling up through this exercise like an abdominal, so it may be laid down with a head here or are they mobile and supple and their movements? Do they use breath to facilitate the movement or does breath get in the way of the movement? How would breath get in the way of the movement?

Holding their breath, right? So like a Val Salvia, right? They'd go and then they'd try to roll up, right? So those are the things we want to look at. So let's see what her roll up looks like. And what I'm gonna do is I'm gonna help her sit up, right? And I'll have her do the roll down first.

And a lot of times I'll even put pressure on the leg just because again, there are novice coming into me, they don't know what I'm really looking for. What I would say to them is, I want you to just roll your spine or take that your spine, like opening a sardine can or laying down the string of pearls on the mat. I want to get rid of any kind of concept of abdominal muscles, any kind of concept of strength or power, and really want to get it to be more of a flow or segmental. So I'm really looking for a segmental movement. Okay. So when you're ready, just go ahead and roll your spine down onto the mat and by my fingers being here carefully, I sorta know what you can do. Now. Here's the rule. If you can do a roll down strategically, you can do a roll up.

Okay. Now they might be so concerned with gravity or the perception of coming up, they're going to over recruit and make it so they can't come up seamlessly. But the truth is if they can roll down seg mentally without assistance, they can roll up segmentally without assistance. It's more of a head game than it is a strength or mobility. So what typically happens is we sort of perceived gravity as this huge thing to overcome coming up. It's just as hard to overcome going down.

So what do we, what do you think we'd do when we get down to the middle of that role with our breath? Cool. Huh? Right. Or I mean when we're coming up. So we get about halfway up and we hold breath, hold, breath stops. The movement from t 10 1112 l one two, three, four and that's why you have this huge lever and then all of a sudden the legs come up. So what you're going to do now is do your roll up and just roll your spine up. Nice and easy. Beautiful. Roll Up. So that's a three point roll up, right?

If she was able to roll up and I saw the feet come up a little bit off the ground, right? Or she had to over recruit some muscles, that would be a two. If she asked to use her hands or tilt to a side or grab onto a thighs to come up, that's going to be a one. Who would you give a zero to? Okay. What kind of people can't do it? Asked to process. Right? Or somebody may be with an acute disc injury. Some of the flection precaution, we just don't put a zero. We don't have to make them even worry about it. Right?

We could find other things, other ways of testing. It doesn't have to be the flection, but because pilates has so much flection in it, this is a test that we want to see is do they understand the balance is she did a beautiful job between the power necessary lift your body up against gravity and the mobility necessary to decrease the amount of power needed. Right? The longer the lever, more power needed to bring you up shorter the levers, segmental less power is needed and that's really what we're looking for. Nice rollout three points, thing, thing, thing. Alright, next volunteer. Okay.

This is not doing a set of hundreds. It is the a hundred position. I'll show you my progression on it. So I do this also we have even with my patients osteoporosis, I'll show you how I modify that. So in the a hundred measure, we're sort of looking at a couple of things. The hundred exercise really is about breathing. It really is can you withstand a constant load and exchange air in the lungs while maintain the intra abdominal pressure constant.

That's the technical jargon of a hundred right? If you cannot maintain the long load or the load on the hips while you're breathing, all right, then it no longer as a a hundred exercise. So it's very important that we know how to modify that to be able to, to create that. So what I want to know first of all is I will do a build and have her just bend her knees up, right? And so I might have somebody just bring their left leg up into a 90 90 yeah.

And then bring it down and then bring the left, right, like up into an 80 90 so I know she has hip range of motion, both sides for 90 90 now bring the left up, bring the right up and stay there. Okay, so now can she keep both of those legs up there at the same time? Can you take a deep breath in and exhale. Enemy here. The breath. Inhale. Good. So now I know that she can maintain this load here. Right now.

The next thing I want to know is can she articulate her chest up? So if I had somebody with osteoporosis, I might stop there or I might even challenge them a little bit more by saying, now what happens when you straighten just this leg up? Can you breathe there and maintain that position? So it's telling me how I might modify their 100 and I have, I have some ladies that have become very, very strong and I'm going to carry the weight of your legs. So just let them rest in my hand, right? And they can go here keeping their spine flat and do a full set of hundreds, right? So I'm not asking that of her right now, but I do want to see is there a discrepancy side the side for her to be able to do that and breathe. So what's the final measure and outcome?

I want a hundred it's breath. So I got to see that she can breathe. Okay, so let's bring those legs down. The next thing I want to know is can she roll her head and neck and shoulders up onto the base of the shoulder blade? The hundreds should not come up higher than the base of the shoulder blade. Okay? So it's not a teaser. It's like we're coming up on a hinge up on our sit bones. Okay.

So it really is a thoracic roller. So she's going to come up in that position, sending the ribs down into the mat. Yep. And at that neck a little bit longer. There it is. Good. And there, give me a couple of Nice deep breaths. Okay. So I build on it, two or three breaths and I see where she's at now for her.

I don't feel like I have to go too much further than a 90 90 with her a hundred right? So relax your head, neck and shoulders. So now we're going to put it together and I'm going to bring your legs up into 90 90 I'm gonna roll her head, neck and shoulders up, and I'm going to have her take a nice deep breath there. Good. And I'm seeing good displacement of breath. That's what I want to see. Now from here, could you take one? They got deep breath in. Exhale. Good. Take the a switch legs.

Why do you think I switched legs? It's not about symmetry. Is it possible that she has one leg that she can hold out in one day that she can't? So if you think of sometimes things like pelvic torsions and low back pain and and a weak hip flexors or any of those asymmetries sometimes will manifest when you do that and you realize the reason why they can't do a hundred is not because they can't, they don't have abdominal strength. It's because there might be something else. Ground the legs. So now rest your head, because I live with [inaudible], the youngest guy that said a hundreds enemy.

All right, so now we're going to roll up, reach the legs out, dropped the lays down a little bit lower there. Give me a deep breath in and this is actually the test and Xcel. So what I'm looking for, and go ahead and relax. I do one to two breaths. You can relax the head and if they can do a full breath in a position with legs out straight, that's three points. They don't have to do a set of hundreds. I just need to know that they're not losing the placement of their body when they breathe in. If I see rectus poofiness, y'all know rectus, poof, this is so rectus PUFAs is the spine doesn't change position, but the belly does. Right? So you'll see when the inhalation happens, the belly poofs out, right? So that's two points.

If I see a loss of the lumbar position in the spine comes up when she inhales, that's a one. Okay, now that progression is what I do. So if I can't get them into the position, what do I give them? A zero. Right? So typically somebody asked you a process, I might have a zero, but I still can do some measurement for them like we did with the 90 90 in the straight legs and the breath. And so I can come back in and say with in my documentation with Astia process limitations, able to hold legs at 45 degrees in breathe without losing neutral spine. That's, that's harder to do than doing a regular hundred position.

Okay. So I can still measure them. And the new measures that we're using. A little more sensitive because I can break down the roll up of the head and shoulders as well as the extension, the like. Okay, perfect. Thank you. The next screening tool is one of my favorite and it is the side lift and it gives us tons and tons of information. I will be able to go through all of that. We teach a course, I teach a course called advanced assessment and we spend literally four or five days going back into the screening and be able to really look at all of the biomechanical neuromuscular motor control aspects of the information gleam from doing the screening. So today we're just learning to do the screening, but if you ever want to dive into a little bit deeper, there's a course that we teach on it. So the next one is side left. So I need a volunteer to come up with side lift. I want it.

And this one gives me a line information because I can really see the relationship in the coronal plane. So I'm have you face the audience head down this way and we'll start with your body weight on the left arm. Okay. So what I want to do first is I'm looking at a couple of points. One is I want to see how she gets congruent over the left shoulder, the left Humerus, right? So what I'm looking for is does the Scapula, is it able to come up on top and bear weight on top, or does she get an anterior subluxation? Right?

That's real common. So if we don't have enough range of motion, the tissues here, boom, they'll culottes here or they'll collapse in this position, right? So that's one of the points we're looking at is that relationship. The next point we look at is the relationship. We mentioned the head, the thorax and the pelvis. So I want to know that that relationship is happening and there's not a hinge. So I don't want to see if I was taking the spite out and I see this line here and then a line here and there's just a hinge in the middle of it, then I know that there's not segmental movements.

I really want to feel that axial length. So the crown of the head. Okay. She's got her weight born on that fifth metatarsal there. Yeah. Yeah. We're just going to bring you up into the side lift. Yeah, just get it up and here I'm looking, if I was looking from the top down, I would be looking in that direction and then I want to know can she lift the leg and hand up and maintain that for three seconds. Okay. And then bringing the hand and arm down and then bring the hip down. Okay. So a couple of things that I saw the body had to rotate forward to get congruent on the left shoulder.

Okay. And so whenever that has to happen, you lose a little bit of your connectedness between the rib cage and the pelvis. That's why you saw a little bit of Shakey's. She's trying to really stay up on top of that. But the body wasn't that she was malaligned is that in order for her to have had the power in the shoulder that she wanted to lift off of, she had to rotate the body to go forward to get the congruency in the shoulder. All right. If she had compromise and stayed here, see how that shoulder comes forward. Now let's come up on that right.

Fill that coming, opening there. That's a little better. Good. Now lift the leg and arm up. All right, let's do it on this side. Okay, interesting. So that, and these are the kind of things we want to pick up. So what she's doing when she gets aligned, she's using her inner thigh on this leg to lift her body up on this side.

So the inner thigh on the right leg is actually looking at, rather than the abductors in the lateral flexors on the left side. So when she came up, she was using this leg a lot. Okay. So it's just giving me information. I started digesting information on what's the connection. Let's turn over facing me so we can see it from the back. Okay.

Same idea. Yeah, make sure, and again, I don't want them on the Dorsum of the foot. I want them on that fifth metatarsal like they're actually putting, waiting until it's good to be on a mat so that they're not on a hard floor wood floor till uncomfortable. Okay. When you're ready, come on up. And so again, you can see the rotation of the body forward to be able for her to feel strong on that arm. Let's see the leg lift up here. Okay. And same, same thing. She drops down when that happens and relaxed when the lay down and bring the bottom down. So on this one, right, I would give her a one one because I know I lost the shoulder congruency and two because she couldn't really get that leg up on the one side for sure.

Right. But she was able to get up into the side planks. She just couldn't take the leg off. So that's going to be a one. I took a point off for the alignment, the shoulder because she just trying to figure out, so I'm thinking if I want, whoever works with her in the screening will notice and see it again in the goalposts. It'll poke his head out when she's going here. She can't keep that congruent across the front of her shoulder. Right. If you can't do goalposts like this, it's gonna you sure as that can't bear weight and if your body weight up on it.

So what she had to do is she had to roll forward to get on top of that and change the alignment on top of the arms. So she sort of pulled herself over the arm to use more of a leverage rather than be able to hold it right out underneath it. Right. So that was her compensation pattern. Good. Thank you.

Chapter 6

Push Up, Superman, Prone Shoulder Flexion, Prone Press Up, and Prone Knee Bend

If somebody is kyphotic and would I still go through and do the measurement where still to the test and I typically believe that we should test and see how they do because I often get surprised. Different people's posture manifests differently. I've seen people, a beautiful posture, they can't do the side lift and people with horrible posture that can do the side of just fine. So I do take that into consideration.

Typically you'll see the pattern of the k fosus is going to create a malalignment on the shoulder when you're coming up. So if I was to get on the table and actually do the side lift, right, and I mean here, I wanna be able to have that line right over that and then I can come up into this position, bring it down inside them and back down. So there's a whole number of chain of events that happen in this measurement. It's not just shoulder alignment, hip alignment, lifting the arm and leg up. But when I look at that position, it gives me a lot of information.

So in that little side slot on side lift and putting down a lot of information, and remember you're doing both sides, so you give the to what? The worst side, the weaker side. So the measurements for success on this is one getting up on top of the shoulder into your plank. So if you can get that, that's a one, right? If you're gonna be aligned on the shoulder, that's two. And if you can get the arm and leg to lift up and hold that position, that's three.

Okay. And sometimes people can get in, hold the position, the leg up, but they don't have good alignment. So it's still too okay. Yup. All right. Next test. So this is the pushup and I don't feel like you have to be able to come all the way down the pushups. So what I'm looking for from the side is that she'll come down to where the elbow and the forearm come to the side.

So she doesn't have to come down into this position for me just to come down to here and then back up. Okay. And what I'm really looking for is from the plank position is how she organizes her plank. And is she able to allow the humerus to roll inside the Scapula and the elbow to glide as she does her push up position. Let's find the plank position first. Good. Okay. Now and apply these push up. The elbows come straight back. So she should be able to come down until the arm comes horizontal to the body.

Yeah. And then press back up. Okay. So that would be a three. Okay. And I don't make them do 10 pushups. I just want to see if they can find, so let your knees come down. If I saw her collapse and lose her position of her head collapse or lose the thoracic position in relation to the shoulder blades, or especially collapsed the Lumbar, she's going to have points reduced for each of those. So very quickly to push up that she did a three could be reduced very quickly to a one. So if she came down, for example, and came down to here and she could get to here, fine, but she started to push up and collapsed. I'm looking at the whole movement, so not just the going down. She's got to be able to go down and come back up. Keeping the body in that relationship.

As soon as I see there lose that relationship, I ding a point. Okay. Any questions on push? That's pretty straight forward. The biggest thing is can I get into a plank position? And you'd be surprised at how many people cannot get into a plank position. What about if she had wrist problems? What could we do so we can modify it and go onto forearms. We can go onto a box, we can give her things to put no yoga blocks of, put her wrist on so that she's burying here instead of in too much extension.

Right. So there's a lot of other ways that we can still look at her ability to plank and come down a little bit through the shoulder plane. Good. [inaudible] no, not necessarily because if she's able to do the movement and the exercise, but I just make note that there's risks, concerns, right. I would, I would put just risk concerns. So for playing positioning, cause she did do the exercise, I just had to do a little modification. Okay. Again, thinking of what is it that we're looking at, it could be, I've had somebody who had a toe problem, they couldn't do it. So, you know, just being able to give them something to be able to put their foot on that was soft, that the toe wasn't having so much force on.

It took away that um, the pain so he could do his pushup test cause it really, the toll wasn't necessarily part of it, but the toe is so painful that he couldn't get in a plank position on a wood floor. So we did it on a mat and sort of suspended in that. Good. All right, next test. Next volunteer. Now this one we call superman. I don't know why we don't call it superwoman because there's more women in the field than men. But your hands come out straight to the side. Now the fact that she can even lay prone is a statement, right?

Cause a lot of times we have clients that can't even lay prone with their head in this position. What I want her to be able to do is I want to look at spinal movement. That's between t one and t eight, right? And in the hips into extension. Now lumbar spine already has a curve. So what I'm thinking of in the Chi Fossa, she has a fairly flat thoracic spine, so it should be pretty easy for her.

But let's say that she had a little more kyphosis. Okay? And what I want to do is typically somebody with rigid kyphosis would have a strategy of just hanging in the low back, coming up into their extension. So I'm going to place my hand on the sacrum and about t eight the apex of the thoracic spine. And I'm going to ask her to be able to bring her head, neck, shoulder, and chest above the mat just a little bit and hover without putting pressure on my finger. I've been the head up a little bit more. Good. And then back down. Now bring the legs, however both legs off the ground without increasing my fingers. Good. Okay. And relax there. So that to me, no relax in that up position.

So you're looking at this ability length in this space a little bit more here, so it's not coming from your low back. And if you think of these ribs coming down and back towards me, you think of these groups coming towards me. Hello? Yes. Good. Now that this come up a little bit more. Good. That's where the movement is. So now I'm ready for her to go into dart swimming. Any of the swan exercises because she can understand the difference here, not just increasing her lumbar lordosis. Okay. And relax.

So what happens if I can see only one side that comes up so she get the head to come up with the legs that come up, but not both without going into her low back. That's two points, right? If she going lay prone and can come up, but she's coming up just in a little back. That's one point is she can't lay prone. That's zero points. Okay. So there are cases of people that cannot lay prone, right? Their shoulders are too tight, their kyphosis is too much, the forehead head, there's no way they can get into a prone position. Okay. How would you modify for somebody who could not get in a prone position to be able to do some of these exercises?

Over a box or over a ball or over pillows. Good. What else would you think of? What's that quadriparetic I'm thinking of, I want to get her using extension right in her upper spine, but she's in so much kyphosis. How would I get access to it? It'd have to be over something. Right? So that'd be over a spine corrector. Over a arch over the barrel, over a ball.

Right over the chair. Right. Cause we're working from negative space up towards a neutral spine if they can't get into neutral. Okay. All right, thank you. All right, next one. Prone shoulder flection. So this one lane on your tummy the same direction. Just scoot down a little bit with your feet.

So here we're starting to differentiate the relationship of the shoulder into the thoracic mobility. So the arms are actually going to be overhead headrests down and here we're going to leave the body alone and all I want to know is can she disengage off of the mat, lifting her arms up off the mat and she does fine right and down. So things that I'm looking at with the quality of movement is, is she able to lift that arm up without doing a full retraction of the shoulder? So do a retraction, right? So some people do retraction and you'll see the angles here changing.

So we're keeping this relationship here long and she's able to do that on both sides. So that's great. Okay, so the way we measure this as if we get this orientation, that's three points. If she can lay prone with her arms over head, that's two points. Turn over onto your back. There's a lot of people that can't lay prone with their arms overhead arms coming up over. She likes to show her, you know, she volunteered for the other shoulder exercise too, so she likes to show it. Let's say that you get here. What I use is the height of the forehead.

So I know people have different size heads, but I typically use the height of the forehead. If the arms can get up high enough, the height, the forehead without the rib cage coming up. That's a one. But it's telling me whether these people are able to do overhead activities. So if you're doing strap activities, arm arcs, things like that, you need to be aware. Let's pretend you had that tightness in the shoulders dropped down to the ground and the ribs come up.

I know that movements really for her happening in her low back, not in her shoulder girdle. Okay? So if I was to bring those ribs down and somebody who's real tight, that would bring their shoulders up automatically. Okay. And I want them to know where that range is because that's where their modify their activities. As this area opens up more, cross the pecs, the shoulders will come down onto the ground and she'll be able to keep this connection. So now if she said, Hey Bren, I want to go play tennis, right? And overhead activity. I know that she needs to be able to do this comfortably before I would feel good about her doing overhead activity with tennis or volleyball or other types of activities. Okay, cool. Three points. Two Times.

We're gonna have to find your weakness. All right, let's go. We have two more. Two more tests to do another volunteer. Sure. All right, so now we're putting it together. So you wanna lay down hands come to your side of your chest. This is the prong press up or the Swan, we would call it our exercises.

And we already know a couple of things. We already know what the flexibility is of the hips going into extension. When we did Superman, we already know what the thoracic mobility is. When we did Superman, we know what the power is when we did the pushup and now we're seeing if she can coordinate it because typically swan is not about a range of motion issue. It's about a coordination or awareness issue, right?

So that's we're putting together. So let's do the other test just real quick on her. This look at the combination, right? So let's look at Superman arms out to the side, right? Keeping this space up in here. Lift the head, neck and shoulders. Good. And lift the legs. Perfect. So she's able to do that without increasing lumbar lordosis. Good.

Bring the hands to the side. We're going to do the same idea now and see if she can push up onto her thighs without collapsing a low back. So the first thing you do is head, neck and shoulders. Yep. Good ribs are connected to the pelvis and push up onto your thighs. Good, good. And lay the thighs back down on the mat and the pelvis. Tomi ribs in head. Okay.

So what I'm looking at is she doesn't have a ton of hip extension. Right? And so you saw her come up a little bit higher on her leg. The more hip extension, the more thoracic extension, you'll see more of a curve. But I'm okay if I see Lee less curve. But connectivity. So she was good at connecting the rib cage to the pelvis. So when she came up, she didn't collapse into her back this way. Right?

She took her here and got to a certain point. That's as far as I go. And then she was able to use the power to come up onto the legs. Does that make sense? I'd give her a three because I'm really looking at can she get the movement from the right places, which we saw that she did. Right. And she came up. Now I saw things that I want to work on, right.

So again, what is telling me is that if I teach a swan exercise, she's probably going to be safe. Well, SMA has a gumby of a movement but can't identify that idea of connecting the rib cage in the pelvis coming to swan, and that person is going to look more like a Cobra going in. And as soon as I go into swan two and swan three, you know their risk of injury, aren't they? Because they're going to be having that reverb. They can't control the front, so their legs and head slap up when they come to the end of range in their swan. Right. So I'm not worried about that with her. Right. I know that I could get more mobility out of that mid thoracic and a little bit more out of her hips. That would help her a lot.

But I know that she connects her rib cage to pelvis when she came up, so that tells me she'll do it. The other thing that I noticed that sort of cool was her ability to really identify the thoracic extension different from the lumbar extension. So when I had my hand here, I literally didn't feel any activity coming to the low back. So I was happy to see that she got the thoracic mobility and then pushing up even though it wasn't this like this huge curve that was distributed. I knew that she was connected all the way through from her knees up to up to her shoulders so she didn't collapse in with her arms in different positions.

And those are all things I would look for. So rule of thumb, if she can get all the way up onto her knees or her thighs and maintain that without collapsing, the low back does a three. If I can get her to get up onto her hips or the even the lower ribs and still maintain that relationship, that's a two. If I see her collapse in the low back but she can get up like doing a cobra. That's a one. Okay. So if I see the low back, cause I know she has the mobility to do it. She had to have the control and so one means that I'm going to go back to basic one oh one of spine extension training of how to keep that control and distribute that force. Okay, good. All right, thank you. All right, last screening test.

Now this is where we have not looked at the anterior thigh really to see if there's a problem with control of it or not. And so what I'm going to have her do is just bend her left knee. It's going to grab with her left hand. Yeah. And right there, that's a two. So if she can stay aligned and grab her foot, that's a two. Now I'm going to ask you to do it without increasing the lumbar curve.

Can you lift the left knee just a little bit off of the Mat and she can, okay. So that's a three on this side. We have to look at both sides. Okay, so release this leg, bring this one connect. So she said a two now lift, and this one has a little more restriction on this side than the left. So she's still able to do a three but I feel a restriction. So I'm thinking in my head I might check that out and see what the differences from side to side, because again, if I took her into an advanced exercise with like advanced swan three and those kinds of things, would that have an effect on the distribution of force in her body?

And she's rocking and swan three and it work the sides a little relatively tighter. So I'd want to give her some things like lunges and eves lunge and scooters and things like that that would help balance out that energy between the two sides. So I'm already thinking exercises of things that strategically would help her. She has plenty of range of motion. It's just the, the, the work that I saw she had to do on this leg was much more than the work she had to do on this, Lee. Okay. Both of them are threes, but they're the little intro incurs, um, they're words. I want to say intricacies, the intricacies that I'm looking for, um, from side to side. Okay.

All right. So those are the basic 15 tests. We're going to take a quick five minute bio break and then we're going to pair up in partners and you're going to go through, I'll talk you through it, but we're going to go through and we're actually going to test each other all the way through keeping score.

Chapter 7

Practice Lab

It's imperative that you become, you know, very objective in your measures. This is not about being nice or about offending or being offended. We were just talking about intention. I forgot to tell me your name again.

Julia. Juliana. We were talking about intention with teaching our kids how to deal with things. And it's the same thing here as the intention is to help everybody be a better mover and to identify things to work on that will make us be better movers. So we can't be sensitive to not getting a three on every test, right? Because we're doing it with love and good intention. We want everybody to be the best they can be.

So be very honest with what you're seeing. There is a point of being overcritical and so you can sort of find that balance and I'll talk a little bit about that as well and, and as we go along. But you know, it's like you can identify something and make a note of it or you could vomit on them, right? I prefer the first, right? So it's not a time to make all the corrections and tell them they're doing wrong. It's a time to mark things that you're seeing and see if you can make a score that makes sense and correlates with what you're seeing in areas of the body.

All right, so this is the lab for you to practice. And you can do this at home as well. Just find a friend, a mate, a spouse, a child, a mother or father, a coworker, and you're basically going to go through and practice the screening that we just taught you. And we're going to do that live here in the workshop. And so what I want you to do is make sure you're alternating every time with your, so who goes first. That way we don't get in a bias of one being the dominant assessor and the other being the dominant SSE, right? We wanted to go equally back and forth so that you each have experienced it being the first to do the assessment, the first to be assessed.

And that helps build your skills as well. So when you're taking this back to your studios or you're doing it in your studios in, uh, back at home, that these are the ways you can practice to build up inter and intra test to reliability amongst your groups. So again, it's not saying that if you do it here and you do it there at home, that if the two of you get together, you're going to be looking at exactly the same thing. That won't happen. That's still called Intra test reliability. However, if you go through the screening two or three times with your group and you're sort of rotating around, you will become intrigued, test, reliable inside your group. So when you talk to your other coworkers and colleagues, you'll actually be looking at the same thing and you'll be able to identify that. So there's a great way to build that relationship inside your studios and you have my blessings to share it. All right, we ready to go?

So I have the slide up on the wall. It follows in suit of how the screening is in your paperwork. And so whoever is number, who's who's A's, who are the A's in the group? Raise your hand if your A's. You got a and every group. Okay. And we got bs in every group. Bs. Y'All know who you are. Okay, so we're going to start off with B assessing a on the first test.

The first test is going to be the half squat, the half squat, if you remember correctly. We're looking for the ability to keep a very vertical upper body arms out in front. He'll stay down 30 seconds on the first exercise we're gonna start at the half squats of bees are going to be assessing A's. A's. You're going to come out and just in front of them, you're going to go down the half squat arms come out in front of you, bs. Walk around them as you look at them and just make sure that they're maintaining their alignment. How much Ford pitch do they have?

Do they maintain their spine in good alignment? Vertically is their head in good posture? Are Their shoulders organized well? Do Their feet, collapse or knees? Who are looking at in all angles? You got about 15 more seconds of holding this position. How does the strength look? Are they shaking yet?

You don't take points off for shaking by the way, and relax. Go ahead and mark their score and if there's a little note you need to make to the side, you make that note and when you're ready, we're going to swap. So now a days are going to be evaluating bs. What goes around comes around. This is about Karma. Here we go. All right, so bees come out onto the mat. This is about the speed. We're going to go through the whole quiz, the whole test here, right?

The screening quiz. Not a quiz. All right. Ready? Going down into your half squat, spine stays. Vertical feet are about hip width apart. Looking from all angles at your, does the body pitch forward? Okay?

Are they able to keep, is there enough flection? Any, and you might find, identify even they might tell you, oh, it's my ankles or my knees or my hips that I feel the restriction. Um, you know, I totally get point fives. Yeah. Five more seconds. Okay.

And relax. Good job, mark the score and then put any little comment on the side. And that same person's going to stay in the middle, right? That way you just sort of get, you always get two things you can go a little bit quicker with, right? So bs is still being tested. Now we're going into the full squat all the way down, all the way back up, okay? You can do two or three repetitions just to get used to it.

Hills can come up on the squat. Does a spine stay vertical? No. Look at the alignment of the legs, the knees over the ankles, the hips over the knees. Does the spine stay vertical and just two or three repetitions, see what they're doing and then make your score. Okay. Definitely the photo [inaudible] squad.

Did you go all the way down? I didn't look. No. Okay, so zero and then just write and ask her why, what, what did she feel? Not allowing her to go down. All right, so we're going into, we're going into heel raise. Oh, sorry. Yep. You're right. Switching. See, I'm ready to move you. I'm ready to go. All right. Full squat. A's are on the floor, right? Yeah. Get your A's all the way down to the floor.

He always can come up down. Hey, what's going on? It's not a, um, it's not like a squatty potty, right? I mean, you, you let your hips come up and give the body vertical. You can do it. [inaudible] alright. Two or three times and just take the best one out of those two or three, give them a score, make a note in the side column. That person stays in the middle and they now are going to be doing heel raises, right?

So on the hill raise one leg lifts up and you come up five times onto the ball, that foot. If you cannot do that, then your partner may give you a contact for balance, right? If you can do five without losing your alignment and without assistance as the three, remember you got right and left side. Somebody advancing my slides for me. It's nice. [inaudible] you got my back? Good. Okay. So if they need a little assistance, give them assistance because assistance will only take one point off. Assistants will only take one point off. Okay?

Because I want to know that you have power and range too. So do you have range, do you have power? And then do you have balance? Remember you take the score of the weakest side, so make sure you measure both sides. When you write your score down, switch switch. [inaudible] you can grab that wall really quick. [inaudible] all right, now the next one has a little bit of a space limitation. So you're gonna have to rotate a little bit and find a piece of wall when you finish with your heel raises. Yep. Uh, so a is still being tested. You both have done heel raises or no, you need to do heel raises.

So do your heel raises and then you'll be the first one to do go talk to me. Yeah, you can find some other walls possibly to goalpost on. All right, so on the goalpost, okay, you're going to find a wall. Wow. I remember the first thing is your feet come out about one foot with the way from the wall when you're getting ready to do that one. Yeah. Good. Tell bone thorax and head against the wall.

Okay. And if you had that, that's a one arm's coming up into the scarecrow position. Okay. Scarecrow position is gonna be a to The v without losing the alignment without coming away from the wall is going to be a three. Yeah, absolutely. You guys can go [inaudible] go first.

So there can be a lumbar curve. We just want to make sure when your arms come down, get that nice long position. Now bring the arms up. Does that arms coming up? Change the rib position at all. And then when you go up into the V, does that change the rib position at all? Does it increase that tension?

The elbows don't have to stand back. Well, they're supposed to. Sometimes you have a carrying angle though. That makes a little hard to do that. Yeah. So the way you would tell is if your arms come down to the side, you don't have much of a carrion angle. Unfortunately you can't use that Lupo that um, they'll have to say stacked. And when you come up, do they change at all?

Can You keep them here and that same place when they do the The v? Yeah. So long sit, we're looking for a position of Sacrum, right? So if they can sit and relaxation the hip flexors so they can sit vertical and they don't feel that tension there. Right. Sacrum is a little bit inclined. That's a three vertical two posterior one.

Okay. Put your hand right on their sacred. It's not their upper back. They could cheat and do this. They can cheat and do this, like be rounded back here and push those ribs forward. Cheating. Right. So yeah, keep her up.

Right. And for her, she has a little bit of an incline there, so I'm fine. She doesn't need to do that. The shift for though, like she was doing, I'd rather see her now come up and around. Yeah. Send these ribs up underneath your heart as you bend forward. Right. So I know she has enough movement there in her sacrum. Yeah.

[inaudible] how are we doing? We're switching. So theoretically you should get to go through the screening in about 20 minutes with your clients to get the information. Did you become more and more familiar with it? [inaudible] get your hand on that sacred. See what's going on. Remember the Sig Crum, if you almost find the tailbone, gives you a good idea of where the angle is. Right? So that's a little posterior. Yeah.

So if she bends her knees, okay. And then you see where she comes into a vertical position, you know that's how much you want to lift her. Right? To get that [inaudible] she's one because she was supposed to, right? So two is vertical posters. One. All right. Has Everybody gone through long? Sit now going into abduction. Yeah.

So remember you're looking now for, you look for coronal line and you look for this sagittal line that makes a 90 degree angle and you look right in the middle of the legs or perfectly in the middle of that line. That's a two. If they go beyond it, that is a three. If they're inside of it, even on one side, that's a one [inaudible] right? So if you think of the line, here's one line here, right? Here's the one line here, right? Right. So she's a little bit on the inside of it or about 40 degrees, right? 40 degrees. Is that where you're supposed to be or not supposed to be? This?

How's this where you are? She's a 3.5 [inaudible]. Now if you feel like you need to lift their bottom up a little bit because of the hamstrings, you can roll their mats up underneath and that will give you a little more room, right? To be able to come up off the mat and be able to now measure the abduction. Once you find that neutral pelvis, when you're doing that, can you cue them to see if they can get into that position?

I use looking at right where they like, if I can, you can queue them if you want. Can you shift this way a little bit so I could see if she could be aligned? You could ask her to be as vertical as possible to the spine to put her sit bone down. Yeah. All right. We're good with the abduction. We'll get caught up to you in a second. Everybody's done the abduction. All right, let's move on to z set.

Remember Z set is about verticalness in the Z set position. If you cannot get verticalness in the Z set position, but you don't have to put your hand down, that's a two. If you had to put your hand down because you can't get vertical as typically your older gentleman that comes in and tries to do mermaid with you. If he lifts his hand up, he's going to fall down, right? So that is what you're looking for. If you need to give a visual image, it's really just sitting tall or sitting equally on both sit bones. Right.

Is the, is the cue for it when you see somebody sit bone coming up a little bit and they have good balance. Um, I'm just interested to know is do they need to have a little modification to make the exercise work for them? Right. So in Courtney's case I'd give her a little bit of a lift underneath the sit bone cause really her limitation is internal rotation or hip. But I bet if I looked at external rotation or hip it would be a lot. So it's not that she's missing movement in her hip, it's just the relationship. We see this a lot in classical dancers that have a lot of extra rotation turnout. They don't have so much internal rotation.

So when they go into a z set position, they often will have to come off the mat. They don't have enough intern rotation. So rather than freaking out about it, lift their bottom up a little with a mat, a pillow, a yoga blanket, any of those things to give in position. Because what is it that we want? We want nice symmetrical side bending and rotation in the spine coming from the neutral pelvis sitting on the floor. So if they have to be in this kind of position, you're trying to get him to side bend to the side and they're already back inflection rotation. The other way you're creating abnormal forces, right. That's why we're doing this screening.

So that would be an example of limitation, not a yellow flag or a red flag. It's just a limitation and we just have to deal with it. Okay. All right. Everybody's gone through their side. City z setting.

Chapter 8

Supine and Prone Practice

[inaudible] sure. You test both sides. Yeah. [inaudible] so I am less concerned with getting the weight equally and perfectly on both sit bones and more interested in, are you able to sit as vertical as possible?

Yeah. Make note of the side that has less movements. Right. The more challenging side. All right. Everybody's gone both ways. Yeah. A's and B's measured. Finish up your Z set. We're ready to go into roll up now. Remember, start sitting up and do it as a roll down first.

It's a lot easier to measure and you know, if they can do a roll down without your assistance, they probably will do a roll up. Even if they can't do it with you today. If the feet lift up, that's a two. If they have to use their hands or bend their knees or use assistance to get up, that's a one. If they have osteoporosis, they have to thrust after those campaigns. You're just, you're measuring what they have to do. So ideally no thrusting. Okay. And if they have a neck problem, you're going to do zero. What's that?

Did you do a three? Right? If you really want to do it while you can sing while you're coming up, one, two, three, four. [inaudible] it's a seven, six, four, three, two, one going right into the hundred test on that second position. Let's break it down and do it the way I showed it to you, right?

So laying on your backs, you're just going to lift one knee up to a 90 90 position. Taking a deep breath. Exhale. Make sure that the can be maintained in that position. Some people can't even do that. And then bring up the other leg and test as a difference right to the left.

And if that's good, then they bring the left leg up and the right leg up. Nice deep breath exchanging. Can they still maintain that relationship with the postures they breathe? And then bring both legs down. Let's go up into the head, neck and shoulders. So now bring in the head, neck and shoulders up to the weights on the base of the shoulder blade.

Hands lift off the ground. You don't have to pulse your hands yet. We're not really teaching the a hundred we just want to see if you have that orientation. Can you take a deep breath in and out in that position without losing your posture? Excellent. Okay, so now you've got a good full breath there. Then let your head come down and we'll add it together. So we're going to bring the legs up in 90 90 head, neck and shoulders up.

Deep breath in that position. And if you got that, then straighten the legs out, lower them to 45 and again, can you do a nice deep, full inhalation exhalation in that posture. Maintain the legs without having to do the beats so that having to do multiple breaths. If you can do it without losing it, that's fine. If you get rectus pu first, you get two points. If you lose spine orientation in that you get one. Okay. Sewage people test single leg, then test both legs.

Okay. Tests in the breath, right? And then you had to test head, neck and shoulders rolling up base of the shoulder blade. Can you take a deep breath in without rectus? PUFAs without losing lumbar control. [inaudible] and then add the legs and the roll up.

[inaudible] test of breath there and then test it with the legs out. 45 or lower deep breath in. If they can do that without rectus. Poof. Assessed three points. Yeah. Nice. I saw some nice variations. I'd hope to see some nice variations from this class.

Helped see a nice variation from you. Alright, moving on. We're going into side lift. Okay, so side lift. Remember getting up on top of the arm and the shoulder, the alignment, stay on that fifth metatarsal, lift the hip up and that nice long body like a plank of side plank. And then when you're ready, lift the top leg in, hand up off of the body, hold it for three seconds and then at the leg and arm, come back down and let the hip down. If you can maintain that with good alignment, that's three points on that that works. [inaudible] okay.

All right, so again, pay attention to the relationship between the ribs and the pelvis. Good cue there and that was nice. Okay. All right. Well the scoring on anytime you do in both sides goes to the side that's weaker or lower score. Make sure you make notes of what's going on.

What do you see? Alignment Organization of the shoulder girdle. How Elvis? Two rib cage, the head, the neck, three second hold and then down. Okay. We switched. Yes. Both sides. Both people.

Okay. Make sure you're marking the scores and remember, even though you get a three on the score, there still might be some things that need to be addressed. So make sure you write a little something on the sideline there. The three does not mean perfect. It just means just means you can do a level three activity. Oh yeah. All right.

[inaudible] [inaudible] make sure you do both sides. [inaudible] all right, we're ready to move on to the pushup. Remember the Pushup, we're only going to come down until the arm comes to the body and then back up so you don't have to come down past it. We used to say you had to come all the way down and touch your chest, but there's so many variations in chest size that we changed our mind. [inaudible] you're looking at alignment. Where's the head? Where's the thoracic? Where's the shoulder blades? If they lose that alignment or collapse, they lose a point for each one.

What? The shoulder blade. Well, they do actually, when you're doing what you don't want to see as a thoracic collapse. So the question is, what happens if the shoulder is retract a little bit? Retraction guys, ladies is normal. What you don't want to see as a collapse. So retraction is normal.

Scapula has to move out of the way as the head of the humerus rolls into extension. Okay? So it's normal that the SCAP is going to retract a little bit. What you don't want to see is the loss of concurrency. So Chester dropped out. [inaudible] if the arms come out to the side where you go all the way down, that's a two. If you drop the knees down or change something, that's a one [inaudible] good.

Okay. Trace free table for free. [inaudible] oh, I see some good pushups. You know, it's like I, I've never allowed anybody in pulse started call a pushup. A girl's pushup cause either a pushup or it's not a pushup or it's a kneeling pushup. So we had a little deal at home that if, if, uh, the guy had, we'll do more pushups and pull ups or beat one of my daughters in the arm wrestling match to be able to take them out. Very hard to do. All right.

The next one is superman. Superman is looking at upper thoracic mobility and hip extension, so when you're looking at your partners, you don't want to see lumbar extension. Lumbar stays quiet, so it's just rolling the upper thoracic to meet the angle of the lower thoracic and the lift the legs up off the ground just a little bit to give the opening of the hip extension and the front without lifting in the low back. That's the challenge. See if you can find that difference. Sacrum doesn't come closer to the thorax and thorax doesn't come closer to the sacrum and a lot of people feel like they have to lift really high.

The truth is you don't, it's not about lifting high. It's about lifting correctly where that movement comes from. Excellent switch people. So good. This one. So rolling that neck. Thoracic.

Huh? Can you come a little higher with the head? There you go. Now bring the lower ribs back down to the mat. [inaudible] how much work was she doing in the low back? Try not to go to meetings quite so much.

[inaudible] bad. I feel like that was better. [inaudible] I felt like that would great. Yeah, she can find it. I'd like to, I like to manipulate that thoracic spine. Yeah. How much? 10 degrees. 10 degrees. Yeah.

Okay. Alright. How are we doing? That's good. Right there. [inaudible] alright, we're almost there. [inaudible] we got a boogie. Let's finish up. Okay.

All right. Shoulder flection. Prong shoulder flection. Head stays on the mat. Chest stays on the mat. It's just floating the arms up to three inches off of the mat, which you're looking as the relationship of the shoulders to the ears to each other. Is One side lift up easier than the other? Look at the creases between the shoulders. It's important to you that the artist, yeah, they can be in a v.

What would you straight the questions. Is it okay if I do? The arms have to be straight and we do want the arms straight. They can be in a little bit of a v so they're not overhead this way, but here, but they should be straight lifting up. Remember if they can lay on their tummy with straight arms over their head. That's a two. If you can disengage the arm, two, three inches off the ground, that's a three. You can make note of how they organize it though.

So do they organize by bringing the shoulder blades up to their neck and around their ears or are they able to glide the scapula down and around or um, I typically bring thumbs up. [inaudible] all right. Once you've done your shoulder flection, you're going to tie everything together with a prone press up. So we've done the goalposts, we've done the Pushup, we've done the superman, and we've done the shoulder flection. So now we're going to bring them all together and see how you do with your prone press up Prom, press up. We're tying it together now.

Chapter 9

Tying Everything Together

So we've got hip extension, upper thoracic mobility power, and the arms connectivity between the lower ribs and the pelvis.

Where's your head? Where's your alignments? CV? Come all way up onto the lower thighs and then bring yourself back down without increasing unnecessary lumbar curve. So it should be a nice smooth distribution. The other area that common movement faults here is the organization, the shoulder girdle. So you should pressing a times l press into pro protraction and then go back into a round back.

[inaudible] all right, switch people. Be honest with your scoring. I saw some twos there. Make sure you burn down, Huh? No cheaters. Just twos. Yeah.

So you're looking for spine. It sounds zero, but it should be proportionate to what's going on. So it's like the ratio of the cursor. Here's your kyphosis and thoracic spine and upper. It's going to come up and meet the slope.

I mean down into the lumbar spine and the hips are going to meet the slope coming up from the sacred without increasing the lumbar curve. Then from there you could increase everything symmetrically and have some, it's really flexible with have increased lumbar curve, increased the Ras again, hip all the same time, like the bottom of a rocking chair, right? Yeah. We don't want to see the hinge with the keeping the Kyphosis unhinging the low back. Right? [inaudible] all right, let's finish off that second person in Prom. Press up.

Go, go, go. I've been the heads here actually. Yeah, I've been the heads there. Yep. So now let's bring that down in the head up there. So that's what this relationship stays the same now and now let's press up onto the thighs without increasing the lumbar curve. Yeah.

[inaudible] yeah. So these ribs are still reaching down. There you go. Now lay it back down. Keeping Long. So yes. Yeah, there you go. Yeah, that's better. So if you were to rock on your belly like a swan, two or three, you would not be compromising your low back. Okay? Yeah. When I do swan, I keep them low so you can feel this relationship. You don't have to squeeze anything. Don't squeeze anything. Just send this down.

Let the head and shoulders started coming at me head. Knees come a little bit more. Yep. Good. So lengthen the back of the neck there. Good. Now continue to push your hands into mat. Right? Coming up on the thighs. Careful not to increase the lumbar too much.

There you go. Keep that connection. The way you do this. Think of this rib coming down into the pelvis even a little bit more. There you go. That's the curve I want. Now. Could you lay that down long almost. So you couldn't go into a swan two or swan three? Yes. Yeah.

Good. And he said she didn't lose too much of that shoulder girdle either. Wow. Good. All right. Last one. If you haven't done it already, pro knee bend. Let's finish it up. [inaudible] so if you can grab your foot without increasing the lumbar curve. That is a two. If the knee goes out to the side or the lumbar increases in extension, that would be a one, right? If you get a hamstring crab, a hamstring cramp. No points off for a Hanson grant. Yeah. Does do want more for [inaudible] on the MCC?

[inaudible] all right, everybody is both sides and switch. [inaudible] I know that foot's back there somewhere. Find that foot [inaudible] make sure you test both sides, right? The scores down. It's back there. [inaudible] yeah.

All right. [inaudible] yeah. What's that? You guys? Your phones. You your math. All right, so let's, how do you give me your attention. We'll wrap this portion up here and how we organize this. Now I'll wait till you get everybody's attention. Some are doing the math already.

They're way ahead of the game. One Times 15 is 15 okay. Yeah. All right. This kid, no ego in this one. All right, so when we now have these scores, more importantly is what you wrote on the side of those scores. If you think about it, if you would be able to identify a pattern that exists.

The other thing that I did not talk about, which we teach in events assessment is the intake interview. So any information that we gather, this information allows us to be able to make better decisions in designing the program. And we said the three domains are assessment and design of a program, knowing the pilot repertoire and the history and the philosophy to apply it to our clients. That whole body workout. And lastly, understanding how to reassess and to modify where needed. Okay, so now you have a tool that you can start implementing that process. It's one of many tools. Okay. It's not the tool. It's one of many tools. And so your eyes, when you watch people move, now you're going to see a little different things. When you watch a movie, you'll be looking and going, oh, that's what Brent was talking about when we were doing the prone press up and we were doing superman or when we were doing the squat that you'll notice.

And so now your treatment plan should reflect the findings that you had in your screening. Now I wanna make something really, really clear in plots. We always provide a whole body workout. So the idea is not to do what we call Smorgasborg PyLadies Smorgasburg. Claudia's is, oh, I like doing footwork and I like the quadro pet stuff, but I don't like doing anything that causes extension in my body. The truth is, is everybody needs extension.

Everybody needs flection and side bending or rotation. It's just what you can tolerate and what you can do at this stage of the game. So as we look at the next stage of this workshop, we have two volunteers have come in that have some history and some pathology or surgery that we're going to take into consideration. Our goal still is to give a whole body workout. It's just what modifications and changes do I need to make so that they have a successful movement experience without pain.

And that's really the essence of it, isn't it? We want to have a successful movement experience without pain. And you now have another tool they can tell you, you know, their strategy of extension really puts a lot of pressure down their low back. That's probably why they don't like extension exercises. Right? Or the alignment in their hip in relationship to the knee really is off.

And that's probably why they take so much load into their ankle or into their patellofemoral area. And that's why they're having pain there. So when we start understanding that better and we can see it through the testing and the screening, we can design programs that are going to be more equipped for that person to have a successful experience. Okay. So when we go through the entire intake methodology in Pollstar, the things we look at is we do our personal interview too. So we asked them, you know, why did you want to do politics? What do you expect to gain from doing polarities? What would you like to return to being able to do that right now you can't do and then be quiet and let them talk. Right?

That pause is more powerful than any suggestion you can put in their mind because it is the neural network that they're going through to go like, well, you know, I haven't been able to run for 10 years. I haven't been able to ski. I quit skiing 15 years ago after I had that knee surgery. Um, you know, I don't, I quit playing soccer with my son, quit playing soccer. You know, if I'm going through all these things and let them figure out and then they have to weigh it because then the question comes out, how important is it to you to return to those activities? And some of our clients will say, oh, I would give anything, anything to be able to return to those activities. And I'm like, anything really anything. Are you willing to come in four or five days a week? Is it that anything? Or is it like once a week maybe kind of anything, right? What is it that you're really committed doing? But that's when they start realizing that they're the ones that are responsible for the change. We're the facilitators.

We're going to create the experience as positive for them so that sticky and if they want to come back and do it, if you make it so that it's uncomfortable or it points out all their weaknesses or it makes them feel inadequate, the likelihood of them coming back isn't very good. If you can create a positive experience for them to say, you know what, you did really good today for the first day and we're going to work on a few more things next time and I'm really proud of you, that's more likely you're going to get that followup. And really the thing that we want is we want them engaging and doing their exercises and their lifestyle changes on a regular basis and on a daily basis. It's a lifestyle, isn't it, that we teach. It's not just exercise. Exercise is one of nine things that Joe Taught, right?

So he said whole body health and whole is a balanced development body, mind, spirit, which is defined by exercise, good nutrition, good sleep habits. Plenty of sunshine and fresh air and a balance between work, play and rest. That's plot his lifestyle, right? That's what we're teaching. So if we can create positive experiences where people have a desire to continue, then it's going to be a much more powerful. And I often measure my success by the number of people who fell, right? And we say fail because they no longer come in. It's not how busy I am.

I'm always busy. But I want to know how many people stop coming in and why they stopped coming in. That's the class how I measure my success, right? So if you're looking at that, you might find, wow, I'm really missing the boat on retention because theoretically you had 50 clients and they all saw you twice a week. You'd be busy forever if you had a hundred percent retention. So if you have room for any new clients come in a waiting list, that means that you're losing people somewhere and granted people move, but not all of them. Right?

So I say it's worth checking into and finding out what happened to them with existing clients. It's very simple. I mean, I think we just say, hey, I learned some really cool things to sort of see where we're at as a teachers and where you're at as the student. And if you're willing, I'd love to be able take you through those tests and get a baseline so we can continue to mark your progress over the next six months. And I throw out numbers, I don't say a week or two sessions. I mean, I think people need to understand is the lifestyle. It's six months, it's three months, it's a year of change. They need to do anybody that wants to change and become active in something and they have been active for who knows, you know, 2030 years, they really need to commit at least six months of diligently training to get their body ready for that activity. And that's where the place teacher can really influence them. But you have to be honest with them. It's like, you know, you've been a sagittal beast behind that desk for 30 years and now you want to do yoga and now what you gotta do is you need to do, you know, [inaudible] with some modifications for at least a, you know, three to six months before you start getting into some of the poses or playing golf and preparing your body for rotation.

Cause otherwise you're gonna rotate in the wrong place and too much force and you're not going to have a pleasant experience. And you're gonna think it's the yoga, the golf that's bad. When in reality it was your behavior for the last 30 years. That was bad. Right? And that's what we're teaching. So it's easy to get in and give them, let's, let's try something new and to see how you're doing. You know, people love to know how they're doing. I would love to develop a program that was built off of, you know, almost like martial arts where you get the yellow belt, Brown belt, black belt kind of thing, and show that people able to really show marcation you're like, they're doing judication of, of dance. You know, the Chichetti method and the Royal Ballet. So it'd be great if we could, you know, some one of you are going to invent that. I'm giving you some tools, but you can, you can invent that. Maybe you'll invent it, but the idea is that you'll be able to figure out how, you know, how do we show people that they're progressing, how do we show them that their quality of life is better? Right?

That's the powerful tool. So we're here to, uh,

Chapter 10

Post Hip Replacement Screening

take a look in this third part and Mindy in who recently had a hip replacement, a, it's probably one of the most common surgeries now orthopedically. So the numbers arising somewhere like 20, 25% per year of the number of total hip and total knee replacements that are happening per year. And, uh, it is a very successful procedure and a lot of people would return to a lot of activities that they could not do prior. So I'm going to ask you a couple questions, many, and, and, um, just to get an idea, and again, I'm approaching this as a [inaudible] teacher, not as a physical therapist. So I want to make that clear as sort of a disclaimer. Um, she's getting physical therapy, she's had surgery and uh, the idea is how would we know what we can do with Mindy and where are we going to progress as polarities teachers following a hip replacement that clear to you and absolutely. Okay. All right. I would love to do your physical therapy as well, but Miami's a long ways to go for your physical therapy. All right. So, um, give me a little bit of information as far as prior to the hip surgery, what, what was your profession?

What were your activities that led up to eventually having a hippie? Uh, I was a dancer for over 30 years. Dance Teacher, uh, [inaudible] instructor now and Gyrotonic instructor, um, gymnast throughout high school as well. Um, style of dance, ballet and can tell a modern modern dance and more modern as you matured in the field or did you always I had a classical, I always had an, I taught ballet for a long time. I asked that with a, you know, as I use the word mature in the profession, I didn't use the other word, but my question to you is this, because when we deal with, um, ballet in class of ballet, it has different demands on the hip than even say, modern dance or jazz or other contemporary forms of dance. And so that's why I was sort of asking is how much did ballet dominate your dance career and teaching compared to modern or even contemporary ballet as a performer? I was a modern dancer, however ballet probably was.

That's where I started. And continued unless you find any limitations in your dance. Um, comparatively between ballet and modern, like was there anything that you felt physically in your body that you felt inclined to go modern versus my body didn't fit ballet as well. I have short limbs, long, long torso. Anything else that you noticed that you felt was difficult in ballet? A, not a very good air. Basque. Okay. And Arabic, same on both sides. Growing up in dance. So did you feel like you had a dominant side?

Um, I had more a rotation external rotation always on my left side than in my right. Okay. Now the reason why I asked that, I'm not, not from a physical therapy standpoint, but just trying to understand behavior and history that she's had that would lead to more degeneration, those kinds of things that would lead to a total hip cause remember just because she had the hip replacement, doesn't Esri change the orientation of that hip? Does that make sense? So it's like you still have, they tried to match as closely as they can, your right hip with the prosthesis to give you as close to normal for you as possible. They don't try to give you a mirror image of your left hip. Correct. I understand that. Yeah. Okay.

So when I think of things that I would want to be careful with is I would want to be careful of trying to make the right hip look like the left hip. That makes sense. Cause it probably didn't look like it before. And so if you tried to put those kinds of types of stresses on the prosthesis, you would potentially do some of the same kind of harm to that joint and that capsule again. So we're going to be looking at what is the range of that hip and it's normal Claudia's movements so that she can, you know, get back to it. And I was activities.

So next question I have for you is what are, uh, what are some of your goals right now coming back from this hip surgery? What are activities that you would like to participate in that you feel you're not? Participant Penny and now walking. I literally have, uh, been unable to walk my dogs, um, for six months. Yeah. And when you say walking your dogs, how long or how far would you typically do that prior to the surgery? Uh, if I were lucky I could get halfway around the block.

Okay. And how long do your dogs need to be walked? Well, I mean, if you were doing it right and you were walking your dogs, your dog sake and do at least a, a couple of miles. Okay. And how long has it been since you've done a couple of miles? It's been well over a year. Okay. So this last year there was a lot of signal deterioration that you felt. Okay. And is it important to you to get back to be able to walk there?

Absolutely. That's, that's my small little goal. Now here's my question. How important is it to you to be able to return to those things? I would, I would do anything. Okay. So you're ready to be serious about dedicating time to that? Absolutely.

But I know you are anyway. Alright. Other goals, other activities. And then I asked to dance again. Uh, I don't have my expectations or not to have my leg up to my ear anymore. However it be nice to just move without pain is really a significant. Okay. A little bit more range of motion. They really. Okay. And where do you feel, where do you feel limited in your movement?

Um, well now the range of motion after, since the, uh, since since the surgery and, you know, strength wise, of course, I'm slowly getting the a sensation where it was quite numb when they'd asked me to lift my leg. I was walking after five hours after surgery, I had no sensation that I could lift my leg and now I'm able to do that. So it says this little, little, uh, increments, right? Yeah. All right. So what I want to do is, um, we're going to go through the screening and I will take certain measurements out that I don't think you're ready for, that we would do maybe in another month just to give you an idea and we'll basically take a look and see where you're at. And then, uh, later on we'll design a class that will be designed based off of your findings. So people that might have similar findings as Mindy. And again, like I said, total hip replacement is very common. So, uh, there's probably a lot of you out there that are in the same situation. Again, we always encourage you to talk to your doctor and to your, uh, your therapist or Chiropractor, whoever your treating practitioner is, but it's important for you to be able to, you know, have the clearance and know that you're ready to move on. Now, I did ask you some questions off the side, Mindy, and I want to make it clear too that Mindy is actively doing her physical therapy. She's in compliance with the guidelines that her physician has given her.

She's been asked to, to be partial weight bearing using the walking sticks for another maybe three to four weeks and gradually do sit the need of it. But, uh, every physician has her different requirements and they know what prosthesis are doing. This one happens to be an anterior lateral approach, which is becoming more and more popular. And uh, it also has less restrictions and precautions compared to some of the older total hip replacements because it is an anterior lateral hip replacement. The, it seems to be that the greatest precaution is only early on and typically it's going to be with extension, external rotation and abduction. So that would be the direction that they actually had to move the leg to do the total hip replacement. Just like if you did a, a posterior approach. The restrictions we're all familiar with is the flection abduction, internal rotation and of course, um, that is thought to be a lifelong precaution. Where with Mandy, this is not going to be a lifelong precaution. It's very short term precaution. That's the beauty of some of the new procedures that are doing. Okay.

So with that disclaimer, we're going to move forward with the screening and see what you can do. And um, one of the things that I'm going to do is I'm going to be anytime you feel like you need your walking stick, I'm gonna be your walking sticks so I can sort of judge how much of me you need. I can't really tell how much of your walking stick you're using, watching you use it. But if you're pushing it to me, I can tell. Okay. Okay. So we uh, immediate gonna eliminate the full squat with her, but I am going to do a half squat with her because that's like her getting on the toilet or getting in and out of bed or getting in and out of car. So those are all very functional movements immediately that we need to make sure that she can do a full squat down to the forests. Probably a little premature. Okay. We want to do it on film. All right, so the half squat, we're going to go into that house squat position and I'm going to be your walking stick. You might not need me hardly at all for this, but I want you just to go into that position keeping the upper body vertical.

Yup. Good. Right there. Good. And hold the arms out straight and actually I see good position and good alignment. What are you feeling in that position? No problem. Right? Looks good. So she's going to get a three out of three if she can last another 10 15 seconds. Right. You got it. Nothing any weekends. This is the beauty of an anterior approach because the posterior approach cut through the postier muscles to be able to get to the hip and with the anterior lateral, they do a blunt dissection typically, so they don't even cut any muscles in. Come on up. Perfect. All right, so that looks good. Let's take a look at your heel raises. So I'm going to be your hand.

Let's do the left side first and let's go up five times. Okay. And find a balance on there for me. Mindy, on that last one. You can you get rid of my hands? Not very well. Okay, so on the left side she's a two. I would say she's fine in it there. It's okay. Good. Let's go onto the right side. Can you sing a league? Wait bear. You're going to use me for a little bit of the wheat. Okay.

Do you have the ability to do on the plan? Reflection. Go up on your toes. Okay. And how does that feel? Okay. All right, so let's do five of those. So again, I'm just sort of watching her. She's putting a lot more weight in me with this. And she was on the other one, the other one, she barely needed me at all. And they're seeing a little tired there. Right. Okay. And I realize, so I'm going to give her a two on that because she really needed my help.

But I'm making note that obviously the right side was weaker and I don't know that it was weaker and the caffeine just was weaker all together. So I'm not making an assessment of that. Just that you know, we would want to start getting that symmetry, single leg kind of footwork that we might do with her. Some of the bridging, even marching and bridging, getting that strength in the boat. You're probably doing that in your physical therapy. Good. Okay. And then let's go, and again, remember pilates is a whole body experience. So we just, because she had a hip replacement, we're going to look at the whole body. So we're going to look at the goalposts. Am I gold posting over here?

So we're going to go over here. I'll be your walking stick. All right, so up against this wall. All right, and now we're just looking at her. You're going to ignore that little microphone box there. All right, so I know that she has good alignment in her ability to line up straight.

So we're going to look and see does she have the right space behind her neck, the right space? Pan Her low back? She does. Can she go into the scarecrow position or the goalpost position? And she does. There's no change here. I'm not expecting to see anything different here. Slide the hands up into the V. Good. I have a little more challenge here on the right side than the left.

Any particular reason? Do you feel anything located this p and so it tells all like, she didn't tell me she dislocated her shoulder before, but we know on the goalpost she gets a three but I'm going to make a note of the asymmetry and the history. She just told me. So a lot of times clients are poor historians. They forget that they had a major La bottomy like just a couple months ago. And so when we go through the test, things come out.

It was like even what we saw with one of the squats earlier today and we saw, oh yeah, well she just had the metal removed from her ankle less than a year ago. So that would make sense that we would see those restrictions. Okay. All right. Let's go ahead and move on to the table here.

Chapter 11

Developing Mindy's Program

So when you go into a long sit position, and before you do that, let's swing around this way and just to the left leg and along set. So I might, this way I can look at her and I can see that.

I know and I would expect her from her career what she did for years to have that flexibility. But before I assume it on the right side, I want to see what it's like on the left side so I know that she's fine there. And let's see the right side come up. Okay. And just to see if there's any change in that sacred position. There's not. What I want to know is, does she have to do a lot of work over here? Around the incision site to be able to hold herself up and she does, which I would expect so you can relieve that leg back down off the side. Okay.

Was that uncomfortable for you to have the leg up in front there? Stay moderate. Moderate. Okay. So long since she's a three but I'm just going to make note that there was increased tension and I would assume that because she had the surgery site right through that area. So I would assume that if in using any of that muscle would be a little Tinder for her left t l okay. And then I'm going to bypass the abduction right now with her because I don't really want to go there yet, but I'm going to come back. Right.

So I'm thinking that in four weeks I'm going to come back and measure that in four weeks I'm also going to come back and measure the full squat. So that's going to be two of my goals in my head is that she could do a long set. I didn't want, I know she's uncomfortable sitting there in the long set. I'm not going to keep her in a long set. Okay. I'm also not going to do z sit. Okay. AndZ said, I may not come back to ever. You might not need you. Right.

But I just know that I'm going to create a modification for it based on that hip. Okay. So now let's test you laying down on your back. I got your box here. So I'm going to pull the box off to the side. Yeah, go ahead. And do you have any apprehension at all of rolling up? I think I'm good.

Do you think you're good? All right. I'm gonna give you my hand the first time I'm going to be you're springs and because I know also contextually that she's applaud his teacher, so she knows what to anticipate. Right? It's just whether she's done a roll up since she's had surgery last four weeks, probably not. Okay. So I'm going to be your assistance and let's just see your roll up. And what I'm looking at is when did he jump into hip flexors? Right?

So I want to keep the hip flexors out of it. I'm probably satisfied that she can do that, but I know that I saw the grimace on the hip flection. Right. So those come back down and she didn't feel anything going down because gravity's in her behalf. So I'm going to give her a two on the roll up only because I know she needs a little bit of my assistance in that one area coming up through the hip flexors and again I'm just making notes of what I want to pay attention to. I now want to see what she can do with her legs going into the a hundred position right now.

I would never do a long lever with her coming out of surgery. Probably not for six months. So just to give you an idea, um, I'm not a big fan of long lever exercises with anybody that has any hip pathology, so I'm going to be modifying anything that's long lever for her and exercise. She's going to do with a bent knee for quite a while. Okay. You're listening to me so I don't really like long legs, straight leg raise. I can stuff this sort of bugs me. Right.

And being some of that has hip pathology. I get it and I, what I want is, um, we'll strengthen hip flexors in a lot of different ways. We do a lot of quadruple exercises and other things that will be seen in the Mat class tomorrow that will be powerful for her to be able to get that strength without having the full weight of gravity on that anterior hip, particularly the capsule. Okay. So let's try this leg first and just go into your 90, 90 taking a deep breath, right that, that come down and that, that out. And I'm going to help you with this. Okay. What do you feel they're tiredness, but are you able to hold it there? Okay, so taking a deep breath and what happens if the left leg comes up and joins you and you hold both of them there? Okay. Deep breath in and Xcel raw head, neck and shoulders up the breath.

Then is it easy with the head, neck and shoulders up? Yes. Yeah. Good. So this is where her hundred position goes. So she's clear for a hundreds as long as she does her modification by bringing the knees in. I wouldn't want to do a law. Now what if she wanted to do straighten out that left leg just to make a little more challenging and she felt good. I'm okay with that. And eventually where we'd go to start doing that with the right leg before I let her have full access to it in six months. Okay.

So I would give her a two on the hundreds exercise or tests. And that's just because a precaution of long lever. Right. So that's what kind of a flag red or yellow? Yellow flag. Good. Okay. Now side lift.

I'm going to have her do a side lift on her left side, but I would not do it on her right side. Right. So I'm going to have her turn facing me. Okay. Okay. And I'm even going to just spot the leg so she feels secure. But I know she can do this because she's using that left side a lot right now to walk and move around.

So go ahead and come on up and lift this leg up a little bit. Beautiful. So she has the strength to do that. Some of you guys couldn't do this today. She has had hips and down. Perfect. Okay. So the only reason why I'm not doing this now, I think she could probably even do it in a couple of weeks, but that would be our goal is that by four weeks, again, she'd be able to do this test as well on this side. Okay. She's going to have that strength from her physical therapy very quickly and we will be working on that. Okay. So let's go into, um, on your tummy.

Yep. I gotcha. Okay. So can you go into a plank position? I love it. Okay. And let's see your pushup. Okay. Then that's for a while, right? That's fine. That's good. Go ahead, let your knees come down to the mat. Okay. You're okay on your knees. Okay.

So you notice one of the things that we are looking at, this is a much better way to load the anterior hip than doing it against gravity of the direction. So a plank position is much more comfortable for her to load the anterior hip power rather than being on her back with long levers. So I'm going to be just shifting gears a little bit. When we do the class just already thinking out loud that we'll do more things in prone to be able to get that anterior wall. Then things in supine. Are you with me on that? If following cause I can get just as much load on that.

Right. It's just going to be a little different angle so it doesn't uh, give me a little bit pike. We're not going to be loading up that anterior capsule so much. All right. From here we go into lane prone. So you gonna lay down on your tummy and we're just going to test your mobility of the shoulders. So the short arms are just out to the side here and we're just going to look for that nice roll coming up with the head, neck and shoulders.

That's plenty and back down. And one more time. Good. So she's completely out of her low back. Here's the question. Can she lift her legs up off of the Mat. Perfect. Right. And what do you feel different on the right on that versus the left hamstring weakness? You feel that it actually be able to lift it as being weak. Okay.

Yeah. All right, so she gets a three but I asked her because I could see that there's a little bit of a quiver on the right side and that's what I want to know. What was causing that? Was that a little bit of pain or was it more weakness and she identified it as weakness. So sign, let's see, side lift, we said remember side lift, I have to put zero but that's just because of the surgical side. And I put one month on that pushup. She was a three out of three. Just felt weak and superman, she's going to get a three but she has a weakness on and rather than identifying a muscle, I'm just going to say right hip extensors.

Okay cause she said hamstrings. I'm going to stick to the more global on that. All right. Arms overhead and keeping the forehead on the mat. Let me have you just gently float the arms up. No problems there. So that's the three edit three, how that right shoulder feel with that line. Okay. And then prone press up. We're going to go into, and I am going to let her do a prone press up.

She has been working on some extension already, but we're going to keep that connection. Yes ma'am. So get this to come in. Head comes up, lift up. And how do you feel in that position? Any discomfort in the hip? No. Nope. Okay. You feel stable on it? I'm relatively okay. I feel weak just in general. Okay. All right. Come on up. Okay, we'll shaky.

Shakey's okay, so now with the left leg, let's just check the range of motion. So bend the left knee, grab it with the left hand and just float that knee off the ground little bit. Okay, good. Now on the right side, I just want to see if you can grab the foot. I'm not gonna let you go too far. Okay, so she's got that and I'm going to stay there. I don't want her lifting her knee off cause they don't need that fulcrum push in the hip interiorly but I know that she has plenty of range of motion or quadriceps so she hasn't lost anything yet. Okay.

And that's just a judgment call, right? It's too early. I just know that it's an anterior lateral approach so I'm not going to go after doing any kind of false [inaudible] or leveraging on the hip. Everybody with me on that. Okay. All right. So Mindy, go ahead and sit on up. We've gone through the test. You good? You did really go, okay.

See this is why we want the whole world doing pilates because can you imagine moving this well after having a total hip replacement four weeks ago and this is why people who keep their bodies up on stay in shape and have movement, their foundation are going to do so much better when they have a major surgery, like a total hip replacement or a total knee replacement. So she's far beyond the average person with a total hip replacement, even though it's a successful surgery for people that are out of shape too. But it's going to be a lot more successful for Mindy long as she can keep the reigns on a little bit and not be too overzealous. Right. This can be the hardest thing. So let's talk about what we found. We found that her half squat was a three.

Her full squat we did in do, her heel raises were a two out of five and the right side was significantly weaker than left. So immediately I'm just thinking that totally makes sense. I'm not worried about that because as we just start working on her strength and the thing she's already doing, there's very little that I wouldn't do with, you know, standing lunge activities, those kinds of things that I would have. We're starting with right away, whether it's on equipment or some things in mat with some assistance with her poles. Like I would even do some, you know, some a marriage proposal, lunches, kind of things, partials with your poles, working on getting used to be able to go down to the ground and back up. Very functional, um, goalpost.

We picked something up that we didn't expect. So goalposts who picked up a history of a shoulder subluxation that she had had or dislocation. How many years ago was that? A couple of years ago. There's actually the, the clavicle, the clavicle. Okay. Even even more, uh, traumatic, the clavicle. So the clerical, we can keep an eye on that and just think of keeping that mobility. I saw a little bit of a twist in her rotation and the extension as well, which makes me think that's probably tied to that. We saw it in the goalpost, we saw it in the, uh, shoulder flection and we saw it on the pushup. The interesting thing is that she has so much good mobility and other parts of her body, that distribution and movement equals distribution of force.

So a lot of times those of us that move fairly well, um, injuries have less power over us because there's not only one part of our body that just keeps getting abused over and over again. Then you can distribute it and that's what she's doing. But we get the same time, make it a little bit better. Right? So we'll work on some thoracic mobility for her as well as um, working on some shoulder girdle organization exercises and we'll play with that a little bit tomorrow. I'm probably never going to enter it into, her workout is going to be the Z set. So I would just say I'm going to do what? What am I going to do?

A modification, right. So I'm just going to do a modification with her for at least six months on that. I think she'll be wanting to do it sooner than that, but I would just say six months, no long lever, nosy said after six months I'm comfortable her doing whatever her leg says it feels I can do. So I would expect it to be able to go into it at that time. We definitely would give her the range of motion with the exercises we're doing, but I wouldn't want to put the torque on the bone. The bone actually is healing into the prosthesis.

So there the way the bone grows into it, and I don't want to do any kind of Torque or force on that, on that stem. That would be potentially a problem. Right. That's the biggest precaution. Okay. You're good with me on that. They put in a fear in you not to do that. Yeah, cause I think you could, I, I think you would very easily be able to go in that position if we made that. Our goal is it doesn't need to be our goal. Okay. All right. Um, for any long sit things, we're going to go into lifting her up and to the point where she no longer has tension in the front of that hip. So I would use different props.

I'm a prop that I might use with her would be something just like an Eric's cushion, something like this. So let's try your long sit position. Okay? Yup. And lift your bottom up on there. Okay. Is that enough height? Does that take out? Some of that is soft. Right? Great.

So for her, this would be a great modification. I just want to know whenever you're going to do class, you're going to have your little three inch Eric's mat to do any of your long sit activities. Okay. And that way we're not putting any torque on the hip. She's comfortable. Now she's flexible. So if you're out there and you're not as flexible as Mindy and you've got this, you're probably going to need a chair to do some of those activities that are long sitting. It's just sitting in a chair on top of the box is another great way to do that.

Okay, cool. Cool. All right. See if there's any else here I want to bring up. Um, okay. And I, I think things like the roll up in the hundred, I think she's going to be able to participate 100% and those activities very quickly. I just would do some modified assistance to both of them for awhile.

And again, no long levers. Okay. And that would be my program with her. So we'll create, we'll have that class tomorrow. Those of you who are going to be with us and following this that you'd be able to sort of follow along and participate in the class. That'd be designed for somebody in this case, Mindy. But somebody like Mandy that maybe comes from, there's a lot of you out there that come from the dance world that have had a total hip replacement. Um, I'm in line for that by the way. So I am, I'm just trying to do all I can, not to have one but a, I know, I know it's just one little thing and pretty soon it's coming.

So I'm watching you guys closely. I'll be taking my own class in a couple of years. But the idea is that if you fall into this profile that Mindy's in, where you come from a strong movement background, you've had some HIPAA theology, you resulted in early total hip replacement. This is the type of class that we're going to be designing for you, that you have some of these similar things and, and if you're close to this same area, and again, remember Mindy is ahead of the game. Um, so I would say she's probably where I would expect most people to be at eight weeks after surgery. So she, that's a lot to do with her preparation and just her staying in shape. So I wouldn't feel the pressure to be where Mindy is at a four weeks out.

I would think you should be there at eight to 12 weeks out, but that you'd definitely can get there and be in that profile and participate in these activities. Do you have any questions for me? I'm sure I'll have lots tomorrow. Plenty actually. I feel pretty good. I feel I'm very informed both from what I've, from my own education and from you mostly a the confidence and the moving that uh, you've given me cause it's scary. You never know what it feels like somebody else's leg or, yeah, you just don't know what to expect and you don't know if it's bone or if it's muscle. That's the odd thing. You know, the good news for you is your hip is incredibly safe. That's a good news and it's a very successful procedure.

And I can tell just by watching you walk and what we did here that it was done very well. And I think that, um, you know, a lot of it is going to be building confidence back up. You know, and when you come at a surgery like that, only four weeks out, you're not quite sure how that legs going to respond, but every day will be better. And I, again, our goal here is to create this positive movement experience without pain is to give you the successful whole body movement that we're going to do in the movement of classes and be able to give you that graded activity that allows you to eventually return to, you know, the full movement experience that we believe our bodies are capable of doing. All right. Thank you. Thank you. Pleasure. So we're back for our second case and this is Lisa and Lisa has a history of,

Chapter 12

Screening for Back and Neck Issues

uh, back issues and neck issues and uh, has been through a quite a bit of physical therapy and treatment, no surgeries and uh, has been practicing pilates for quite a while. How many years have you been practicing Palladio's? 12 years. 12 years. And do you teach applies as well? Yes. Yeah. And so, and how has the plots helped you?

It saved me. Yeah. Yeah. So what are you changing? My whole back completely. Okay. Little by little. And what do you feel as being your biggest challenges now? Back extension. So spine extension, finding my place on my shoulders. Okay. All right, so let's set the case here. So we have, um, I talk about this all the time where I think that the thoracic mobility is incredibly important in decreasing the risk of shoulder and neck and low back and even hip pathology. And so the idea of breath and thoracic mobility become increasingly important in my mind as a physical therapist, we're going to approach this as a pilates teacher, but I just want to reemphasize the fact that um, if I was Lisa's physical therapist and was prescribing her to come and do Pele's or to continue with her PyLadies um, I would immediately, even in the back of my head, I'm thinking thoracic mobility, thoracic mobility, thoracic mobility. Okay.

And so I'm also going to be looking at posture wise. There is another test that we do in the new test, which is the amount of excursion of the lower rib cage with breath. And so those are the things, I'm not going to look at that with her today, but it would be something I would throw into the, um, into the evaluation process is seeing how much her ribs actually move with breath and how mobile this her thoracic spine. Okay. So that being said, what kind of things right now besides the extension exercises, do you feel you're limited on or behaviors that you want to overcome or, um, you know, what would you say is your goals at this stage of the game? So you've been practicing things for a long, right. So my, my goal would be to be strong enough to support my body in a, in a sitting position without any pain.

And that's in a chair or the car or especially on bike. And can you just point to where you feel like you're having that pain when you sit for a long time? So it goes from right here, but through here. Okay. Right through there. All right. All right. So, um, just hearing her say that again. I, my wheels are turning. I want to share my wheels with you a little bit.

That's the idea. This event is to share that appreciate you by the way, for volunteering to do this. But what connects from the front of the viscera and the chest to the back? It's the diaphragm. That's right. And so these are areas that she's been concerned about from the standpoint of other other things that she was worried about as far as flared ribcage and sort of the, the exposure there and she's drawn it in. But maybe in doing so, the diaphragm has become a little insufficient. So I do want to look at her breath capacity and look at the movement of the diaphragm. If I was your physical therapist, I would also be looking at some of the matter of Fascia release techniques of getting that diaphragm to release in that lower thoracic area in the back, all the way up into the front and across the cruises.

So just giving you an idea of how I would be thinking as a physical therapist. Okay. As a politeness teacher, I'm still thinking, how would I move diaphragm as a his teacher? How do we move die from as applies teacher breath activities. So we're going to be using the breath activities to be able to do that. And just sort of watching her, the fidgetiness is because the diaphragm and the breath is not creating enough movement for her on its own spontaneously.

So she has to move and fidget herself around externally to get the same relief that a normal breath would probably give her. So that seminary that we would want to, to focus on. Alright. Anything, the activities that you're not doing now that you feel you should be able to do besides the city? And I've got this thing riding my bike. Okay. And that also is a city activity. What do you, um, are you riding your bike now at all? No, but I'm, I'm almost there. I just have to find the right bites. Okay. And what do you feel would stop you from riding a bike right now? What's, what's sort of keeping you, um, so far my tailbone, uh, if I, if my pelvis wants to Tuck when I'm on the bike, like I slouch, so my tailbone is being pulled under and that's painful.

And a few times when I've tried it. Um, in the last five years, my um, middle back starts to spasm and then it goes all the way into my neck and then I just stopped. So it's more of the flection activity that tends to send you there. So the pelvis rolling under flexion, thoracic, the load. Okay. So I'm also thinking a couple of things on biking. You know, can she find a bicycle that the seat tilts forward a little bit so we can incline the seat, the handlebars can be a little bit higher to keep her from being in the flex position. Right. And that would be maybe where we start and build the confidence up to.

A lot of times the body anticipates, she's been dealing with this for so long that the brain anticipates that there's going to be something with certain activities so she doesn't have to have any harmful stimulus that a lot of times it's just the opposite. It's not a tissue damage that's causing the pain anymore. It's literally messages coming from your body that are normal messages that the brain saying, you know, you've been dealing with this for so long, Lisa, this has to be something bad. And the brain anticipates that and it creates pain to try to protect you. That's pain's purpose. So when we do it chronic pain, what we want to create are these positive movement experiences without pain.

So that Lisa's brain starts believing that her body can move without pain, right? Or can sit without pain. Right now it's really a sitting issue for her. I'm not going to make her sit much longer, but I've got about five minutes and she's already fidgeting, right? So he gives me a good idea of what her tolerance is. So goal of ours is going to be that she could sit for half an hour without having to fidget and to have that kind of stamina and also that kind of awareness that, you know, as soon as those messages started firing from the body up to the brain and they go up and they said, hey, ah, Lisa, um, have you ever felt anything like this before? And Lisa style on this goes back to the pridal lobe and ask the prior lobe and the prowler goes, heck yes, she's been in pain for the last 15 years. What the heck are you thinking of?

And so then Thalamus says, all right, I'm going to crank it on. And then your back goes into spasms. And that's how the body works, right? So the body's saying that you've identified certain behaviors as being pain provoking activities. So any sensory from a tendon, a muscle or ligament of bone, a disc that say you're in load in that orientation to gravity is going to create the signal for there to be pain. Even though in reality it's not doing harm to the tissue, the tissues aren't tearing. They're not rupturing, they're not herniating, they're just sending intention messages up to the brain. It's the brain's interpretation of it.

So one of things we want to try to do is create experiences where you start also believing that this is not tissue damage. And we already corrected one of the things with Lisa, which was um, you know, we often come, we've been diagnosed by so many people and so many things that, um, we sorta hang our hat on those things. So you have scoliosis, you have this, you have that, you have a spondylolisthesis. Um, you know, those types of diagnoses often create what we call catastrophize inner sensationalizing. So this is sorta an area of my specialty in the spine is trying to understand why do we have these sensations when there's nothing that is really causing or enough to cause tissue damage, right? And that's what we want to look at is how do we start breaking down those patterns of that anticipation, the anxiety, the things that come along with years of having pain. The first thing out of our mouth is I have scoliosis, um, to me, and I should know that she has scoliosis when in reality the amount of scoliosis that she has is very small, but somebody diagnosed to a scoliosis.

So the scoliosis now takes on its own behavior. It has its own personality. And so when things can't be done right, it's the scoliosis fault, right? It's my scoliosis doesn't let me do a roll up. My scoliosis doesn't let me do swan. My scoliosis doesn't let me ride a bike. My scoliosis, it doesn't let me sit for longer than this smear.

So long as you have that to hang a hat on, poor scoliosis catches all the blame. But the truth is is that scoliosis has no higher incidents of back pathology than a normal spine. Matter of fact, it's less, you have less risk of having back pain than people without scoliosis. How about that? It's just statistics. I mean, uh, you know, 90% of the world is in the Western world is going to have low back pain in their life and a 25% of them will be chronic low back pain for their whole life and they'll cost about $300 billion a year in health care. Just in the United States alone. People with scoliosis, there's less than 25 degrees, have like a 60% likelihood of having back pain. Yeah, better odds. All right.

So the idea is learning how to move with it and how to appreciate segmental movement. That's another course. But what I think we want to do is let's get rid of any of the periphery and let's look now and see what actually moves and doesn't move and how you organize. And then we'll go into creating the class tomorrow. That would be one, hopefully that would provide a positive movement experience, but also take into consideration what your goals are and particularly being able to sit and being able to ride a bike. So if you're out there in cyber world watching plays any time right now and you feel that you actually match up with what Lisa has experienced, at least four or five of the points that we found. Um, sitting does tend to be a very common restriction and challenge for people with low back pain and thoracic pain. And a movement is also one of the most important things to start.

Reeducating that. So we want to create these positive movement experiences. Again, we encourage you to talk to your doctor or your therapist to make sure that you're cleared to start doing some PyLadies, but we'd like to be the place that you start doing here on plots any time. So let's get started. We're going to go through the screening. You saw a little bit of it as you're watching and um, is there anything, any of those tests that you saw that you are worried about? I'm not word, I know which one will be a challenge.

Which one do you think is going to be the channel? The one that's going to be a challenge is taking my arms straight up. Okay. All right. My v White d a wide v. Okay. All right. That's fair. We can take a look at that. Good. So let's get started.

I'm going to have you facing me standing on the floor and we're going to start with the half squat. So that means that you can have your feet about shoulder with the party and if he wants a little bit wider. Yep. And we're just going to go down with the body nice and straight. Arms out in front and we're going to hold that for 30 seconds. Okay. So I'm looking at least, so she's holding and I'm looking into relationship and I do see her being fairly vertical.

She has plenty of movement in the depth in her ankles for knees and right hip. So I'm happy with the range. Um, I see a little bit more happening from the Lumbar Lordosis when she goes down. That's what sets sort of what picks up the difference from her hip and her low back. Cc a little bit of that. And you got about 10 more seconds and she's doing fine. No collapsed. She's aligned up. Okay. What did you feel weight wise? On both feet. They feel similar to you or you feel heavier on one foot. Oh Ethan. Okay.

And come on up. Alright, so increase or doses? Yeah. Yeah. And a little bit of left internal rotation. Okay. And then the next thing we're going to do is a full squat. So the full squat, we can practice a couple of them. You can let your heels come up. Hands are four. We're still stand up. Nice and talk.

And all the way down and then all the way back up. Very nice. Let's do one more of those. Excellent, Lisa. Okay, so that's definitely a three pointer where next one we're going to do is going to be the heel lift. And so do you feel you could do Hillis without touching me or do you feel like you need to touch me for a little bit of balance? Maybe just put my hands. Okay, let's try it first. And I usually start people where I give them hand contact. Right.

If you just tell them to do it without hand contact, that's a little intimidating. Right. And then they'll find when they get comfortable with it, they can find their balance and do a couple of without. So I'm keeping her at a two on that side. Okay. And how do you feel strength wise on that? Weaker. Yeah, I can see that. Okay.

Yeah, let's go the other side. Five on the other side. I'm ready. Not so there's a little bit of power issue there. She's going to hit her five on each side, but I like her to be a lot stronger than that. So I'm seeing some weakness in there that we're going to address. Okay. All right, so that's going to be a solid two and we're going to come over to the wall over here.

And if you're going to be about one of your feet away from the wall, okay, there you go. Good. And just line up so that we're touching. And again, here, I can tell already and you don't have to make something be that. It's not just, you know, it's going to be what's comfortable for you. And I'd rather see the behavior because that's really what's happening during the day. Okay? You're smart because you're already plotted. ISED you know, and so it's like, you know, you're already trying to create that ideal posture, but I want to see what really sort of happens. Right? And so let's go from there. You know, as I'm not getting the head all the way back to the walls, just about a centimeter away, it's almost there. But that also tells me just some of the tightness she has that she's dealing with. Let's bring the arms up into the goalpost position. Okay.

And I'm going to bring up a little bit, let them come away from the wall a little bit. Yup. So just to give you an idea, this is where I see alignment now. Right? And that would tell me that she's having a hard time getting thoracic to open up and she knew that she prophesied it. Right. So she either is fulfilling prophecy or she really has a thoracic restriction, which I think the ladder is correct. And that way when she brings her arms back to the wall, she's actually getting a little bit of loss of alignment in the glenohumeral. Okay. So for her to do overhead activities, I'm glad she didn't say she wanted to be a volleyball player or to do acrobatics hanging around at Cirque de Solei because that would be a problem in that shoulder girl. Right.

She would have to come here and I'm already prophesied in this. When she does her side lift, she is going to have to have her arms in front. To be a writer, you have to rotate around that shoulder to be able to get the weight bearing on that joint. If she's out here to the side, what's going to happen? She's going to collapse into that shoulder. I shall lose it. So it could be a risk of impingement. Okay.

And I'm not even gonna ask you to straighten the arms up. Okay. Unless you want to try it. Let's see what happens. Be Good for them to see. All right, so this is giving you a really good idea and you know she's a pilates person, right? And she knows that she has some pathologist, she's overcome a lot of it, but you can just see where it's like trying to figure out where is that restriction coming from. So what's happening is the shoulder blades not able to drop down, that would give her that range of motion there. And so that's something that we're going to need to refer out and talk to your therapist a little bit more about. Good.

Chapter 13

Lisa's Screening Results

When you go into a long sit position. So I'm gonna have you sit on the mat there. All right. And long sit. She's an tier. So she is a three by the definition there. She is tight in the hip flexors.

So I'm going to bring her up just a little bit. I think she might do well just take them up on the red. Yeah. Does that take a little bit of tension there? Yeah. So for her right now, again, this is not a lifelong thing. This is saying that temporarily for her to really be able to appreciate, and remember we want to take the stress off of her low back, her coccsyx in her upper back. So she's forcing herself to pull forward with those hip flexors.

It's actually causing the sheer force on her low back. And she might even find that really to be relaxed. She needs another inch even. And that's fine too because we want her to be successful in that movement. So she, even though she gets a three with whether sacrum is hip flexors were two taught and they released at about one to two inches of a lifts. And I know what I want to modify with her in that long sit position.

Now let's turn sideways and I think up here you can do it, but we're going to do an abduction. So I'm going to have you turn facing the audience. Okay. Sit on top of this and you're going just flat. You're going to go into abduction so you can spread your legs. You're gonna sit up, not you're sitting and just go the legs open.

Yeah. Yeah. I didn't do this with Mandy because I didn't want to do it with Mindy, but I want to do it with you. All right? So seeing nice and tall. I'm also realizing cause with her, I want to know stresses are on Lisa's pelvis, right? So I know she was talking about, you know, sitting riding a bike and do some activities in that pool that she feels pulling her underneath. This is part of that too, that the legs have to be able to abduct that force will also participate in pulling her into that posterior tilt. Okay. So she's a, she's actually a one, she's not quite to 45 degrees on her legs. So that's an area that, again, that sort of ties into this whole thing, right? Having a hard time opening shoulders, hard time opening hips. Alright, so you're already click, click, click, click, click.

You're thinking of areas that we want to work on with her. Okay, good. Let's see what your z set looks like. And I'm gonna allow you to still still stay on this path. So let's go into a z set. The Mermaid. That's a mermaid position. Yep. Okay. And she stays nice and straight on that.

I'm going to move the pad away and see if you can still maintain straight on that. And she does. Let's try the other side. Now this one's a little more challenging for her, right? And where are you feeling that in the right hip. Okay. So I'm going to give her a two on the side set because of the right side. Right. But I'm going to blame it on the right side.

[inaudible] cause the left side was okay, wasn't it? Yeah. And that's the internal rotation on the right side. And so that's given, making me, you know, think of, um, again, just thinking of rotation in her body. I'm not getting a lot of rotation in her body and I want to get more rotation and I want to get the joints opening up with a rotation. All right, let's have you lay on your back. Okay.

And before you do that, just sit up there with the legs long and just do a roll down. Okay. So the fact that her legs didn't come up and erect this, poof. This, I know that she's capable of doing a roll up. So let's see you do, you roll up. All right. So I'm giving her three. There's something I want to check real quick. Roll back down. Stop here. Yeah.

And really think of these ribs coming up underneath your heart a little bit as you lower that down, right? They're not contained at center under your heart as you exhale and roll back up around it. There you go. Good. So it's just giving you a little bit of movement here and I come back down into it and I'm going to play with your little bit of scoliosis. Kay. So we're just going to rotate just that little bit there. Keep sending the ribs down and now you're going to find some movement in that plane there. Stay in that [inaudible], roll that down. Good.

Right there. That's it. You see how you move through that. I mean she's learned to compensate through those areas, but this is just giving you where that movement can happen. So you just have to do a little bit of a right rotation through that lower or left rotation that lower thoracic and that's all the rotation you need to compensate for the little bit of scoliosis you have. Okay. It's like five degrees, right? You barely did. All of a sudden it's like [inaudible]. And that whole thing is muscles that she hasn't used for a long time because she's moved them as a block because that whole area has a little bit of rotation, right?

So just that little bit of queuing gives you a little more freedom. So now you're aware that, oh, there's four more vertebra that I can move from, right? And that can distribute for us. Distribution and movement equals distribution of force. Okay, so let's have you lay back down and you feel right there that little c that you see how easy it was to roll through that. But if you try to do straight, it's like if your facades are here and your goal is to move here, you can't get blocked. You can't move through there. So you gotta do a little bit of rotation and then you can move through those segments. They're normal segments, normal sets, normal synovial fluid, normal disc. It's all normal. It just has a little orientation to the side. Okay.

All right. The next one is the hundred and we're going to start with the knees bent. And let's just jump right into it because your inexperience will give me that. Yup. I got it. I gotcha. Yup. Okay. You did the roll up over that.

Don't do that at home. Alright. Don't put hard objects behind your back when you're doing the roller. Okay. So let's bring this like up to 90 90, just taking a deep breath. And so I get zero diaphragmatic breath on her relatively speaking like her abdominal wall, I guarantee you is in contracture. Just watching her walk around. So, um, interesting story. I'll be very quick.

We did research on 140 PyLadies teachers. You can put your leg down at the PMA and we did an ultrasound looking at their pelvic floor and their abdominal wall and all we asked was you do what you think you teach in lifting the pelvic floor. And then we looked to see if it correlated or corresponded to what they thought they were doing. So the reality was, is 45% apply. These teachers, I thought they were lifting, pelvic floor up, are actually pushing pelvic floor down and many who thought they were doing ta contractions were actually in an abdominal oblique internal bleak contracture, which means that we've walked around holding our abdominal wall in so much that we'd become actively insufficient with our diaphragm and with our pelvic floor. These are the same people dealing with things like incontinence and mid and lower thoracic pain. So sometimes we over do the facilitation of that recruitment when in reality a healthy body should be able to have a diaphragmatic expansion of the abdominal wall as well as a narrowing of it.

What's the excursion of that wall? All the way around. So we don't want things being held ever or this goal, this false goal of everything being a hollow abdominal and skinny, right? Buddha was pretty happy and he was fat, right? So the idea is we have to be able to allow, I've been working on that a lot lately, being a happy Buddha, but we had to be able to expand and contract those tissues to be healthy. So let's try that again now.

But I want you to thinking is you're going to balloon this area up for me. We just, without lifting the legs, just let it more, more, more. I want big with the inhalation. No, not just pushing it towards me. Right? So you can see that that breath is not expanding rib cage and it's not expanding abdominal wall. So typically short of breath, right?

So this is an area that, you know, it'd be great to go study with a Chigong master or to go study, um, you know, some yoga breathing with somebody that you trust, they'd be gentle with you. But the idea of using breath, it started getting that movement and in your Polonius training, definitely focusing on that from a physical therapy standpoint or mild fascia release from massage is really getting in and releasing some of that. And there's other things that are built into your image in this area that you're gonna need to work with. I'm not going to discuss here, but the things you needed to work with and the imagery of that, of getting that to be normal for you, it is normal for you. Right? And so we're just going to release those tissues. So now let's test the abdominal strength with that. Look, this like come up, but this like come up, right? And let's see you breathe a deep breath here. So funny enough, when we load her, she gets more excursion, right? Which is a good thing. So now let's roll head, neck and shoulder up. That's plenty high enough. Taking a deep breath.

[inaudible] one more time. Where's that breath going? That's better. Good. And what happens if we really loaded up? So I actually get more excursion when she's loaded. Not loaded by drugs, but I mean loaded by gravity and relaxed. So that's an interesting thing to figure out. And that's probably from her training.

So when she's had to do the hun hundreds and those types of exercises you have to breathe. And so you've trained to allow it to move. But in resting breath you don't. So that's something we're going to definitely focus on with a heavy breathing program. All right, so she got a three in her hundreds cause she got better as she had more load. Interesting. All right, let's go into side lifts or just going to turn into your side facing them. Now this one member, we're already have the thought about her lift on this shoulder, but let's see how she does. Remember a lot of times I see people trick me, okay.

And lift the left leg up nice and long. So she actually gets on it, doesn't she? Pretty well, very little subluxation. Relax. Come on down. Let's trim on the other side. So once again, I'm less worried about what we saw on goalposts with your shoulders. We're just watching what you're doing here. So let's see this side. Same thing. Now hold this side for 50 seconds and come on down. That's fine.

What did you feel on that side compared to the other? In the left. From the hip itself to lift up. Okay. All right, very interesting. You're going to turn over on your stomach. All right, so in this position, we're going to go right into our pushup. So let's watch your plank position and come on up. Find your plank. Yep. And we're just going to do a pushup to where the elbows come to the side of the body and then back up again. Give me one more of those.

Good. Can you go lower than that? Let me assist you. Keep going. Keep going there and I'll come back up. All right. So go ahead and relax on your tummy. So things that I'm looking at again is just the relationship in this area. If I can get a little bit more mobility here, I think I can get rid of some of that collapse. So she's having a pie, right?

So just just thinking out loud, let's go into, our superman says can be arms out to the side. Yep. And what I want you to do, this is going to be one of the more challenging ones for you is I want these vertebra to lift up, but not these to lift up. And that's really tough for those. High enough there. Alright. And can you float your legs up? Hovering like dark, get a little bit longer for me. Longer, longer, not higher. There's longer reach in the crown to the wall. Yes. Good. Okay. And come down.

All right. So I'm going to give her a two because the legs come up fine. But the thoracic did not come up fine. Okay. She had to drop into the low back to get the thoracic up because of this area here. And this is what we want to work on. Okay. Hands over the head. All right. And what do you feel in this position here? Do you already feel like you're a little tapped on range between my scapula?

I can feel like tension. And if you were to float your hands off of that, what would happen? Wow. So it's very challenging. Yeah, I can see that. So I'm going to give her a clean too, but I'm not going to give her a clean three. Good and relax. And that's because what she had to compensate to be able to do that was not healthy.

So she was pinching subacromial and she was squeezing and collapsing in between shoulder blades. So those were two things that we saw there. And I think those are both related to that mid thoracic movement. All right. So now we're going to go into our prone press up. So bringing the hands to your side that the elbows come up. We're going to send the elbows down, connect the ribs in front of the Palestinian, come up onto your thighs.

So like a swan. Okay. So I want her to feel this and see this. What's going on in her extension? Come on down. Where did all of her movement come from? Low back. Right? So that's why she doesn't like extension.

None of us would like extension if that's what's happening in our extension that's happening because it's not happening here. Right. So let's try something. Let's try a little bit. Keep your hands where there? Yup. I'm just going to rotate you a little bit. Yep. There we go. Now come up with the chest a little bit. Just a little bit. That's plenty. And back down and back up.

Hmm. So all I'm doing is giving her a little bit of that rotation that we wanted to correct in that area. So those four sets are lining up. Try and come in this way. That's even easier for you. Huh? There we go. Okay. Oh, okay. Let's try it again. This time. Let's stay out of this area. You can rotate which one felt better to you?

A little bit to the left a little bit. Yeah. That's what, there you go now. No more extension. Come up onto your thighs. MMM. [inaudible]. Yeah, without collapsing there. Keep that. Okay. So we've got some work to do there. Okay. Come on down.

And she could have predicted this one, right? Would you have predicted that? Yeah. Yeah. Okay. Let's grab this foot with your left hand. Leave this arm down and without increasing the low back, can you lift the left knee up off the mat? Good and back down. Perfect. Do the same thing on the right side. And I always put my hand there to fill this size.

A little more difficult though. Tight? Yeah. And where do you feel at the front of the quad or the hip or the quad. Okay. All right. So we have all our measurements here. You can go ahead and sit on up. All right. This was very revealing.

What did you learn? Kind of a lot of work to do. You've been doing a lot of words, you've done a lot of great things, but what are the things that you learned about your body? That rotation is the biggest one. Yeah, like I feel like I'm twisting and leaning over to me, but just, just for kicks, going back and do your goalpost and see if it feels a little bit better. And now go ahead and the hands up. Yeah, so already it's better, right? We got, so, I mean just for her to be able to get here now she's not nearly as Sublux as she was. Right.

And that's just because just doing the movements we were doing to make her be honest with her extension, the upper thoracic was bringing that about, okay, let's go ahead and sit down or you can hold on to that. So what we're seeing to me is what I said very early on. A lot of times the back pain, the instabilities, you can see how that low back sucks up. Everything that she does right. And whatever can't happen in the mid thoracic is happening down the low back or in the shoulders. Now she doesn't put a lot of demand on her shoulders, but she puts a lot of demand on her low back. And that's why she has this sort of constant battle. It's very hard for her to find the comfortable place when even breathing right is so challenging. So we're gonna Focus, and this is a very common scenario actually in in a world of low back pain is we see that restricted thoracic, maybe a little bit of scoliosis and we see an inactive diaphragm.

She's gone to great lengths to make her waist look nice and skinny, right? So she looks phenomenal when she stands up and puts on a nice dress. But the idea is that she goes to such extent to do that, that she's lost the diaphragm mobility and the expansion that area. And that's exactly where she needs it. And that's where we're going to focus our class on tomorrow is seeing if we can get some movement in those areas. Are you going to be in the class tomorrow?

So I, I don't know if I can get you in a class cause I would love to put you up on two or three of those tests afterwards and just see how you feel after doing the movement. Okay. And that's just, we're looking at it just from politesse teacher. I would love to get ahold of her as a therapist and I'm resisting, but we're just looking at her as a pilates teacher and that's where we're at. So again, if you're out there and plots anytime land and you happen to have some of the same characteristics that we saw with Lisa today, um, this is a great opportunity for you to maybe talk to your physician or your therapist and see if some of the classes that we're teaching are able to help you have better movement, easier breath, and most importantly, a successful movement experience without pain. And that's really what we're looking to do here at plays any anytime is to create these experiences for you with a wide repertoire of classes that you can participate in and feel better and be happy and be healthy. Good. Yeah. All right. Thank you.

[inaudible] now that you've successfully completed the workshop for screening,

Chapter 14

Class Introduction

it's time for you to test your own skill set. Take the information gathered from the person that we just screened and build your own class and they compare it to the class you can take on pilates. Any time that we build specifically for her. Enjoy and we'll see you on politesse anytime. Hello, this is Brenda Anderson at Paulie's any time and we are here for a class that we

Chapter 15

Mat Workout for Hip Replacement

designed specifically for Mindy. Um, Mindy recently had her hip replaced as little as four weeks ago and we did an assessment with her in a workshop that we did. If you're interested, you can always go to apply it at any time and see that that workshop. But the class are designed for people who is a growing population every day of those who receive total hip replacements is going up by 25% per year.

The number of people over the age of 40 that are now having total hip replacements with success, we turn into full able body movement. Now this particular case, Mindy had an anterior lateral approach. And what I want to just make sure everybody understands is that you need to get clearance from your doctor and your therapist before you attempt to do a class like this. But this is based off of our assessment of her. She is doing physical therapy. She does come from a strong movement background from dance pies and Jared atonic. And so this class is designed for her.

It is good for anybody that wants to participate in this class and if you fit those particular parameters, uh, boy, we'd love to have you join us on piles anytime. So let's get started. I want to begin just in standing and you know, Mandy does have a walking stick with her, which she has been told by her physician, a therapist that she should be using for another couple of weeks, um, just for safety and for her assurety. So that's why I asked her to use it here, just like I would ask you to do the same thing at home. And so having this awareness on your legs, what I want you to do is just close your eyes for a moment. And with that assurity that you are safe, just notice how the pelvis sit on top of the femurs so you're really observing, you know, is there any tightness or restriction in the front, the side, the back or the groin and if you just shift your weight side to side, right to left, just notice as well. Is there anything that you notice different about one side versus the other nine guarantee you Mandy's noticing a difference because of the lagers operate on still is going through it's reawakening stage and she's starting to take ownership of that leg again, I usually takes anywhere from four to 12 weeks to feel ownership of the leg after having a total hip replacement.

Now just resting in that standing position again, just make a mental note of it and take a snapshot as if he had a camera inside your body, what you feel and record it and have that recording inside to come back and compare. After we do the class, everybody with me eyes open. We're going to go down onto the ground and we're going to start laying on our backs with knees and a hook line position. And uh, we have this down to a science here. You got, I'm gonna take this away from you. Okay. All right. You good? Fantastic. So what I want to start with, and I do this almost with every class, it's just a little bit of awareness of the pelvis. We're going to go into a little more detail because our goal really is to wake up the relationship between the pelvis and the femoral head, especially the new femoral head, and to start increasing awareness through movement in all directions and angles so that those proprioceptive fibers inside that hip can now start being awake and give her the sense of ownership of her leg. So with that being said, imagine that your pelvis is that beautiful large bowl of soup that is half full.

It's a smooth, warm soup. Let your feet be spread apart about hip with the part is if they lined up with your sit bones and just very gently anteriorly and posteriorly tilting that pelvis, we can incorporate our breath so the inhalation tilts, the pelvis forward, the exhalation tills the pelvis back and each time using less and less force to get their movement. It's almost like the soup is sloshing and the pelvis is moving around the femoral head. That's exactly what we're looking for. Just a very gentle movement and tear in postier and again, anytime that you would feel discomfort would be worth checking to see why you're feeling discount for these exercises. They are particularly indicated for this particular circumstance that we're working with.

Now come back to that quiet place in the middle and let's take the pelvis untilt it to the right into the left as if your legs were on a coat hanger and I was maintaining the legs up vertical. Just sort of holding them, allow the pelvis now to rotate around the femoral head, right? So we're getting that nice side to side, this rotation of the spine, and we're looking for the ability to keep the knees vertical and allow the pelvis to roll around the new femoral head. So let's do that for a couple repetitions. The tendency is to want to hike the hip. We really want to keep it so as just rocking side to side.

You all have very nice rocking side to side and each time try to see if we can increase that movement again with efficiency, using as little force as possible to be able to get that movement successful. And again, let the pelvis rest back into the central position. Now we're going to combine those two movements to do a diagonal. And this is a very important move for this because this represents walking. So for her to have that diagonal walking.

So what we're going to do now is the anterior tilt and rotation towards the right foot and then a posterior tilt and left rotation towards the left shoulder. If you're thinking of the pelvic clock or felled in Christ clock, we'd be going towards seven o'clock in the morning towards that right hip and up towards one o'clock in the left, right left angle. So we're just going on a diagonal side the side. And that's a funny one, isn't it? Right? But what you'll find is this is actually walking and back to the left and down to the right. And this is often a range of motion that is lost following a hip replacement because they don't have a lot of ad duction or internal rotation, that easy a little bit. And just when you learn that diagonal, it's time to do the other diagonal.

So we're going to take it down towards the left foot and up towards the right shoulder. You got it. And again, just feel that sync and up and sink. And you can still use your breath for this. So inhaling down towards the left foot, exhaling towards the right shoulder. And again, just try to allow the pelvis to move around the femoral head in all the angles. This increases the awareness inside those hip joints.

And that's exactly what we're looking for. And when you're ready, let the pelvis become quiet again. We're going to go into a full circumduction now as if I was stirring that bowl of soup with a large spoon and that there was a current. So imagine the current going around clockwise and the pelvis and being able to get that fluid moving and the pelvis now moving around the femoral head. So the femoral head is quiet and the pelvis is moving around, massaging that femoral head, waking up the proprialceptive fibers around the hip socket itself. And again, let the movement just start happening.

Less and less thinking more and more moving, right? Just allow it to happen. And if you want a little more movements, you can take a little soup out of that bowl and make it so the movement is a little bigger. It's a little uncomfortable. You can put more soup in the bowl and decrease that movement and we're ready to go back the other direction. So when you're ready, start stirring that soup in the counter. Clockwise Direction. Less work, less muscle, more flow. Imagine the current that the breath be part of it in.

How's you come down towards six o'clock exhale as you come up towards 12 moving around, waking up those hip joints. Beautiful. Alright, and relax. Now we're going to do is we're gonna use our hands and we're going to bring the knees up to a 90 90 position and place the fingers on top of the knees. So you're going to hold it with this hand and hold that with the hand and we can do a gentle circle. Roundabout, just a tiny little circle imagining the femoral head dropping down into the pelvis and sort of opening it up the back of the capsule. That's right. And just gentle circles. I think more of the opening of them coming around here.

That's it there. Yeah. And then reverse that circle. And what I like to do in this part of it is just really trying to get away from anything that's pinchy. Anything that feels like it's bunched up. Just sort of allowing the femoral head to drop down. Let gravity be some of the source of the movement that wants to open the legs, that wants to move the legs around into the, so very gentle, reversing the direction of your circle. Same thing going back the other way and again, feeling like the pelvis itself is being massaged.

Now remember we massage the, the uh, this, the pelvis with the, around the femur the first time in the public circles. Now we're massaging the pelvis with the femurs from on top and relax that the legs come back down and we're gonna go right into our bridging. So the feet about hip with the parts, and this is a very good exercise to be able to start waking up the post to your fibers of that pelvis. And we're going to ask you just to go right into a simple bridge. So hands down to the side as you exhale, rolling the spine up, and then take a breath up on top. Exhale and dropping through the sternum, down through the ribs, one segment of time, all the way down until the tail bone comes down.

And Go ahead and appreciate the inhalation, letting it tilt forward a little bit. So we're just getting that massage around the hips. Then exhaling and rolling back up. So we're keeping that movement all the time around that femoral head. Again, awaking the femoral head and that socket up. So let's do about two more of those simple bridges on your own piece.

Rolling up. Okay. Take a breath up on top and segmentally rolled down. Again, thinking of the ribs gliding and sliding down until you're all the way back down. Now this time we're going to go into a single leg bridge, so we're going to roll up with both feet. Come up until you're parallel. Drop the sternum down just a little bit, right. Give yourself a little bit of control there and then see what happens when you shift your weight to the left.

Just disengage the foot a little bit off the ground and then bring the right foot back down and disengage that the left foot come up just a little bit. Yeah, and shift back to the other side. Nice and easy. Shifting side to side, gently lifting that foot off. Disengaging back down for more advanced variation, we would be doing some gestures, maybe an advanced class, being able to lengthen the leg out or do circles with the legs. At this stage of the game, we're happy as can be to just switch the weight into the, into that movement. We'll do one more on each side and then roll your spine back down. Now another important factor for coming off of a hip procedure like this is getting spine mobility.

So we're going to do the bridge one more time and this time we're going to do a little bit of lateral shifting side to side to be able to wake up the spine muscles because a lot of times when people will complain of after a hip procedure is their hip feels a lot better, but they actually might have some back pain and that was the case with Mandy that we want to try and get that back feel a little bit better. So sliding that pelvis to the right to the left as if the pelvis was on a skateboard. So you roll up into your bridge, shifted pelvis to the right, shifted pelvis to the left, and then come back in the center. Drop this down at centimeter. Good and shift. So we're just going to slide and slide. Come back to center, drop this down, slide slide, drop it down, slide and on again side each segments. We're trying to get multiple segments of that articulation. Very nice Mindy.

All the way down to the bottom comes to arrest, side to side. So just a quick note on this, if you had 10 or 12 vertebra that we're going to move between the base of the shoulder blades and the sacrum, you're looking at the ability to slide from t a t nine come back to center, drop down a centimeter to t 90 10 slides. I decide. Come back to center, drop down another segment, slide side to side until you finally get to the bottom. So let's try it again and see how many segments you can actually treat. A smooth translation for each level. Okay, so roll it up and let's try that again. And sliding to the right, sliding to the left, dropped down through that sternum slide again to the right slide to the left, come back to center and drop down. Right left. You got it.

This looks great. And again, and you should be able to get at least five or six segments that you're able to translate through successfully to wake up those local stabilizers to get rid of any kind of cramps or spasms that are in the back from all the change and deviation after having a surgery like that. Very good. Bring the back of your hands together and rest them on your sternum like this. Yup. So fingertips are pointing down towards the pelvis. Elbows are in front of you, and we're going to do a modified chest lift here. So as you exhale, you're going to reach your elbows forward as you roll the head, neck and shoulders up.

I think create the image that from the elbows is a hammock that comes around and supports the head that it actually is lifting the shoulders off of the mat and then come back down onto the floor. I'm going to be your Lyft. Okay, so here we go. I'm going to pull the elbows. Just relaxed. Don't work so much. It's there. You feel how the head can relax there? Yeah. Good. So the idea is that we use that as a hammock. If you think of the trapezius muscle hooks to the shoulders, and we draw that forward to articulate the spine up from above, down towards the base of the shoulder by that's as high as we need to go. And then roll back down. Last one and exhale, roll love and come down. Take the hands behind the head. Going into a real chest lift.

Elbows were in the peripheral view, right? So we can see the elbows at the side of your eyes and then draw the back of the neck a little bit longer. Imagine your hands are still on your sternum and as you exhale, begin to slide up around those top ribs. And from here, stay there. Inhale, release the hands. Law Arc. Let them come behind the knees. Exhale, lift a little bit higher using your arms, right. Not The hip flexors, but the now stay there. Inhale, bring the hands back behind the head and then exhale, roll back down.

That's the whole chest lift less. Repeat that three more times, and exhale. Roll Up. Inhale, arch. Grab the legs. Exhale, lift a little bit higher. Inhale arch and exhale and rolled down. Really use the arms to bring that challenge yourself. Come up a little bit higher.

Are arms grabbed by Philly's and lift up a little bit higher. Get up off that shoulder blade a little bit. Stay there, bring the hands back so you should really be funny here. Not here. Okay, last one. Here we go. Exhale. Roll Up. Inhale, arch. Exhale, lift. Go ahead. Stay there. [inaudible] has behind the head. Stay there. Right there. Stay up. Taking a deep breath three times up in that position. Expanding the ribs.

[inaudible] two more breaths. Deep in expanding Xcel. We didn't say it was gonna be an easy class. We're just going to be sensitive to the hip, right. Exhale and relax on down. Excellent job. Okay. Going from here. What we want to do is bring the legs back up into that 90 90 position and you put your hands both hands behind the right leg, okay.

Or the leg that's affected whichever leg had the hip replacement. And we're going to do a modified version of the single knee stretch, right? So roll yourself up using your hands behind your legs. You can push into it to come up in that position. And we're gonna do this. We're going to keep holding onto that right leg, okay?

Cause that's going to be our safety. And what you're going to do is reach the left leg out and bring it back in, pushing into the right hand. Reach it out again, the left when you return with a left, push into the right hand. So inhale, exhale, oh and relaxed. Now what we're trying to do is create the sensation of what it would be to push that leg out if we had those privileges. Now you can rest your heads. I specifically gave Mindy sort of the idea that we don't want her doing a long lever out from her body for probably six months after the surgery, but we can prep the tissues and the load by having to push into that. So want to try that one more time.

Roll up using the assistance of the right leg. And again, if you have the left hip surgery, you would do it on the opposite side. Exhale, reaching that left leg out and in hell pushing into the hands. Exhale out. Push into the hand. Push out and in, out in, out in one more time. And relax. Hands behind both knees and rest your head. Shoulders down. But keep the hands behind the leg. We're gonna go into a modified roll up, right? So we're going to use the weight of the legs and the mobility of the spine to be able to come up into a seated posture. Right now, the challenge here is it's not about thrusting, it's not about pushing or pulling or jerking. Very gently. Just be patient.

Start sending the legs away and down while you're holding on with your hands. Let the arms lengthen as you head. Neck and shoulders roll up into position to come up. That's right. Good. And just come up in that position, right? You don't have to sit up all the way. Just sit up here and deep breath. Exhale, roll back down through your spine.

Use your legs as you can to lever and roll back down. We're going to do that two more times and exhale, rolling ups in the legs away. Roll the spine up into a seated posture. Very nice everybody. And again, inhale, exhaling, rolling back down. Now we're gonna try something a little new. We're going to combine the corkscrew of this in the sense we're going to keep it simple as the modified up, but we're going to roll down on one side, come up on that side, and then roll down the other side. Come up on the other side. So roll up into your seated posture, right?

And this time we're going to wait the left hip and roll down on the left ribs going into your roll down. So you that side to sort of feeling the side on the left, rolling down on the left all the way down and then roll back up on the left. Very good. Now shift the weight over to the right side and rolling down through the right side. Same idea. Very nice. You guys got her off the bat. You have to demonstrate it or anything.

This is awesome and roll back up on the right side and now let's go a little more fluids. You will come up and shift to the left. We're rolling down to the left and continue to come up on the left. Shifting over to the right, rolling down onto the right. Using your legs all the time to help you, you push in, takes the stress out of the hip flexors and allows the oblique and the tummy muscles to work and organize appropriately. So as little work as possible. One more time on each side and liking that and I feel okay Mindy. Yeah, get some movement in that spine.

That's awesome. All right, and come on down and rest. We're going to let your lace come down to the fore for a second, give them a rest. And let's just take the hands to the side as we sort of get ready to do a modified hundreds as well. Right? So again, we're teaching an intermediate course or class with the modifications for the hip replacement. So this is sort of, you know, it's not a beginning class, it's an intermediate class where we're doing some some work that we would expect you to have a basic knowledge of the polarity. So that said, I gave you a long enough break, roll up into the a hundred position, bring one leg up at a time into the 90 90 position and you're ready to go. Palsy in the arms, deep breath in, focuses on the breath and let's go into three, four, five out, two, three, four, five and in and out. And if at any time you get tired of holding that leg up, you may let that right leg come down to the mat to keep the left leg up and keep going. We have a few more breaths ago.

Four as a matter of fact and a two, you know the Briscoe we go, the easier it right? If we were to slow it way down, it would be really hard and challenging. Last breath. Here we go, and in and out and relax. Beautiful. At the legs. Come down, you arrest down, rolling over onto your left side. I'm going to go into book opening, so you're going to bring your hands on top of each other. Laying on your left side. Arms are out in front, and we're going to take that right hand or we're just going to slide it across the body. Opening up into a little bit of rotation.

Remembering that hip is about rotation, right? The hip has rotation, the spine has rotation. So if I don't have rotation in my spine, I put too much stress of rotation in my hip. So gradually bring the hand back across your body and roll back into sideline and that's repeat this three or four times, nice and easy. Just rotating that upper body, opening that spine, releasing any restrictions that might be in the upper back, which again, distribution and movement equals distribution of force. So if we get that move in the thoracic spine, we can decrease the stress on the hip with your normal movements on a daily basis. Let's do one more time to that side. Using your breath to facilitate that movement.

Take it all the way out to the right and now bring your legs up and over to the right side and you can adjust yourself on your mat. We're going to go over onto the right side, left hand on top of the right hand, and do the same thing on the opposite side. Rolling back through that part of the body, opening up the chest, the thoracic cage, rotating the spine and bringing it back together again. Let's do that book opening three more times to the left. Feel good to get movement and other parts of your body.

This is what happens a lot of times after a fall following a major surgery. We think we can't participate in the activities and other parts of our body and support and that we make sure that they have a whole movement experience in their body, not just focusing on the site of the injury or the side of the surgery. Last one. Okay. All right. Now from that sideline position, what we're going to do is we're going to push up into a side set position.

So it actually looks something like this where we'd come up from here. Just come up into this position here. Almost like a Cleopatra, right? So you're gonna come up in that position and we're going to use breath to help us move the rib cage into a side bending. So as you inhale, we're going to expand into this rib and getting tall. You can let it come down. You're going to actually work on getting something similar to a mermaid, right?

There you go. And just getting that opening up and that side for the side bend. And again, remember distribution and movement is distribution of force. We expect the Femur to be able to have that movement of side bending or abducting. If we get that in the spine, we actually can, the amount of load on the hips. Okay, so let's just do that for one more second. Using a nice deep breath into the lung, the right lung, and when you're ready, slide back down. Roll over onto your left side. Slide back up. And let's stretch out the left lung, the left rib cage, right. So that Cleopatra position legs are safe.

Deep breath in to the left lungs are filling this space out here, right? You're that nice long curve. Almost like that opposite curve to the right of your body. Okay, nice. Deep breath. Yeah, right. And when you're ready from there, we're going to go into sidekick position.

So just lay straight down on that side. It's your right leg is up, right? So we're going to come up on your forearm, it's going to be your forums, intermediate class. But what we will do is we will bend the knees. Exactly and we're going to start off with like a clamshell where the feet stay together and we're just going to work on a little bit of opening that right knee up off of the left knee. So just bring that right knee up towards the ceiling and back down just to where you feel comfortable. The body long, we still have the axial length, we still have that relation to the rib cage and the pelvis. If at any time you feel uncomfortable, make sure that you relax, come down and we'll try that exercise later as your body continues to heal.

Now from there, bring that right knee down. Take the whole leg and lift the whole leg up just off of the leg, just as connecting back down. Let's do three or four of those. Now remember you only lift the leg as long as you can maintain the rib cage in a quiet place, right? So we don't want the rib cage dropping down. Every time the leg lifts up, we want to keep it pretty pure. And then from here, straighten that top leg out again, just a small little lift. Turn the toes down towards the mat a little bit and work on that post to your part of that hip. So lifting the leg up and down. Just tiny little pulses, tiny little pulses, three, four, five, six, seven and relaxed there. Now we're going to do a little bit of sidekick.

We don't want to move too far, so it's going to look something like this. That leg will straighten out. It's literally going to be six inches forward and maybe back to neutral position, right? So it's a very small range. So lifting the leg up into that nice position and we're going to take the foot forward and the foot back. Perfect. That's enough and forward. Use your breath with it. Inhale forward, exhale back, add the foot gesture, flex the foot and point the foot as you reach back.

Flex the foot as you come forward. Point the foot as you reach back. We'll do one more of those. And that's plenty to start out in the first time and relax. Very good. We're going to roll onto your tummies right and we'll get over to that left leg and a little bit. And what we want to do now is go into our dark position. So the hands down to the side, your forehead is resting on the mat. Lift the hands off the ground a little bit.

Take your head, neck and shoulders and just barely disconnect them from the ground. So your length and long like an arrow or a dart legs. Hover a little bit off of the floor. Pulse in the arms. We'll do a reverse set of hundreds in Haley in t three four, five out two, three, four, five. Use your breath to expand the lungs into the side, into the bag.

Hadn't come up a little bit higher and boom right there. Good. Keep it going. We got a hundred of these to do your at 60 keep going into three, four, five and out. And again, the stronger we are in the back side of our body following a hip surgery, the stronger we are in our standing, our posture, and we're going to see how good man he feels after the class of getting these muscles to wake up. Last one and relax. Rolling over onto your other side. So on your other side. We're on that right forearm. Knees are bent feet together.

Left knee comes up as a clamshell opening and back down to get that body nice and straight, so get that long so we're not going to move the pelvis when you open, so go. That's it. That's right. Good. Stay on top of that right arm. That looks great. Exactly. Let's do three more of those and again, make sure that you keep those ribs lifted up. If you think of sending those ribs from below up towards the ceiling, it's going to give you a lot of stability there.

Now the whole leg lifting up with the bent knee coming up just a little bit again, when the leg lifts up the ribs or lift up at the same time, right leg lifts up, rib lifts up, up and up and down. And that's going to keep that rib cage from collapse in the pelvis from collapsing. Last one, straighten that leg out, lift that straight leg up, toes inclined towards the floor. Just give me four of those. Nice and easy. Two, three and four. Sidekick forward with a flex foot and forward and reach back and forward and reach back. Now, if you were uncomfortable laying on your side of the surgery, you can always put cushions or padding or pillows down to protect you just from the soft tissue tenderness that you might have following the surgery. No real precaution, just nice and easy.

Last one reached the like back and then rolled over again onto your tummies. This time go onto your forearms, your hands together. We're going to go into a single hill kick, so we're going to get up nice and tall onto the front of the pubis, or even under the Thyolo, but lifting the belly button off of the Mat. And we're going to start with the unaffected leg. So the left leg, just to get an idea of the exercise and we're going to pulse the hill towards the bottom of the flex foot two times. And then you're gonna reach it out back like we did with the dark.

Just a little bit of suspension, reaching and back and let it come down. Okay. Affected leg. Let's go to the right leg and try the same thing. So we'll do this together. So it's flex, flex and reach. Left leg, flex, flex and reach back. The neck is long. Flex, flex and reach and flex, flex and reach. Keep it simple. Flex, flex and reach.

Fill the lift and the tummy when that leg comes in, right? So it's lift, lift. As you pump, lift the belly, lift the belly as you reach. Lift, lift and reach. Lift, lift and reach one more on each side. Lift, lift in, reach, kick, kick and point and relax. Excellent job coming up into quadripolar. Now you're going to go right up onto your hands and knees and we're going to have a little bit of a relaxation here. So this is a great place for the hips to be able to be nourished, to be able to be fed, right. The blood's pumping.

Now we're just going to move the pelvis gently around the femurs so we can start off with a very simple sort of cat and horse movement and really enjoying the extension in this where let the bottom stick out a little bit. You're in a safe place. Nice and easy, forward and back. And then we're going to go into our circles. So we're just going to go around and sort of massage those hips. That's right there it is. And really trying to get them massage.

Now let the head be part of that as well. And you start to become aware of it, that we have that full integration of the movement through the spine. So the whole spine is articulating, we're communicating cell by cell from the knees all the way up to the crown of the head, that there is a connectedness in the body. So one of the big problems as I mentioned earlier, as you sort of feel like whose lay is that attached to me after a surgery like this, and this is a way to wake it up and say, no, no, you're part of the body. You're, you know, we're all friends and we're communicating right? Reverse the direction of that circle.

And you might notice one direction is a little bit easier than the other and that's very typical as well. So a nice smooth play for rotation of the spine. Around the pelvis, around the femoral heads, giving it neutral nutrition, giving it plenty of fluid, getting that synovial fluid working, making sure this lubricated and moving nicely. Now come to that neutral position that you can find, right? So the neck is reaching this hell bones reaching long.

The ribs are in a good place for the abdominal. Moving a little bit as you breathe in and out without the spine moving. So I'm saying you feel the belly dropping down when you inhale and lifting up when you exhale, but the spine stays quiet. I feel that connectedness. Now from here, we don't have to lift the arm and the leg up too high. All I'm looking for at this stage of the game is a weight shift and disconnecting the limb from the floor.

So we're going to shift the weight over to the right knee a little bit and just pick up the left knee, right? So sort of slide it back a little bit and then bring it back in. Just like we're doing the alternating, but we're not going as far as shift to the left knee and just reach the right leg back a little bit. And again, getting the hip extension in the leg out straight is a great exercise in this orientation with gravity, we can't do it in the other direction because of the load on the front of the hip. So let's gradually increase the reach of the leg without moving the pelvis. This is very important.

The temptation is to move from the spine and the pelvis and we're going to keep that control. So I don't care how high the leg goes, I really just want to see the organization, the pelvis, and sort of having the awareness of how much extension do you really have in that leg as we go back and forth. Now let's add our arms to it. Alternating arm and leg. So as your reach the right leg out, the left hand goes out, bring them back home, inhale and switch, reaching the left leg and the right hand. Inhale back home and exhale, reaching back out. Excellent. Now I failed to mention earlier that in this class we need to have the box and we'll be heading into some box work real soon to help us understand how we can modify some of the more advanced exercises after a hip procedure like the one that Mindy had last one on each side.

And we're ready to use our boxes. So what we're going to do is bring your box to the center of your mat and we're going to sit on that box here. You're going to sit here if they facing that way. Are you doing okay? You got it beautiful. And actually that's not a bad idea. Sit with your feet facing the center.

That way you can see me and we're going to start with spine stretch. Okay, so the idea is that when we're seated on the box, her hips now in a pretty safe place, you don't have to worry about that long sit position for her, which was a little challenging. She has plenty of mobility to sit in that position, but she didn't have the strength to really hold that position. So this is a much safer place. Hands down to the side and feel like the fingers are sliding down towards the floor or down the box a little bit. Head going up towards the ceiling. And at that same time we're going to then reach the arms out to the side, right. Hug the imaginary tree, and now send the lower ribs up underneath your heart as you flex over your knees and let your hands come down to the front of your shins. And that's far enough.

Okay, that's plenty good. Taking a deep breath there. Exhale, slide the hands up the shins. As you stack the spine back up into a tall seated position, arms should come back down towards the side of the box. Yeah, you got it. Send the hands down. Send them out. Hug the tree. Ribs come up underneath your heart. As you come around, that imaginary ball hands will come down to the middle of the shins. Taking a deep breath, relax in the back of the neck and stack the spine up the hands.

Just drag the leg in the down to the side of the box again, send the hands down as the head goes up. Take the arms out, hug the imaginary tree ribs, come up underneath the heart, sending that way. Hi, really supporting that hip as you bend over the hip and notice each time that you're going to get a little more flection. And if then we want to avoid any kind of impingement. All right? So we don't want to feel anything pressure in front of the hip so that lifting the heart or lifting the ribs and the heart is really going to prevent that and just go to where you can go through the upper spine. Start realizing that your flection is coming from the spine, not as much from the hip. Okay? This time, bring the hands across the chest.

So we're going to go into our spine twist and we'll start here. Really pure vertical rotation. So you're going to feel the weight on your sit bones. You're going to find that your spine twist is much better sitting on a box and sitting on the floor, okay? And you're going to rotate to your right. Okay? And rotate to the end of that range of motion, where that left sit bone does not glide or slide.

So you're still at nice vertical axis you've rotated around and then come back to center. Rotate to the left far as you can stain on that vertical axis, filling that weight equal. And here's a little trick with the ribs. If you're rotated to the left, feel like that left rib. Lower rib is going to reach down a little bit towards your hip. And the right lower rib is going to lift up underneath your heart and notice that you'll actually get a little more rotation because what happens is when you can create the connection between the lower rib and the pelvis, the top ribs construct a slide on each other.

Come back to the right side and rotate to the right. Same thing. Now, so here, that right lower rib is going to reach down towards the hip and the left rib is going to lift up underneath the heart and then rotate a little bit further. Okay, and let's go again back to the left. Appreciating that relationship, rotating to the left axial length. Come back to the center and to the right. And we'll do one more to each side. And we're getting ready to combine them into the SAR, right?

So let's take the arms out to the side. Now we should have plenty of room between us. Are we going to start with the spine twists or we're going to rotate to our rights? Yeah. Now take that left hand and fill the ribs.

Come up underneath your heart as you bring it down to the middle of the right shin. Stack it back up through the spine. Bring it back up and rotate to the left. So we're going into the sauna. See the position reaching the right hand over towards the Shin, towards the toes. Stack it back up through the spy. Bring it back out to the right. Rotate to the right a little bit quicker and up and over and stack and open and rotate and up and over and up and rotate.

One more time to the right and reach left and stack up and reach left and reach right hand. You got it. And up. Beautiful and relax. Very good. Now spin around. So you're facing the front of the room still with a box. Place your hands on the box. Yeah, and you're going to put your feet out straight in front of you and all we're going to do is lift the bottom up off of the box. So it's a leg pull exercise. Your heels are anchored on the floor.

If you want to modify it, you can do it with bent knees. Let's try with bent knees first and just feel that control, right? So we're bent knees, we're just going to look bottom up off the box. That's it. Good. And back down. So it's almost like you're going into, you really want to feel the opening of the hips by using the posterior part of the body to lift the bottom up. Okay, you got it lifted pelvis up. That's it. And back down spring, using a little closer there and up there we go.

And down that fellow safer. Yeah. You're worried that your feet were going to slide out. Make sure you have nonskid. There's a lot of push for toe socks. Nonskid socks. You pay me later, Joe. Here we go. Now let's straighten the legs out and do it from the heels. Okay.

I'm going to give you that safety there and then we go up and down. How are you doing? Little shaky. I would expect it to be a little shaky. Shaky just means it's working. No discomfort. Okay. And she had her physical therapy already today, so I know she's a little tired and down. One more time and up and down and relax.

Fantastic. All right, we're going to get rid of the boxes and continue with the class. So we're going to go into, um, plank position. So we're going to go back into our quadro PID, right head towards the center of the room. How are you doing? Give me your hand. You got it all. Alright. She's way ahead of her time. All right, so we are gonna go into our plank position. I love plank for the hip.

So what we can start with is just going from the quadramed position into plank and then back into quadramed position. So we're just going to lift up into a plank side. Your legs back. Hold for 10 seconds. Nine, eight, seven, six, five, four, three, two, one. The knees come back down into quadruples. We'll do that two more times. Okay, so rusted up. And again, what's important about this is we're actually getting the strength in the anterior wall without loading gravity onto it. So it's a reverse load. And here we go into plank and hold. 10, nine, eight, seven, six, five, four, three, two and rest.

Now come down onto your forearms. You're ready. Same thing. Plank position. Here we go. If you get too tired, you've been those knees down. 10, nine, eight, seven, six, five, four, three, two and rest. How are we doing? Come back on a little bit if you need to. You want to come up onto your hands? You're good. You got one more? All right, here we go. And playing. 10, nine, eight, seven, six, five, four, three, two and arrest. Put your hands into push up position. Now with your knees down or your knees off, you're going to do one full pushup.

If you can do it off. If she's doing it often, everybody should do it off one. Push up all the way down and come back up. Walking the hands back towards your feet. You can soften your knees if you need to soften your knees. And I'm coming to help you out here. Yeah. And Roll your spine up and we're going to do a roll down in a roll up.

One more time just to where you feel comfortable right now. The key thing here is I don't really want so much hip flection is I want the spine to be able to move in its place. So the more spine mobility you have, the more you can do the daily activities without going so much movement into the hips. So let's do the spine roll down just down to where it really is all about the spine. And then soften the knees when you get down to the low back and then stack it back up from there. Right? Beautiful. And let's do that one more time. Segment by segment, articulating the spine down.

Find that place. Knees soften a little bit forward. Tailbone goes down, pubic bone lifts up, ribs lift up underneath the heart. Effortless roll. Oh the way up. And take a nice deep breath. Now once again, in this position we go into assessment. So the class is over. Where are we? Eyes closed. If you feel comfortable and you want your walking stick, you feel good.

No walking stick. I like that. Okay, so now standing in this position, just notice how the pelvis feels on top of the femur. Is there a little more awareness? Shift the weight to the left into the right, and just notice if the body is able to receive that weight equally on both sides. How do you feel when you're on the right and the left side? And then just even do a little bit of a circle around the hip. And just notice if you feel a little more control, a little more safety all the way around the hip joint. Because that's what we want to do is wake up those little mechanical receptors inside the hip that had been turned off and wake them up again so that we feel like the leg is ours and we have control of it in this range of motion.

Open your eyes. All right, and that's the class you feel. Thank you. Alright, so at home, again, I just want to encourage you to make sure that if you did recently have a hip replacement, that you would have talked to your doctor, your surgeon, your physical therapists. They're welcome to look at this class with you and make sure that it's adequate. Again, we tried to deal with an anterior lateral approach, so again, different types of hip surgeries have different types of precaution. This class was specifically designed for Mindy and many others who have anterior lateral approaches that could benefit from this class. We hope that you'll join us on other classes that will continue to evolve and prepare her to return to all of her activities in the plots world at [inaudible]. Anytime. Hello,

Chapter 16

Mat Workout for Neck and Back Pain

I'm Brent Anderson at plots any time and excited to be here and we've designed a special class for Lisa, but it is a class designed for everybody and we took a look at Lisa in one of our workshops and realized that she had restricted mobility in her chest and thoracic area.

She had a decrease in rotation in her extremities and in the spine and more importantly she had over recruitment of her abdominal wall and had some inefficiencies in her diaphragmatic breathing. Now I see this all the time and these are the type of problems that lead to neck pain, shoulder pain, low back and hip problems. And so the purpose of this class is going to be a little bit breath centric, focusing on restoring mobility. We're going to stay away from any type of muscle contraction queuing to make sure that we have a nice flowing movement experience and I hope you find it as beneficial as we do. So we're going to get started and what I'd like to do is just have everybody sort of stand up for a second on the floor and just do a little self reflection of how we feel today and with eyes closed, provide, don't have a movement disorder or balance disorder and just taking a couple deep breaths and just notice what happens when you inhale and exhale.

Where does the air transfer? Do you feel the weight shifting as you inhale and exhale? Are you able to expand laterally in your lungs, in a standing posture? And just be sensitive to that because we'll come back to this at the end of the class and we'll see if you notice a difference of how you feel when you're standing. So with that being said, let's go ahead and have you laid down on the mat and you're going to be on your back and hook line position. And I want you to place a hand on your belly in a hand on your chest.

So placing one hand on the belly, one on the chest, and just taking a nice deep breath and observe. Where do you initiate breath from? So if you initiate breath in the chest, that's fine. There's nothing that's wrong. You might be initially a chest breather that some of you might be diaphragmatic breathers, but just notice where does the air pass and continue to inhale the air until you do a maximal inhalation, expanding the lungs as much as you can and then do a maximum exhalation. Getting rid of the air as much as you can. And again, just observing. Do you notice anything as far as one being more dominant than the other, possibly the chest or the belly.

And then place your hands on the side of your ribs and just notice what kind of breath pattern you have breathing out into the ribs sideways. So expanding that lateral expansion and narrowing is just as important as expanding. So just again, observing the mobility that you have in your chest wall right now is really important. Okay. From here I want you to turn over and lay onto your right side so everybody rolling over onto your right side and just laying on your right side head can rest on your arm. We're not going to move. You can even bend your knees a little bit if you want for stability and just test what it's like gradient into your left lung, not just into the center but to the front and the back of it as well. So we're just expanding that whole left side with an inhalation and then exhale, let it relax down that gravity takes the air out, right?

So you get an expansion out to the side and to the back. Expand, expand, expand, really bring in that air and then just relax the breath out. Again, we're just observing if there's movement and if you have displacement front and back in sideways when you're laying on your right side. Now from here, roll over onto your tummy. Now laying on your belly prone hands can be down to the side. Your head can even look to a side. See what happens when you breathe to the side and to your back.

So feeling the lungs up posted early and be able to feel that air filling into the lungs in the back and then let gravity take it back yard and just observe. How much displacement can you create from the ribs posteriorly expanding versus the chest interiorly expanding into the floor. So it's like you're filling up the balloons of the air in your lungs. Rise and fall one more time. And not that there's a right or wrong to it, it's more about just observing and seeing how you breathe.

I know sometimes people come to me and they say that they were told that they were bad breathers and I always remind them there's no such thing as a bad breather unless they're dead. So everybody it's allied is a is a successful breathers. So turn on your left sides. Now let's do the same thing we did on the right and let's observe that. So just inhaling into the right lung, coming into the front, the back and the side and just feel that expansion and then let gravity take it back down. If you notice that one side might be a little more restricted compared to the other side, really expanding that rib front back and up towards the ceiling. Do One more breath there and then take just a moment as you roll over on your back and we start with our exercises to reflect and just think, where did you breathe easier? Where did you have more restrictions to?

Was it more challenging to expand anteriorly into the chest to breathe in fairly into the diaphragm, laterally into the ribs or even posteriorly into the river. So you hear us often in the plot is teaching. Breathe into your back, reach into your right lung, breathe in your left lung. Observe where you have movement and where you don't. So when we come back after the class, we're going to check it out and see if there's a difference. Okay, so let's go and start with our first exercise, which is going to be the pelvic circles and pelvic tilts. And we're going to start with that concept where I love to start with this exercise.

You've seen it before in plot anytime with a pelvis as if it's that bowl of soup. So we're going to start with that concept of this large bowl, right? That is the circumference of the pelvis, the pubic bone, the belly button, and the pelvis. And imagine it half filled with a nice warm soup. Okay? And just tilting it anteriorly and posteriorly till the soup comes to the lip of the ball. Now what I want to add to that image is that your breath is going to facilitate this movement. So as the pelvis tilt anteriorly, we want to make sure that we're inhaling expanding that diaphragm down into your belly. Do not worry about looking skinny in this class.

I really want to see that Buddha belly and that expansion, that diaphragm, because one of our objectives in this class is to get that diaphragm to really start expanding and creating breath exchange. So in hell as the pelvis tilts forward, exhaling as a pelvis naturally tilts back, so it's more of just a relaxation inhale anteriorly. Let's go a little bit quicker and I said back in one more time. Inhale anteriorly and exhale back. We're going to go right from here into our bridging.

So just with that same idea, let yourself have a little bit of the anterior tilt to prepare with an inhalation and then exhale, allowing the spine to roll and pull up until the weights between your shoulder blades. From here, you take another breath in, but pay attention to where you're inhaling, right? See if you can expand the ribs to the side in this position and then exhale, allowing the front of the chest or the sternum to soften as you roll down through your spine, one vertebrae at a time. Now, one of the things that we often do that could be considered a faulty movement is that we exhale too fast, right? So what I'm going to have you do is just sort of imagine that you're blowing through a straw. You don't have to make any noise, but as you're exhaling, when you're coming down can give you a little longer breath. So a nice big inhalation up in the bridge. Exhale through the straw, filling the ribs, sliding down into the mat and creating more movement. So we should see a little more expansion each time you do this.

Now on the next bridge, you're coming up, everybody's going to come up, stay up, take the weight onto the right side of your rib cage and roll down through the right side. Maybe a little bit like the familiar exercise of corkscrew, but in a much more basic version and rolled down through that right side all the way down and anteriorly tilt in that right side as well. Exhale, roll back on that right side. So we're rolling back up through the right rib cage all the way up. When you get to that base of the shoulder blades square off, then rotate to the left, taking a deep breath and as you exhale diagonally coming down, rolling through the ribs. So again, this is a great way to start opening up those ribs and let's repeat that. Roll up on the left side and let's make it a little more fluid. Now you're going to come up and over to the right and rolled down through the riots.

Inhaling as you come through that anterior tilt XL roll up on the right square off across the center. As you inhale, exhale rolling down on the left. Exactly and really concentrate on trying to find this part of the rib cage. As you're rolling up that lower rib cage rolling up, that's at least a good come across to the side and drop this down. This is what has to drop down. Fine that there. Oh, life is good. One more time and roll up on that left side. And then you'll come back to the center and roll down through the center. Give your hamstrings a little break and we're going to go into a little side glide. But again, I want you to imagine that when you're up in that bridge, we're literally siding those ribs side to side.

If you could think of the ribs as rings and rings stacked on top of each other. We're sliding the rings across each other. So let's go into one more bridge. All the way up. Yup. Take a breath here, drop sternum down just a centimeter and now translate the pelvis to the right and to the left as if you were on a skateboard or something that slid side to side. So it's really horizontal. And from that a little bit lower. One slide. And slide and slide, and every time come back into center, drop down another centimeter and slide and slide. So at this stage, we're also waking up those local stabilizers in the low back, and you might find that there's a little cliff or a drop in your exercise. That's okay.

That's just telling you that you need to find that segmental movement. Let's do that one more time. So you come to the bottom or roll up, taking a deep breath on top, softening the sternum again, it's breath centric today and translate side to side. Just like on a skateboard. You got it. And feel that translation really opening up segment by segment, all the way down, waking up. That's it. Good.

It's like a typewriter. If you remember the typewriters. All right. Now in this position, take your arms up over your chest, fingers to the ceiling, and I'm going to allow you to cheat a little bit. Okay? So I want you to let your arms come over your head and let your ribs come up. Just let them come up, heaven forbid, right? So let them come up and just observe that position.

You'll notice that you're not doing any harm to yourself. It's just not what we would consider to be ideal alignment, but I want you to understand what it feels like incorrectly when the ribs come up and now see if you can leave the arms down as you exhale, bringing the ribs back down towards the pelvis and only exhales far as you can. Keep your arms close to the floor. Try that again. Deep breath to relax the arms on the floor. Feel how the breath influences that. Leave the arms on the floor and exhale, drawing the ribs down, so opening up that shoulder girdle and that pelvic area. Inhale, one more time.

This time, keep exhaling, bringing the ribs down and let the arms float back up or over the chest. Fingertips to the ceiling all the way up to the ceiling. You at this time, leave the rib cage where it is the spine in Helena. Expand as you exhale. Let the arms come down towards the Madigan, over the head, over the head, only as far as you can go with control. That's it. Bring it back up over the chest. Let's do two more of those.

Exhaling over the chest, bring them back up, take a breath in. Exhale, one more time over the chest. That's right. And again, just getting that awareness of that relationship and noticing how you can allow it to open up and free up that part of the body. Okay, so now what I want you to do is you're going to roll over onto your right side. Knees are gonna stay bent. Arms are going to stay in that position, right? So just roll over to your side. Going into our book openings and book of his another way, very early on in the class to be able to wake up the movement and those ribs, you're going to take that top hand and slide it across the bottom hand.

Slide it across your chest and open it all the way out to the other side, leaving the knees on the floor. This is one of those delicious exercises where it's like, oh, Brent's been so nice to me today. He must have some hell of act heart exercises coming up, which you're probably right. Alright. So what we're going to do here now is again, listen to your breath in what you feel, right. So take a deep breath in and see if you can feel that arm coming down a little closer, right to the mat. Feel the ribs opening up, and then when you're ready, start peeling that left hand off of the floor and draw it across the chest and reach it out to the other hand.

And let's do two more of those a little bit quicker now. So we're just going to slide it across the chest, open it up, reaching long. Feel that opening through the chest. Feel the ribs expanding with that inhalation right into the front of that left rib cage, right. And then when you're ready, you can peel that hand back across the chest. Yeah, yeah.

Let the arm even be a little softer. So here we go. One more time. Soften that arm. Let it lay out. Open. Oh, life is good. And Peel back soft arm all the way through. Beautiful. Okay. This time we're going to roll over onto your back.

Take it over to the left side. Same idea opening up. And again, everything at this stage of the game and the clock of this class and the warming up is observing where you move from easier, where you have more challenge. So continue with the same exercise, sliding the right hand across the body, opening up into that rotation, opening up that chest. Beautiful. And when you're ready, slide that hand back across the body. You got it, I think. Yeah, go ahead. Now concentrate on where that air is going. Underneath the right armpit, underneath that rib cage, fill that expansion in those ribs starting to move.

That's where the movement comes from. So we're going to fill it right underneath there, last one. And then this time, leave the arm out there and enroll your knees up and scoot yourself into the middle of your mat. So we're going to do the opposite now with knees, side to side. And so the hands are going to stay out to the side, right? And we're now going to allow the knees to come over to the right side. And this is where we start really learning about where movement happens.

So this is what we're going to do. You're going to take a deep breath in and the first exhalation is going to start bringing that rib down underneath the armpit, and that's going to gradually bring those legs back up into the center position. Okay, go over the other side. Inhale into the left lung. Exhale underneath that armpit. Sanding that rib down. That's right.

So let your breath in the rim movement actually remove the legs rather than you moving the legs from your belly. Rib. Slide down. Exhalation ribs. Draw the legs back up. How many ribs do you have? 12 ribs, right? See if you can find all 12 ribs starting way up underneath the armpit in the neck. Starting to drop those ribs down, bringing the legs back up. One more time. Side to side.

Got It. Slided down. Find that route. Yes. Yes, that's it, Lisa. Good. Now resting the legs in the center. We're gonna sort of cover a quick rule. I call this the rule the ribs. So we're going to take a quick break and just have you come up onto your knees facing forward. And I'm going to do it with you as well. So we're just going to kneel down and what I want you to imagine is that your ribs, right, are connected in two places.

They're connected in the back end of the spine, right in the center of the spine, and then they have another part of the a rib that connects to the transverse process. So it has two parts and that creates two separate rules to movement, right? So the first one says that wherever the disc of the spine goes, the rib goes. So if I'm going into flection, that would mean flection. It'd mean that my spine is going into flection, my disc is going posteriorly, it's going back. That also means my rib is going to go back with it. Okay? So where the disc goes, the rib goes. If I go into extension, you can do this with your hands as if it was the spine. So you go into extension, the disc is going to go forward.

That means the ribs also go forward, right? The second rule is a little more important to us because what means is that it's connected to the Vertebra of below. So when I go into flection, the rib is going to slide back, but it also is going to tilt up underneath my heart. Can you feel that? And when I go into extension, it's going to slide forward, but tilt down towards my pelvis. We have that concept [inaudible] intuitive. It's counterintuitive, but it's going to open your rib cage up significantly. Okay? So we're going to play with that concept as we go into your mermaid and let's go ahead and sit so that we're facing forward with all of our legs to the right side facing forward. Yup.

So in the mermaid, and I teach this a little bit differently, we're going to put your left hand down like normal. So you put your left hand down and I like to soften the elbow just a little bit into your body, right? So the shoulder is going to drop down with it and bring your right hand behind your head. And we're going to take that right elbow and we're going to reach it up towards the ceiling and give just a little bit of a counter push with that left hand, right? So if you think about it, your left forearm is lining up with the ribs on the right side. So if I'm pushing just gently with that left hand, it's going to be pushing my right ribs out towards the side.

So think of the role of the ribs. If I'm side bending to the left, my ribs are going to be reaching to the right. Okay, now stay in this position and just feel the breath coming into the rib, right? Feel that expansion as you reach that arm up towards the ceiling, really opening that space and it's okay to stay here and do three or four breath. Learning how to expand that space doesn't just happen with one breath and thought that Lyft or reaching through, through, through, through, through good. Last breath in this position and when you're ready, we're going to come up and over to the right. Keep the knees where they are. The hands come down to the shin. Now the left hands behind the head. Now this time it's a little more fixed. So the left hip cannot come up. When you're in this site, you can, you feel that left hip to anchor down.

So now it's more likely that when you breathe into that left lung, we're going to get a nice expansion right in. Just think of those ribs sliding through the lungs, expanding underneath the armpit as that right hand goes. Now left elbow goes up, that's it right there. Beautiful. We've had a moment like this before. [inaudible] anytime. So now let's pick up the speed into a regular mermaid with the gesture arm long.

So you're gonna come up and over to the left, reaching the right hand and up and over to the right. And just now like seaweed would be the image I'd like you to imagine right out in the Pacific Ocean, watching out for those sharks up and overside the site and really feel the flow through the thoracic cage rather than just dropping downside. The side. You got it. This looks really girly. So come up and over and feel that ridge and up and over. You got it? Good. Excellent. Now this time, come over to the left. Stay there. Bring that right hand around towards the ground. Bring the left hand out a little bit. You got it? I'm here to help you. You.

Okay. All right, so now this is another one of those sort of pause moments where let your breath be your friend, right? So we're just going to expand the breath into the space between the shoulder blades. Think of the ribs. The ribs are going to come back and up underneath the heart, back up underneath the heart as you expand those ribs, right? Feel that space increasing so it's coming back up underneath the heart. Opening that up. Okay. We'll do one more breath in the flex position.

Expanding the space in the back and when you're ready, we're going to leave the hands where they are, but we're going to start sending that lower rib cage through to the front. Pushing with the hands in the sit bones can come up a little bit, but feel those ribs coming forward as you expand. The air forward into the chest, right. And then from there you're going to exhale, push with the hands and send those ribs back again. Right. Trying to feel that lift in that opening in between those shoulder blades. Yeah, I feel that breath and let's go a little bit quicker now.

So we inhale up into extension. Exhale, pushing back into flection. Opening that up. Inhale up into extension it. Excellent back into flection. Create that movement and inhale flow in. Yep. All the way through that spine. Cause if we get that thoracic mobility, we're gonna feel so much better in our neck or shoulders in our low back.

Last one, come up into extension. Excellent. A flection slide that left hand into the middle. Yep. Right hand behind your head. Open up and come back up into seated position. Arms behind you. Now on the ground. Lean back into those hands and switch those legs gracefully over to the left side. And we're ready to do the same thing on the other side.

So now you've learned from one side, put that right hand down. Drop that shoulder, bend that left elbow, right elbow, a little bit left hand behind the head. And we're going for that same little ride. Here we go up and over to let the breath take control. That's it. Breathing into that left lung. And when you exhale, you can also lift up from underneath so you can, you know, inhale into the left lung here and then exhale, lifting those lower ribs up. So if you think of the rule, the ribs on the right side would be like flection.

So those ribs are going to slide to the left and lift up underneath the heart. On the left side, they're sliding to the left, but they're reaching down towards the pelvis. Can you feel that opposition right? And just let the breath do it. You just have to allow it to happen. Give it permission to move in that direction. One more time.

And then we're ready to come up and over to the left side. So left hand goes down to the Shin, right hand comes behind the head, right about up towards the ceiling. This is the more challenging side because that pelvis is fixed. Hi Lisa. How are you doing? All right. Yes. Good. And we're going to breathe into that right lung.

Just getting breath in that space answered. Good, and then expand again and expand. Now remember on that exhalation, we're going to lift from underneath. There it is. Now just a little word of advice is you don't have to have a lot of tone in your face or in your shoulder or your hands or your knees, right? Cause we're just using breath is the move or last breath.

And we're getting ready to go into seaweed mode ready and we go up and over to the right gesture arm, reaching long and up and over to the left. Gesture arm reaching alarm fluid. Just feel that fluidity of the ocean. Moving you with the tide. Breath involved. Oh [inaudible] you guys. Let's do two more on each side and up and over to the left. The last one coming over to the right. Place that hand in the center. Slide it out a little bit in. Rotate around, dropping that left hand onto the mat. Let's open up that spine. Okay.

So pushing with the hands a little bit. Sending the sit bone down. We're going to use our breath again to really open up that spine. So inhaling between those shoulder blades, get that opening, and then exhaling filling those ribs. Lift up underneath. One more time. Deep breath in. And exhale. This time we're going to go right into extensions. On the next inhalation.

Start bringing the head and ribs and sternum up, opening that space, pushing with the hands, and then exhaling back down into flection. Ah, inhale into extension. Exhale in deflection. Yeah, yeah. Inhale. We'll do it one more time. Both directions. Inhale, exhale. Stay in the flection. Slide that hand to the center, right hand behind your head on rotate and come up from the mermaid position. Great. Now we're going to go right into quadruplets from here. So just turning to your right.

Go right onto your hands and knees and we're going to have a little fun with some spine articulation here. So really there's no rules. What I want you to feel is just allowing the spine to move. We'll start with more or less a cat in a horse. So we're just gonna arch the back up towards the ceiling, sending the tailbone and the head down and they go the opposite direction, sending the tailbone and the head up. So we're going to be working that full flow, see if you can feel it all the way through the spine.

So it's every single vertebra that is participating in that roller coaster. Yeah, it's sorta like l five talking to l four and l four talking to all three. How are you doing? How are the Pha sets? How's that synovial fluid doing these days? Fantastic. How is your disc doing? Oh, she's good. She's a little cranky lately, but we get her walk in and she seems to be a lot happier now from here, we're going to go into circumduction.

So circumduction we're gonna move all the way around, all the way up around and just doing circles and really feeling the segmental nature of the spine. So there's no right or wrong here. Just sort of move around like you're dancing on a stage, the spines moving around. I won't say what kind of stage you might be on if you're dancing. I this and rotate the other direction. You know, we've got to put humor on plot is anytime or they don't pay me any money.

So you gotta I gotta put always a couple of jokes. All right, so getting that movement just to allow her to keep going. We versed the direction if you haven't already, and then come as close to what you think is your neutral spine. So it's always debatable what that is. But really what we're looking for is if I laid a stick on top of your back, the head, the thoracic, and the sacred would all be touching. There'd be a little space of the lumbar and a little space behind the neck, right? So we're gonna soften this just a little bit. Now from here, we're going to go into a belly breath.

So without changing the spine at all, inhale into the belly and allow to drop down as if you maybe had a two or three pound weight with a string attached to your belly button and really allow that expansion. This is that Buddha belly part that I was talking about. And then exhale, draw the belly back up into the spine without the spine changing position. Inhaling, expanding the belly and then exhaling drawing the belly back up in end as combat right here. Good. Inhale into the belly. That's it. Good and Xcel. That's right. And each time try to expand that belly and that diaphragm a little bit more.

Really filling that expansiveness that comes with a diaphragm breathing that we often miss in polite cause we're always worried about holding our powerhouse. And I think that leads to a lot of pelvic floor and diaphragm problems. That's it. You got it, Christie. One more time. Beautiful. This is a great way to get our clients to avoid over recruitment of the abdominal wall. Now from here, you're just going to go lay right onto your tummies, right on your bellies in prom. And I want your arms in the scarecrow position. So at 90 90 your forehead resting on the floor.

So I talked about rotation, rotation. Another thing we want to try and incorporate into this class, and not just rotation of the spine, but also rotation of the arms, the legs, et Cetera. So in this position we're going to do the scare crow and I like to break it down into a couple different levels. So the first one is going to be just lifting the forearms up, pivoting on the elbows, and then backed down, right hands and forearms up, hands and forearms down in forum up. So it's a rotation and keep sending the elbows away from the center of your heart. So send him to the side of the room, expanding them and seeing if you can find a little more natural rotation inside the shoulder itself. Let's do that two more times. Hands and forums. Up, hands and forms down.

Hands informs up has informs down. At this time we're going to add the elbows, but still in the sequence. So we're going to go hands and forearms up, elbows up, elbows down, forearms and hands down. That's the sequence. Hands and forearms up, elbows up, elbows down, forearms down a little bit quicker. Hands and farms, elbows, elbows, forearms, hands. One more time and now we're going to add one more component, which is going to be the head and the neck. So it's going to go hands, elbows, head and neck. Neck, head, elbows, hands. Who got it? Hands, elbows, head and neck. Head, elbows, hands in that sequence. One more time. Hands, elbows, head and neck. Stay up there. Bring the hands down to the side of your chest. For priests, one, elbows. We're up towards the ceiling. Hands are right mixed, tight to the chest. Feel the elbow sliding down in a way, right from the shoulders. A lot of times we tend to squeeze them together. It's not squeezing together.

It's just send them down. Coming up into [inaudible] so that the head, shoulders come up a little bit higher. And now we're coming up just to the base of the rib cage. So you should still feel that lower rib intact with the floor and then let yourselves back down until that forehead contacts the floor. Still thinking of that rotation coming from the shoulders. Right? So for the rotation of shoulders, the head, neck, and now the thoracic come up until we meet the base of that rib cage and then back down. So this is our pre swan. You got it.

And let's bring the hands down a little bit lower. Yeah. And now we can give that direction. That's it. And you know, this looks good. Now just to give you an idea, in one of the workshops we did at Paulie's, any time we did an assessment with some plottings assessment skills that you can find on pilates anytime. And we happen to usually says one of the subjects. And so this class is designed around some of the restrictions and I just wanna let you know that she's already doing better with the movement through this thoracic area than she was when we did the assessments. So good news. One more time.

Come up with that base of the rib and now we're going to go into the full swan one coming up onto your thighs. Now the key here is we don't want to increase the movement in the lumbar spine too much. So we're going to come up and just gently slip the hands forward, continue to come up like we practiced, right? Coming up onto the knees. So you look like the front of a maiden voyage. A ship, right? So you're strong and stable. You could break away wave. If the wave came up against you, lay in the thighs, back down on the mat, keeping that body long, then the belly, then the lower ribs and in back all the way down until the forehead touches the mat. And we're going to repeat that two more times. So again, elbows down. Head comes up, kind of the base of the rib.

Connect the front of the ribs up. We go onto the thighs with a deep breath up and exhale, letting the thighs come down, keeping the body long and connected as you lay it down. Beautiful. Now the key here is used as little force as possible. So this time come up with that same beautiful length. Use less arms, less strength, come up in that nice position. You don't have to use a whole lot of strength to get up and allow yourself to come back down. Keeping that lengthened, actually elongated position and relax. Very good.

Now from here, roll over onto your right side. Come up onto your right forearm. We're going to go into sidekick and I love sidekick because as we did in the sideline breath this time, I want you to really pay attention to what the ribs are doing while you're in this position. Can you get the rib cage up and over that right shoulder, right? So we're combining the rotation in the arm, the movement of the rib cage, and the axial length. So take that left leg now and let's lift that left leg up and left leg down, left leg up, left leg down. Now lift that leg as high as you can without the pelvis moving. Right?

So that's going to challenge that control on the downside of lifting. So if you think of the ribs lifting up towards the ceiling as the legs lift, you're gonna create the control. That's it. Yep, that's it. That's exactly what I'm looking for. Bring it halfway down and let's go some circles forward and one and two, three, four, five, six as smooth as you can. And reverse two, three, four, five, six, seven sidekick with the flex forward point, back and flex and back, you got a flex and back. What's the breath and inhale and exhale and inhale and exhale and inhale and exhale. Last one. Inhale, leave the leg back on the exhale.

Take that left hand and reach it forward. Opposite of the left leg going back. So reset, left hand forward, forward, forward, forward. And this time let your body rotate and spiral around that central axis so you can reach long, long, long. And I'm going to take you a little bit further into here. Yeah. And feel that connection of where that rib is. That's right.

That ribs going to come in. That left lower rib is going to lift you up a little bit here. Reach, reach, reach. Now taking a deep breath and we're going to make the sound of a beat. All right, so breathe in. I'll do it with you soon. Always embarrassed. Exhaling zero connecting belly button to l three and sternum to t four keep going. Tell there is no more air and when you run out of all the year, you can roll over onto your tummy. Beautiful.

Oh Rhonda, the left side. Same idea up on that forearm. Now you're loosening up as we go. I can tell already. You're wondering though. I can see that challenge. Like is he almost done yet? I'm not almost done here. We're getting close. All right. Same idea. Lifting that right leg up, make sure that chest is up and over onto that left shoulder and down and up and down.

Also send those lower ribs up the same time the leg comes up. That's where your stability comes from. Can you feel that? When you think of those lower ribs lifting up and sliding and that plate as a leg comes up, it gives you tremendous control and stability and that allows that left leg to be a little more free. You could also think of the femoral head, the femoral head gliding and spinning down into the groin. Rather than thinking of lifting the leg up against gravity. Now bring the lay down halfway circles going forward.

You know the routine and one two. What's good for the ride is good for the left. We do both sides and seven eight reversed that circle too. Three, four, five, six and ready to sidekick. Bring it forward and back and forward and back and inhale and exhale and inhale and exhale and en and x and N. Leave it back. Reach that right leg back, reach that right arm forward.

Really feel that diagonal. Taking a deep breath. Keep the head part of the movement and let's hear that buzzing sound. Deep breath in. [inaudible] I feel that connection the core. Keep reaching a little bit further until you have no more air in your lungs.

The ribs have been drawn into that central axes. When you run out of air, roll over onto your tummy one more time. Bring your hands down to the side, head rest and going into the dark position. Right now we understand that subtle movement in the upper back, so we're talking about just a little bit of extension because the dark, you don't want a dark to be in full extension because then you would deviate from your course. So just allow the head and the upper thoracic to lift ever so slightly off of the ground lengthening and even not. So Hi for me is come down a little bit lower arms a little more wide. Yup. That's the position. Legs float up a little bit off of the ground. You got it.

We have some beautiful darts, their palms up towards the ceiling. We're doing our hundreds in dark position and pulse. The hands up and breathe in and exhale. What's the most important part of this exercise is going to be your breathing as you inhale, two, three, four, five. Exhale and and feel the expansion of those lungs for the expansion, that ribcage and exhale, creating more space around the front of your chest by that exhalation, the ribs coming in and then expanding all the way around the back, especially into the back. You have two more breaths to do and in and x and in [inaudible] and x and relaxed. Very good. Bring your hands to the side of your chest.

We're going to ride up into our plank position. We're going to go right into a leg pull front, so come on up into plank. Nice long spine. Fill that organization. Now the shoulder blades around the trunk, reaching that right leg back, lift it up and point the toe and back down and left leg up and down and right leg up and point and flexin down. Left up and point and flex and down and up. Point. Flex down. Point. Flex down. Last one point.

Flex down and I want one perfect pushup. One perfect push up and back up. We're going to walk our hands back towards our feet. That's it. And from there we're going to let our feet come apart a little bit. Bend the knees down and go into a squat position and put your elbows between the legs. See if you can't get the hills down.

I remember I talked about really wanting to get the rib cage and the diaphragm to move. This also is for the pelvic floor to move. So we're going to just stay here for a little while and again, using breath as our tool. The breath in, expanding the belly, expanding the pelvic floor. Really that the Buddha belly come out. Now feel like your pelvic floors pressing down towards the floor, belly pressing out towards the front and an exhale. Let it just spring back. So don't lift back. Don't drop in just spring back. So here we go. Inhale, expand and then exhale, spring back in and fill yourself. Settle into the hips as you get a little more relaxed to that pelvic floor, right? So again, deep breath in and out.

Okay. You can feel your hips relaxing almost as you go through that. It's a nice feeling. And I do this a lot with my clients and patients that have low back problems. Uh, even pelvic floor dysfunction, incontinence, uh, postpartum, pre partum, just trying to get that pelvic for that diaphragm to work correctly in their breath. The last one, exhale.

And then bring your hands back to the floor. Press back with your legs, right. And if you need to allow the knees to come forward a little bit, the back of the neck is long and we're just going to go into a rollout stack. You our spine backup, oh way up articulating that spine into a knife top position. Now this is time for the reassessment. At the end of the class standing in that position, they're straightening out your shirts for the camera so everybody knows that we're looking good and we're conscious about this. Close Your eyes and just notice now when you take a deep breath in, how does it differ from the breath that you were taking earlier?

Do you feel a greater distribution around the back or the sides? Do you feel the diaphragm working and dropping down into the belly? Can you feel that whole rib cage expanding with every breath a little bit easier and then draw your attention to your vertical axis? How do you feel as far as the head, the rib cage, the pelvis on top of the hips, all the way down to the feet just by having a breath centric thoracic cage centric class that allows us really to focus on how that empowers us and gives us, you know, more mobility throughout the whole body. Remember, movement is very important. Distribution and movement is the same thing as distribution of force.

So in Lisa's case, where she was having thoracic pain, low back pain, shoulder pain, neck pain, much of this was due to restrictions of the thoracic spine. By adding a few more segments and more mobility in that area, it's going to decrease tremendously the stress that goes through her neck or shoulders and low back. I hope it does the same thing for you. I look forward to seeing you in the future and other polities anytime classes, have a great evening. Let this be the start of a brand new day. Thank you.