Archives For May 2014

courtesy of Pilates Style

courtesy of Pilates Style

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Courtesy of Huffpost

One doesn’t have to look far to find many testaments to the value of Pilates during pregnancy. Though it has not received a specific endorsement from any UK health authority (RCOG for example), I doubt that there are many Pilates teachers who would tell a mum-to-be that Pilates wasn’t a good idea. Searching for ‘risks of Pilates during pregnancy’ doesn’t yield many results.

Equally, though perhaps less numerous, there are a number of women who will attest to the value of (appropriately scaled) CrossFit during pregnancy. Indeed there is a website, and social media pages and websites for ‘CrossFit Moms’. In this instance the doubters are a bit more vocal. While they may be largely lay people, photos of a heavily pregnant CrossFitter doing weighted squats caused a storm of controversy, with commentators declaring that she was endangering her baby, and that this activity should be regarded as child abuse.

I am an enthusiast for both of these exercise modalities, but recently I’ve had cause to reconsider my beliefs around pregnancy and exercise.

I’ve also had cause to wonder, prompted by social media threads in particular, about the prevalence of pre- and post-natal sacroiliac joint problems and symphysis-pubis dysfunction. Of course, the release of relaxin, not to mention hyper mobility, will have an impact on joint stability. We know that relaxin is released for a reason, yet it seems a very inefficient (thus unlikely) natural response if it causes lasting problems. I don’t believe in the ‘we just spontaneously break’ model of health that we generally adopt in the developed world. Something about our inputs, or our environment causes ill health – whether it’s joint problems or heart problems, for example. If we are (symptomatically) hyper mobile I suspect it’s because something in our diets, or parents diets (inputs) led to changes in collagen structure leading to lax connective tissues. There appears to have been a variety of research around the subject of diet and collagen (a protein), particularly in relation to caloric, protein, or cholesterol restriction – here’s a study on rats, if you fancy it. Thus, pelvic instability is not a random luck of the draw occurrence, but has an underlying cause. This is not an attempt to lay blame on anyone who has suffered with this problem – rather, to suggest that they have been unfortunate in their genetic inheritance and expression; or have not received the best guidance.

To get back to comparing exercise, first off, what are the most important exercises, or important muscles to be worked during pregnancy? Pelvic floor, right? You’ve got to do your pelvic floor exercises, for heaven’s sake! I’ve certainly done my fair share of teaching PF contractions to pregnant clients.

And then, last year, I watched Jill Miller’s webinar on CreativeLive, which featured the excellent Katy Bowman, as she put it, ‘dropping the Kegel bomb’ (Kegels is the term used in the US). She asserts that the most effective, and balanced way of keeping one’s pelvic floor toned during pregnancy is to squat, and to walk. We might say ‘practice natural human movement patterns’….Her argument is that, while they may be appropriate for some women, isolated pelvic floor exercises may lead to excessive pull on the inside of the sacroiliac joint and consequent imbalance/instability. Squatting would give more balancing posterior support, and both walking and squatting would help to keep tone in pelvic floor muscles.

And what are the issues around Pilates and pregnancy? We encourage pregnant clients at our studio to work with the apparatus, rather than doing mat classes. We’ve had great results and have had plenty of women coming to class right up to the end of their pregnancy. That said, during their second, and especially in their third trimester, a lot of their class doesn’t look much like classical Pilates. We don’t encourage participation in mat classes largely because of the restrictions in lying down (though I’d be the first to agree that guidelines on this are heavy handed, and that a woman’s body will most likely have a way of telling her to stop if lying down is causing vena cava compression), and herein lies one of the fundamental drawbacks of Pilates, especially in the classical practice – there’s a lot of lying down. I know of Pilates teachers who have had terrible problems of pelvic instability during pregnancy. There was a heated debated on a Facebook forum recently about the rights and wrongs of allowing a pregnant woman to participate in a Pilates mat class. Another recent post on the same forum was from a Pilates teacher in her third trimester, unhappy that her workouts feel incomplete because she can no longer follow the sequence that she’s used to. Advice from her responding peers ranged from suggestions for standing (Pilates) work, to taking walks and enjoying nature. Great suggestions, yet I fear that they may fail to address the problem of the lady’s frustration – her workout has to change completely. Is there an issue with the scalability of Pilates? Or the scalability of a ‘classical’ approach to Pilates? Mari Winsor’s book, ‘The Pilates Pregnancy’ is a case in point, with a number of reviews on Amazon commenting that the sequence of exercises varies little from one trimester to the next, and that she doesn’t offer much in the way of modification. In the third trimester she suggests the Hundred with bent knees and feet on the floor, or kneeling up if lying down is too uncomfortable.

Lying down isn’t just a problem from the point of view of possible restriction of blood flow, but also because it doesn’t train the muscles and soft tissues around the hip joints and pelvis to handle to take the increasing load of the growing baby. Indeed, would it not be better to be loading these joints (hip & SI) before conception, and in the early stages of pregnancy, in order to have a strong/stable foundation for the certainty of increasing load?

Here’s where the CrossFit mums-to-be that I know of step in. (Firstly, let’s be clear – I’m sure that many women have had happy and healthy pregnancies and deliveries with Pilates as their exercise companion). The wife of my first CrossFit coach is due in a matter of days, and still doing pull-ups. Another lady that my current coach is training, who is expecting twins in three months, is still deadlifting and squatting with weight – and maintaining that her back has never felt better. The beauty of the exercise methodology that they are following is that it can be scaled to fit their changing needs, without having to change the exercises themselves, and there are articles, in addition to the website mentioned above, to guide mums-to-be and coaches alike. In other words, they can squat throughout their pregnancy – the load and the range needs to change but the activity remains the same. High intensity workouts can be left ’til later, so there’s no need for any stopwatches, but there’s lots of scope for strength work (indeed, it doesn’t matter whether it’s called CrossFit or strength & conditioning). A lot has been written about the community aspect of CrossFit, and one of the benefits of this scaleability is that it means that pregnant women do not have to miss out on their fitness community, and the potential disempowerment of ‘I can’t do what I used to’.

I’m not really advocating that everyone pregnant gives up Pilates and signs up at their nearest CrossFit gym. I just wonder if there isn’t (sometimes) something missing from Pilates that needn’t be. Or maybe there’s a middle ground. I’ve never seen film or photographs of Joseph teaching a pregnant woman, and I don’t remember any reference to pregnancy in his writing. Perhaps he never intended pregnant women to use his method. If, like me, you believe that Pilates is about moving well then many activities can be approached with a Pilates sensibility, perhaps to the significant benefit of women both pre-conception and during their pregnancies.

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people-spring-lift-ecard-someecardsI’ve been involved in a discussion lately on https://www.facebook.com/groups/pilatescontrologyforum/ around the subject of why we teach spinal flexion in Pilates. As is often the case, this discussion began to deviate slightly from the starting question, leading into other (for me) interesting territory. Namely, it made me wonder if there is a consensus within the Pilates teaching community as to whether Pilates is itself a functional movement/exercise discipline.

It’s helpful, if not necessary, to define what one is discussing – and so I realise that I have accepted in my own mind a rough definition of functional movement, derived from who-knows-what varied sources, that seems to make sense. If I have to pin it down, my definition would go something like this:

Preacher-Curl1A functional exercise is one that teaches, or reinforces a movement pattern that is useful, and health enhancing, beyond the execution of that discrete exercise.

For example, I would consider the Hundred to be functional because (amongst other benefits) it requires the maintenance of spinal stability under load (from our legs), and also the ability to disassociate our shoulder joint – to move our arms in our shoulder joints without uncontrolled spine or scapular movement. Both of these being very useful in a variety of scenarios (dare I say “fundamental movement patterns”?) I wouldn’t consider a bicep curl as pictured above to be functional, because the machine removes any requirement to create stability, or to transfer load into the centre (free-standing curls would be a different story, of course).

The Facebook discussion reminded me that there are other definitions. For what it’s worth, CrossFit has this definition, and if we turn to Wikipedia they do not have a page for functional exercise but will direct you to ‘functional training‘, which ties in to occupational therapy. Within the discussion, the thing that was slightly jarring for me was the idea that Pilates might not fall into some people’s idea of ‘Functional’, since it seems (generally speaking – more on that later) to fit that description very well.

I’m not a fan of ‘evidence-based’ exercise, because I think it’s naive to imagine that we can ever prove (to meet standards of proof in controlled studies) the efficacy of any given exercise. There are too many variables that cannot be controlled for when comparing even a small number of people practicing the same movement. At the same time, I think applying what, if we were clinicians, we might call ‘clinical reasoning’ to exercise selection is essential. Let’s call it ‘reasoned Pilates’ for the moment (for the record, I am not trying to create a new sub-genre – there will not be a trademark application). Teaching reasoned Pilates means, with your observation and your client’s input, assessing what they need most, choosing how to implement your assessment, and then evaluating whether your choice was successful. So if someone is kyphotic, and is new to Pilates, giving them the Swan Dive on the High Barrel may not be the best choice. The short version of all this is that I want to be able to explain why I’m teaching anyone anything, beyond “that’s what’s next in the sequence”, or “that’s how I was taught it”. In other words, “What’s the point?”

All that said, I do agree with a contributor to the forum referred to above, who said something along the lines of “sometimes people ask too many questions, instead of just doing the work”. I do think it’s often possible that doing the work will lead you to the answer to your question (“Why is it done this way?”, for example). I have heard Romana, on the excellent images“Legacy Edition” DVDs, quoting Joseph answering “What is this good for?” With the wonderful response “It’s good for the body.”I’m not suggesting that clients should be constantly questioning why they are doing things, and their teachers constantly explaining everything. Rather, I hope that they find the answers for themselves whenever they can, and that I have the understanding to explain the ‘why?’ if I have to. I believe I have a better chance of being an effective teacher if I have that understanding.

As an aside, I’d much rather be described as a ‘teacher’ than as an ‘instructor’. The first definition that my dictionary gives for instruct is: “to direct to do something; order”. The first definition that it gives for teach is: “to help to learn; tell or show (how)”. I think that the element of reasoning may be the thing that distinguishes between an instructor and a teacher.

‘Reasoned Pilates’ fits with my perception of Pilates as something that makes you better at other things, rather than Pilates as a thing to be good at. I don’t believe that Joseph Pilates complied the exercises in ‘Return to Life’ for people to practice in order to become very good at doing those exercises. The point was to practice those exercises in order to enhance one’s health (No?). I know that there are people that consider Pilates to be an art form, but I can’t call myself one of them. Seeing someone display a high level of competence in anything is usually enjoyable, but I find the many videos, that do the rounds of social media, of people working on the Reformer (perhaps with dramatic lighting) to be somewhat tiresome. (Equally, photos of lithe bodies on exotic equipment adapted from Pilates apparatus, rather than “Looks beautiful”, make me think “But why? What’s the point?”. It’s as if Pilates is being practiced for someone else other than the practitioner.

Another element to the consideration of ‘functional’, that I was reminded of whilst trying to follow some of the Reformer work demonstrated on the aforementioned DVDs, and may have been missing from the definition I offered above, is fun, or feeling great. It’s sort of covered by the ‘health enhancing’ idea, I think, but deserves its own mention. Something that makes you appreciate, or helps you bask in the joy of whole body movement surely performs a valuable function? To return to the bicep curl analogy, I’m no body builder, but it’s hard for me to imagine that anyone ever had much fun doing sets of bicep curls. Yes, viewing the hypertrophic results in the mirror afterwards may result in a flush of pleasure, but actually doing the sets of curls? Surely not. I don’t know whether the response to doing the various rowing exercises on the reformer was musculo-skeletal, hormonal, emotional, or what. It felt marvellous.

If you think that Pilates doesn’t fit under the heading of functional movement, or functional exercise, I’m sorry, but I don’t understand.