Pilates, Moving from Injury Back to Peak performance

Julia Rosenthal PT, DPT

Julia Pilates

As an avid high intensity exerciser, I am always looking to push myself in my workouts. When pain gets in the way of my progress, it can be extremely frustrating. For years, I have been struggling with chronic hip and sacroiliac joint (low back) pain. These symptoms intensified about two and a half years ago when I fractured a lumbar vertebra weight lifting. Recovery was hard, and during that time I was told by doctors, friends, and family that I could not or should not return to the things I loved: lifting heavy weights and running outside. I was devastated. I tried swimming, biking, the crazy looking stair treadmill at the gym, and while I was able to get some exercise in, I still felt like I had lost one of the things that brought me the most joy.

Months after my injury, I finally started listening to my body and my physical therapist friends rather than the limiting and negative advice I had gotten. I started returning to weight lifting and running and began trying not to judge myself for the strength I had lost. The more I did, the better I felt. I was scared, but I felt liberated at the same time. But despite making some initial progress, I started to hit a wall. I couldn’t deadlift as much as I could before, I couldn’t lift as much overhead, and I was too afraid to run on concrete or to get in a squat rack, which was where I had hurt myself all those months ago. I started to feel that hip and sacroiliac (SIJ) pain again after every workout, and I knew I had to change something about what I was doing.

Enter: Pilates. Pilates and weight lifting are both forms of resistance training, but there are key differences between them that make Pilates an effective form of cross training for a weightlifter. When you do any singular form of exercise, your body is learning how to complete a task one way. Introducing a different form of exercises gives you variability, and teaches your body to work under lots of different conditions using different muscle groups. The more options our bodies have for how to complete a task (like a deadlift), the stronger we become.

Here at Beyond Basics Physical Therapy, I had the opportunity to work with Kierstin Elliot,a certified Pilates instructor with a wealth of experience working with clients who struggle with orthopedic issues, including pelvic floor dysfunction. “In Pilates,” Kierstin explained, “subtle nuances matter and you have to be a stickler for form and alignment.” Weightlifting athletes, on the other hand, generally focus more on larger, more powerful movements. Because of these differences, Pilates can make a big difference when it comes to increasing strength and decreasing injury in people who typically exercise with high resistance. In the months that I spent working one on one with Kierstin, I achieved personal bests in my squat and my deadlift and could feel that I was much more steady in any single leg weight lifting activity.

If you like to lift weights and you want to see your performance improve, here are 5 specific ways that Pilates can up your weight lifting game:

  1. Eccentric Strengthening
    1. While weight lifting certainly helps to develop core strength, Pilates does so using lighter weights and more eccentric contractions. Eccentric contractions require muscles to work and lengthen at the same time. Typically, weightlifting and other forms of exercise will strengthen the core in a concentric way, meaning the muscles are asked to shorten and tighten in order to build strength. While both are effective, the best option is a combination – variability is key. Eccentric contractions are also a great way to increase mobility.
  2. Increasing Mobility in the Spine and Extremities
    1. The demands on the spine are very different in weight lifting versus Pilates. Lifting heavier weights requires you to maintain a certain amount of stiffness in the spine to protect it against a heavier load. While that is an important skill (think about how hard it can be to lift a heavy suitcase, stroller, car seat, etc.), it is also important to be able to manage resistance at times when our back can’t be in a “neutral” position, like when you’re putting a baby in a crib or digging things out of your storage unit. Pilates exercises are done at lower resistance and in various different spinal positions: flexion, extension, side-bending, and rotation. This allows you to learn to move well under tension in lots of different positions.
    2. Pilates is also a great way to increase your hip and shoulder mobility, both of which are important for weight lifting. Squatting, deadlifting, and overhead movements were the things I was having the hardest time progressing back to, and these all require good shoulder and hip mobility. Pilates exercises are often done with the trunk supported, and with resistance applied to the limbs by springs. This means that there are more eccentric contractions involved (working and lengthening at the same time), which can be a great way to improve strength and mobility at the same time.
  3. Increasing Stability
    1. Weightlifting focuses on powerful movements. These types of movements will require increased work from our larger “global” muscles which tend to be longer and move lots of joints at the same time. While strengthening these muscles is important, using Pilates to strengthen the smaller “stabilizing” muscles is a great way to enhance the strength of the global musculature. When we do a big, powerful movement, we need the smaller stabilizing muscles to automatically fire too – this enhances our overall strength, improves our balance, and makes us less prone to injury.
  4. Increasing Endurance
    1. Training for increased endurance means training at a lower weight and performing more repetitions. In weightlifting, the goal is to work at a higher percentage of your 1 rep maximum, meaning the greatest amount of weight that you would be able to lift once. In Pilates, on the other hand, lighter resistance is used for more repetitions.
  5. Increasing Body Awareness
    1. Proprioception is the sense that allows us to know where our bodies are in space. Exercises that are done in a closed chain – meaning one of your body parts is in contact with a fixed surface – enhance this sense. Because reformer Pilates includes spring tension with your feet or hands in contact with a surface, almost all exercises are done in a closed chain. This can be a really great way to ease into a movement after an injury. The support of a closed chain exercise allows you to tailor the movement to your current level as you progress back towards more traditional open chain (no contact with a surface) weightlifting movements.

Thanks for reading! I hope this blog post helped you understand how you can take your training to the next level. If you are interested in experiencing what Pilates can offer or how physical therapy can maximize your athletic potential, please call our midtown (212-354-2622) or downtown office (212-267-0240) today!

 

Check out what Kierstin has to say about Pilates here!

The Benefits of Pilates While Healing Diastasis Recti

Pilates with Kierstin! Standing Side Splits

Pilates with Kierstin! Bridges with Stability Ball

References:

  1. Ahearn EL, Greene A, Lasner A. Some Effects of Supplemental Pilates Training on the Posture, Strength, and Flexibility of Dancers 17 to 22 Years of Age. Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science. 2018;22(4):192-202.
  2. Di Lorenzo CE. Pilates: what is it? Should it be used in rehabilitation? Sports health. 2011;3(4):352-361.
  3. Phrompaet S, Paungmali A, Pirunsan U, Sitilertpisan P. Effects of pilates training on lumbo-pelvic stability and flexibility. Asian journal of sports medicine. 2011;2(1):16-22.
  4. Queiroz BC, Cagliari MF, Amorim CF, Sacco IC. Muscle activation during four Pilates core stability exercises in quadruped position. Arch Phys Med Rehabil. 2010;91(1):86-92.
  5. Valenza MC, Rodriguez-Torres J, Cabrera-Martos I, Diaz-Pelegrina A, Aguilar-Ferrandiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clinical rehabilitation. 2017;31(6):753-760.
  6. Why Pilates and Lifting Weights Aren’t Mutually Exclusive – Girls Gone Strong. Girls Gone Strong. https://www.girlsgonestrong.com/blog/strength-training/why-pilates-and-lifting-weights-arent-mutually-exclusive/. Published 2019. Accessed May 26, 2019.

How to Travel with Pelvic Floor Dysfunction

Fiona McMahon PT, DPT (She, her, hers)

airplane-backlit-clouds-1262304

It’s that magical time of year in New York City, that I call “Goldie Locks Time”. It is that brief stretch of one to two weeks right after the cold of winter has left us and right before the sweltering hot gritty city summer descends upon us. It is the time of year that the weather is so supremely pleasant, that the hustle and bustle of the city slows and usually frenetic New Yorkers actually take time to stop and smell the roses, literally. My pediatric patients begin to grow giddy as school is wrapping up in a couple weeks. It is a time when many New Yorkers start looking forward to their summer escapes back to their home towns across the country or vacations to new and familiar locales alike. Having the time and resources to travel is a luxury, but for those with chronic pelvic pain, it can seem like a really daunting task. People often wonder, “how can I fly across the country if sitting for more than 20 minutes causes my pain?”, “how will I keep from flaring?”, “How do I negotiate the demands of travel so I can actually enjoy my time away?”. Although travel can be really daunting, there are steps that you can take to ease your journey and help you enjoy your time at your destination. Below are some considerations for travel I hope that you will find helpful.

Hydrate- Even if You Have Bladder Problems

Recirculated air is the worst and is inevitable when flying, but is also something you should consider with bus, car, and train trips. Long and even short haul flights can leave you feeling parched and dry which can cause issues with many pelvic floor symptoms. It is really important to not get on the plane dehydrated. In the week or so preceding your trip, be extra mindful of trying to get enough water. A popular guideline we use at BBPT with to try and consume at least one half your body weight in water in ounces. For example, if you weigh 150 pounds, drink 75 ounces of water. Being properly hydrated will decrease irritation within the bladder and can even reduce frequency, reduce your chances of constipation, and ensure the tissues of your body have good mobility. Also be sure to hydrate on the plane and in the airport. Water sold at airports is usually overpriced and has the downside of being packaged in environmentally unfriendly plastic. To save money and the planet, I suggest bringing an empty reusable water bottle through security. Once you are through security you can fill it up and keep on your hydration game. One thing to remember is to take your water bottle out of your bag and place it in the screening bin, so you won’t lose time having security check inside your bag to verify that your bottle is indeed empty.

Prioritize Pooping

In my world, it’s all about poop. Traveling can lead to some gnarly cases of constipation, which makes virtually every pelvic floor complaint worse. We talked about keeping up with your hydration, which is a really good first step. Making sure that you have a enough time to eat, chill, and have a solid BM before rushing off to the airport is really important. So when possible, Try and carve out at least an hour of pre-travel chill time before heading out the door.

Food

Eating well is so important. Many of our patients have diets that make them feel better. When travelling, food can be a wild card. With the change in routine associated with travel, it can be all too easy to throw a diet that is working to the wind. A huge change in dietary routines is one of the top reasons I see people flare. Although indulging in margaritas and other treats can be so much fun, be aware of how it will affect your symptoms and overall enjoyment of your trip. It is good to come prepared if possible. Packing snacks that you know don’t make you feel like garbage if you are going to place where you are unsure of what the food situation will be like, will help.

Choose your Seat

The idea of sitting on a long haul flight is daunting especially for those who have pelvic and or sitting pain or bladder issues. There are travel cushions you can bring with you to ease your symptoms. If you don’t typically use a travel cushion, check out my cushion hack bellow using a jacket.

seat.jpg
The cushion hack: If you find you have sitting pain but no cushion, use your coat or sweatshirt to fashion a cushion

Choosing seats next to the bathroom when possible can go a long way towards reducing stress for folks with bladder issues. Additionally ,opting for an aisle seat can also be helpful. To the extent possible, try to get up and move to reduce the pressure on your pelvic area.

Manage Travel Stress

Travel is a stressful thing for most of us. There is so much out of our control and there’s no amount meditation or mindfulness that can change that. That being said, meditation and mindfulness practice can help how you deal with how you react to  cancelled flights, lost baggage, the works. Allowing yourself a quiet moment to breathe before and during your travels can help you re center and get back to enjoying the journey. Both Calm and Headspace make really awesome guided meditation apps that you can use while waiting for your flights.

 

Get out There!

This world is so big and beautiful. It can be really hard if pelvic pain is holding you back. Try these tips out on smaller trips to see if they help you! If you find that you are still having pain that holds you back, see a pelvic floor physical therapist who can help you get out there!

Beyond Basics Physical Therapy offers intensive week or weeks long treatment to those who live out of town and do not have regular access to pelvic floor physical therapy. If you are feeling like taking a trip to the Big Apple, NYC, check out more about our out of town services here.

 

The Benefits of Pilates While Healing Diastasis Recti

Ta facilitation pic

Kierstin Elliot

Almost all postpartum women experience some degree of diastasis recti, or separation of the rectus abdominis or 6 pack muscles. Think about it, your abdomen is stretching continuously for a solid nine months! Something’s got to give. The linea alba (line of connective tissue that splits your rectus abdominus right down the middle) separates as a result of a growing baby. On some women, this separation naturally heals itself within the first year postpartum. In other women, the separation is so severe that they need a little extra attention and care to fuse their rectus abdominis back together again.

Once you’ve given yourself enough time to heal the inflamed tissues from giving birth, usually about 6-8 weeks, then you can start implementing some basic Pilates principles into your routine. Drawing attention to the breath, the transversus abdominus (TA), and the pelvic floor without creating excess pressure throughout your system, will be essential while moving towards healing your diastasis.

Connecting to your breath and your TA should be the first step. Deep three-dimensional inhalation to the back of the ribs and mindful exhalation, tapping into the TA will be crucial. During the exhale you should feel as if your abdomen is hugging or wrapping around your waist like a belt. This is TA activation. Once you’ve established the TA activation, focus on drawing your bottom ribs towards your naval and narrowing your ASIS (hip bones) towards each other. Imagine a drawstring; when you pull the drawstring, the opening of whatever object you’re trying to close, draws together from all sides evenly. That is the effect we are trying to create with the abdomen. Visualize your naval as the center of the opening and your exhalation pulling the drawstring closed.

Once you’ve mastered connecting breath to the TA, shift your focus to the pelvic floor. The easiest way to achieve this is by lying on your back with a neutral pelvis with knees bent and feet flat on the floor. Visualize the tailbone unfurling and your sits bones widening as you inhale allowing the pelvic floor to gently stretch and relax. On the exhale, as you engage the TA and obliques, feel the pelvic floor tighten slightly and if appropriate (after a pelvic floor check from your PT) find a kegel. The ultimate goal is to be able to contract and release your pelvic floor without any problems. After practicing this breathing exercise every day for about 8-10 reps, you should start to feel stronger throughout your core and find some closure or firmness in the linea alba.

This first step is HUGE. After 2-3 weeks of consistent breath work and core activation, layering more extensive exercises will become safe and accessible. Keep in mind that it is not wise to go from zero to one hundred, but rather continue to build and progress slowly. It may feel tedious, but I can’t stress enough how imperative it is to lay this foundation and rebuild your core after birth. Once you feel you’ve made considerable progress with breath work, add in marches (leg lifts) targeting lower abdominal stabilizers and add in a side lying series to challenge pelvic and core stability while also strengthening glutes. Try a side plank starting on knees and then progressing to feet. Any exercise in quadruped is a safe bet that targets shoulder stability, core, glutes, and hamstrings!

One thing to note is that women with more severe cases of diastasis should avoid abdominal curls, rollups, or flexion of the rectus abdominis until there’s been a considerable amount of progress with the deeper core muscles. If you fall under this category and constantly wonder if you’ll ever close your diastasis, yes! You can! And you will if you dedicate the attention and mindfulness to connecting to your body. Think you’re doing everything right, but still feel like no progress is being made? Feel free to book a session with me at Beyond Basics Physical Therapy! I’d be more than happy to help you out on closing your diastasis and transitioning you back into the wonderful world of pilates 🙂

What is Myofascial Release and Why do We Always Talk About it So Much?!

Fiona McMahon PT, DPT

Corey works on lower back 1

If you follow anything in the physical therapy world, you probably have heard about myofascial release, or MFR if your hip to our abbreviations. It has been a darling of the manual therapist’s tool kit for some time. But did you know their many different camps of physical therapy and these different camps prefer different tools? I love coming from a field that can produce multiple solutions to any given problem. I feel it maximizes every unique individuals’ chances of finding meaningful relief through treatment, but it’s definitely fair to say that MFR does have some detractors in the physical therapy field. In this blog, I will be discussing why MFR is a wonderful tool for treatment of pain conditions and functional issues. MFR doesn’t always get the love it deserves and it is my hope, that by the end of this blog you will understand how MFR is thought to work and why it can be so helpful.

What the heck is the myofascial system?

As the name would imply, the myofascial system is the combination of the muscular system (myo) and the fascial system (fascial). Most of us have a pretty good concept of the muscular system but the concept of fascia is slightly more elusive. Fascia is the covering and connection of just about everything in the body. It wraps around organs, nerves, and muscles and allows these parts to retain their shape and function well. The composition of fascia is fascinating, even if you aren’t a total nerd, like me. We may encounter fascia when removing that filmy substance from a chicken breast while preparing it. When you see that film it looks pretty simple, but on a microscopic level that “stuff” is actually teaming with diverse and different cells all doing different things. Within fascia we have adipocytes, (fat cell makers), fibroblasts, which make collagen and elastin…. AND ARE CONTRACTILE! Yes I put this in all caps because it is amazing and it can be easy to overlook when you are thinking about fascia. Fascia also has mast cells (which make histamine) and histocytes (are part of the immune system). It’s honestly a cell party inside that stuff. Keeping with the metaphor of cell party, the house those cells are chilling in is made up of collagen (which provides support), elastin (which provides strength and flexibility), and ground substance (which is the cushioning).

All this stuff together helps fascia to accomplish some pretty cool tasks. Like I said before, fascia covers everything in the body and helps it keep its form. It also allows organs and muscles to slide and glide over each other, which is obviously very important when we are thinking of muscles. But what’s most interesting, in my opinion, is that fascia acts as a sense organ. It is innervated with type III and IV sense receptors and responds to light touch. It can contract and when fascia is stimulated it has an effect on the autonomic nervous system (think flight or fight). You probably could guess that issues within the myofascial system could wreak havoc on the rest of the body.

What goes wrong with the myofascial system and why does it get messed up?

The concept of fascia and its dysfunction contributing to pain is not necessarily a new one. People were thinking about myofascial pain although they had different words for it as early as the late 1600’s with the first description of trigger points in 1816. Trigger points have been called many different things from “nodular tumors” in the 1800’s to “muskelshweile” meaning muscle calluses, which is my personal favorite.

So where do these “muscle calluses” and trigger points come from? The reasons are myriad. Fascia can become restricted with discrete injuries (what I term, “the Oh Poo moment”, where you know you have injured yourself) or they may build quietly over time due to poor posture and other types of repetitive strain or chronic muscle holding.

Fascial restrictions and trigger points can cause a whole host of symptoms. It should seem obvious that restrictions in the fascia of a certain area of the body will restrict the movement in in that area. But fascial restrictions can present in less obvious ways.

Fascial restrictions can affect organs and dysfunction in the organs can affect fascia. This is because of the somatovisceral reflex and viscerosomatic reflex respectively. We see a lot of organ and myofascial interplay at Beyond Basics Physical Therapy. We commonly see increased trigger points in parts of the body that are innervated by similar nerve root fibers off of the spinal cord. Specifically, we may see someone who has endometriosis adhesions on their rectum experience pain and trigger points in their pelvic floor. Additionally trigger points in the pelvic floor can refer to other parts of the body and present as pain in the bladder or rectum, and other places.

Restrictions and trigger points in the fascia are linked to a whole host of symptoms. Treating the body at the level of the fascia is often very helpful at easing or resolving these symptoms. Below is a non exhaustive list of symptoms and conditions related to myofascial trigger points and dysfunction:

  • Fibromyalgia pain syndrome
  • Myofascial pain syndrome
  • Migraines
  • Tension headaches
  • Whiplash
  • Pelvic pain
  • Complex regional pain syndrome
  • Back pain
  • Urinary and fecal incontinence
  • Sports and orthopedic injuries

How do we treat it?

Here is where it gets “controversial” in the health community. Fascia is strong. Really, really strong. Some would say as strong as steel. There are many in the community that claim myofascial release is impossible because there’s no clinician who is strong enough and applying enough force to break through and make a difference in the knots… I mean, I have a pretty solid deadlift but you won’t be finding me bending metal beams anytime soon. This argument misses the point and fails to recognize how complex fascia is. Think back to our cell party. We are not simply trying to break through fascia; we are providing a sensory stimulus and allowing the fascia to adapt or change in response. When true myofascial release is formed correctly, very little force is being used and it is usually an extremely gentle technique that can be tolerated by many patients who may not have been able to tolerate more aggressive techniques. When performing myofascial release, the clinician engages the barrier, meaning they apply enough force to feel the first inklings of resistance, and they hold their pressure there and slowly take up slack as the barrier melts underneath them. There is nothing forceful about it. In fact, when I first learned this technique from a mentor trained in Barnes myofascial release technique, she would always say, “If you think you are working too hard, you probably are”. There’s nothing steel beam bendy about MFR at all. Myofascial release allows the tissue to respond to the input the clinician is providing, rather than aggressively stretching, mashing, or pulling it. Although the exact mechanism of how MFR works is elusive, many theories recognize the individual players and cell types within the fascia, (remember our cell party), whether that be down regulation of the autonomic nervous system, (reduced fight or flight), activation of the central nervous system, and release of chemicals from the cells within the fascia.

The fact is with physical therapy, there are so many different tools that one can use. Usually clinicians tend to gravitate towards what they are good at and what tends to help the maximum number of their patients. At BBPT we value MFR as a helpful tool in our repertoire.

Ajimsha M.S., Al- Mudahka N. Effectiveness of myofascial release: Systemic review of randomized control trials. J Bodyw Mov Ther. 2015 Jan;19(1):102-12.

Horton R, “Mobilization of the myofascial layer: pelvis and lower extremity”. Raleigh, NC, USA. 9/22/2017- 9/ 24-2017. lecture.

Shah J, Thaker N, Heimur J, et al. Myofascial trigger points then and now: A historical and scientific prospective. PM R. 2015; 7(7): 746-61

Marathon Training and Racing Wellness: Why I Chose Tina

Molly Team Tisch MSMolly Caughlan PT, DPT

I am very excited to announce that I will begin training soon and will be running the New York Marathon for the first time. I will be running as part of Team TISCH MS alongside my awesome and inspirational co-worker, Fiona McMahon. We are working together to raise a combined $10,000 dollars to support multiple sclerosis research. You can donate to my personal fundraising page here. This is an incredible opportunity that I feel so honored to be a part of. I decided to run the marathon as part of my New York and life bucket list. I see marathon training as a perfect way to get to know all of the five burrows. Running has always been my way of getting to know the city I’m living in.

I have trained for several 5K, 10K and half marathon races, but only one full marathon. My first (and only) marathon I call my “almost marathon” took place in Savannah, GA in November, when the weather should be sunny and 70s. Unfortunately, due to a heat index of 105 and with several hundred participants fainting due to heat exhaustion, they cut the race short and made everyone turn around at mile 14. I was relieved, frustrated, exhausted, and incredibly HOT. My 6 months of training in the hot Atlanta summer had not prepared me for the intense humidity that made me feel as if I were swimming and not running.

Beyond Basics Physical Therapy has generously offered physical therapy services to me to help me meet my marathon training goals. First and foremost, I’d like to complete my training and marathon without any major injuries. In previous races, I’ve been fortunate to not have any serious injuries and just minor aches/pains. My main problem areas are my right sacroiliac joint and right foot feeling occasionally unstable and achy. Second, I’d like to finish in under 4 and a half hours, meaning little to no walking breaks. My pace is on the slower end (around 10 min/mile) and I’m hoping to increase my pace. My third goal is to get the most out of my training and to fully enjoy the whole process.

My co-worker Tina Cardenia will be my physical therapist and I could not be more thrilled to be working with someone so incredibly talented, intelligent, and experienced. Tina has an extensive background working in an orthopedic setting and has completed the intense certification process in Functional Manual Therapy (CFMT). Tina uses this strong framework to look at the body as a whole and bring its function to optimal capacity.

These next 6 months will be intense, but I’m excited to push my body to new limits and finally cross “marathon” off the list. With the help of Tina, Team TISCH, and Beyond Basics, I am excited to take on this new challenge. I’m confident that I’ll meet all the goals I’ve set out for myself and look forward to November as they come into fruition.

Both Molly and Tina work in our Midtown Location.

PT Molly

 

PH101: Ladies Only Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on April 23. Please register at pelvichealth101.eventbrite.com

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Spring 2019

Pilates with Kierstin! Standing Side Splits

StandingSideSplits

Kierstin Elliot

Exercise: Standing Side Splits

Set Up: Stand with one foot on the carriage and one foot on the platform with weight distributed evenly between both legs. Slightly turn out your legs to help engage outer rotators and glutes. Lighter spring setting will focus on adductors (insides of legs) while a heavier spring setting focuses on abductors (outsides of legs).

Execution: The breath for this exercise changes based on adductor or abductor focus. For adductors- inhale to push carriage away from the platform and exhale to pull carriage back in. For abductors- exhale to push carriage away and inhale to control the carriage back in. Move the carriage out only as far as you can go while maintaining good form, as soon as neutral pelvis shifts to a tilt or a tuck, you’ve gone too far.

Focus: Be sure to keep the integrity of your form throughout the entire exercise. Keep a tall, stacked spine with ribcage over hips, neutral pelvis, and lifted arches. Think of a string lifting you up from the crown of your head. It’s common for the arches of your feet to drop, causing pronation. Keep that pinky toe connected to the machine. This will also keep the knees in correct alignment.

Importance: Great postural exercise. It’s meant to focus on either adductor or abductor strengthening depending on desired resistance. As a whole, it draws attention to weight placement and how that affects your alignment while standing.

Modifications: If you are apprehensive about balance, grab a pole or a long dowel and place that on the floor right in front of you while standing on the machine. If this exercise bothers your knees, keep a slight bend in them the whole time.