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- An understanding of the body’s movement potential
- Analysis of the available movement in the body by identifying holding patterns caused by dysfunctional movement in the individual
- Changing restrictions through techniques such as muscle energy, innovative Pilates set-ups on the apparatus and hands-on work
- Developing a whole body approach for strengthening and brain imprinting exercises to reinforce a new way of moving
- Self practice and continued education
Centered the workshop is designed to give teachers an in-depth look at techniques that facilitate structural and functional change. How to teach a client a felt sense for learning new movement patterns, clear hands on directions for the practitioner, and time for observing movement. The theory and techniques in the workshop are part of my book also titled Centered. The workshop gives you the ability to watch and practice techniques with my guidance and a body in action. It also includes extra techniques you will not find in the book.
The workshop is divided into three parts. Section one, starting at the base sole to spine. The foot influences structure and function of the body. Specifically the lower limb, pelvis, and lower spine. A spiral motion of the foot needs to be present for the synergistic movements of the ankle, knee, hip, and pelvis.
The techniques shown are assessing the foot and restoring a spiral motion of the foot through the leg, using a hands on approach while the client is moving on the apparatus. Section one progresses from the subtalar joint through the knee techniques, hip releases, and finally coaching movement patterning on the reformer.
So let's take a look at her achilles tendon in the shape of the achilles. So we're gonna notice whether it's a vertical line or if there's a slight bow. Some people bow this way.
And can you exaggerate and go the other way? Go to arches out. Some people bow this way. So what we're looking for is we're gonna see how is the person standing on their whole foot. And at times we'll find one achilles tendon more bowed than the other.
And that has to do with the function of how the person stands on their foot and the relationship of the bones of the foot. So here's the skeleton of the foot so we can see the relationship of the bones and how they move with one another. So here we have the calcaneus, which is your heel. We have the talus, it just sits on top. Like a little turtle shell with it's little head sticking out of the turtle shell.
And connected to that is the navicular. And for me it's like the turtles wearing a hat. That's how I remember the navicular. And on the lateral side of the foot we have the cuboid bone. Which is a keystone of this arch and meets the floor.
So there's articulations that happen and micro-movement that needs to happen so that the whole functional foot can actually do it's twisting and untwisting as we're walking and moving. The most important one for me I think is the subtalar joints. So if I turn this upside down and open out the bones here, you can see that there are three facet joints here between the calcaneus and the talus. And what needs to happen as we're moving with the heel lifting up and down even as we're walking is a slight little rotation. You can see it looks like a fishtail.
Or a doorknob if I'm turning a doorknob. A little doorknob fishtail action. It's a very small movement. And then the heel needs to spiral up towards the medial side of the foot. So it twists up like a doorknob and comes back down.
So that's the subtalar joint motion that we need to have. Now if the heels weighted and you're standing on the foot, then the talus will either fall towards the outside or the inside. And I call this arches out and arches in. This is a normal motion. Kind of a writing motion when we try to balance our leg.
The tibia comes down onto the talus. So if the talus is tipped outward, the tibia's gonna be tipped. If the talus is tipped inward it's also gonna be out of alignment. So we wanna stand with that talus in as best a neutral position as possible. And as that talus is moving you see it moves the rest of the bones of the forefoot.
So we're gonna do two hands on to find this. One is gonna be, we're gonna place our hand on either side of the talus. And we're just gonna see if we can move it arches in and arches out. This is a good teaching skill to teach a person when they're standing in arches out or arches in so they can feel it. The second one, the legs gonna be dangling and we're gonna take the hand and we're gonna wrap it around the talus so that we can stabilize it.
And then we're gonna hold that heal and we're gonna turn it like a doorknob fishtail and see if we can feel for any micro-movement here. And if you don't feel micro-movement here then the technique, the calcaneal spiral will be appropriate to do. So if she lifts her toes up, we're gonna notice that we have some strong tendons here. There's one tendon that runs this way from the anterior tibialis here. Comes around and wraps under.
And then we have extensor digitorum longus here. And this tendon is out here. And if you find those two tendons on the foot, you will find in the center of those two tendons is where the talus sits. So relax the toes and I'd like you to place your hand on the outside of this tendon and on the outside of this tendon here. Right at the joint.
And when your hands go in gently you'll be able to feel that you're on either side of the talus. So if the talus is on the outside, arches out. It's gonna be pressing out into your hand here. And come back to center. And then you can move the talus inward and you'll feel the bone more prominent on this side.
So we need to have a little motion here to have this kind of rocky motion. But in standing we wanna see and feel that that talus is in a neutral position. Not arches out or arches in which helps set up the achilles tendon in a nice straight line. Which then sets up the tibia, sitting on top of the talus in a nice alignment. So let's check the heel now.
So come sit and slide back. So to test the heel in the subtalar joint, you can grab the heel this way and we're gonna take the webspace of the hand right where the ankle bends this way. Right at the talus. And I'm gonna wrap my hand around and securely hold the midfoot and the talus. So I've got my thumb on the inside, this finger under the ankle here.
These three fingers underneath the foot, and I'm gonna stabilize here and I'm gonna hold the heel. I'm gonna bring the foot up with these fingers so that the foots in a gentle ease, not active dorsiflex action. Not fully flexed at the end joint. Just somewhere at the middle. And the persons relaxed.
And I'm gonna turn the heel. And with the heel I'm going to try to feel like I'm doing a fishtail doorknob motion. And as I'm trying to move her heel, there isn't any motion here. It's a very very tight, very stuck, no gliding at all. So this foot needs to have the calcaneal spiral technique that we're gonna do on the Cadillac.
Okay so come stand up and let's look at your achilles again. Good. So we haven't done any techniques yet but I can cue her to feel where the talus is and go slightly to arches out here. So I get that talus in a more neutral position and that kind of straightens this up a little but more. But what it then it does is it changes her forefoot.
So her big toe tends to lose contact. So there's a little work we have to do on this side to bring the talus into neutral. To help her forefoot be in a better position. And some forefoot exercises as well.
The calcaneal spiral is a technique to restore the micro-movement of that calcaneal subtalar joint that we described already.
So we do the hands on and I felt that Amy's right heel and subtalar joint didn't have that micro-movement. So we're gonna the technique on her right foot. So just gonna bring the bar up onto the ball of your foot and press up. So I have a bottom loaded with just a blue spring. So not too much resistance.
Now I'm holding the bar a little bit so it's not a lot of weight going into her body. Because I wanna show you how to position the leg properly. So just relax your foot, yeah. And notice what I wanna see is if I put a little pressure by pulling the bar down this way I'm creating some ankle movement. The pressure of the force is going into her knee and it's traveling through into the hip.
It's actually very good position. Now, move back this way. So let's show it. Let's say she lies down here, and I'm gonna test to see if where she's lying down is a good position. I wanna see the force vector from the bar transfer through the knee into the posterior part of her hip.
So as I pull down you'll notice it's coming out her knee. There's no motion, no weight of transfer going into her hip. So she's too far away. So coming in. So most likely when people lie down to do this technique they're not gonna necessarily be in the proper alignment to get this feeling.
So when you feel a difference? It bypasses the knee, goes right into the hip. So now I know she's in the right position. And I'm gonna move around here. The technique is that you're gonna clasp the hands this way and you're gonna cup the heel with the hands.
It's gonna take a lot of pec work to stabilize the heel. I'm gonna ask the client. And I don't give them which direction in or out. I just let them choose. I'd say I'd like you to rotate your thigh bone in and out.
And just keep moving it. And when you hit the end, reverse your direction. Yeah go slow. And when you the hit the end, reverse. A tiny movement.
There you go. So it's a mid-range of rotation. I shouldn't feel like she's gonna knock me over. She hits the end and then begins to reverse the direction. Try to focus on the head of the femur and the socket rotating.
So less pelvic, there you go. It's gonna be very small at first. I'm not allowing your heel to move. So what's happening is her femurs spiraling out. It's trying to.
And spiraling in. Which translates down into the tibia, also moving in and out onto the talus. So now I'm holding the heel still and the motions happening at the subtalar joint. And it's starting to move a little more now. So keep rotating, good.
And what I'm doing is when she rotates in I have pressure on my outer hand. When she rotates out I have pressure on my inner hand. So she's gonna continue to move in and out. There we go. I'm starting to feel a little more, there, good.
So what I start to feel is that there's a resistance, it lightens up, and the heel and the talus are moving a little bit better now. Good, and stop and rest. And bring your foot down. And then we could just retest the heel to feel that that motion has been restored.
So we're gonna work the calcaneal spiral with the lower leg press on the Wunda Chair.
Which has a soleus emphasis to it. However it's also working the deep posterior, posterior tibialis, the peroneus longus, the anterior tibialis. So we have that spiral happening of the foot. And her metatarsal heads are on the bar. And everyone's foot shape is slightly different.
Some people have very even toes. Some people have short big toes and long second and third toes. So look at the metatarsal line and you'll see is it a straight line across? Does it make an arc in the little toe, is much lower than the rest of the other toes? And when you're looking at the bar here, you look at the metatarsal arch here.
You wanna see that the weight of the foot, the center of the spiral, the washrag foot comes between the second and third metatarsals here. So we don't wanna emphasize too much on the lateral part of the foot because that changes the whole organization of the heel. And it will not allow for that spiral twist of the foot that should happen. So let's start in a relaxed heel. Now in standing she had an achilles that bowed with a concavity on the right side here.
So there's tightness through here and a weakness through this side of her leg. So we're gonna be working not only on the positioning of the ball of the foot on the bar, but we're also gonna be watching how her heel spirals. And I'm gonna be looking that she's actually contracting a little more on this side. And I'm going to give her a fascia release stroke up through this lateral concave side of her achilles. To create a lengthening here so she contract a little bit more evenly through the lower leg.
So we have metatarsal arches here. So for her, the little toe is slightly off the bar. Not a lot but this is not a full contact. It's not that important. The most important thing is that second and third toe.
Now I'm gonna ask her to slowly push the bar down and I'm gonna watch to see that this inner edge of her heel moves towards that medial malleolus. So there should be that spiral of her heel. And then it should come back as she comes down. And that achilles straightens out. So don't allow the bar to go up so high that the person ends up bowing in the achilles.
So here we go. This corner, so I cue it. Try to bring this corner inner corner of your heel towards the inner ankle, keeping your weight on that second toe. There ya go. So there should be a turning.
Remember the doorknob and fishtail. And then coming back down. So now I'm gonna take a little bit of lotion, 'cause she needs a little bit of help. And I'm going to give her as she's. Now we're gonna do it as a stretch.
So she's going to first point her foot this way. Good, now as she's coming into dorsiflexion is when I'm gonna lengthen with her. So as she's stretching through there I'm giving her a sense of length of the tissue through here. And then she's gonna do it again. Plantar flex, I'm gonna help her encourage that rotation.
There ya go, can you feel that? So contract a little more on that side and now start to let the bar come up. Feel the achilles long. There ya go. There, right there.
It feels very tight through there. And again, point and it should try to spin. Turn that doorknob. Keep your weight on that second toe. The other thing is people, and she's not doing it but some people tend to cheat when I try to get them to be a little bit more of that spiraling action on the heel by externally rotating the tibia.
You gotta be very careful that that is not happening. And we wanna get the heel to do that. It's a micro-movement. There ya go, it's gotten better. And then coming back down.
And the achilles is actually starting to lengthen out here. We'll do one more. Watch the spiral of the heel. Keeping the weight in the center. Very good.
And now start to flex. Dropping the heel, give her a nice stretch. Oh that already feels better through here. And rest. Okay, and come standing down.
So we're gonna do a heel clock. So if we can imagine that the bottom of the heal, that there's a circle at the bottom with a 12 and a six, and a three, and a nine. And you're gonna place the foot relaxed on the ball. And I'm holding the heel here gently.
And then I've got that hand with the web space around that talus. So the movement here, we can go into dorsiflexion and I can guide the heal down so the achilles is getting long without the toes lifting. So we're really looking for that true ankle joint motion. So sometimes I have to place this hand here to kind of not allow. Go ahead and lift your toe.
Some people would wanna lift their toes to dorsiflex. So we wanna keep the foot relaxed. The forefoot is just resting on the ball. And we're going into plantarflexion and the dorsiflexion. But I want the motion at the rear foot.
So I'm giving her a little tug of the achilles here at the calcaneus to lengthen this way. So that's going flexion, pointing. Now we're gonna wanna go around in a circle. So we're gonna go back to the dorsiflexion so that heel point on the outside here is 12 and then we're gonna roll around the clock. So the talus is going arches out.
She's moving into neutral with a plantarflexed foot. Now I'm rolling and I can feel how the talus is going arches out and in. Now into neutral, back to the 12 o'clock. So we'll go again, arches outward. The talus and the calcaneus are moving.
Now she's coming through the neutral. Now the talus is rolling inward, arches in, and then back down to neutral center. And we'll reverse it. Arches in through the plantarflex. Arches out into the dorsiflex.
Relax that forefoot, I can feel under my hand when that starts to tense. So the motion is very minimal. The client is moving but with as little effort as possible. So the tension doesn't come from the toes. That they can feel this, there ya go.
Nice, smooth, circling, talus calcaneus navicular. Navicular we go arches in towards the cuboid. Arches out and then coming back to a neutral position into the dorsiflex. Many people have difficulty doing a good dorsiflexion. So this getting this motion back and using the ball.
And then the client can actually do it themselves without the hands on. Now they have a feel for it. It's a little harder because now the ball's gonna move. And they have to control it a little bit more. So try a circle, dorsiflex.
Come back to dorsiflexion. And then circle the heal clock around. Arches in, there you go. Back into dorsiflexion. See if you can get that good glide back down.
There, that's it. So they need to do it about three times in one direction for the body to kind of understand what the motion is. Arches in, down. Now good dorsiflexion. Good and rest.
So we're going to use a rotation disc or you can use a functional footprint for this movement. And we're going to emphasize the rotation of the knee that's necessary for normal functioning knee motion. So as we notice as she's sitting here relaxed, the foot is tending to be a little bit in a turned out position. And the tibial tubercle is a little bit off in alignment to her knee. So her leg kind of likes to sit in this external rotation.
So we're gonna observe her move without the thigh moving towards internal rotation and see what happens. That's about it. There, so not much motion and she's working quite hard. And come back to the neutral. So we're gonna help that by introducing a muscle energy technique for here.
So I'm going to take the foot and she's gonna move into a range that's up to a barrier. Which means she's not gonna supinate her foot. And she's not gonna move her thigh in. So it's a true rotation happening at the knee. And from that point I'm gonna say, I'm gonna push you further into internal rotation.
Don't let me do that. And she's gonna try to turn the disc out. So her toes are going out, her foots trying to turn the disc out and I'm not allowing that to happen. So we have an isometric contraction happening in the muscles and tissue that externally rotate the tibia. We hold for five seconds.
She relaxes that and now I let her move into a little more internal rotation. It's very small. That's enough. I watch for the forefoot so that her toe doesn't come off the disc. And we do it again.
I'm gonna push her in to internal rotation. She's resisting by trying to turn the disc outward. Try to relax the toes, do it from the knee. Go ahead and turn out, hold. It's hard.
That's it. Keep on hold, that's it hold. Hold. And then relax. And then turn it in.
Oh that's good. Okay stay there and we're gonna do it again. I'm gonna push in you push out. Try to turn the disc outward. There, did you feel that up here?
Yeah, very good. Now she found the muscles that actually do that. And then relax and we're gonna turn in again. Very nice. And one last time.
She's turning the disc out, I'm pushing the disc in which creates no movement. But an isometric contraction in her whole leg. And then she relaxes and turns the disc inward. Oh there's the freedom. Usually takes three to four times.
Now she's gonna come back and relax here. And then turn the disc in. There, good. That's enough, good. Now see if you can find a neutral position.
So turn in. And then come back. A neutral position would be lining up through the second toe, second and third toe and the knee.
We're gonna do an Ilitibial band lateral leg to waist release using muscle energy technique. So I want to point out on this right side if you notice her leg is a little bit more of a curvature right in here.
And my hand, I'm feeling her, a lot of tension and tightness through this groove right through here. So we're gonna see a change once we do the MET for this side of her leg. So she's gonna come up onto the barrel. With the hip on the top of the apex of the barrel. Elbow on the table to support her head.
So once the client lies on the barrel, we wanna make sure that the ribcage is not collapsed down creating a side bending of the spine here. So there's a little lift of the ribs that should happen. A little stability here. If that's not possible for a client you can certainly put a bolster in this space here to give them some support. And then supporting the head and neck.
So we're gonna take the arm, now we wanna bring the pelvis into a neutral position. So I'm gonna use the fleshy part of my arm and with the weight of her legs dropping downward, the hip tends to move down with it. So I'm gonna bring the pelvis up so it's in a neutral position here. She's gonna bend this knee and put the heel right on the ankle. So she's supporting herself here.
Now if you notice with the hip here in a neutral position, the true length of the lateral side of her leg is at this angle. It's not too bad but it should be actually a little bit lower. So as we do the technique we should see a change in the angle of her leg as it's dropping down towards the floor. So we're gonna introduce an isometric contraction. So I'm gonna ask her to push up and resist with her top foot.
And I'm gonna give a resistance with my hands. So she's pushing up right now. I'm gonna count to five, four, three, two, one. And then she's gonna stop contracting and I'm gonna lower her down a little bit. Gently, she's doing it herself, she can pull with her own foot.
Great, and I'm making sure that's the end 'cause I can feel that her pelvis is starting to move. See that? So don't let them pull so much if that pelvis loses it's position. There we go. And again push up.
Two, three, four, five, and then relax. And we're gonna let it go down. We're letting gravity take it and she's pushing a little bit with her own leg. And again, pushing up. Two, three, there ya go, four, five, and then she releases it downward.
So you'll notice the angle starting to get longer here through the side of the leg as the feet get lower to the floor. Now she's doing really well. It's keeping her leg at a more neutral position. Most clients, when they start to pull down will start to roll the leg forward and inward. If that starts to happen then you can take your hand at the lower leg below the knee, not on the knee.
And turn it a little bit outward to keep that alignment as they're lengthening down. Because they're gonna wanna go into the shortness of the band towards the quadriceps. So we have to keep that alignment here as she's coming down. Now once we've got a good line, then we can add kind of a rotation in and outward of the leg. And this way we're kind of stretching and moving all of these fibers that's like a fan here.
An the iliotibial bands attached to the quadricep septa and then also the hamstring septa. So we wanna get that lengthening of both ends towards the quad and the hamstring. So this kind of motion really enhances that. And then we can come back to a neutral. And if it's really tight, the ilitibial band will tend to stick towards the front near the quadricep more.
So you can take your other arm, the fleshy part of the arm. And I'm gonna go to that lateral edge here near the quadricep of where her band is. And I'm gonna glue my hand on that tissue and then I'm gonna draw it back. And then I'm gonna change down about an inch. I'm gonna glue the tissue under my arm and I'm gonna pull it back.
And then glue the tissue here and I'm pulling it back. And I'm gonna work my way down the whole lateral line of the leg. This is more user friendly than killing yourself on a foam roller. Plus it's more functional because we're actually realigning the tissue here all the way down to the knee but we don't wanna press on the knee. And what a nice angle we have here.
So I'm gonna have her stand up to see if we notice a difference in the change of her leg. So come sliding up. So now we can notice if you go back to the first image of her leg how this tissue has changed. First of all by touching it it's much softer here. It's not as rigid.
It has more of a sense of a whole side of a leg instead of parts of a leg intention. And you can see that the line has really actually straightened out this alignment. And that's the effect we wanna have. I recommend that you do both sides because the iliotibial band is part of that fascial connection into the glutes, into the back, and somebody will be really off balance if you don't do both sides.
We're gonna work on heel tapping and toe tapping in order to help enhance this movement that's avail, a micro-movement at the fibula head here.
So first you can take your hand and go to where you feel the top of the fibula head and place your thumb on the front part. Find it here. It's not easy to find. There it is, it's right here. Now the other fingers are gonna go around the back of the bone, but you have to be very careful because we don't want to get behind the tissue because there are nerves that run through here.
And it could be very painful perhaps or impinging. And we don't wanna be going into it. So be really clear it's the thumb that's most important on that front part of the fibula head and the fingers are just gently holding in a pincher grasp the back part of the bone. And then I'm gonna stabilize her leg with my other hand. And I just wanna test.
I just wanna see, can it move on a diagonal back this way and can it move on a diagonal forward this way. So thumb against the head. Finger behind. I've got just the bone. And I'm gonna see, does it move back or move forward?
Move back. So it's a very tiny tiny motion. And actually now I feel that as I try to go back you can see there's resistance. And I can pull and it does move forward. Oh there's a little bit of give so I'm gonna wiggle a little so you can see the motion.
So I do feel there's a restriction going this way. So what I'm gonna do is have her tap her heel and in coordination with her heel tapping I'm gonna be thrusting back every time her heel hits. So let's start again. Good. So watch.
Wait wait. So we're gonna go together. Ready and go. Hit, hit, hit. So I'm just moving the thumb back against the fibula head with every heel tapping.
And we're just gonna do this until I feel that I've got some freeing up of the motion here. Oh there it goes. I start to feel it. This is really good to do after you've done the MET for the iliotibial bands since the fascia's all attached in this area here. And then we'll stop.
And then we're gonna reassess. And I'm gonna, there we go. Nice movement. It's small, we don't want too much movement. There it is.
Nice easy movement. If there was a restriction of it coming forward you could do a toe tapping. Which I won't actually do it because she doesn't need it, but she can tap her toe. So toe tap like you're impatient. Be impatient.
Okay not that impatient. Okay there we go. So we're gonna do it in rhythm together and I could pull her a little bit forward. Which I'm not gonna do 'cause she doesn't need it. So heel tapping is a good motion to get that fibula freed up a little bit.
Or toe tapping.
So I'm gonna show you some very specific cuing on foot and leg work on the reformer. So that we are recruiting the patterning that is appropriate for the function of full leg work. So we're gonna show you in a neutral position which I consider right where the heel meets the cuboid bone. Right at here.
So the foot is placed on the bar. So there's heel contact but also at the area where the cuboid bone is. So both feet here. Now one way to test to see whether or not the foot is placed well, if we transfer weight, if I put pressure on the top of her thigh, the weight should move through the tibia on to that talus and then through the heel. And if it's too high, let's say it's too high on the heel, when I push, the foot's gonna point around the bar.
If I'm too low on the heel and I push she's gonna be moving into dorsiflexion bouncing here. So I wanna find the spot where she really can feel solid and as she transfers the weight through the foot. Relax. I'm gonna move it just a little bit. So stay on this part of the foot.
There we are. Nice and solid. This is what I'm looking for. So as I press she has that contact. It's a good tactile cue to also teach the client where to feel their body weight into the bar with their feet.
So as they initiate they're pushing out. There's a sensation that they're gonna be pressing into the feet. Then we want to initiate the actual, it's like standing up out of a chair. So the first action is gonna be hip extension. So what I say to a client is this.
I say I'm gonna move your leg in this direction. And then I place their foot back on, making sure they're in a good position again. And I'll say okay I'm gonna do that again but don't lift your foot off the bar. So as I start to push she's resisting and can feel strongly that hamstring engagement there. And then I repeat it on this side.
It takes one time to feel it. So that's the action. So when they're pushing out, the first thing they should do is to feel the feet and push through the back of the leg and then slide the carriage out completely til the legs are straight. And when the legs get straight there should be a pull of the patella up through here. If there's a co-engagement with the hamstring and the quadricep, the tibia doesn't drop into a hyperextension.
Now from this place what I wanna see is a different motion coming back in. The first thing should be is that the knees unlock. They unrotate from the screw-home mechanism. They unlock and you can feel how that's coming from the back of the knees. So it's popliteus and the hamstring start that action.
And then the femur sinks into the socket. Into that posterior glide. To line up the knees you notice some peoples knees go in when they're coming in, and that's because they're not connecting the feet through the hip. And they're missing the rotation at the knee. So a good cue to bring the rotation back into the knee, I'll show you.
So first she's gotta push out. She initiates from the back of the leg. Pulls up her patella. Now, I'm gonna place my hands on the shins here. And I'm gonna ask her first to start the knee bending, not the hip.
Now pause, now feel the weight of your shins moving away from my hands as you're coming in. So pull the shins back. Pull the shins back. Great, so the action is coming through here. And then I get this rotation that's happening at the tibia.
So I'll go over the cues again. It would be press here. Pull up the knee caps. Release the knee slightly, start to bend and pull your shins away from my hands. Now in a class situation or if a persons working by themselves or if you don't want to be touching or pushing here on the legs, you can take a band, a very strong TheraBand works nicely.
And take it mid thigh and I'm gonna give it some resistance. Hold on, wait. Okay, so what I want the client to feel is I want them to feel the thigh moving in the direction of the band. So I'm cuing the bones to move that way. So she's gonna press her thighs towards the band and slide the carriage out.
And then she's gonna release the knees first. It's like unscrewing them and still keep pressure on the band. And that helps the head of the femur sink. Very good, pressing on the band. Fully elongating, pulling up the patellas.
Nice, now keep pressure on the band as the knees unscrew and the femurs sit in the socket. Very good.
So this technique is muscle energy technique to help release the adductor. Specifically the adductor magnus. But also it'll improve a medial glide of the hip joint.
So we have the trapeze set up with the long purple springs. And I put a fuzzy around the loop just for comfort. And the person lies on their side in good alignment and good form. And I've got the foot on my hip so I can support the leg at this angle. And I've got the support of the knee here.
So the person can relax here so that I can hold. And then you can play with the angle of the hip. Either back or forward. See how I'm moving my pelvis. So that I can make a decision.
I'm gonna start her leg here. Here feels like it's too much of a stretch going on. I want her nervous system to be in a more released position and state. So what she's gonna do now, I want you to press down on that fluffy under your leg. And I'm supporting her knee.
It's gonna move down a little bit. But I want her to feel a contraction. She's gonna hold it, perfect. We count for five, four, three, two, one, and then she stops contracting. Relax.
And reach out of your knee a little bit and we're gonna go up, increasing the length of the adductor and improving the medial glide. Now we're gonna stay at this level and she's gonna press again. And press down. And I'm gonna hold it there. One, two, three, four, five, and then relax.
Great, and I'm gonna reach out the knee just a little bit and it's gonna make a little curve path upward. So I feel she's deepening a little medial glide in the hip, which is good for the deep hip abductors contracting. I'm gonna hold this level and she's gonna push down on it again. It's the inner thigh pushing onto it, it's great. Hold.
Two, three, four, five, and then release. And we're gonna lift up and allow the hip to glide and open and lengthen the adductor there. Now if we straighten the leg, come back down. If she holds the leg straight now, we're getting a little bit more of the other adductors and again, you can play with the angle of the leg depending on which part of the inner thigh you're looking to release a little bit. So we're gonna go here, a little bit more forward.
Thinking a little more pectineus and adductor longus kind of feel. So go ahead and push down on the fluffy here. And hold. Two, three, four, five, and release. And I'm gonna allow her leg to go up again.
And I'm gonna take it back a little bit to get a little more length in there, beautiful. And again, push down. Two, three, four, five, and then relax. And I'm gonna lengthen up. So she's moving with me but very slightly.
Not a lot of effort but a little effort. And one more time, pushing down. Two, three, four, five, and release. And lifting the leg up. And bend the knee, great.
It's a good release to do prior to doing any kind of side leg lifts or side work on the reformer or on the Cadillac. It frees up the motion of the hip and allows for lengthening of the adductors.
So to help find the Psoas and to cue the client how to feel it and engage it, have the client lie down. Now in practice I have this knee bent. So we're usually in a home position normally in our practice.
But for the sake of seeing it we're gonna straighten the leg down so you have a better view. So you place your hand on the soft tissue in front the groin right here. Just very gently. We're not pressing or digging. It's just resting your hand on the pelvis.
I have this part of my finger here on the ASIS. And then the fingers are just resting on her tissue. And then you hold the knee and you give a sensation of a posterior glide of the hip. So I'm giving a little bit of weight into it as I lean my body and move with her. And her leg is relaxed.
And then rest the leg on your chest this way. So I'm comfortably holding her legs so she can really relax and let go. And then I will ask the client to simply draw the knee. And I tap my fingers. Draw your knee up into my hand, pulling the knee towards your chest and then get 'em to feel a little sensation with my fingers here and say can you feel right under my fingertips and engagement?
And usually they say yes and then relax. And then your hand can also feel to see if any of the muscles on the lateral side of the leg, like the TFL is contracting. And if it is do it a little bit of a circle to set the femur in the socket. Just nice and easy, go in any direction. And then you come back to a more neutral position and you can guide with your hand, a little cuing.
And again, bring the knee toward your chest and draw up from here. Much better. And hold it. And relax.
So this is the lunge with a hip drop.
And the hip drop action actually will create elongation on the one side which will be her left side because her left knee is on the carriage. So we're creating space between the ilium and the lower rib. So that means that we're encouraging length of the QL in the Psoas area. The erectors on this side. The obliques on this side.
We're also encouraging an anterior hip glide. So we're improving the motion of opening the front of the hip. So we start kneeling with the high bar. She's got a light spring. Just a blue spring.
You wanna start in a level position here. The foot is very close to the reformer so that when we line up the foot on the shoulder rest the alignment of this leg is in a line. And we wanna start with the PSIS's in a level position here. So you see the dots here. And we want them level.
So for some people if they have long legs or short legs, you might have to put a bolster under the knee to lift the leg up. They may have to bend a little deeper in this hip, the standing leg. We want it so that we can find that this is level on your person you're working with. So now 75% of your weight is gonna be on the left knee. There we go.
And what's that doing by putting that much weight on the knee is it's fixing the femur into the socket here. And then she's gonna start to slide back by flexing in the standing hip. So she's going down this way. The pelvis just stays level here. Good, you only go as far as before the dots or her PSIS's actually change.
So let's do that again. So for some people they're very tight on the side, it's not gonna be a very large movement. So here she goes. She's gonna put her weight out of her knee and she's gonna sink into hip flexion on the right leg. And right there stop.
Because I start to feel that the pelvis is starting to change. Now she's not gonna shift in the ribs. In fact I'm gonna hold here to make sure there's no translation in the ribs. And she's gonna continue sliding the carriage back, dropping this hip. So you will see that the hip drops on the left.
Good. Without translating the ribs. And then come back up. Come all the way in, just come in normal. Yeah.
No big deal about coming in, nothing special. So let's do it again. It takes about three times to really get it. So let's give her a break. So come sink into the hip.
Good. And when there is tightness in this area the ribs will translate instead of the hip dropping. So go ahead and now reach the carriage back through your, there it goes. See you just did it, it's beautiful. Nice.
See now the hip dropped. Good that's enough, I don't want you going too far. And bring it back in. What I was seeing is she started to shorten too much on the right side of her waist. That's not what I'm looking for.
So last time, going back. It's starts to feel easier every time you do it. And you only need to do this about three times. And there she goes. She's easily dropping the hip.
Excellent. Beautiful. And that's enough. Then come back in. And come stand up.
Feel your long left side now. Good.
Okay so here's a movement cuing to line up the legs so that we have activation of the pelvic floor and deep hip rotators without changing the sacrum or pelvic position. And giving the client a felt sense of how to engage from the foot all the way through to the pelvis. So what I like to do is have a client start with the internal rotation.
Feel the sit bones wide in this position. And I'll use a yoga block because it's firm in between the upper thighs for the moment. Good. And so they can really feel this kind of opening out and their pelvis on the mat. Then you bring the femurs in to alignment.
They can still be turned in. There we go. So it's not splayed out. So we have femurs in line. But the feet are turned out this way.
So what I'm gonna cue the client to do is I'll take my fingers, you place them on the inside of the heel like this. And you slowly ask the client to slowly press and rotate the heels inward, putting pressure but not going the past the heel going vertical. So let's do that again. The whole leg is gonna roll. So press into my hands with both legs.
There ya go. Now find the block but don't squeeze it. It's just there for you to feel. So go ahead and again a little more pressure through the heel. Good, now pause here.
So what I'm looking for is that we keep the little toe on the mat and the big toe on the mat. And that heel straight up to the ceiling. And then the engagement, come on and put a little pressure here without turning. Feel the block, don't turn your heels so much. That's less pressure than that.
I'm trying to find a place of engagement. Here go a little more. Through the block. There ya go. Can you feel it from the inner heel all the way up.
It takes about three times for the client to find that engagement that goes all the way up into the sit bones with the sit bones staying with but the legs engaged. So now we'll remove the block. Go ahead and turn your legs again. So find the sit bones wide. Now imagine the block is there and start to roll the legs and the heel into my hand, feeling that pressure, keeping the sit bones wide but feeling the engagement of the muscles around that area.
Perfect. A little bit more on this side, it's a little weaker. There ya go. Now hold that. Excellent.
So what we're looking for tone is we're looking for nice overall tone here. Not a squeezing tone.
So we're gonna work on some pelvic mobility on the reformer. Using it as a guide to swing the sit bones back and forth. To encourage pelvis and sacral motion.
So you're sitting upright. There are no springs on the carriage. The knees are over the ankles so we're not in a deep knee forward dorsiflex position. And there'll be no movement of the knee forward and back. It's all done in the pelvis.
So we do the elongation. And she's gonna exhale and she's gonna roll the sit bones under. Good. And the whole time what I'm looking for is that her shoulders stay right over the hips. And then the sit bones are gonna lead and they're gonna reach back and I'm gonna see that the pelvis just slightly goes forward.
That's it. And sit bones engaging as she curls. Rolling the carriage back. Feeling the neutral and then just a little more nutation of the sacrum here. And then curling back.
So you can isolate the lumbar area for it's motion, inflexion, and extension, so keep moving. Here's the extension. With the extension there needs to be a little lift of the sternum so it's a full arch. Good and curling back. Keep curling under, good.
And reaching back to neutral. Now she did that very well. She kept the elongation. She kept the shoulders over the hips. Most people when they try to go into a rollback or start to curl, they'll tend to start to curl and they'll tend to collapse and start the curl in the thorax.
So what we're trying to teach people is to feel that the tailbone is curling under with the pelvic motion as it's coming backward onto the sit bones. And then rocking through the hip joint. And this is also hip flexion and extension. And so if the hip joints not moving with the back, then we don't get a nice evenly bowed spine. So I'm interested in looking at the hip extension and flexion in balance with the nutation and counter nutation of the sacrum.
And the balance of the response of the thorax as she's curling and arching. And come back to neutral. So now we're gonna change to the coronal plane or side bending of the pelvis. Which also includes ab and adduction of the hip. So if you notice we have dots on her PSIS.
So what I'm gonna cue her to do is drop the weight of her right sit bone down into the carriage to slide it away. Good, which should bring up this hip. Not too high. And then come back down. And what I'm looking for is how much her ribcage is turning or translating.
And you can see it's doing that a little bit on that side. So let's see what the other side looks like. She's gonna drop her weight down and move the carriage to the right. Notice how the spine stays. I'm gonna show you with my fingers so you can see.
So go towards the right. There. So there's a nice side bending happening and the fingers are staying stacked over one another. And when she goes to the other direction, the TL junction tends to move and rotate off of this center point. And come back.
So I'm gonna have to cue her to try to find that range of motion to begin with. Wait wait. Okay so I want you to inhale into this left side for me as you drop your right sit bone down. That's far enough. And then come back to neutral.
So we're gonna start in that range that she actually can do. So she's gonna inhale first into this left side as she's moving the carriage to the left. Very good. And come back down. Do you feel the difference in that?
Good. What the inhalations doing is putting her attention of the TL junction, trying to stabilize it as she's moving. It's like a tail wag motion. And one more time. Inhale into the left and roll it.
Very good. And then come back, exhale. And let's go to the right. You can inhale as you go. And into the right side.
And come back to center. And go in the other side, left. Inhaling. That's it and come back. So I would keep repeating this to imprint this new recruiting pattern that she has through this movement here.
Very good. And come back. Now when I see something like this I would move onto working with a rotation first to see how the rotation motion is and improving that with a little MET. And then come back to this to see if this is improved in it's side bending motion. So now we're gonna do the rotations.
So I have the carriage loaded so I don't want it to slide. And she's sitting on a back disc. And I have the two dots again so we can see what the rotation is. Now I have two poles at her tail junction. So she can track whether or not she's rotating from the thorax or truly rotating from her pelvis.
So it's hip joint, ab and adduction again, and along with some rotation of the pelvis and lower spine. So I'm gonna hold the sticks at first. So just simply go ahead and reach your right knee forward and that should bring the right ileum forward and the left one back. And then come back to center. And reach your left knee forward which should bring the left ileum forward and the right hip back.
And then come center. And the other thing I observe is is she starting to extend and hinge from the sticks? So keep your lower ribs really in contact with the stick in the back. There you go. Alright, so reaching forward at the right knee.
Good, and come back forward with the left knee. And come back. And I'm gonna feel for the motion. Okay and come back. And forward with the left knee.
So it feels like she has more range going this way with her left knee going forward than the right. You seem to be efforting a little bit as you're pushing. The left seems to slide a little easier. So come back. So I'm gonna introduce a little muscle energy technique here with the disc.
So I wanna improve her right knee reaching forward. So that the hip through here. So what I'm gonna ask her to do is I'm going to take the disc and I'm gonna say I'm gonna rotate you backward this way and I don't want you to let me do that. So I start to turn the disc, she's resisting, we have the isometric contraction happening. Count to five, four, three, two, one.
And then stop but don't rewind. Yeah, now reach your right knee forward a little bit more. That's enough. Good. And I'm gonna pull back on the disc and you resist me.
Hold, two, three, four, five, and then stop but stay there. And reach a little bit more. Great, now how are our sticks doing? Are you rotating? Good, one more time.
I'm pulling the disc back, you're going forward. So it's a sit bone action. She's really engaging in the sit bone area to do that along with the spine and the pelvis. And relax and come back to center. Okay good.
Now stay against the stick with your lower ribs.
We almost seem to do left now. Forward with the right. 'Cause that's very good. Forward with the left. I'd like to see it a little more even.
So I'm gonna actually add a little bit on the left side. So let's come back to center. And I'm gonna pull your left side back on the disc and you go forward with your left knee. There we go and hold. Two, three, four, five, and then relax.
And go forward a little bit. Here, watch the stick. Good. And resist as I pull back. Two, three, four, five, and relax.
And go a little more forward. Watch the stick, we don't wanna twist. Ah! Good, and last time. Pull, two, very nice. Four, five, and relax.
And then come back to center. Great, and now move your knees forward, and forward, and forward, very good. Forward, excellent. And come back to center. Usually I find that most of the time I do it on one side and it seems to balance out.
But if you watch them move and the other side seems restricted, go ahead and do the other side. So let's take this away and see if your side bending improves at all. So here she goes. She's gonna side bend. And come back.
Now breathe into that side as you do it. Inhale into this side. There you go. And come down. And other side, inhaling into the left side.
And come back. Okay I see the rotation has improved. That you're not rotating as much. But now you seem to be translating a little too much through here for me. So it's more of a side bending issue now rather than a rotational issue.
So breathe into this side for me. So come back to center. Feel my hand here. So you're gonna stay over here, inhale here. And move away from the foot bar.
So move to the left. That's it, that's all it is. Can you feel that? And come back down. So this is a strong oblique action.
And not only in the back but the front. So do that again. And I want her to move from the sit bone. Dropping the right sit bone. There ya go.
So now you got the obliques working in the front. So she's working through here as opposed to just shifting it's so much different. There you go. So now you're recruiting the obliques on that side to work. Yeah, so this is a training technique to get people to feel that engagement of the side that's weaker in the obliques.
That's good. And come back and rest. Go to the right. Just so you can balance. See it's so much easier for you to engage in this part than the left side.
Much better. And relax. Very good work.
Section two, primary center, the trunk. In section two you will see techniques that balance the diaphragms.
Specifically the thoracic and pelvic floor diaphragms. You will see how to find and engage the Psoas and reorganize the intercostals. Both necessary for stability and better breathing. Additionally, mobility techniques for the upper thorax plus the release of the pectoralis and latissimus fascia which inhibits not only the breath but shoulder girdle movement as well is presented here.
So this is a muscle energy technique to release the pectoralis and latissimus fascial connection in the body here.
And the client will sit on the barrel on the lip and not in the well. Because I don't want an arch of the back. The feet will come under the straps so that we're anchoring the feet. She comes to slide the sit bones towards the edge to lie back. And we need a head support to support the head here.
Great. And I always check to make sure that the pelvis is in a more neutral position and not having an arch is normal. Yeah, in the back. Okay, now the bar here, this is a very dangerous position for the bar. So it's top loaded on the outside.
This is the most dangerous spot for this bar. So you have to be very clear that you don't let go of the bar. And when the client let's go you still have a handle on the bar. So you're gonna stand here and we're gonna reach behind this way. And we're gonna bring the arms to the bar.
Great, now she has good flexibility in the shoulders here. So for clients who don't have this range over their head, you can move the bar up higher. You can have a lower barrel or a bolster. So be mindful about the range of motion of the shoulder joint that's appropriate to the client. Now the upper arm bones are kind of spiraling inward this way which is actually an external rotation of the shoulder.
So you wanna make sure that they're not splaying this way. That the armpits are more connected. And we wanna look for the humeral head. Sometimes if someone is very hypermobile in the shoulders this is actually not a good technique to do for them. Because the head of the humerus will actually kind of pop out of the socket here.
So keep it mindful. This is for your tight person. Not your hypermobile person. And we're gonna roll that in. So now I'm gonna take the bar and I'm just gonna take up some slack of her tissue.
So we're gonna lengthen here a little bit. There, so I feel the barrier here. And I'm gonna ask her to keep her arms straight and pull the bar towards your head. So she's doing a lat-pec pull downward. So there's a strong connection and contraction going on through the armpit through here.
And then she's gonna let go. That was about five seconds. And I'm gonna lean back, give her a little length. And she smiles. And again, she's gonna pull the bar towards her with the arms straight.
Which sets up an isometric contraction of the lat and the pec. And then she's gonna relax, just keeping breathing. Good. Ah, I'm gonna lengthen again. And pull.
Good. Holding for five seconds and relaxing. And lengthening. And if you notice I'm not pulling, I'm just leaning back. And one more time.
And I'm being sensitive to feeling what her tissue is sliding. How it's sliding and how it's moving. And release. So here's a slide. There's a nice give to her tissue.
I'm not pulling super hard. Now she's gonna hold this position, I'm gonna ask her to push the bar away from her and I'm gonna hold the bar still. So push it away. Which is activating the opposite set of muscles to set the length that we just created in the lat and the pec. I have the bar, so take your hands and cross them on your chest and just stay there for a moment.
I've got it, very good. Now I'm gonna show you a really easy way. Now that we've released the front through here, we're gonna wanna have her come up without curling up. So I'm gonna take my hand and put it under her head. And take the towel away.
So she's resting on my hand. You can take your feet out. So what I want you to do is kind of lean back into my hand. Just gently press down into my hand. Deep a little more, a little more down.
That's it, now keep that. And up she goes.
So we're gonna use the magic circle to help emphasize and teach a person how to move through the sternum and the ribcage as they're breathing. So we have the magic circle on a box with the magic circle leaning on the sternum. You gotta be careful when you place the magic circle on the sternum.
You don't wanna be on the notch here. And you wanna not be on the xyphoid process. So we wanna find the midpoint of the sternum for the circle so it's comfortable. And then we try to achieve more of a neutral thoracic spine here. So the person elbows have to be wide into the box keeping the width of the back.
And simply what she's gonna do is she inhales. I'm gonna ask her to move her sternum onto the circle. So she's gonna inhale and there should be a little extension up in here and a little pressure into the ring. And then as she exhales the magic circle should recoil and go back into her sternum through here. So inhale, a little lift of the sternum and the clavicles are rotating upward.
And then as she exhales she relaxes and there should just be a little retraction and recoil of the magic circle. So keep doing that. As that cuing happens here, you wanna pay attention to what's happening at the lower ribcage. So keep breathing. Very nice.
There's a bucket handle motion that happens down here. So as her sternum is moving, can she coordinate that with a bucket handle motion like this of the ribs? So the inhalation goes ribcage, bucket handles opening. Sternum reaching forward. Exhale sternum softening.
Bucket handle returning back. Let's do it one more time. Inhale bucket handles moving. Sternum's going into the ring. Exhale sternum softening.
Ribs are coming back down.
We're gonna work on breathing and we're gonna use a sling with a trapeze to help the client feel and be able to see when their breath is going into the back and sides of the rib. So I added a black strap, which is called a sling. Attached to the bottom of the trapeze bar. Two long purple springs.
A little heavy if a person doesn't have the sensation or ability to breathe into the back of the ribs I would recommend using long yellow springs and then progress to the purple springs. This is really an educational tool so it's not an exercise you'd be repeating quite often. Once they get the feel for it it's just part of their practice after. So then you ask the client to bring their feet between the two straps. 'Cause I only want it on the sling part.
She's gonna lift up like a bridge and we're gonna bring it back to the posterior part of her diaphragm. So not on the floating ribs per say but just above it a little bit. And then usually what happens is the weight of this spring will lift most peoples bodies up. Amy's a little more grounded so she has contact. But you might see and that's okay.
Because then they're gonna breathe into their back and the whole sling is gonna move towards the table without pushing. So relax. So the client can watch the bar now. So I'm gonna cue her to inhale into the back of the ribs. And as she's expanding, see if she can notice how the bar is very subtle, it's moving downward.
And as she exhales she relaxes. It's a relaxation in the bar moves back up. So inhale into the strap. So we're trying to expand the ribs in the back and exhale relaxing. One more time.
Expanding into the ribs, moving the bar downward. And exhale. And once they have that motion it's wonderful to add any kind of stabilization, leg movement. So she can inhale down. So now I'm gonna say keep the strap down.
You can exhale, but don't allow the bar to go up. Excellent. And that engages the core with that. So inhale into the strap again. The bar may not move because it's already down.
Now exhale and bring your right knee up. Dangle your leg. You can dangle it. Yeah, and then place it down. I'm weighting the foot.
Inhale into the strap keeping it down. Exhale, keep it down and unweight your foot. And bring it back down. So you can do a variety of leg motions. You can do leg slides.
Any kind of motion through the core to practice keeping the breath and the back of the ribs and the stability of the lower thorax. Very good. And rest.
So this technique is a muscle energy technique to improve the bucket handle motion of the lateral ribs in breathing. So what we're gonna do is take your hand and follow the lines of the ribs.
As you can see my fingers are on each rib here on both sides. Now you have to watch your thumb. So you just relax it on the side here. And you're gonna ask the client to take a breath in. So she's gonna breathe in.
You should feel some expansion here. And I expand with my fingers. And as she exhales my fingers are gonna relax. So I'm just following her ribs here. Now many times there's not a lot of movement here.
Breathe in. So we want to introduce an isometric contraction to the intercostal muscles in this area to allow the ribs to have a little more mobility. So what we'll do is the technique is this, as she starts to exhale, so she's inhaling now. As she exhales, the ribs come in close together and I'm gonna bra my fingers in and hold them there now. She's gonna breathe in and I'm gonna resist the ribs opening.
And then relax. And as she relax I'm gonna let go of my hands. Here let her just relax and reengage those ribs again. And she breathes in and I'm resisting the ribs moving. And then she exhales I relax and at the end of her exhale I'm gonna recoil again and I'm gonna hold them there.
And exhale. Now you might notice that last one. Her breath, because I was holding the ribs it actually started to expand. Which is natural through here. I'm not gonna ask her to hold here.
But I want her to send the breath into my hands to try to open those ribs. So here she goes. Inhale again. Exhale and drawing the ribs in. Now she's gonna breathe in and try to open the ribs as I'm resisting.
Much better. So I hope you notice and review again. Exhale. How that changes the belly breath here. And we'll do it one more time.
Emphasize, here we go. She's gonna relax first, I'm not doing anything. There. And I draw the ribs in. She's gonna inhale into the ribs.
So you have to cue them to feel that into the ribcage. Much better. And then relax. And then you'll notice after three or four times, breathe in again. Yes, more expansion is possible here.
So a positional release technique for the pelvic floor is a very comfortable position. Where the client is lying on their side. The knees are bent at about 60 degrees. Whatever's comfortable for them. Between 70, 60 degrees.
The feet are up on six inches or higher. So a small box, a yoga block would work. And then you place the hand on the greater trochanter. And you just put about five grams of pressure. So all I'm doing is resting in my body and I'm leaning gently onto the greater trochanter.
And the second hand will be at the lumbar spine above the sacrum. And it's a positional release and you maintain this pressure, gentle pressure. And you just wait. You can hold anywhere from one minute as a minimum to as much as five minutes. And as the client's nervous system starts to adjust, you might experience and feel some unwinding happening underneath your hands.
And when I'm doing this with a client and I start to feel that turning, sometimes my hand at the greater trochanter feels like it's turning clockwise or counterclockwise. Which it's doing right now. And I point out to the client do they feel that my hand is moving? And they usually say "Yes, "isn't your hand moving?" And I'll say, "No, actually my hand isn't moving, "it's your body that's moving "and I'm just following it." So I'm not making the movement happening, but I'm just following with her. So after a one minute hold, there's usually a place, the tissue stops the turning.
And you wait until you feel a breath movement. And I just felt a whole breath come into her pelvis and her lower back. Which means we've completed the motion.
Section three, resilient shoulders to head. In section three we explore scapulohumeral rhythm and learn to cue the movement so that the client embodies the feeling.
There are release techniques to free up the scapula motion. Allowing for better arm and neck movements. You will learn neck exercises to inhibit the tight posterior neck muscles and strengthen the anterior neck through hands on work and the use of props. Client home program exercises are shown so you may help your clients help themselves. Learn to teach how to move the neck and head functionally through imagery of moving the hyoid bone.
Additional releases for the neck are presented using MET techniques.
So we're gonna do some scapulohumeral training movements of the scapula, humeral head, and the clavicle using this stick. So the client holds the stick on the low end and we start with the arm low. See that the scapula's sitting on the ribcage in a more normal position. Let me ask the client to gently pull the stick down towards the floor as I lift the stick up.
So pull down. Great, so they feel this engagement through the scapula, through the armpit. Not too hard. Good, now we're gonna keep some tone. Some sensation of keeping a pulling down and I'm gonna slowly lift the stick up.
And as they're doing that they're engaged in the muscles, which is the serratus anterior. Primarily. And there will be upper rotation of the scapula to about 60 to 90 . So already right here. Then the clavicle takes over.
And as she's going up with the pole. Now if I lose a little sensation I'm gonna ask her to pull down a little more. I wanna keep those muscles engaged but not locked up. And she's gonna continue the motion. Sometimes you have to add a little assistance to get that scapula moving out there.
Get that clavicle to rotate upward. So when the arm is fully up we've got full rotation of the scapula. Full elevation of the clavicle. Then from here the client can pull the stick down. I can add resistance here as she's pulling down.
And I watch how the scapula moves back into it's normal position. So right here we're gonna pause. So what I don't wanna see anymore scapula movement at all. She just brings the arm down without any motion of the scapula. We'll do that one more time.
So pull down gently. We're gonna watch the scapula rotate as the arm is going up. And I can feel that she has resistance. The muscles are working. She's resisting the stick but allowing it to move.
Very nice rotation. Elevation at this point of the clavicle in the front, I hold the stick up, she pulls it down. I'm watching the scapula move back in a downward rotation. And when it comes to a neutral position on the ribcage, which is around 90 degrees, maybe 60 degrees right here, then I'm gonna cue her to not move her scapula anymore and to continue moving the arm downward. And this is a training technique to teach the client the sensation of how the scapula should be moving in a full arm range.
So this is a release for the upper fibers of the serratus anterior. The upper fibers of the serratus anterior tend to tip the scapula upward and present as a raised shoulder blade. So many times we're thinking that it's levator or perhaps upper trapezius which is keeping that scapula elevated. But on the front side of the scapula, the serratus fibers can also be restricted holding the scapula in that place. So it's one little piece that can be missed in terms of helping the scapula sit better on the ribcage.
So we're gonna start side lying. I have the blue spring loaded also on the dangerous part of the bar on the other side. And the client starts with arm extended, with elbows soft. And I'm gonna take a hold. I'm gonna let go of the bar so the client really has to understand that she can't let go.
But I also don't want a death grip. So she's in charge of the bar. And I'm gonna trust her. And I'm gonna take my hand right at the inferior angle of the scapula, and my other hand underneath the upper trap here on the top part of the scapula. And then I'm gonna ask her to extend her arms slowly.
And I'm gonna encourage this awkward rotation of the scapula. And we're gonna pause right there. Now what I'm gonna do is try to hold that scapula in place, not let it move, and ask her to bring the elbow towards me slowly. And you can see what's happening. I'll pause right here.
It's great. The top part of the scapula is starting to tip away. Which means it's stretching. That's far enough. It's stretching the top part.
There of the fibers. Good, now you're gonna reach the bar away. Good, and I'm gonna continue help her upperly rotate the scapula a little more, a little more, a little more straight arm. That's perfect right there. I'm gonna hold the scapula there as she pulls the bar towards her.
Which is gonna tip the top part of the scapula away from the ribs. Elongating those upper fibers of the serratus. That's far enough. And then extend the bar away. We only really need to do this about three times.
There we go. I'm encouraging the upper rotation. There we go, nice. And then she's gonna pull the bar towards her and I'm just holding. All I'm doing is holding the scapula in place as she's moving her arm.
And then release up and finish. And relax.
Okay we're gonna do a fascial stroke with arm movement to open up the fascia under the clavicle and also the pectoralis area here. So the client lies on an arch with support of the head. Or you can use bolsters and towels and pillows to get this angle of the trunk here.
So to set the arms up, what I would like is that you externally rotate the arm. And I come in and I want the client to rest their arm on my chest so that their muscles are relaxed in the arm and that will give me a chance to set the scapula. So your back hand here is gonna come under onto the spine of the scapula. So I'm holding the spine of the scapula. My other hand is coming under the pec muscles.
So my thumb is going into the armpit and I'm on the top of the scapula over here around the back. And what I'm gonna do is just rotate, bring the scapula down and lift the pec up a little bit to set the shoulder. Then I ask the client to maintain that position of the arm. Let me do the other side. So we bring the arm up.
It's gonna rest on my shoulder and my underneath hands on the spine of the scapula, the top hand is on the top of the scapula as well. And then I'm going to rotate the scapula down. So we have a nice set. Now, you're gonna need a little bit of lotion for the skin. So you wanna check with the client that they don't have allergies or any kind of complications with certain kinds of lotion.
Biotone cream is also very nice 'cause you don't wanna inflame the skin and you wanna be able to get a good glide. So you come up over the top. And what I'm gonna do is cross my fingers so the pads of my fingers are gonna be right under the clavicles here. Now as the client is moving the arms out to the side I'm just gonna roll right across underneath the clavicle, leaning my body weight into it, out over the deltoid, creating that nice length. And we're gonna repeat that.
And I encourage the arm motion and external rotation to come back up. There, so we're gonna make sure the shoulders are set. So I'm gonna about one inch below where I was before. And she's gonna go. Now I'm just leaning my body weight lightly into it.
Finding that line going across the pectoralis here onto the arm. And we'll do a third stroke. She's gonna rotate the arms back. Good, last one. One inch below that and we go across the chest.
Over on to where it attaches onto the humerus. And then coming back up and finish.
So this is called screwdriver and it's a motion of the whole spine, the upper thorax, head and shoulder. And it's rotation, flexion, side bending, extension. So it's a full spiraling motion to the right for her and then to left upper corner.
Now the bar is set up where it's top loaded. Her hand is turned downward and you notice she's sitting on this end of the table. And what I wanna see is that the angle of her arm is comfortable for her range. You don't want the arm too far back 'cause the shoulder will come out of it's alignment. And then the other piece to look at is your bar.
If the bar is too high for the person it could bring the shoulder up. So you may need to move the bar down one notch. So we're looking for already before we start a good alignment of the shoulder and integrity here. So the movement will start with a chin tuck and flexions gonna soften the chest and she's gonna start to rotate to the right and that inspires an internal rotation of the shoulder as the bar goes up. Now she's gonna keep reaching the bar away and then the arm is gonna screw.
This is the screw diver part where she's gonna rotate, come towards me as she extends and rotates opening the front of the chest and the pec. And she's gonna circle around, the heads gonna drop down. She's gonna make a half a circle with her head softening the chest so that we get flexion. We get internal rotation of the shoulder. Great, and then she comes back, leaning into the bar.
Rotating the shoulder, opening the chest kind of leaning into the bar. Very nice. And one more time. Chin goes around, circle half circle. The shoulder's spiraling in.
Now she keeps reaching the bar away so it's not jamming up. And I've got control of the bar as well. This creates a nice length through the neck, the side of the neck. Rotation. Mobility of the shoulder and then external rotation.
If she leans we're getting some fascial stretching. There ya go, that was nice. The pec and the lat here. And then come back to center and let go, I have the bar. Oh and rest.
So we're gonna take a look at the alignment of the wrist bones and the radius and ulna. Whether the weight should be on the hand. We're doing it on the wall. You can transfer this onto the floor in a quadruped position and also when you start working on plank. Everyone has a slight different alignment here so I'm gonna show you where the emphasis should be.
One is looking at the wrist crease here. The radius is a bone that comes from the outside of the elbow. And it will cross over the ulna to come over to the thumb side. So we're looking at a diagonal from the outer elbow towards the base of the thumb. And the radius is wider here so we're gonna be including the second and third fingers.
So the weight of the hand needs to be more towards the second finger and the base of the thumb. So that the radius weight is here. It's thicker at this end. Then to find the alignment of the radius at this end we can roll the radius this way or we can roll it out this way. But as you notice the wrist as she rolls with the elbow up, people try to bring the elbow up thinking they're creating external rotation.
Which they are of the shoulder. Trying to keep the chest open. But I'm gonna show you a little bit different. What that tends to do is kinda depress the humeral head down. So we wanna keep the armpit free.
We wanna have the weight at the base of the thumb. So I'm gonna ask her to roll her elbow out and in. And we're gonna watch where the weight jams. So here it's jamming at the little finger side and when she rotates that way. Yeah.
So now we wanna find a medium in between there. So we have a nice, that's great. Vertical line here. No tension at either end and then weight at the base of the thumb and the second finger. And that lines up her elbow a little bit facing me this way.
So let's try this hand. Now I'm gonna note too that the finger alignment here is very slightly. Some people actually need to have their hands slightly turned out so that the second fingers more vertical or maybe even a little bit out. For her it's actually better straight up. Right, and spreading the hands, a nice amount.
Not too much, 'cause that can weaken the hand. So we wanna have the hands just spread. Good, in the elbow position. Now the activation to keep the chest open now is going to be. I'm gonna cue her.
I'm gonna bring my hands in here and ask her to bring the lower arm bones in towards my hands. So she's gonna draw the bones in towards the midline, a little more. There. So these bones are moving in towards the midline which puts more of the weight at the base. I know it's hard work.
And then, we're gonna ask, I'm gonna ask her to widen her shoulders by pressing out against my hand. So there's a contrast of outward with the shoulders with the inward, with the lower arms. Which actually then engages through the whole arm. And it feels extremely. Look, very strong and balanced here.
So when you're doing a plank, having this alignment of the wrist and the hand creates a more stable position for someone to hold and move in that plank kind of position.
Okay we're going to work on improving the external rotation motion of the shoulder. First let's observe her range. So I'm supporting her elbow here. She's at 90 degree flexion of the elbow and I'm just gonna turn the whole arm.
The elbow and the forearm. And that's it for her range. We wanna have a little bit more range for normal shoulder function. So what I'm gonna do is take her into that externally rotated position and stop when I feel the barrier. And then I'm going to tell her I'm gonna rotate her arm out more and she's gonna rotate her arm inward.
And she's gonna contract the inward rotators of the shoulder which are tight. Inhibiting her to externally rotate the arm. So then relax and then we're gonna go a little bit further. Nice, good. And again, rotating in.
Holding it. It's usually about five seconds. And then relax. And again, rotating inward. Always do this without any pain or discomfort.
And relax. Look at that. It's really getting better. And again, push again. And relax.
Now when I get a good range I'm gonna ask her to stay at that position and I'm gonna have her now engage the external rotators. So I'm gonna push you up and you try to push down towards the floor. So now I've got her engaging those external rotators to set the new length we just created of lengthening her internal rotators. And now relax. Good, and I'm gonna come back to where we started.
And look at that range. Improvement is really good. So she has a muscular tightness and fascial tightness that was inhibiting her from externally rotating. Now you can choose to do this in different ranges too. So now we can bring the arm up to a different range and see how it is.
And we can introduce the rotation here, the MET so she can push in at this angle. And we just would repeat exactly what we did. And relax and then get more length in opening. And then she can push down towards the floor. And relax.
And if I wanted to we can continue and go up higher and do the work here. To improve the range of external rotations through this whole range of the arm. And then I would follow this with the doorway muscle energy technique in the book for the client to do as a home program.
So we're gonna work with a small bone called the hyoid bone. Which is floating on the front of the neck here.
As you can see. And there are attachments of the muscles on the top of the hyoid bone that creates the floor of the mouth. And then from underneath the hyoid bone there are muscles that come down onto the sternum and onto the first rib. And I like using this bone as a movement cue and movement as you flex the head into kind of a curling up position. So the bone will actually be moving in the direction of the ears.
So on a real person the hyoid bone is approximately across from C3 in the back. And you can just gently place the thumbs on either side and you can find the little edges here and here. Very very gentle. It's almost like holding almost like a newborn baby. Newborn baby head, you gotta be very very gentle here.
I'm just finding the outer edges of the bone. And when this bone is forward it creates that line of double chin mouth breather kind of feeling. We want the hyoid. If we think of flexing the head on the spine, when we do that movement. Let me show you.
The hyoid bone actually moves back and up towards the ears. Which creates the length of the neck. So the front muscles in the neck engage to bring the hyoid bone. Can you see the motion forward and back towards the ears. This direction.
So without my hands the hyoid bone go forward. And then draw the hyoid bone up and back towards the ears.
So this is a movement reeducation tool using the foam roller to teach the client how to engage the anterior cervical muscles when they're going into a chin tuck to curl the head up off the mat. And also to find where in the neck is a nice neutral position for them. And then we're gonna add a rotation.
So the client's lying comfortably. I chose to lie in a bolster so that the head is level with the roller. And the clients forehead is placed on the roller. And they simply are just gonna move the roller away with the forehead which lifts the chin up. And then she's gonna drag the roller back in.
And again, we're getting to feel that hyoid bone moving up into the neck this way. And then she can push the roller away. So you can observe as they're moving and pulling in. Which direction they need to emphasize. Some peoples necks are too flat so they need to emphasize kind of pushing the roller away and then pausing so that they have a nice curve of their neck.
Some people are too arched in the neck and they need to emphasize the pulling in. So as you're working with someone you wanna find which range do they really need to work a little bit more. Now I'm gonna come right into the middle. So not too arch, not too flat. Good.
And then all you're gonna do is float your forehead up off the roller to unweight it and then you hold. So this is contracting via gravity the neck muscles. Both in the back and the front. And then she can lower it back down. And we can do a movement.
She can go away with the roller and pull it in but not flattening the neck. And then lift up and hold, just easy. And then come back down. Now I want you to observe, she did it very well. What many people will do when you ask them to float their head up off the mat is they'll extend in the upper back.
So can you show us. Lift your head up by extending. So we don't want back muscles to be doing that motion. We're really looking for the cervical muscles in the front and the back to do the motion. So it's a very small movement.
So now we're gonna do rotations. So we're gonna turn the roller this way and I'm gonna ask her to place her cheekbone near her nose, near the nose. So you're actually gonna feel like you're closing your nose. So you're on the cheekbone, yeah. Yeah, so you wanna be sideways.
Just the edge near your nose. There ya go, can you feel that? Now you rest your weight of your head on the roller. Very nice. And all you're gonna do is roll along that cheekbone towards your ear.
Slowly, that's too fast. So feel the weight of your head on the roller. There ya go. Now keep the weight of your head on the roller and roll it towards your nose. Mm hmm, good.
And roll it back towards your ear. You know it's very hard to keep your head weighted. There ya go. Do it with your cheekbone. The cheekbones doing the motion.
There, that is different activity in your neck muscles. And push it away. Very nice. Beautiful, so now we're getting the motion higher up in the neck where we want it to happen. Engaging those muscles.
Yeah, really deeply. And pushing back. And rest on the roller. And we go do the other side. Good, so resting, you wanna start near the nose.
So you're not in a full rotation because that's down in the lower part of the neck. There ya go, and rest your head on the roller. And then we're gonna roll it away towards the ear. Easy, and put all the weight into the roller and drag it back towards your nose. Good, and push the roller away.
Very nice. Keeping the weight of the head on the roller. And pull it back. And rest. Good.
So for more strengthening of the neck mucles we can do contractions with the arms as a home program for your client. So we're gonna start with the hands behind the head. And the client needs to find the head in alignment with the spine and then go behind the vertical axis of the head. Very good. So that we're not lifting the chin up.
We're keeping that relationship of the neck and behind. And then she's pressing back into the head. And try not to drop your chin. Just push back. There ya go.
And we hold, hold, hold. And then come right back to your vertical axis. And do it again. Behind the vertical axis, the client presses back with the head into the hands and keeps breathing and contracting. And then come back to the center.
Good, and one more time. So you could repeat this five to eight times. Go back a little more, good. And then contract. And hold.
Pressing back, good. And what's a nice sensation is after this as you bring the head back to the vertical axis and bring your arms down, and all of a sudden you can feel the front of your neck is really engaged in support the head. Good, so we're gonna add a little more strength for the front of the neck. So we're gonna place the hands on the forehead. And with the head in alignment.
So it's very dangerous that the chin might come forward. So we wanna keep the ears back, the hyoid bones lifted up, and you just press into the hands and keep breathing. And hold just for a count of five, not to hard. And relax, good. And again.
Now monitor what they're doing because sometimes people press too hard and their jaws will tighten, the neck will compress. We're looking for a floating head and a gentle press forward. And relax. We're stimulating the. And relax and do one more.
We're stimulating the deep postural muscles on the front of the spine. And they don't require a lot of resistance. Just a light resistance to turn them on. And relax. So we're gonna do some side bending.
So the hands back behind the head again. And we go behind the vertical axis. And this time we're gonna lean to the right. So you're gonna feel the right corner of the head contracting and holding. Good and keep breathing.
And then just come back to center but be in the vertical axis behind it there. Sorry. Yeah and to the left. It's okay. And pressing back diagonal.
So we've got a back diagonal happening, and then go to the other side, back diagonal, good. Just watch your chin, don't draw it back. Yeah. And other back diagonal. There ya go.
Can you feel that now? Yeah, very good. Getting all of this lateral muscles of the neck. And release and come back center. Now we're gonna do a little more rotation and diagonal.
So we're gonna place one hand on the forehead above the eyebrow and the opposite hand on the back corner. So we've got this kind of like diagonal hold. And you're gonna add resistance as you're looking down under the armpit of the front hand. So she's doing her left hand so it'll be under the left armpit. And then she's gonna look up and resist with the back hand as she's going back into extension.
And come forward, resisting. Getting the diagonals of the neck and backward. Resisting. And then come back to center and we'll do the other side. So it's corners.
Over the eyebrow and opposite head. In the back and looking down resisting. And coming up and then back diagonal resisting back. As you're going through the movement and come forward. So you don't have to hold.
You're actually moving. So moving and resisting. And when you get to the end you reverse it and move. That's good. And resisting.
And come back to center. They're less isometric and a little bit more concentric and eccentric with the movement and with the resistance. Good.
So for chronic or even acute neck issues and tension, teaching your client to do some isometric contractions to the neck in a sequence can help relieve some of the pain and tension in the neck. So first we wanna do front and back.
So the client will take their hand and place it on their forehead. And with the head in alignment, not moving forward in space, they're gonna press their head forward into the hand and resist. And count two, three, keep breathing, four, five, and then relax. And then bring the hand to behind the head and pressing back without retracting the jaw and just relaxing the jaw as you press back and breathing. So there's contraction in the back of the neck.
And then release and then we repeat to the front. So then go back and forth between front, five second contraction. And then the back. And just gently, it doesn't have to be a hard contraction. And you might feel lengthening in the front as you're pushing in the back.
Good. And then there's side to side. So one hand on the side of the head. And it's as if you're gonna tip your head to the side but you're not actually moving your neck muscles so you're just thinking about the top of the head moving to the side and resisting. So there's no actual movement of the face.
For five seconds and then other side. You repeat to the other side. So it's a feeling as if you're tipping your head to the side. But there's no present movement. It's just an isometric contraction which is contracting the sides of the neck.
And repeat the other side. Now they wanna repeat it probably five to 10 times per side. We'll only do it a couple since you got the idea. One more. Two, three, good, four, five.
And the other ones rotations. So the hand will be more at the cheek. We still want the head aligned with the spine and you start with the eyes. So you look to the right and then think of turning your face to the right but you don't actually move. And you create a resistance and you should feel actually tension on the opposite side of the neck.
And then relax and we do the other side. So the hand at the cheekbone. Eyes move first to the left and then you think of turning but resisting. For five seconds. And relax, we'll do one more each side.
And eyes move to the right. You think of turning your head but you don't. For five seconds. Keep breathing. Switch to the other side.
Good, and rotation. Keep breathing. And relax. So this sequence if it's repeated often enough can actually relieve some tension and pain in the neck.
This is a muscle energy technique for the suboccipital muscles at the base of the neck.
And I'm gonna gently take my hands and cup 'em this way so that the pads of my fingers are right under her occiput. So I'm gonna come under gently, lifting the head. And you'll see I'll get my fingers gently right up against the occiput and she's gonna rest her skull like a bowl in my hands. And then I'm going to cue the client. I'm gonna say I'm gonna move your head in this direction.
And I want you to not let me do that. So your chin will actually think about going upward. So I pull you this way, you go upward, there's the contraction, we hold it. Two, three, four, five. And then she relaxes.
Beautiful, and then I can move the occiput a little bit more away from the cervical spine, creating a little more space there and we're gonna repeat it again. She lifts the chin slightly. And I can feel under my fingers the suboccipital muscles contracting. And then she relaxes. And you can watch how her neck just falls closer to the table.
And I'm gonna move the occiput again a little bit more. And we're gonna do one more time. The skull is pulling back. Now you can listen with your hands and feel whether one side is contracting more than the other. And relax.
So you can cue the client if for instance the left side of her skull wasn't contracting I could ask her to put her focus on the left side. So as she starts to lift her chin I'm gonna resist and I'm gonna just cue her a little more on the left. Now they're more even. I can feel both sides contracting. And then release.
So you could always repeat that if that's what you're feeling with the hands.
If you complete this workshop, you will earn:
3.0 credits from National Pilates Certification Program (NPCP)
The National Pilates Certification Program is accredited by the National Commission for Certifying Agencies (NCCA)
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