By: Amy Stein, PT, DPT & Denise Small, PT, DPT
Denise Small, Physical Therapist and resident Pilates instructor spoke on the differences between Pilates’ practices, and what aspects are important for her patients with chronic pelvic pain. Denise is third generation instructor of Joseph Pilates’ technique. She has also taken supplemental training courses with Eric Frankel and Thomas Myers, both well-known body workers and movement therapy practitioners.
Denise explores movement patterns in her patients that may have caused pain in the past, and are now labeled as something to fear. Patients try to avoid these movements; however, they are necessary for healthy functional mobility. Denise uses the Pilates method to explore these movements, and to make them pain free and more familiar. Denise is guided by Pilates’ 8 movements principles, which are the staples of Joseph Pilates’ methodology.
1. Whole Body movement- all structures are involved, even if they are not moving.
2. Breathing- Pilates refers to this as an internal shower, or a massage for your internal organs. This also helps coordinate your movement, using breath as your internal rhythm.
3. Balanced muscle development: concentric and eccentric movements happen in synchronicity with the use of the Pilates’ springs.
4. Concentration and focus: Required for all of the above to be performed together
5. Control- Pilates is not about repetitions and muscle bulk. Pilates is about Form and coordination of all the movement principles. If all of the movement principles are being incorporated, one needs only to perform 8-10 repetitions of each exercise for maximum benefit.
6. Centering- Pilates heals the mind and body, by bringing your attention to your core. That is: the abdominal wall, the diaphragm, the pelvic floor, and the deep spinal extensors.
7. Precision- If the movement is specific, there is very little room for error
In addition to being guided by the movement principles, Denise has a few staples of her own, that she uses to frame her sessions. First, Denise believes that you need to have tissue mobility before stability. For example, one needs to be able to move their abdominal muscles before they can begin strengthening their abdominal muscles. If a patient’s abdominal wall is hard, then it is not necessarily strong. A strong abdomen is a part of a strong core. A strong core requires fluid coordination of the diaphragm, pelvic floor, the spinal extensors, and the abdominal wall with movement. This lack of coordination may be observed when a patient is performing an abdominal strengthening exercise. Does the patient hold their breath? Are they tucking in the tailbone and gripping their pelvic floor muscles? Does their abdomen bulge? Many of these compensations can be avoided with the use of breath while performing more subtle core exercises, like marching, before progressing to more advanced exercises.
Second, Denise always highly recommends rolling out your patient’s feet before doing any mat or reformer work. Studies have shown that the fascia of your feet is directly connected to the fascia of your core, pelvis, and spine. So, if you release your plantar fascia, you can release restrictions all the way through your legs and torso. Once the muscles and fascia of your feet are more pliable one can better align their skeleton, from the domes of their feet to the roof of their mouth.
Lastly, Denise likes to use as few cues as possible to not confuse or overwhelm the patient. In addition, her cues are oriented around the bones. Bones are easier for patients to visualize, and focusing on the bones alleviates the possibility of dysfunctional muscle recruitment; i.e. gripping. For example, for pelvic floor muscle tightness and pain conditions, Denise cues widening the sits bones with squatting and inhalation. The patient/client needs to work on letting go of the muscles and the sits bones, while we work on eccentric control. To learn more about Denise, visit her bio and our Pilates program . Also see her recently published health tip to get started.