Injuries & Rehab

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Those pesky knees

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by Shoshana Goldstein

In 2013, I learned the hard way about this delicate joint when I tore the meniscus in my right knee during a ski accident. Not long after, 60% of my meniscus was removed in surgery. Since the meniscus acts as the shock absorber in one's knee, this meant I would now have hardly any cushion in my right knee!

The orthopedic surgeon told me that recovery would be slow and that I would also probably need a knee replacement when I was older - to which I said 'heck no!' I was sure that with Pilates I could not only fully recover, but could do so quickly and also have a sustainable & joint-safe form of exercise for the long term.

And that's exactly what has happened.

Within 12 months of the accident, I was fully recovered and back to swooshing down the slopes.

General guidelines and modifications
Here are some general modifications and guidelines for a mat or reformer Pilates workout for this situation. This information comes from both my own experience along with insights from my mentor and master Pilates instructor Shari Berkowitz - see www.theverticalworkshop.com.

PLEASE realize that these general guidelines are not a prescription. If you've had knee surgery, it's essential that you work with a skilled practitioner (i.e. a Physical Therapist or an experienced Pilates instructor) both during the acute phase of rehab and subsequently when restoring full functionality.

1. One of the key things about knee rehab is that every repetition needs to be pain free. We work around the injury in order to avoid pain and focus on the strong parts of the body to support the knee joint.

2. Set your feet a hip socket width apart and parallel so that the middle of your knee is inline with the second toe joint of your foot. This provides good ankle, knee and hip tracking.

3. Reduce the range of motion when in knee flexion to avoid pain. For example:

    A. On the reformer set the foot bar at a lower setting or move the gear bar for a longer carriage.

    B.  While doing a Mat exercise like Single Leg Stretch, use your hands to block your knee so that the knee stops directly over the hip.

4.  When doing mat work that involves repetitive knee flexion with 'hand' pulling - like in Single Leg Kick or Rolling Like A Ball - place hands behind the knees or at the back of your leg. Omitting the arm portion of the exercise is also a possibility. Just reach your arms long at hip bone level.  Likewise, you can do just the arm and torso portion of an exercise and omit legs.

 5. Eliminate exercises that involve being on your stomach (prone) while flexing the knees like in hamstring curls on the reformer or Single and Double Leg Kicks on the mat. These exercises may put too much pressure on the knee and make it difficult for proper tracking.

6. When setting up for Shoulder Bridge Preparation, set your feet further away from your hips so that there is less knee flexion or omit.

7. Kneeling exercises likely need to be eliminated.

8. You might have to omit exercises with legs in straps whether on the reformer or tower. Straps do not provide much stability for the knees

9. Lower the amount of weight from the springs for any work with feet on the reformer’s foot bar or foot pedal. The pull from the springs can be compressive.

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Pilates Guidelines for Osteoporosis

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by Shoshana Goldstein

According to the National Osteoporosis Foundation (NOF), "Osteoporosis is a disease of the bones. It happens when you lose too much bone, make too little bone or both. As a result, your bones become weak and may break from a minor fall or, in serious cases, even from simple actions, like sneezing or bumping into furniture." 

Pilates can improve your strength, balance and flexibility. However, it is important to alter some of the exercises to avoid potential fractures. Here are some guidelines to follow, formulated by Shari Berkowitz of The Vertical Workshop.

1. When exercises call for a head/chest lift, keep your head down. 

2. Omit any exercises that involve forward bending. Instead, hinge from the hips. 

3. Exercises that are on your stomach (prone) should be eliminated, unless you have low osteoporosis and no fractures. Pressing into the ribcage can be traumatic on the spine.

4. Avoid rolling exercises.

5. When in a seated position, make sure that you are not sitting behind your sitz bones in a "tucked" position. Instead, sit on top of your sit bones with as much bend in your knees as needed. 

6. In any balance exercise, make sure you have support. 

7. Depending on the percentage of osteoporosis that you have you might need to eliminate rotation exercises and lateral flexion exercises.

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How Pilates Can Help with Lower Back Pain

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by Shoshana Goldstein

If you've ever groaned, "Oh, my aching back!" you are not alone. According to the National Institute of Health, about 80% of adults experience lower back pain at sometime during their life.  Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Lower back pain can be associated with many issues. These include spinal stenosis, bulging discs, herniated discs, degenerative discs, spondylosis and spondyloysthesis.

In Pilates the focus is to de-compress the lumbar spine by working to create a balance of strength between the lower, deep abdominals and low back muscles. The equipment we use provides support to the spine and provides tactile feedback.

The Pilates session focuses on safe movements. We provide modifications as needed and/or omit exercises. Each repetition of an exercise must be pain free.

Seated exercises should be omitted at first as they put a much heavier load on the lower back compared to lying down. Even though you might not have pain while sitting, you might notice pain while exercising.

When you position your legs in an uplifted or up-stretched position, the weight of the legs pulls on your pelvis and compresses your lower back by going into an arched position (anterior tilt). Therefore, it is recommended that in an exercise like The Hundred the legs should be kept slightly bent, high toward the ceiling or bent at the knee with legs resting on the mat.

Since stretching the hamstrings pulls on the pelvis and compresses the lower back, all exercises in the Pilates repertoire that includes a hamstring component need to be adjusted. For example, in the mat exercise Single Leg Stretch keep a slight bend in the knee of the circling leg. Likewise while sitting as in Spine Stretch Forward, sit up on a bolster or small barrel.

Exercises that include a lift of the hips over the shoulders can also compress the lower back. Instead in rolling exercises like Rolling - Like a Ball just balance. The Half -Roll Down is a good alternative to the Roll Up. (See video)

Spinal rotation can also be compressive. Sit up on a bolster for mat exercises like The Saw and Spine Twist. Make your rotations smaller or eliminate rotation exercises all together. Always listen to your body. Remember that NO PAIN is of utmost importance.

If you are working on the reformer be sure to follow these modifications.  Decrease the spring load as appropriate: For example, 4 springs would go to 3 springs, 3 springs would go to 2 springs. However, do not go lighter than 2 springs. As you go lighter, you need to have more control. When you are in pain, you have little control. When transitioning, roll onto one side, using your hands and abdominals to help sit up or to lie back down.

Pilates can be a great for you if the movements are done safely. It is important to make wise choices of what to do and what not to do. Create good communication with your instructor. If you experience any pain, you must inform your instructor immediately. As Shari Berkowitz of The Vertical Workshop says, “The rule is No Pain. It’s not the old “No pain, no gain.” “It is just No Pain.”