Archives For stability

The Pilates System (?)

February 11, 2015 — 4 Comments

imagesAs seems so often to be the case, the convergence of two sources at a similar time has got me writing. Soon after I saw this from Andrea Maida’s blog, I also saw this piece, written by Joanne Elphiston. Wildly different, you might say – one is an attempt to define the original order of Reformer exercises, as determined by Pilates himself (no doubt a demanding piece of research in itself), and the other is a critique of (what may be) the prevailing thinking around stability training and injury management.

To stray from these for a moment, after spending 4 days last year learning from Ido Portal, I felt that my concept of movement, and teaching movement had been blown apart. For the first few hours it was mildly traumatic as I wondered how on earth I could go back to teaching what I then recognised, as a result of what I’d just seen, heard, tried etc.,  as the relatively narrow approach of Pilates. What saved me was recognising that, like most if not all movement disciplines, Pilates only makes sense as a system, and what I needed to do was to keep exploring the new material and ideas, integrate them into my teaching as appropriate, and teach in a systematic way. I hope that prior to this my teaching hadn’t been haphazard, but there was definitely room for more of a systematic approach. (It may be worth mentioning that I have become much better at the kind of record keeping that insurance companies recommend as a consequence).

Naturally then I’m drawn toward articles like Andrea’s, because it helps to reinforce a system. Not to mention that, as well as laying out a sequence, she does a great job of rationalising the order that she offers (and with humour – so much nicer than dogma…). There are other orders laid down for the Reformer – Whereas in Andrea’s list the Long Stretch Series comes after the Long Box, in the Romana Legacy Series DVDs the Short Box appears immediately after the Long Box – I don’t think these distinctions are important because there is an underlying system to both.

What of Ms Elphinston’s thoughts? In case you haven’t read it yet, she begins: “We see a lot of injured physiotherapists and Pilates teachers in our clinic. Many of them have turned to Pilates in order to address their own back pain, and it initially gave them a sense of control over their situation. However, they nevertheless still have back pain.” And she goes on to ask why this should be. Partly because I have seen this scenario many times (or at least it feels that way), I am willing to bet that the Pilates teachers whom she refers to have not pursued the system – have not treated it as something that you keep working to progress within. My guess is that they discovered, through Pilates, the exercises that they feel help them (which can feel like a miracle), and they get repeated over and over (“I know what I need.”), but the idea of Pilates as a system to progress in gets lost. Or maybe it was never there in the first place. I began Pilates at a studio where there was a clearly defined warm-up sequence that most clients learned sooner or later. There were ways to modify or layer things but the basic movement patterns were the same. Over the years things changed – my guess is that teachers got drawn into playing therapist, or got bored and added their own ‘creativity’, or simply lost faith/interest in the system. If you go there now you may be hard pressed to find a teacher who expects that the clients will adhere to a system.

There may always be debates around whether or not you can teach exercises that you cannot do yourself. Leaving that aside, I suspect that we tend not to teach the exercises that we don’t do ourselves. Or that we don’t effectively teach the exercises that we don’t do. I’ve been here before – if we entertain the idea that there’s Pilates repertoire that we needn’t aspire to, then why bother with any of it?

It seems that a lot of continuing education in the UK Pilates world relates to other disciplines, or to approaches to specific pathologies and, therefore, modifications. (Why should, for example, Pilates for Golfers, be substantially different from Pilates for non-golfers? Is there repertoire that’s contra-indicated for golfers, and other repertoire only suitable for golfers?) This, coupled with an absence of goal-setting and diminishing expectations, means that it’s easy to ‘do Pilates’ and actually only scratch the surface. The system itself can act as goal-setter, and inspiration (me, I’m working on nailing Balance Control/Step Off this year), and means that you don’t avoid the things that you don’t like. It’s now a running joke/accepted law in our studio that everyone hates the things that they need the most (and I do NOT love Breaststroke…)

Ms Elphinston’s writes “we remember that stability arises from systems, not muscles. This requires variety and variation in our programmes, working our way up to variability in order to foster robustness and a range of solutions to meet the challenges in our work, play and general environment.” Hah, Systems! I know that she is not referring to systems in the same way that I was above, yet it seems that these ideas dovetail nicely. The Pilates system is about developing stability not by focusing on muscle recruitment but by developing a range of movement patterns with ‘variety, variation and variability’. The mixture of midline stabilisation and hip/shoulder dissociation with spinal articulation fosters robustness – not, God help us, ‘Safe Spine Pilates’.

If you’ve spent any time in a health club then I’m sure you will have seen those people who dip in and out of things – a bit of treadmill, some shoulder presses, a bit of a stretch, the cross-trainer, maybe the leg press etc. Perhaps you’ve felt sorry for them and their lack of structure in their workout, and maybe thought that if only they had some more method to their session that they may see more progress. The Pilates studio (or mat class) is just the same – the magic’s in the system.

 

 

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I just tried an internet search for “pilates low back pain” and Google returned 1, 380, 000 results. Google scholar also offers hundreds of ‘scholarly articles’ that touch on the subject. Amazon offers several DVDs of Pilates for low back pain, but their offerings are dwarfed by the hundreds of YouTube videos on the same subject. Another Google search for the same terms but in the News section suggests that in the last month English language newspapers and magazines have also had hundreds of articles on this subject. Coupled with my own experience of Pilates ‘fixing’ my low back pain, is it any wonder that I’ve spent years believing that Pilates offered the best solution for anyone suffering from this nearly ubiquitous affliction?

The Dummies.com website has a page, attributed to Ellie Herman on: ‘Easing Your Back Pain with Pilates‘ in which she explains that the causes of back pain are “faulty posture” and “sedentary lifestyle”. While we might like to suggest some other possible causes, I don’t suppose that many Pilates teachers would disagree with her – it seems like pretty basic stuff: you sit and/or stand badly, your postural muscles get lazy, you ability to stabilise your spine is compromised, and from there you’ll be very lucky if you don’t wind up in pain.

So, why is Pilates so good at helping relieve low back pain? Well, of course, it targets your ‘core’, deep postural muscles that give your lower back its stability. The less uncontrolled movement that you have in your lower back, the less likely it is that you will have pain. As your stability improves Pilates can help to develop efficient movement of the whole of your spine, encouraging good posture during a variety of activities. In addition, helping areas of relative stiffness to become more supple, and areas of relative ‘looseness’ to become more  stiff (stable) can help to bring more balance to our structure, and integrate our limbs into our trunk.

I was lucky enough to receive a pretty high level of training as a Pilates teacher (certainly by UK standards), and to work with some truly brilliant teachers from the UK and the US. I hope that I can reasonably consider myself to be well steeped in the principles of Pilates, and how to apply them when faced with clients with chronic pain and/or injury. I know about ‘working away from the pain’, and I’ve particularly enjoyed Ron Fletcher’s anecdote on that subject in his conversation with Kathy Grant (I referred to this DVD in a previous post) – Fletcher (a dancer at the time) explains that he went to see Pilates for help with a knee injury. Every time he went to Pilates’ studio he would be given exercises to do that had nothing to do, and Pilates would ignore Fletcher’s protestations that it was his knee that was the problem. After a few sessions Fletcher discovered that his knee was better.

So, I think my training has equipped me to help clients deal with back pain fairly well. I also believe that I understand a lot of the potential causes of back pain, as well as the importance of posture in maintaining a healthily functioning spine. I’ve been fixated (in my teaching) with hip mobility for years, and ‘get’ its importance relative to spinal stability and functional movement. I know, too, that most of us could do with working on upper back extension (and probably rotation and side-flexion too), and that the consequence of that will be less pressure on our necks. The list could go on, and that’s not really the point. In short, I felt that I had the basic understanding that I needed to do my job well, and that Pilates taught well was the ideal solution for all manner of problems. I certainly didn’t imagine that the world of strength and conditioning would have much more to offer in that regard.

More recently my perspective has been challenged. First of all by learning some of Mike Boyle‘s ideas (if you follow the link you’ll see just the kind of website that fit my prejudice completely – all it’s missing is advertising for protein powder) from his book ‘Advances in Functional Training’. (Actually this info is second-hand since it was my wife who bought the book and then explained it to me – I am nothing without her.) Boyle explains the body from the ground up as a series of joints that require, alternately, mobility then stability: ankle joint needs mobility, knee needs stability, hip needs mobility, lumbar/pelvic joints need stability, thoracic spine needs mobility, cervical spine (neck) needs mobility. Genius!

Being peripherally involved in a Pilates teacher training programme I understand how tricky anatomy and physiology can be to get to grips with, not least because it rarely seems to be straightforward, and how often students crave some dependable, simple answers. I’ve suffered the frustration, and seen it in many students too, of different books giving different answers for muscle functions. I know now that anatomy is an evolving subject, not a science in which all the answers have been found and set in stone. Thus, an explanation of what we need from our joints, expressed as simply as Boyle does, feels like a wonderful breath of fresh air. Mobility: stability: mobility: stability….It also seems to fit perfectly with ‘working away from the pain’ – you leave the problem area alone, and look for the adjacent compensations/weaknesses/stiffnesses. I think I had learned the same thing previously, but perhaps in a way that meant I didn’t see the wood for the trees – I knew it in pieces, and had never heard it said so succinctly. Lots of bits of information fell into place as I mused on this idea, and it’s become a constant reference point when I’m teaching.

Following that I was listening to a podcast recently in which the two hosts (one a strength and conditioning coach and the other an olympic weightlifting coach) were answering a question about exercising with a herniated lumbar disc. In discussing the question they came up with an equation something like: “If your hip joints are mobile, and your thoracic spine is mobile, you probably won’t have low back problems. If your hip joints aren’t mobile, and your thoracic spine isn’t mobile, you probably will have problems with your lower back at some point”. More genius! 

It’s just like Mike Boyle said! (Mobility, stability, mobility, stability….) Again, I knew already what they were saying, in fact I’ve probably been saying the same thing to clients for years, just not in such a clear and straightforward way. Perhaps I’ve just been lagging behind all these years, thinking I knew more than I did – certainly I need to view other disciplines with a little more humility than I have in the past. In any case, when trying to learn more about what I do for a living, casting my net wider has definitely been rewarded.

To return to the Ellie Herman piece on http://www.dummies.com, posture may well be a part of the picture, but there’s more to it, and you may be able to make a significant difference to your risk, or management of back pain, by going beyond her advice to:  “sit and stand up tall, keep your belly pulled in, and keep your shoulder blades pulling down your back”. Maybe even by listening to the advice of weightlifters.