The use of Breath in the Pilates Method

Denise Small PT, DPT

The following series of Pilates blog posts will focus on the principles that define the Pilates method.  Joseph Pilates developed his methodology using eight basic movement principles: whole body movement, breathing, balanced muscle development, concentration, control, centering, precision, and rhythm.  Today’s blog will focus on the principle of Breathing.

pilatesBreathing is a natural phenomenon that is performed thousands of times a day. Our daily intake of oxygen and expulsion of carbon dioxide is needed to cleanse our blood, and maintain the functioning of our body systems.  That being said, there are different ways to manipulate one’s breath to help facilitate certain physiological functions. For example, there have been many BBPT blog posts about diaphragmatic breathing, where one breathes into their abdomen to get a stretch of both the diaphragm and the pelvic floor muscles. Well, Pilates had his own approach to breathing, which was a variation on Diaphragmatic breathing.  Pilates approach to breathing was aimed at getting maximal air intake and release to give the body, what he called, “an internal shower” to rid the body of “toxins”. Pilates focused specifically on lateral expansion of the diaphragm, whereas traditional diaphragmatic breathing focuses on the vertical expansion of the diaphragm. In order to achieve this, Pilates encouraged maintaining the engaged tone of the abdomen, while breathing into the front, sides, and back of the ribcage. See the image below for further explanation.

 

Pilates- Ribcage/ Chest breathing versus Belly/Diaphragmatic breathing

This is an overly simplified view of the actual mechanics. However, both versions are very important. With the ability to differentiate between ribcage and diaphragmatic breathing you can offer your diaphragm a 3-dimensional stretch and the ability to work on abdominal contraction as well as endurance. If you have any questions you can ask them in the comments section. Or come visit me at Beyond Basics for a Pilates Private session!

Benefits of Pilates with Pain Conditions

By: Amy Stein, PT, DPT & Denise Small, PT, DPT
deniseDenise 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.

They are:

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.

Beyond Basics’s Pro-Bono Clinic for PT Day of Service!

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Victoria LaManna, DPT

October is around the corner! And a busy month for many. Whether you are getting back into the swing of school or work after summer vacation, preparing your Halloween costume or getting ready for all the upcoming holidays right around the corner – there is a lot going on!
This time of year is also an opportunity to do good and give back. October is National Physical Therapy Month, where physical therapists celebrate their amazing field of healing and getting people back to optimal function. In addition, many of the PT’s throughout the U.S. give back to their communities during this month. This year we are taking it up a notch. Physical therapists WORLDWIDE are getting involved for the second annual Global PT Day of Service Saturday, October 15th. Whether it is by hosting a pro-bono clinic, serving in a soup kitchen, participating in a 5k for a cause, or cleaning up a community garden – physical therapists globally as a profession are coming together to make a positive impact on the world around them.
At Beyond Basics, we have decided to host a pro-bono clinic Saturday, October 1st to give back to those in the New York City area who may not have insurance or access to physical therapy. We are providing 30 minute one-on-one evaluations and recommendations for home programs to up to 30 participants. For more information and to sign up please visit: http://signup.com/go/Nu1T4Q
You can also check out PT Day of Service here and follow on twitter (#PTDOS) to see how the day unfolds! http://ptdayofservice.com/
The American Physical Therapy Association (APTA) is also involved in hosting National Physical Therapy Month. This year the APTA’s focus is on it’s national public awareness campaign, #ChoosePT. This campaign lets consumers know about the risks of opioid use and that physical therapy is a safe, non-opioid alternative for managing pain.
I encourage you to check out educational resources provided by the APTA (www.apta.org) and Move Forward PT (http://www.moveforwardpt.com/Default.aspx). Learn all about how physical therapy can help you overcome pain without the use of opiods, improve mobility and maintain independence throughout your lifetime.

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Spring Pelvic Health 101 Classes are About to Start!

Come Learn With Us! Free Pelvic Health 101 Classes at Beyond Basics Physical Therapy!

By Fiona McMahon, DPT

It’s that time of year again, temperatures are rising, the days are getting longer, and we at Beyond Basics Physical Therapy are gearing up and getting ready to start up our hugely successful Pelvic Health 101(PH101) classes for the spring and we couldn’t be more excited!

Our upcoming Pelvic Health 101 Course is the third in our series of PH101 courses. Our courses cover a variety of topics from male and female sexuality, bowel and bladder health, nutrition, as well as complimentary medicine for pelvic floor dysfunction. In this blog we will sit down with one of Beyond Basics’ Senior Physical Therapists and the creative force behind our Pelvic Health 101 Classes, Stephanie Stamas, to get more information on this wonderful resource.

FM: Why did you begin PH101?
SS: I began the Pelvic Health 101 seminar series last fall out of a desire to help more people. There are a lot of people out there who have consistently been told there is nothing wrong with them, it is all in their head or they should just get over it. I wanted to put together an educational series that would validate people’s suffering as well as give them tools to heal and return to a normal life. I believe that information is power, and that power gives people freedom and hope – two things that are often lacking in patients suffering with pelvic floor dysfunction.

FM: Who is the intended audience for PH101?
SS: Current patients, prospective patients, healthcare providers who have questions about how to better treat pelvic pain – really anyone. I tailor these classes so they are understandable to the general population, but I also try to give more in-depth information than one might find elsewhere. I really want class participants to leave with a clear picture of what is going on with their bodies.

FM: Do you have to be a current patient at BBPT to go?
SS: Not at all! Most of the participants have been prospective patients looking for more information and seeing if physical therapy can be helpful for their condition. We’ve also had plenty of other healthcare providers come to learn more about the musculoskeletal component to bowel, bladder and sexual dysfunction.  Everyone is welcome!

FM: What is your favorite topic to cover?
SS: I really love the bowel lecture, “Why is Pooping so Difficult.”It’s fun to be an adult and get to talk about pooping! Potty talk is often not socially acceptable but I like to open the floor to talk about issues that are often swept under the rug. I also really love our Ladies Only Night. It’s a safe place where women can come and ask any of their questions concerning pelvic health in a friendly, fun, women only environment. It almost has the feel of a girls’ night in with your friends, minus the pajamas and pillow fights.

FM: What are some of your favorite reactions from last years’ class?
SS: I love seeing “light bulbs” click on when people discover anatomical and physiological reasons why they are experiencing symptoms. People get so much bad information along the  way and often times are told everything is in their head. I love the smiles and hope on people’s faces when they hear the good news that it is not, and that there is a solution to their symptoms!

FM: What should people do who are interested in taking the class?
SS: They should sign up online as soon as they can at PelvicHealth101.eventbrite.com. The classes are free but space is limited so they do fill up quickly. Light refreshments will be provided. Check out our class schedule below!

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PT In-Service: Alignment and Core Exercises

By Amy Stein

Our famous Dania Kafka, who is an amazing physical therapist and Pilates instructor, recently discussed alignment, posture and core exercises correctly at our latest PT In-Service. She helped us with proper cueing because we don’t want pelvic pain patients to utilize the pelvic floor muscles, or limit their use, with any core stabilization exercises. We went over how to gently engage the transverse abdominus, which is one of the core muscles and helps with pelvic and trunk stability. If this muscle is weak and the patient is overusing their pelvic floor, they can end up with pelvic pain. Core and trunk muscle imbalances can be one of many reasons a patient ends up with pelvic pain and/or pelvic weakness. Therefore, it is important to have a strong and balanced core. Dania proceeded to lead us through a series of transverse abdominus exercises that were adapted by Shirley Sahrmann, PT, and we incorporated diaphragmatic breathing with each exercise. We practiced neutral spine versus posterior pelvic tilt to compare the difference, and discussed with which populations we would use which position.

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With any pain condition, if there are active trigger points, tightened and/or shortened tissue, you need to address these impairments prior to strengthening these muscles. Otherwise you can exacerbate trigger points and continue to shorten tissues. It is essential to make sure these conditions are resolved prior to starting a core exercise to that specific area.

With regard to pelvic floor weakness, including incontinence and post surgical weakness (prostatectomy, prolapse, etc.), it is important to strengthen the pelvic floor muscles correctly and the transverse abdominus correctly, as well as the rest of the core muscles.

Monitoring each patient with each exercise, is essential for their recovery, in order not to worsen any condition. Starting slow and in a controlled environment is key.

If you have any questions with regard to Pilates and core exercises and when to introduce them for pelvic pain, or pelvic weakness, feel free to call us and ask for any of our PTs. Or, attend our upcoming Pelvic Health 101 this spring!

Pilates: The Inner Lane

In our last few blogs, we focused on movement in the hip joint.  As a bonus to increasing our range of motion, we also increased the tone in our abdomen and in our gluteal muscles.  In addition, we did it all without gripping or squeezing our muscles, and by coordinating the movement with our breath.

Now, to balance out our legs and relate the abdominal tone to our inner thighs and pelvic floor, we will do a new set of exercises lying on our back.

To begin, lie on your back, preferably on a firm surface.  If possible, lay on a mat or towel on the floor and put a pillow under your head.  If you use a towel, place your feet on the floor, to prevent any possible sliding.

Next, place a small pillow or ball between your knees.  Preferably, the object should be soft to discourage any tension in your legs.

As usual, we will begin the movement by focusing on our breath.  Place your hands on your abdomen and breathe naturally.  In your mind’s eye, see your diaphragm floating up and down in your abdominal cavity, like a parachute blowing in the wind.  When I do this exercise, I always think about when we used to play with a large parachute in my elementary school gym class.

On your next inhale, feel your abdomen expand in your hands as you envision your diaphragm floating down into your pelvis. As you exhale, feel your abdominals contract as you envision your diaphragm floating up into your ribcage.

This breath coordination can be difficult to envision at first, but keep practicing.  The diaphragm moves this way naturally in relation to the abdominals.  If you attempt this exercise by envisioning what is happening, rather than forcing the movement, your body will fall into its natural rhythm.

When you feel you have mastered this concept, begin to add a light squeeze to the pillow, or object between your knees.  This slight contraction will add to the tone of your pelvic floor muscles and abdominals, as well as increase the length of your breath.  As you inhale, see your diaphragm descend and release the squeeze of the ball.  As you exhale, squeeze the ball as your contract your abdominals and float your diaphragm into your ribcage.

Repeat this exercise five to ten times.  If you are feeling any discomfort, stop the exercise.  Remember to contact your doctor or PT before continue with any painful movement.
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Pilates: Foot Review

In honor of summer, and the fabulous Riva Preil, we will use this blog to echo Riva’s advice on summer footwear.  We all know that flip-flops are, in theory, the perfect summer shoe.  They are light, they are airy, and they are very inexpensive.  However, flip-flops provide absolutely no support for our feet.

In an earlier blog, I mentioned the importance of having tone in the muscles of our feet.  If the muscles of our feet have good tone, the bones of our feet can maintain the proper structure they need to balance our legs, pelvis, and spine.  However, if you absolutely need to wear your flip-flops, do the following exercise daily to maintain proper muscle tone in your feet.

You can do this exercise either sitting or standing.  In addition, you will need a small ball, preferably the size of a tennis ball.

Place the ball of your foot on the ball and anchor your heel to the floor (photo 1).  Lift your toes off the ball, and then lower them again attempting to wrap your toes around the ball.  Repeat ten times. With each repetition, the ball of your foot should spread wider and extend further over the ball.

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After ten repetitions, maintain your toes wrapped around the ball.  From here, begin to rotate your foot from right to left (photo 2).  Attempt to keep this motion in your ankle, rather than your knee or your hip.  Do this action ten times.

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Next, roll the ball forward and backward under your foot while you point and flex your foot (photo 3).  This will help you maintain the proper heel striking rhythm that Riva mentions in her blog.  Repeat this action ten 10 times.

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When you have finished with one foot, stand on both feet and observe the difference between each.  Hopefully, the foot your exercised feels more grounded, yet, light and supported.