I have always enjoyed physical activity. I probably should have been a farmer instead of an accountant. I always think about how injuring my knees had affected my life and how devastating that would have been in prior periods of history. A debilating injury was just about a death sentence.
My latest visit to the orthopedic was prompted by swelling in the back of my knees after walking and playing golf. In addition, I was experiencing pain in my knees that woke me in the mornings. The swelling in the back of my knees were Bakers cists and the pain in the morning was arthritis. His solution is to replace both of my knees when I feel I can’t take the pain or the aggravation any more. I, on the other hand, want to play golf walking the course while I’m still able to see where the ball goes and hit the ball far enough to almost lose sight of it.
To that end, I decided to replace the knees after I was physically more ready for what would be required for a rapid recovery. I began lifting light weight three days a week and walking three miles on days I didn’t play golf. The weight lifting and walking probably help me greatly with weight control since I love to eat and really love to eat ice cream.
After talking to Stephanie I decided to try Pilates to see if it would help with my conditioning before surgery and have a later positive influence with my recovery. I started all of this about nine months before I was going to schedule the replacements. After spring started and after two or three months of Pilates my golf game changed. I’m sure not all of it was attributable to any of the above but I did notice my swing was more balanced and the turn of my shoulders was smoother and longer. Both of those things didn’t have anything to do with weights or walking so I knew it had to be the Pilates. The weights certainly helped with overall strength. I am sure that Pilates has really improved my core strength (abs, quads, hips, and lower back) . I don’t do anything for those areas other than Pilates and never have.
I was always involved in some type of physical activity and I knew that with most things I had some sore muscles after completion or the next day. In addition, most of these activities were specific to body parts. For example, running left my legs like rubber afterwards and my quads sore the next morning until I warmed them up and ran again. Pilates hasn’t done that to me and I feel the benefit of the exercise in so many different areas of my body. In a normal class we progress through a warm up and the exercise of different muscles from top to bottom and don’t stress any one specific area. I don’t in general get the same soreness that I get from any other type of exercise.
I think I’m ready both mentally and physically to have my knees replaced. I’ll keep you updated throughout the process.
Bill W

In pilates, one of the goals of stretching is to maintain postural balance. Opposing muscle groups need to be balanced in both length and strength for efficient performance and injury prevention. Opposing muscle groups that are well balanced provide optimal stabilization for the spine and peripheral joints.

One size does not fit all. General guidelines exist but specific (modified) stretching exercises will need to be tailored to each individual. For instance, amateur athletes will have different specific needs than individuals with injuries or illness.

Let’s take an example. Let’s look at the lower leg. The hamstrings, the muscles that run down the back of the leg, are classic culprits for “being tight”. Actually consisting of three muscles not one, the hamstrings start at your “sits” bones and stop right below the knee on both the outside and the inside of the lower leg. Tight hamstrings can cause pain and cramping anywhere along the muscle length.

The hamstrings extend the hip and flex the knee. To stretch the muscle, do the opposite. If you can lie on your back and lift your leg to 90 degrees with the hips square to the floor, you meet the general recommendation for adequate hamstring length.

The hamstrings and quadriceps muscles oppose each other. The quadricep muscles run down the front of the upper leg and extend the knee (kicking a ball); the hamstring muscles run down the back of the leg and flex the knee (doing a hamstring curl). If these two muscle groups are not equally balanced, the pelvis, hips and knees will not be properly stabilized and are predisposed to injury. Shortened hamstrings are associated with low back pain and knee pain.

Hamstrings that are too tight for an individual’s sports or daily activities are predisposed to “tweaking”, “pulling” and other injuries. “Tweaking” a hamstring is another way of saying the muscle fibers were stretched beyond capacity creating inflammation, pain and scar tissue. “Pulling” a hamstring usually refers to a tear of some degree. Rarely, hamstrings can rupture completely.

Injured hamstrings take a long time to heal-months to years-and are highly sensitive to re-injury. Prevention is much easier than rehabilitation. Always stretch a warm muscle, and avoid excessive stretching before any sports activity.

What does it take to perform this fundamental move?
-Flexibility in the spine, hips and shoulders
-Muscular strength in the rotators of the spine and hips
-Neuromuscular coordination to control your posture

The first is flexibility in the thoracic (upper) and lumbar (lower) spine.  Inflexibility in the thoracic spine is common in individuals that sit at a computer all day.  Inflexibility increases with age.  If you already have some rounding in your upper back and your shoulders tend to slump forward, your thoracic spine and your golf swing will benefit from the restorative nature of Pilates exercise.

If the thoracic spine is “stiff”, the lumbar spine (the more flexible of the two) has to work harder.  This can contribute to low back pain, particularly if the low back muscles are weak already.  Increasing rotational flexibility of the entire spine will give you a more athletic swing, and allow you to move more freely in every day life.

Decreased range of motion in the shoulders and hips can also prevent a full turn.  Pilates strengthens and lengthens the small muscles of the shoulders (rotator cuff) and hips to improve flexibility and protect against injury. Pilates increases lower body strength in the quadriceps and glute muscles. Learning to rotate, rather than sway, the hips provides a more consistent release through the ball.

Building a strong core of abdominal muscles provides power for the turn.  The six-pack abdominal muscle (rectus abdominis) plays no role in spinal rotation; you need to build the internal and external obliques.  Exercises employing rotation, lateral flexion and flexion with rotation strengthen the oblique muscles.

Neuromuscular control of posture is challenging for many clients.  Your brain and muscles need to communicate effectively.  The first step is the ability to visualize and “feel” correct postural balance.  Small muscles along your spine provide proprioceptive feedback of alignment. The instructor will cue corrections to your posture throughout the exercises to help you keep your spine aligned.

Pilates is not a quick fix.  It takes time to increase the flexibility of your spine.  It takes time to improve the strength and endurance of your muscles.  It takes time to gain better control of your posture.  All three of these modalities need to function in unison to “swing around your spine”.  Pilates is not quick, but it works.

When I found LNK (about 14 months ago), I had been looking for a Pilates studio for over a year. I could only find gyms in the Baltimore area that offered inconveniently-timed classes and Yoga studios that offered 1-2 mat classes a week (no Reformer machines). LNK does Pilates and they do it exceptionally well. I recently developed joint pain preventing me from fully engaging in other forms of exercise I used to do weekly. Pilates is completely adaptable and the LNK instructors are adept at modifying the exercises on the fly during classes. I have always enjoyed various forms of exercise, butPilates is now my favorite. Pilates works all of your muscles (including some you didn’t even know you had) and improves flexibility and balance. If I am in pain, I know the exercise can be modified and I will still benefit physically. If I want to add cardio, jump board classes are available. If I am tight on time, I know I can walk in the class without preparation and a thoughtful, thorough and balanced exercise plan is ready for me. The courses are timely, diverse and well-organized. I can’t say enough for the instructors – they are top-notch. LNK continues to exceed my expectations and a year later I still take two classes a week.

Strengthening and stretching these muscles are critical for good shoulder mobility. The four muscles include supraspinatus, teres minor, infraspinatus and subscapularis. Specific Pilates exercises target each of these muscles. The muscles move the shoulder as follows:

• Supraspinatus abducts the arm away from the body and is active when the arm is raised
• Subscapularis internally rotates the arm and is active when the arm turns toward the body
• Infraspinatus & teres minor externally rotate the arm and are active when the arm turns out

Even more importantly, the rotator cuff muscles work to maintain the head of the humerus in the correct position during movement of the arm. The humerus needs to glide and slide in the shoulder joint. If this doesn’t occur properly, the head of the humerus bangs against the rotator cuff of the shoulder potentially causing injury.

Using the shoulder blades as an anchor, the rotator cuff muscles keep the humerus in proper position during movement. The cue “glide your shoulder blades down your back” during arm exercises is meant to stabilize this “anchor” and allow the humerus to glide and slide smoothly.

Range of motion in the shoulder is also critical to good shoulder function. Stretching is as important as strengthening. Minimum flexibility standards (as excerpted from Johnson in Treat Your Own Rotator Cuff) are as follows:

• Flexion: Lie on your back with your arm at your side and then lift your arm towards your head. All the way up by your ear is 180 degrees; Normal flexibility for men is 160ﾟ and 167ﾟ for women.
• Internal rotation: In a standing position, reach behind your back to your shoulder blades. Normal for men is 1/2 inch above the tip (or bottom) of the shoulder blade (T6) and one inch above the tip for women (T5).
• External rotation: In a standing position with your elbow bent at 90ﾟ and the arm pointing in front of you, rotate your arm away from your body with the elbow bent. Normal for men is 72ﾟ and 78ﾟ for women.

Strengthen and stretch your rotator cuff for good shoulder health to keep you performing at your maximum ability whether you are an elite athlete or just looking to improve activities of daily living. Your shoulders, spine and hips contribute to a strong Core.

Build your Core for More!

*Medical Illustration Copyright 2009 Nucleus Medical Media, All rights reserved www.nucleusinc.com

Three cues for physical performance can greatly improve posture in the majority of clients: 1. Lengthen the spine; 2. Glide the shoulders down your back; and, 3. Strengthen the abs by connecting ribs to hips. To “personalize” your cues, get a formal Postural Analysis to assess your own posture. A static Postural Analysis will allow you to identify postural imbalances and design an efficient Pilates exercise program to help you look and feel better.

It starts by looking at the alignment of your body from head to toe from a side view. The major joints –ankle, knee, hip and shoulder-need to be in proper position relative to the spine and to each other. Flexed or hyper-extended joints cause stress on the affected joint and on the spine.

Next, the shape of the spine and pelvis are assessed. The presence or absence of the natural curve of the cervical (neck), thoracic (upper back), and lumbar (low back) spine is noted. The ability of the spine to flex and extend with ease is assessed as you roll down toward the floor and return to a standing position. The pelvis may be tilted forward (excessive curve in the low back) or backward (flat low back) and correlates with specific muscle imbalances.

From the front view, the ankles and knees may bow in or out creating stress in the joints. The pelvis and shoulders may be uneven, tilted or rotated.

From the rear view, the position of the shoulder blades is noted. The scapula (shoulder blades) can be out of position in a variety of ways-protracted/retracted, elevated/depressed, tipped, winged and/or rotated. All imbalances that affect the ability to stabilize the shoulders during movement.

Your postural analysis is a good starting point for designing an effective Pilates program and monitoring progress. For instance, a flat low back is often associated with shortened hamstrings predisposing to hamstring injury and low back stiffness. Certain Pilates exercises target the hamstrings for lengthening and strengthening.

Rounded shoulders (kyphosis) and a hyperextended low back (lordosis) are associated with weak neck flexors, weak upper back muscles and weak external obliques. Exercises are prescribed to strengthen the upper back muscles and abdominals and elongate the spine.

Remember, faulty alignment results in undue stress on bones, joints, ligaments and muscles. Correct your posture and improve the way you look and feel. Restore posture. Relieve pain. And improve well being.

A research article published in the Journal of Orthopedic and Sports Physical Therapy showed that Pilates-based therapeutic exercise significantly decreased pain and disability in patients with chronic low back pain (J Orthop Sports Phys Ther 2006; 36:472-484).

Pilates exercises may be done on the floor using an exercise mat or using specialized Pilates Equipment. Pilates Matwork on the floor uses primarily your own body weight as resistance and requires good strength and flexibility to perform most exercises. Pilates Equipment-based exercises use a variety of springs, ropes, pedals and bars to assist the body in performing exercises. For clients with muscle imbalances, orthopedic limitations or rehabilitation needs, equipment-based instruction is recommended. An Introductory Private Session is a good way to work with your Instructor to find out what is best for you.

Brenda on the Arc Barrel

At LNK Pilates, we use small props in Matwork instruction. These props include the arc barrel, BOSU** Balance Trainer, Fitness Circle® resistance ring, Flex-Band® exerciser and Stability Balls™.

Not only do props provide variety and interest to the workout but help to assist the client in performing the exercise correctly. Once the client has gained good balance, strength and flexibility, exercises can be done without the help of aids.

Our Studio is equipped with STOTT PILATES® Equipment. There are four V2 Max Plus™ Reformers*. This unit functions as a standard Reformer, modified Cadillac and Raised Mat platform in one unit. The Reformer consists of a moving spring-loaded carriage and pulley system. Clients frequently comment on the soothing quality of the Reformer movement to the Mind while the Body is working hard.

Brenda & Stephanie working out on the Reformer

The modified Cadillac is a wonderful piece of equipment for working the Core and strengthening hips and shoulders. Have fun with arm and leg springs, and challenge your Core with the roll-down and push-thru bars. For clients with rehabilitation needs, the modified Cadillac is central to the exercise program. Our Studio is staffed with STOTT PILATES® Certified Instructors trained to modify exercises for rehabilitation.

Stability Chair

There are four Stability Chairs™ with raised handles and moving pedals that can be spilt utilizing spring-loaded resistance. Try out some of the interesting exercises on the Stability Chair™ to improve your balance! Four Spring Walls™ offer additional options for working arms and legs and Core through springs attached to a wall unit.

Spring Wall

Try the rotator cuff series to improve the stability and strength of your shoulder girdle! Full Studio classes allow the Instructor to pick the right exercises for your body using the appropriate piece of equipment. Clients love the variety and are amazed at how fast the time flies.

Ideally Pilates should be done twice a week for maximum benefit. We can help you pick the right mix of classes for your Body. Come workout with Brenda and Stephanie and see the difference Pilates can make for you.

™/® Trademark or registered trademark of Merrithew Corporation, used under liscense

BOSU** is a registered trademark of BOSU Fitness, LLC, used with permission

A common finding in exercise-induced pain is crepitus around the kneecap. Knee crepitus or patello-femoral crepitus results from abnormal movement of the kneecap (patella) on the end of the thighbone (femur).

Check out this 30-second video file to hear it… CLICK HERE FOR VIDEO

Crepitus can be an isolated finding without pain. If there is no pain, ensure good functional alignment of the hip, knee and ankle to prevent future problems, especially if “flat arches” are present. Pilates is an ideal form of exercise for strengthening, lengthening and balancing opposing muscle groups to allow for proper functional alignment.

Anatomy of the Knee

Normal Knee. Medical Illustration Copyright © 2009 Nucleus Medical Art. All Rights Reserved. www.nucleusinc.com

The quadriceps muscles play a key role in allowing the patella (kneecap) to slide smoothly in the groove of the femur (thighbone). If the lateral quadriceps muscle on the outside of the thigh is stronger than the medial quadriceps muscle on the inside of the leg, the patella will be pulled laterally and rub or bang against the femur as the knee is bent. Performing Pilates side-lying work with feet in straps helps to balance these muscles and keep the patella well aligned in the femoral groove.

Crepitus with pain is often associated with wear & tear of the cartilage behind the kneecap. Chondromalacia Patella is an irritation of the cartilage behind the patella that results in patellofemoral pain or pain around the kneecap. It is frequently described as a dull ache with occasional sharp twinges or stabs. Walking up and down the stairs exacerbates pain. Walking down the stairs may cause more pain than going up. Kneeling is difficult, as is prolonged sitting. Both can result in pain and discomfort.

The Reformer is a piece of Pilates Equipment excellent for clients with exercised-induced knee pain. Leg exercises are performed lying supine against spring-loaded resistance. Lying on the back takes pressure off the kneecap since the client is no longer weight-bearing. The spring resistance can be adjusted to the client’s level of fitness. Limiting the range of movement of the reformer can control the degree of knee flexion. This is helpful to clients with knee replacements or limitation in knee flexion for other reasons.

The modified Cadillac and Spring Walls allow exercises to be performed in a standing rather than kneeling position. Kneeling for even short period of time can be painful and nonproductive for many people with knee problems. Modifying exercises by having clients sit on the reformer box rather than kneeling may be helpful.

Clients with osteoarthritis of the knees frequently benefit from Pilates. Osteoarthritis results from excessive wear and tear of the cartilage on the surface of articulating bone. Simply said, the end of the bone becomes rough and ragged and no longer freely glides along the meniscus surface of the knee joint.

Osteoarthritis of the Knee

Osteoarthritic Knee. Medical Illustration Copyright © 2009 Nucleus Medical Art. All Rights Reserved.

This is a common finding in athletes with prior injury to the meniscus or ligaments of the knee joint. Muscular imbalances combined with prolonged repetitive activities (running, biking, racquet sports) can wear down the cartilage in the knee. Footwork on the Reformer or Stability Chair can allow clients to maintain balanced strength in the legs without further irritation to the knee. Feet in Straps on the Reformer or Leg Presses on the Cadillac can help lengthen hamstrings.

Other culprits of knee pain include excessive weight, genetic tendencies toward early degenerative changes or just the wear and tear of daily activities over years of use. Pilates can help to reduce the biomechanical stresses on the knee by strengthening and stretching opposing muscle groups without causing additional stress on the knees.

If you have knee pain and have had little luck in finding an exercise regimen you like, give us a call and give Pilates a try. Be sure to be as specific as possible with your medical history. If you have radiology reports, we’d like to see them (just the reports-we can’t read images!). Exercises should not hurt! Feeling a hard working muscle is fine but pain is not gain. Be sure to tell us when you feel discomfort and we will modify the exercise for you.

With the proper modifications, Pilates is good for Every Body!