Tuesday, January 14, 2014

Enter stage left: Pilates! And stage right. And from above. And from below.....

Pilates is an exercise program designed to build strength in the so called "powerhouse" of the body: the roughly rectangular shape of the torso, from shoulders down to the thighs. It is all about strengthening those parts of the body that support us most, and at the same time increase flexibility and balance.

Because the emphasis of pilates is on pelvic and spinal alignment, it can be a very good thing indeed for someone with scoliosis.  However.....(don't you hate the fact there is always a "however"?)  not every pilates exercise is good for anyone let alone someone with a bit more curves on one side than the other.  A good instructor will know how to modify an exercise for both range of difficulty and range of possibility depending on what your body is capable of.  Intensity and dexterity can be increased over time as the body conditions and adapts to the exercises. 

If the previous paragraph was not clear enough, allow me to reiterate: It is really, really important to find a pilates instructor who is qualified, and ideally has either experience with scoliosis or with physiotherapy.  Do not tinker with the internet, youtube videos and how-to handbooks.  These are not a good idea for anyone actually. 

Pilates is designed to wake up all those little muscles that don't get worked because the big ones immediately get in there and activate. So if something happens to them or when they start to break down, there is nothing underneath that can keep you upright and mobile.  An introduction to pilates should start with the basics, including how to breathe (I kid you not!  It was soon apparent to me that I have been breathing inefficiently all these years. It's a wonder I'm still alive) 

The powerhouse muscles are the transversus abdominus (the muscle that runs between the ribs and the pelvis), the multifidus (next to the spine in the lower back) and the pelvic floor muscles. Focusing on these muscles strengthens the body core from the inside, like constructing a scaffold, which is not only good for degenerative disc diseases or rehabilitation from a back surgery, the sorts of things that inspired Mr. Joseph Pilates to begin with, but is also the ticket for those with scoliosis. And just as poorly constructed scaffolding that isn't well designed or tailored to an individual building will end in disaster, exercises that are not taught correctly and to a patient’s unique back diagnosis could result in even more problems.  And haven't we problems enough without adding to them?
Work one-on-one if you can or in a very small class to determine what your body needs. Anything that is difficult is probably important for you. And if you are sore the next day, remember what exercise made you sore, 'cuz that's the one you probably need most!

Exercising with good posture is absolutely vital in pilates. There's a constant need to remember to keep your neck relaxed, your chin tucked, your lats. down and firing, your abs. taught but not tight, your glutes relaxed, etc. etc..... Pilates demands such intense mental focus so that you can control each movement throughout an entire sequence, connecting movements between one or more specific parts of the body and the mind while also paying attention to breathing, bending, extension, rotation and flexing of the spine. Looking at someone lying there seemingly taking a coffee break, it may look easy, but do not ever say so or you will get a dark look and perhaps a swift uppercut to the jaw.  Pilates is no walk in the park!

Precision is essential, so that the muscle intended to be worked does the work and doesn't allow a larger, stronger muscle to take over.  It is far better to do only a few exercises in perfect form than a hundred reps. in poor form.  This is particularly important for those with scoliosis, as there will no doubt be exercises and thus modifications that are actually detrimental to a particular curve.
Avoid the tendency to think larger is better; working in flexion and extension works well. For every action there is an equal and opposite reaction (there you are Dr. Mosley - I did remember something from your physics class!) Having scoliosis means you should not be surprises to find that rotation and side-bending will always be limited in one direction. In most cases it is best to exercise both sides the same, but do the side that needs it more.
The goal of course is to eventually exercise in a form and posture that has become second nature, and that can be carried over into everyday life. 

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