Nerve pain can run the gamut and I've seen nerve pain stem from  many sources.  I am going to write about just one stemming from a current patient.  The nerve pain is the result of a bladder 'lift' surgery that this patient had recently.  During the surgery the nerve that feeds into the right side hamstring muscles (back of the thigh) was knicked (this is not sciatic pain).  The result is burning pain and cramping in that leg. Sometimes she describes the pain as getting 'zinged' or a little bit of an electric shock.  But what makes her have to stop what she's doing and lie down is the cramping and the burning/ache in that leg.  She has co me a long way with a 6-week Pilates program and the following notes will give you an idea of how we did it.  Oh, she started Pilates as a last resort which is unfortunately, still usually the case with most people in pain.  She had traditional physical therapy after surgery and then started Pilates about 6 months after surgery.

Her program:

• Hamstring activity.  After checking her hamstring activity (firing v. not firing; weak v. strong) the right leg was definitely weaker than the left but not by as much as I would have thought.  She was able to perform the same activities on the right that she did on the left but the right leg fatigued more quickly and the hamstring cramped easily (a sign of weakness).  My favorite exercise for this? Initially side-lying leg work with a flexed foot at the front of the footbar or jumpboard.  Once she was stronger, bridging.

• Gluteal activation/strength.  With any sort of back pain or lower extremity pain it is wise to check the gluteals.  Are they activating? Are they weak?  Interestingly enough, when I was first training to be a Pilates instructor, there was a big movement to dis-engage the gluteals.  There were signs posted in studios that said: No Gluteals Required.  After about 10 years of working with fitness and rehab clients I really don't understand what 'no gluteals required' was trying to accomplish.  If the gluteals are not firing it is a sign of dysfunction. When performing hip extension while lying prone the first muscle to engage should be the gluteals followed by the hamstrings and then the muscles of the spine. My favorite exercise for this? Prone single leg hip extension on the long box with the head, c-spine and upper t-spine hanging towards the floor. No movement of the carriage, just like the position because it discourages, to a greater degree, spine engagement.

• Spine strength. Endurance of the spine needed to be improved as outside of her nerve pain, low back pain was second on the list.  It makes sense that it would be, the hamstrings were weak and the gluteals weren't helping out at all which leaves the low back muscles to pick up the slack.  You might think with all the extra work these muscles were doing that the spine would be strong but no it was just tight and tight often is synonymous with weak. My favorite exercise?  Back to prone on the long box with the upper body flexed (hanging) towards the floor.  Extension to neutral only no farther.  I rarely extend past neutral with any client. It's an advanced exercise to be able to stabilize the lumbar spine to avoid 'resting' on the facet joints. 

Well, that's probably it for now.  There's a lot more to it, but this should get you started. Happy to answer any questions.  K

I don't usually blog about my radio show. But today is different.  It touched a nerve.  I had marathon runner, Suman, on the air and she was saying things I should have been saying to my patients and clients for years: It's really hard work to get fit so just do it or don't and stop telling me why you can't. I don't want to hear about how your day somehow whisks by faster than mine or that you are somehow busier than I am or that I am fit because I own a Pilates studio or genetics or whatever.  Enough.  If you want to feel great you will.  If you don't want to feel great you won't. 

 I've been working with patients with chronic back pain for 10 years.  I can count on one hand the number of people who have done their prescriptive exercise program at home every day, just like they were instructed. WHY??!! Pain is addictive? No one wants to work that hard?  Not enough time in the day? What?  I do not understand.  And yes, I know what it is like to have horrible back pain. I've had it most of my life and finally had surgery two years ago.  I also kayaked the Channel Islands on my 40th birthday and I am the celebrity dancer in our local version of 'Dancing with the Stars'.  All to tell say that it is possible to have back pain and to work hard to be extremely functional and able to do what you love to do.

But yes, it IS really hard work to be fit. And it's even harder to stop being in so much pain.  You are going to have to spend an hour a day to change the way you have been living.  If you don't have an hour then you will be old before your time and exhausted all the way there.  Not being fit will make you tired, but being in pain is completely exhausting.  You enjoy that?  I mean, c'mon, really?  You'd rather be slugging your butt around because you are out of shape?  Immobile because you are in pain?  Need to scare yourself straight?  Go visit a nursing home.  Scary stuff that.  Fifty percent of the problems at a nursing home are out of our control but the other 50% would have been solved with lifelong good health habits (and probably more than 50%).

I attended a 9am meeting yesterday.  I already had the dogs out for a 2 mile walk and  I did my 30 minutes of exercise for keeping my own back pain in check.  At the meeting, I would say half of the attendees had had similar mornings.  The other half 'didn't have time' in the morning and won't have time later, either.  Really?  How is it that so many people are capable of fitting it all in but then there is the flip side of that: so many people can't. You have no choice but to get your act together if you want to feel better.  I really believe that feeling good is a habit you need to hone if feeling good is really what you want.

Is it worth it?  That's your call. I, and a thousand other fitness/health experts, can give you the tools but the hard, hard work is all your. 

There's quite a few of us out there that would love someone to invent a bra that does the same thing for the backside that a regular bra does for the front side. Why do our booties sag? Is it an inevitable part of aging? Let's talk about the 'why' question first.

Why our Booties Sag...

The obvious answer is that your bootie is sagging because you aren't using it.  But it's not just a matter of doing an hour long butt-busting workout to make that muscle (gluteus maximus) more toned.  I watch clients everyday perform so-called gluteal exercises without using their gluteals. That's bad news.  If the gluteals aren't working then the low back and the hamstrings are working overtime.  The result?  Tight spine extensors and hamstrings.  This pattern is actually very common with anyone who has ever experienced a bout of back pain. No one really knows why, but those gluteals stop working when the back starts hurting.  And when the back pain goes away those gluteals still don't want to work.  Without intense focus those gluteals won't begin to fire again. 

Is a Sagging Bootie an Inevitable Part of Aging? 

Yes and no. Yes, because 80% of will experience a serious bout of back pain at some time in our lives. So those 80% will need to really focus on getting those gluteals to fire again if they are to avoid the Bootie-Bra.  No, because anyone can learn to reactivate those gluteals again but the more back pain you've had the more you will have to work on getting those gluteals to come to back to the party. 

Here's what to look for when you are trying to fire up those gluteals. 

• Are your pants puckering?  If there is no change in the crease of your pants when you are performing a butt exercise then your butt is definitely not working.
• Is there an indent in the side of your hips?  There should be a dent.  The size of half a tennis ball.
• Poke your fingers into the sides of your butt muscles.  You will feel them tighten if they are working.
• And most obvious of all, you should feel them working. When you are doing a butt exercise you should feel the butt muscles. No?  Then you are doing it wrong.  Try again. You can do it. 

Here a link to a great exercise to get you started: http://bit.ly/625QTL

Good luck and let me know if you have any questions.  Karena

 

 'Tis true, 'tis true.  If you were to use correct posture whenever you were standing or walking you would strengthen your abs more than performing sit-ups 'til you puked.  It is a matter of very high repetition and low levels of work.  I get comments all the time along the lines of: Of course, you have a flat stomach you do Pilates all day.  Wrong.  I don't do Pilates all day; I teach Pilates all day. Secondly, I haven't done a sit-up in over a decade: bad back.  Lastly, my abs are very solid.  I stand up straight as often as I remember (dancers are notorious for horrible posture) and when I exercise I try to keep my alignment.

Think about your own workout.  You are in your Pilates class and working, working, working.  You stand up to leave and your posture is horrendous.  I see it everyday.  What did we just work on for the last hour? We worked on making you feel better: with an awesome bonus result of having a higher tush and sexier arms.  If you stand up and don't stand up straight you throw a lot of that work away.  Yes, you'll retain a percentage of it but not all of it.  Your arms and your butt will benefit but your abs won't be able to retain as quickly if you stand with the abs relaxed all day.  But, really, it's not just the abs that work when you stand up straight. Here's the list:

When you stand up straight here are just a few muscle building benefit:

1. Abdominals: Stand with the abdominals gently braced 
2. Upper Back: With your shoulders squared off (not yanked together) and gently pressed down the upper back gets a great workout as do the posterior deltoids (shoulders)and latissimus
3. Gluteals: For those of you who stand with your hips swayed forward, the gluteals never work and the butt disappears and the hamstrings are tight enough to saw down a redwood with.
   
   Most importantly when you stand up straight you are grooving a pattern, setting a new 'normal'.  Ever watch Cesar Milan on the Dog Whisperer? His most common tip is to get your dog out for a walk and train your dog while walking. You are setting a pattern, so when you bring the dog home he is more family/house friendly. More in tune with what you need from him.  Same with your body.  Train it to be there for you.  The benefits of standing up straight aren't purely an instantly flatter stomach and a sexier body.  You create adequate space for your organs (poor posture crushes them) which leads to improved lung, heart and digestive function.  Improved posture has even been said to improve mood. One of those reverse psychology tricks on your brain: act like you feel great and eventually your brain will believe it.  
   
   I could go on....

 

 

I have a client who has had a double hip replacement: a result of avascular necrosis.  I have found that certain exercises and corrections have been extremely helpful but I am still left with some questions on how to effectively 'get into' the correct muscles to groove the correct changes.   First here is what I have found to help:

1. Correct lumbar spine rotation.  Lumbar spine rotation (as well as a l/s lateral flexion) seems to be somewhat common post hip surgery or even spine surgery for that matter.  When the lumbar spine rotation and flexion is corrected, the hips are aligned as a result.  After being properly aligned, this particular client that I am writing about today almost always say, 'Now, I feel like I have room for my hips!'.  I suspect what she is feeling other times is the pressure being put on one hip as the pelvis dips inferiorly on one side causing that side to feel like it is in a constant state of contraction to maintain a somewhat neutral position.  The opposite hip dislocates frequently because it there is not enough contraction.

2. Glut medius and minimus strengthening. Once I get my client aligned correctly, I have her start working on the gluteal medius and minimus. It's a complete waste of time to work these muscles without first correcting the alignment.  Do what you need to do and use what you need to use to gain proper alignment.  If you are going to err, try to err in the direction of over-correction.  My client always finds her way back to her old pattern fairly quickly. I use a lot of side-lying leg work to strengthen these muscles as well as to work on the obliques.

3. Grooving squatting patterns. After some pain had subsided we began grooving squatting patterns using assistance and a chair that was bolstered up about 10" above normal.  I watch for that lumbar spine rotation and I have her sitting on a rotational disc so we can monitor the rotation.

So here's my question:  My focus with this client has primarily been gluteal: med, max and min. as well as on correcting alignment. If you have experienced this surgery or if you have worked with clients/patients in this situation I would be grateful to know your favorite (most effective) exercises for creating change.  Her main issues are alignment in the lumbar spine and lack of gluteal endurance.  But maybe there is something I am not seeing as well.  If you get a chance let me know if there may be something I am leaving out.  Thanks, K