The old saying, “You can’t fix it if it ain’t broke…”  Well if you’re not aware of what you’ve been doing to “break” it – how could “fixing” it even begin to solve the problem.  The first “fix” has got to be with the mind-body connection and improved body awareness, or old bad habits will be impossible to break.

Regardless of your athletic  or dance background, or how old you were when you started your first exercise program, or what physical shape your body is in – it’s never too late to improve your health AND strengthen your mind-body connection!  It just takes the desire to work on it – and a good coach to guide you along the way!

It’s been interesting hanging out in the local health clubs recently….I know that there are lots of GREAT personal trainers and Pilates teachers out there...but there seems to be such a difference between the typical weight-room training sessions  that I’ve observed lately, and a one-on-one Pilates training session.  I suppose unless you’ve experienced both – you don’t know the difference.  But they seem to be light years apart in the amount of fine-tuning and corrections a client actually receives to be in the right alignment and improve technique.  I’m sure these comments will stir up some controversy!

I find it difficult to keep my mouth shut at the gym watching these poor people do exercises in absolutely horrible alignment with zero support in the right places, or being asked to do an exercise that is way to advanced when there might be something much more appropriate to start with.  At the moment… this is probably the best venue for me to express myself!

** (For the purposes of the rest of this article – when I say “Trainer” I’m referring to anyone you hire to assist you with your wellness program (personal trainer, Pilates Instructor, Yoga teacher, coach, or other health professional.)

For the less experienced clients out there who are wondering how to get the most from your workouts and hire the right Pilates teacher, Personal Trainer, or Coach.  Here are my tips suggestions:

• If you are not asked to complete a fairly comprehensive personal assessment, medical history, and goal setting evaluation before you begin – proceed with caution… I know that it seems like a hassle to fill out all these forms, but this personal information and/or fitness evaluation gives a trainer the information they need to help design a personalized program that’s appropriate for you.

• If you complete assessment forms and you have had a recent injury, surgery, or medical issues – don’t keep these details a secret! You might even be pro-active and schedule a consult with your doctor or physical therapist to get written pre-approval to start your new fitness or Pilates program.  All this will only help your trainer do a better job for you!  Bring any guidelines, therapy exercises, or information with you that might be useful for your new wellness coach.

• If you’ve notified your trainer that you have a medical issue, back problem, or injury and they don’t seem to be taking that fact into consideration as they are putting you through your paces…Remind them of the problem.  If they ignore the issue – STOP Immediately, Do NOT finish the session, ask for a refund and find a new trainer.

• If any trainer works with you and says, “do 8 more reps.”  And then proceeds to tell you about their weekend, or asks you questions about the weather – or any other conversation unrelated to how your body feels while executing the exercise – they are distracting your focus , shutting the door on improving body awareness , and minimizing the concentration you might need for your effort.  (I need to point out that watching TV, and possibly the music on your IPod may be doing the same thing!)

• If any trainer explains  how to do an exercise, demonstrates it for you, but then never actually looks at your body to make corrections for your breathing, form,  or technique….in my opinion – you’re not really getting your money’s worth. Either they don’t really care about you, or they don’t know enough to critically look at your body and make corrections.  Either way your potential risk for injury just got higher, and they aren’t doing everything they could to help improve your body awareness and health.

• If you are doing an exercise and it hurts–anywhere – Notify your trainer immediately.  If they are NOT able to modify, adapt, or change the exercise to make it safer and more appropriate – find a new trainer! There is a difference between muscle fatigue and pain!  A well-qualified trainer will work with you to be sure that everything you do is beneficial AND safe.   The better your body awareness is – the easier you’ll be able to distinguish between the two.  When in doubt…Leave it out!  Or take a break.  Or go on to a different exercise.  If you’re not used to paying attention to how your body feels during exercise, there may be a learning curve for both you and your trainer to find the right exercises for your program.

• If you are at risk for Osteoporosis, or have Osteopenia (the beginning stages of bone loss)  your doctor probably wants you doing weight-bearing exercise.  However – guidelines in the U.S.A.  for exercise safety are no forward bending, side bending or twisting!  Is your trainer selecting appropriate exercises for you to help build bone density and avoid fractures? If you’re not sure – Find a new trainer.  If you inquire about these guidelines and they can’t tell you why they are important…..Or they’ve never heard of them (and then they ask you to do another ab crunch…)  The potential for you to get injured just went way up!  Please be safe.

• It’s important for every exercise to have a purpose.  Can your trainer tell you why you’re doing everything in your workout program? Knowing the benefits will help make everything you do more valuable to your health and well-being.  (And you may be less likely to skip the exercises you hate – because you know that they are in fact the very best ones for you to do!)

• Ask questions about the qualifications, training, experience, education, certification, and areas of expertise for the trainers you are considering.  There is no hard and fast right or wrong rule here.  Just realize that you will probably get what you pay for.  Sometimes hiring a new or less-experienced trainer because they are “cheaper” may not be in your best interest.  But a few sessions with a seasoned veteran – and they might be able to oversee a continuation of your program with a newer instructor (especially  if you are starting a program and have medical concerns.).

• Your goals and priorities will change – is your workout program changing to help meet your objectives?

• Never hesitate to ask to work with a different trainer. It’s always appropriate to make a change, and can be good to get opinions and insight from a fresh perspective –  It’s YOUR body!

Discover and develop your own sense of body awareness so that you can make corrections in your form, and pace yourself to get the most of your workouts.  Always listen to your body and make safe exercise choices.  Know that workouts with a well-qualified trainer will always be money well spent.  Use your trainer to help guide and motivate you to stay active and healthy and let them assist you with a safe and appropriate workout program.  If you ever have any concerns – express them, and know that there are lots of great fitness and Pilates professionals out there…Keep looking until you find the one with the experience, expertise and personality to meet your needs.

Here’s my revelation for the week!  (or perhaps it’s just today’s revelation – and something else will pop up eager for me to share tomorrow.)

I’ve always cued my clients to begin learning their exercises with the awareness of working within the framework of the Pilates “Box.” Think about the torso from shoulder to shoulder, and hip to hip.  Every exercise starts from the center of the box, moves away from, and back to center.  The farther away from center you move, the stronger you have to be to maintain balance, control, and core support for your exercise or movement.  Feeling where the corners of the “box” are help create an awareness of being evenly  distributing your weight and staying centered.  Great concept!

So when the knees bend in towards the chest on any exercise where should they go? 

I encourage clients to stay within the framework of their “Box” and here’s why:

When the knees don’t open wider than the body there are multiple benefits for strength, flexibility, joint range of motion, core stability and control.

Here are 5 Great Benefits for “Knees Over Chest is Best – For Pilates Training”:

1. Better abdominal support for a safe and healthy back. The abdominal muscles have to pull in – out of the way when the thighs/knees pull in towards the chest.  This cues the core muscles to work and get stronger while the legs are moving.
2. This improved abdominal support, and the relationship with the thighs to the chest, provide a massaging action on the internal organs to assist the digestive system and elimination processes. If the knees open wide and the abdominals “pop” out to the front – support for the spine is lost, as well as the strength to hold the organs in a natural resting position in the torso.
3. Strengthen the Adductor Muscles. The inner thigh muscles work more effectively to stabilize leg control, and guide the legs in a precise plane moving away from and back to center.
4. Improve Knee Flexion. The medial hamstrings will do more work and get stronger as the legs bend in towards the body. This will help strengthen the knees and assist with smooth, controlled movement.  (With the legs opening wider than the body the inner thighs and medial hamstrings might not be working much at all!
5. Moving the legs while tracking within the Pilates Box, strengthens efficient alignment and allows the ball to drop in the hip socket to a good posterior-inferior position.  This helps to develop a free full range of motion for the hip joint (which is necessary to maintain and improve bone density),  trains the legs to move independently of the pelvis, and effectively stretches the glutes, and lower back.  AND while all this is happening, you are maintaining support with the back and core muscles.

I encourage you to play with this concept and see how it feels.

With which Pilates exercises can you see value in thinking about the “Box” and Knees Over the Chest position?

Has this post changed your perspective on wide knees vs. knees over the chest?

I’d love to know what you think!  Comments please….

Exercise Underutilized for Chronic Back and Neck Pain

About the Research Study

A recent study, funded by the National Institutes of Health, looked at exercise prescription-who is prescribing it, who is getting it, and what type of exercise is being prescribed-and found that exercise may be underutilized for chronic back and neck pain.

This study was published in the February 2009 issue of Arthritis Care & Research. Led by Timothy S. Carey and Janet K. Freburger of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, researchers conducted a phone survey of almost 700 individuals who saw a physician, chiropractor and/or physical therapist (PT) and were treated for chronic back or neck pain during the previous 12 months. They asked participants the following questions: if they were prescribed exercise, the amount of supervision they received, and the type, duration and frequency of the prescribed exercise.

The Benefits of Exercise for Chronic Pain

Exercise can commonly be used to improve physical function, decrease symptoms and minimize disability that can be caused by chronic low back or neck pain. Numerous randomized trials and clinical practice guidelines support exercise as a beneficial modality, and studies suggest that personally designed, supervised exercise programs are associated with the best results.

Results of the Study

“Less than 50 percent of the subjects in our research study were prescribed exercise, one of the few moderately effective therapies for the highly disabling illness of chronic back and neck pain,” the authors state. Also, health-care provider seen played a major role in whether participants received a prescription for exercise. Of those who received exercise prescription, 46% received the prescription from a PT, 27% from a physician, and 21% from a chiropractor. The authors note that these findings correlate with previous studies that have shown that “who you see is what you get.”

The authors conclude: “Considering current evidence on the efficacy of exercise, these findings demonstrate that exercise is being underutilized as a treatment for chronic back and neck pain.”

Pilates Exercise Programs for Chronic Pain Clients

As Pilates practitioners, it is beyond our scope of practice to “prescribe” anything. (Exercises included!) However, you can grow your business with an excellent source of client referrals if you work closely with the doctors, physical therapists, and chiropractors who have prescribed exercise and work to develop personalized Pilates training programs that meet the guidelines and “prescription” recommended by your client’s health-care providers.

The following things I always request from clients who are starting a Pilates program and have special considerations / health issues:

1. A written release \ authorization to begin an exercise program from their physician.

2. Contact details for both the doctor and physical therapist, and permission from the client to contact these professionals and discuss how we can work together to solve the problems, alleviate symptoms and pain and restore a healthy, active quality of life.

3. Information about any medications they may be taking for pain management.

4. A copy of the exercises they have been “prescribed” by their health-care provider (physician, physical therapist, chiropractor)

5. Any other information they think might be beneficial and relevant.

Physician and Physical Therapy Referrals for Pilates and Exercise

It’s actually been my experience, that when a physician says, “you need to exercise.” That’s as specific as it gets. They rely on my expertise to develop a safe and effective Pilates exercise program. I actually had one new Mat class participant show up with stitches from recent back surgery because her doctor told her she was ready to go, didn’t need physical therapy and needed to get started with an exercise program right away!

I believe that as Pilates professionals it’s our job to help educate the medical community as to the benefits of Pilates, and appropriate place to start for their post-rehab patients. Doctors who have never done Pilates themselves need to be educated about the differences between a personalized Pilates equipment program and group Matwork class so when they refer their patients, they’ll be confident that they are in the safest, most appropriate program to start.

While some physical therapists are in a situation to provide supervised care, unfortunately, our health-care and insurance system is not set up for them to provide patients with the length of care they might require for a full recovery. This is where communicating with a client’s PT can be an excellent networking opportunity to establish a lifetime Pilates wellness program for ongoing post-rehab care.

If a client is currently in therapy and has been given the ok to begin Pilates, it’s important to know what the safe movement guidelines are for them at this point in their recovery. As they progress, it is only with physician or P.T. approval that increased resistance, and additional ranges of movement should be incorporated into their program. Always defer to the recommendations of their medical health-care providers.

If a client has been released from therapy, it’s still important to check before beginning a program or adding anything new-until their physician, and physical therapist are confident that they can do whatever they want with no restrictions.

The Medication Consideration (and effects on exercise)

Many people with chronic pain may be managing it with medication. This is an important piece of information, as their medications may mask their ability to assess how their body feels before, during, and after exercise. Encourage clients to work closely with their physician to monitor how much medication they may actually need, as this may change as they get stronger and more flexible with their exercise program. And be aware that you might easily push too, far too fast, because with their medication they can’t feel the pain that would normally indicate the need to stop or modify an exercise.

Ask lots of questions before starting an exercise program.

Here are some I usually start with when interviewing a new client with chronic pain:

• Is your condition related to an injury? What happened and when?
• How long has this bothered you?
• Do you ever experience numbness or tingling?
• What do you do for a living? Sit more, Stand, Active?
• What activities, exercises, movements aggravate your condition the most?
• What activities, exercises, movements give you the most relief?
• Is your pain a dull, ache? Sharp? Stabbing?
• Are there times of the day when you feel better or worse?
• What things are you doing now to improve your health?
• What things have you tried in the past? How long? What were the results?
• What has your doctor told you to do and/or avoid?
• What exercises have been prescribed by your doctor or physical therapist?
• How often are you supposed to do these exercises? How often are you doing these exercises? How do you feel while you’re doing them? How do you feel after?
• How can I help you the most?
• What are your goals for participating in Pilates?
• Are there any other injuries or accidents that you’ve had during your lifetime? (Related or unrelated to the current issue?)
• Is there anything else you feel it’s important that I know?

The answers to these questions, the information provided by their health-care providers, and an initial assessment of standing and walking posture provides the starting point for developing a safe and effective Pilates exercise program to assist in the care and management of chronic back and neck pain with the goal of using exercise to improve function, decrease symptoms, and minimize disability for an improved quality of life.

Be Pro-Active and Incorporate a Pilates Exercise Program into your Lifestyle to Manage Chronic Back and Neck Pain

As a Pilates practitioner, take the time to network with the health-care providers in your community to build a referral source for quality care. As a client searching for ways to improve your health, be pro-active! There are many traditional and non-traditional methods for reducing pain and improving your quality of life-Pilates and exercise can be a great choice! Consult with your doctor, P.T., and chiropractor to determine the options available in your community. It is never too late to improve your health!

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Resources:

Article: “Exercise Prescription for Chronic Back or Neck Pain: Who Prescribes It? Who Gets It? What Is Prescribed?” Janet K. Freburger, Timothy S. Carey, George M. Holmes, Andrea S. Wallace, Liana D. Castel, Jane D. Darter, Anne M. Jackman, Arthritis & Rheumatism (Arthritis Care & Research), February 2009.

http://www.ptproductsonline.com/SOAPNotes/2009-02-04_01.asp

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Aliesa George is a wellness consultant and author with 25+ years of professional experience. She is founder and president of Centerworks® Pilates Institute. Certifications include: PMA Pilates Teacher, ACE Personal Trainer & Group Exercise Instructor, and Bigu Qigong Weight-Loss/Weight Management Instructor. Ms. George is available for private/group training and offers workshops in Pilates, movement re-education, and mind-body health enhancement. For additional resources and to contact Aliesa, please visit www.Centerworks.com.

I may be a bit behind the times when it comes to enjoying the fun and benefits of all the new interactive video game products on the market – like the Nintendo Wii Fit…  but recently my techno-geek boyfriend purchased a Wii Fit for home.  (He’s had one at work since they first hit the market.)  Being a bit shy about actually getting a computer to do what I want, for me is intimidating, never mind the hand-eye coordination it takes to “win” a computer game…..I was never any good at these games as a kid.

I have to admit my extreme skepticism about the benefits of staring at a TV screen and using a computer game for fitness.  But am always excited to hear about new ways to inspire and encourage people to increase their exercise and activity level, and ANYTHING that people enjoy doing that involves movement can be a great way to improve health and fitness.

After playing with the Wii Fit only a couple of times, I am a happy to report that I am a fan of the fun, interaction, and health benefits that this gadget can provide!  Last night my family spent 6 hours playing Wii Fit games together!!!  Tennis, Baseball, Boxing, Bowling, Golf, balance games, yoga.  I think we explored the gamut of options!  I can honestly say that I can feel my abs this morning – so core muscle strengthening was definitely happening, and I wasn’t one of the folks that spent tons of time playing! So can only imagine how sore a few other people might be today!  We had more fun, spent more time laughing, talking, and encouraging each other in competition that the evening flew by and nobody wanted to stop playing.

While I wouldn’t want to spend all my workout time on the Wii…I think it’s a great option for friendly competition, a way to check-in on your health status with weight, Body Mass Index (BMI), goal setting, and some basic fitness testing for strength, balance, and control.  This gizmo provides instant feedback to see where you’re at, games and skill challenges to improve your health, and a way to do something besides just be a couch potato in front of the TV.  I also think that the balance awareness and assessment tools are excellent.  More about that in an upcoming blog post!

Do you Wii???  If you’re doing or teaching Pilates and haven’t tried this yet…find a friend who’s got one – create your Mii (your own personal cartoon version of you!) and go play!  I’d love to hear what you think about using Wii Fit as a tool to help your clients track improvements with their health and check-in with Posture and being “on center” for balance and body control that is such a key aspect of Pilates training.

Share your Wii Fit experience!

I’m thrilled to see foot-care and foot exercise making national headlines! 

 Did you happen to see or hear the news?  I’m not a regular National Public Radio listener, but fate stepped in and brought it to my attention. So how did I find out?   It was a double whammy….which to me was a sign that I had to check it out. 

First, someone that heard the story on NPR and Googled Pilates & Foot Exercise which led them to my site to order Fantastic Feet and a Centerworks Pilates Foot Fitness Kit.  Bless them for commenting on their order form as to how the found me and my foot fitness products. 

My second wake up and take notice…was from a client at the health club I’m teaching at – who came in for a lesson and said – NPR had a story about the same problem I have with my feet (plantar fasciitis) and Pilates!  She was so excited and encouraged that Pilates was a great thing for her to be doing to improve not only her overall fitness level, but to really help reduce the pain in her feet and get her back to a normal lifestyle.

The information she heard in this story helped lend credibility to her Pilates teacher, that they’re on the right track with her Pilates exercise program and addressing her foot issues.

I think it’s great to have articles like this in the news that help reinforce the variety of benefits that clients can receive and achieve with a Pilates workout program.  I haven’t seen a lot written for the general public about the benefits of good shoes and exercising the feet.  Our feet desperately need more attention and usually don’t get addressed until a problem arises. (Unless someone is regularly participating in barefoot activities like Pilates, Yoga, or dance.) 

People actually think that it’s ok for their feet to hurt, and don’t think too much about the shoes their wearing and how they might be causing foot problems.  So I think it’s great that the NPR story addressed the problems with wearing Flip-flops, and open backed shoes.  There’s also a nice video from Podiatrist-turned-Pilates instructor Colleen Schwartz that demonstrates a few helpful exercises to get you going for foot care that can help reduce heel pain and help stretch the plantar fascia.

How great – A Podiatrist/Pilates instructor encouraging people to exercise their feet!  This is a wonderful tool for Pilates promotion to markets where general exercise is a problem due to foot issues. 

If the excuse is “I can’t exercise because it hurts my feet.” 

The reply is – “You can do Pilates, and over time we may be able to reduce or eliminate your foot pain, are you interested in learning more?”  

I found that so many of my clients benefited from a focus on specific exercises for the feet – that it’s the reason I wrote Fantastic Feet – Exercises to Strengthen the Ankles, Arches, and Toes.  I wanted people to have a resource to help develop a foot exercise program for home and travel.

If you’ve got friends, family or clients with foot issues encourage them to check out the NPR website and read the article “How to Keep your Feet Happy” by Allison Aubrey.  They can also watch the short foot exercise video that’s linked to this story in the Health & Fitness section.  Then if you’d be so kind, please spread the word about the foot-fitness resources available from Centerworks Pilates! 

Question: Is Pilates appropriate for someone with peripheral atrophy? Balancing is becoming more & more difficult so yoga is no longer an option. If appropriate, please tell me where I might find a certified teacher/instructor. Please advise.

Answer: I do not feel it’s appropriate for me to answer this with a specific yes, or no – because I’m out of my scope of practice to recommend Pilates for a specific person, with a specific medical issue. (Especially someone I’ve never seen or worked with!)

However, here are my personal thoughts on the subject:

There can be many different reasons for peripheral atrophy. It would be important to know the causes, what parts of the body are being affected, how long it’s been an issue, symptoms, challenges, goals, a personal medical and exercise history, AND get prior approval from your primary care physician and medical specialist who is treating you for this — before starting a Pilates program. Your physician should give you the green light that it’s ok for you to begin (or continue) an exercise program – Pilates training or other forms of exercise.

Based on my years of Pilates teaching experience, and having worked with several clients with moderate to severe health challenges related to degenerative nerve and muscle diseases, Pilates training didn’t help reverse the clock and make everything “normal” but I have watched my clients enjoy substantial benefits in regards to gaining and maintaining strength, flexibility, balance, and body awareness for an improved quality of life.

Because a training session with the Pilates equipment can get you off your feet, and into more supportive positions – the challenge of balance can be taken out of the equation while learning different ways to improve strength and body control. The goal, of a Pilates program (in my opinion) would be to help identify things in your daily life activities, movements, and posture that are becoming a challenge, and then develop a program with the Pilates exercises that will best help to maintain and improve your fitness.

Some of what I do with my special needs clients is Pilates. Some exercises have been creatively modified; other exercises I pull from my experience in dance and general fitness that I feel are applicable to continue gently encouraging the body to stay strong and healthy. This is my approach! It might be different with a different teacher.

If your Physician agrees that Pilates might be beneficial and recommends you give it a try, then you can start the search for a qualified Pilates teacher with the knowledge and background to work with you.

Not all Pilates teachers are created equal. With health challenges, it would be best to find a teacher with good experience, and it might be advisable to find someone with rehabilitation background or physical therapy experience (You want to find a Pilates teacher who is confident to work with special populations.)

Ask your potential Pilates trainer if they’ve worked with other clients with special needs or peripheral atrophy. If you’re lucky enough to be in an area of the country with an abundance of Pilates professional, I’d recommend visiting several studios, asking lots of questions, and possibly take lessons from a few different teachers to be sure you’ve found one that has a personality that clicks with yours and fits the bill for knowledge, expertise, ability to help encourage you, and can design a Pilates training program that allows you to work at your own pace.

Begin with private one-on-one Pilates training, and let the teacher you are working with help guide you into Pilates Mat or other equipment classes if and when it’s appropriate for you. (Private Pilates lessons may be your long-term best and safest option.) Chances are there will be lots of exercises and concepts that you will be able to take out of the studio for “homework” as a supplement to your Pilates personal training routine.

To locate a Pilates Teacher near you:

• See what’s listed in your local phone book under Pilates.
• Inquire with your local health clubs.
• Call sports medicine / physical therapy / or kinesiology / chiropractic clinics and ask where they refer their patients for Pilates Training.
• Check with the Pilates Method Alliance. The PMA is an international membership organization for Pilates. You can search on their website to locate a PMA member Pilates Teacher/Studio at http://www.pilatesmethodalliance.org/curntmemb.html
• PilatesStyle Magazine also has a good studio referral network at http://www.pilatesstyle.com/web/directory.aspx

It’s so important – that we maintain a good level of wellness! Finding an exercise program that you can do safely to maintain strength and flexibility will keep you as healthy as possible. It doesn’t have to be a wild and vigorous workout to get results. There is a difference between a professional athlete training for sports performance, and you or me enjoying exercise to maintain a good quality of life. Check with your doctor to be sure it’s ok for you to be active, and then find exercises you can do and enjoy that keep you moving at your own pace… and keep on moving!

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If you’re looking for more general info on peripheral atrophy visit: http://www.nlm.nih.gov/medlineplus/ency/article/000593.htm