Spine Pathologies Lab

Hello, my friends in Pilates anytime. I have been having a blast here recording the last three days, and we've done some wonderful workshops. One of them was looking at how we can work with spine pathologies. And one of the questions that came up was the idea of mobility, and the more importantly, the focus of distribution and movement equals distribution of force. It's a very powerful tool when working with spine pathologies.

So we thought we would do a little lab, and Aaron's gonna help me out with this, is, demonstrating, but we're gonna look at some queuing and some teaching things to look for in five exercises, five orientations with gravity that can help us benefit from the concept of distribution of motion equals distribution of force. So we're gonna start with bridge, and I'm gonna have you lay on your back And in the bridge, a lot of times, giving you a couple cues or images that can help with the idea of distributing movement more in this region of the body. Right? Very often we'll go into a posterior tilts and then just arch up in our back. Right? So let's show what one that might look like for a novice and just arch up. Yep. Good. So in this one, all the movement the shear force is happening in l four five zero five s one. Bring it back down.

And you notice at one, it went into an extreme flexion. And then when it came up, it went into an extreme extension at that segment. And this is a strategic problem. This is a strategic limitation that the majority of people find, if we don't address it in our classes and we don't have the right kind of images and queuing points for it, we often will see that behavior. Right? So one of the things I like to do is create an image where if each of the vertebrae, again, I will instruct patients and clients to understand that between their shoulder blade and their sacrum, there are about 12 motion segments. Those are called the vertebrae.

There's a disc in between each one, and they articulate and move in their own space. Unfortunately, our sedentary behavior, our natural human behavior, we tend to use the l four five and l five s one much more than we use the other segments in the spine. So what that means is that l four five and l five s one have an excessive amount of motion, and that's why we see so much pathology in those segments. So things like disc degenerations, disc pathologies, facet injuries, stenosis, spondylolisthesis, all of these things we talked about in the pathology course, are happening because we're not getting good distribution. If we catch it early enough, so here's a thought maybe somebody out in qualities any time land.

If we can teach children and teenagers how to have segmental motion in their spine, we could prevent the pathology long down the road at massive, levels. Like, we could really reduce the amount of spine pathology if our children and teenagers weren't sitting so much, and they also knew how to distribute motion in their spine. So let's get started. So if we think of each segment of the spine as being a little tiny shot glass that's half full with water, what would that look like if we were just tilting one glass at a time all the way up to the base of the shoulder blades. So from here, I want the knees reaching into my hands a little bit. Yep. So we'll feel them reaching, and now feel the sacrum glass tilt just a little bit. And then l five, and then l four. Yep. Good.

Keep working away. Now coming into l three, l two. You're gonna feel the bottom start lifting up. Right. And then l one. Yes. Good. Be patient there.

Be patient. I keep from the knees reaching. Kind of thing like t 11. Very nice. And now we're up. Right? So with Aaron, we had about four or five segments that move, which is fantastic. We don't necessarily need more than that. We just don't wanna have one and two.

Right? So if you think of four segments moving, that decreased the force by 50% in l four l five and l five s one. Now coming down is where we have our greatest learning opportunity. So if you think of your breath now, taking a deep breath in, and I'm just doing a tactile on the back of the T seven spinous process and keep drawing that down, and it's an opposition of force. So the sacrum is still maintaining itself up, as she continues to slide the segments down and bring the cups back into their resting position. So that's one image that we could use to sort of give that idea of segmental movement.

Another one we've used for years is a string of pearls. Right? So we've all heard the string of pearls, but we really have to imagine that the pearls are about that big. Right? They're about the size. I mean, they're worth a lot of money on the market if you're a pearl salesman. Right? And what we're looking at is these big pearls now are going to lift up. So if I have the end of the string of pearls here, I still want that energy drawing down away from the spine, and we're gonna draw it away and just feel that I'm doing it slow enough that each pearl is lifting up off of the mat. Very nice.

Taking a deep breath. I still have that elastic tension here on the quarter pearls, and we're dropping the top pearl down the second, the third, the fourth, fifth, possibly six. If we can get there, yes, nice, and seventh pearls. That's another nice image. The last one I'll use in the bridge is imagining you're in the ocean. And you've heard me use this one in some of my classes.

And to take it into almost a cellular level of movement, getting away from the bony structure, imagine you're a jellyfish. So here's this gelatinous body laying on the beach, and let's imagine the head tentacle of that jellyfish is fixed in the sand, and the warm water coming from Miami, the warm water, low wave coming in, and just gently rolling up cell by cell, the gelatinous body up onto the shoulders. And then when the water pulls back out, this is the beauty of this image, it's drawing the cells and creating the length as it lays it back down into the sand and creates that distance going in this direction. Right? So those are three or four good images that you can use to create a better segmental movement. We avoid doing a lot of posterior tilt at the end of range. So always think of that limitation there, will help you out a lot. Alright.

We're gonna move into the next exercise, which I love doing spine articulation is quadruped, but before we go there, I like to teach the pelvic circles and the pelvic clock kind of movement. So if we think of simply doing an anterior, posterior tilt, I wanna feel a rhythm to this, and this is gonna make sense when we move into quadruped, of that connectedness from Aaron's tailbone all the way up to the crown of her head is sort of like a, slinky being pulled in different directions. Right? So now let's go into quadruped. Let's use that same image, hands and knees, of how we might create that image. Now, one that I often will use is the pelvis is like a bowl of soup. Well, now the bowl of soup is upside down, so we have to pretend that we're on the moon. Right, where there's no gravity. And what we wanna do is we wanna start finding that relationship again, and finding that connection now all the way up into the head and the spine. What we're thinking of is like this sort of running up and running back down.

Communication happening between the elastic tissues around the spine, between the disc, between the vertebra and the muscles and myofascial system acting sort of like a spring and a combination of tension, compression, tension, compression. Now from here, we can start having a little bit of fun. We could also do something where we're doing a diagonal. So we can take the hip forward to the left, and then back to the right. Forward to the left, and then back to the right.

And we'll start finding, yes, there it is. Find that connection. Very often our clients from sitting so long, their head is not connected to their spine. It looks like it is, but in movement, it's not. And that's because they're not finding the connection through here. Try the other direction. So here, you'll find it. Yep.

And back. You'll find it. And she's sort of forcing it to happen right now, which is fine. That is what we call declarative learning. We learned that in other one of our workshops on Pilates anytime. And I want her to practice it until it becomes natural and spontaneously of finding this diagonal. And rest for a second.

That particular diagonal actually is walking. So we you might think that it's hard to do a diagonal in the pelvic tilts in the pelvic circle, but that actually is a very basic human movement. So if you find one side is more challenging than the other, whether you're doing on your back or in quadrupeds, you'll probably find something related to it as to foot, knee, shoulder, low back, hip, kind of symptoms or restrictions that are not allowing you to have normal bipedal movement. Let's take this one step further and go into full circles, like circumduction with a hip and just see if you can find the relationship. Yep. There it is, between the head and the tailbone.

So if I put a finger on the tailbone and the crown, I can feel them, and if I had a slinky, I could be doing the same thing, right? If you've ever played with a slinky, and filling how the different rings of the slinky are sliding at each level of the spine as she directs that movement. And reverse the direction, we can also think of where do we initiate the movement. So I could think if I wanted to initiate the movement between the shoulder blades, what would that look like? Compared to maybe doing it l three, the apex of the lumbar spine? Right? Or compared to doing it with the sternum.

So we can play with the idea where we see a restriction, and you haven't heard me talk about breath yet. Right? Breath is being moved because of the mechanical displacement of the lungs. So Aaron is naturally breathing. If I saw her holding her breath, I would know it because there would be no movement in these segments of the spine. So rather than giving a breathing cue, just allow them to have their mouth or nose open, basically, as they're moving, and the breath will naturally come in and go out as the thoracic spine is moving, and relax.

Beautiful, beautiful. And last thing I'll say in Quadrupid, there's no feedback coming into their back. So it really becomes a proprioceptive gem that she's able to create in her body. Of discovering all these different options of movement in this 24 segment chain. Even somebody that has two or three levels of fusion or 10 levels of fusion, there still are 14 additional segments that can be enjoying movement, including the hips and the shoulders.

So please don't be discouraged by the fact that you have somebody that has a fusion, what you want to think of. Let's say they have an L4 l5 fusion. How do we get movement up in this part of the spine? To take the stress away from the segment right above and right below the l four five fusion. Very important concept.

So I hope you enjoy that one. We're now gonna move into mermaid, and I'm just gonna have her sit with her legs off the side of the table. She didn't have to be in a z set. This is working with movement into the coronal plane. And in the coronal plane, we're looking at what we call side bending in the spine.

If you remember, let's play a little facet game here, the facet dance, and this is, for example, a lumbar facet in the lumbar spine, and I'm the vertebra above it. When I move unilaterally, the motion of the lumbar spine that is natural is lateral flexion. In the thoracic spine, the orientation changes of those facets in the back of the vertebra. So we have a coronal plane 65 degrees. So lateral flexion because of the ribs and the spine doesn't happen as easily, right? So it's gonna be more of a translation that we need when we go into side bending.

So let's give this a try. Hand behind the head. Give me a little bit of a fulcrum through this arm. You can do this in your z set or without the z set because it's more important about what's going on in the spine. But this fulcrum here now is I'm looking at the arm here and the arm down below is being in the same plane of movement. Right? They're opposite of each other. And the force is opposite.

So the hand is pushing into the mat, the elbow is reaching up towards the ceiling. So that creates the playground now. That we can use breath to start mobilizing the ribcage, breathing in and expanding out into my hand, like, an accordion or, again, the slinky or a Spanish fan, opening that up and then exhaling. Come back up with an exhale. Let's play with that. Inhale, open, exhale, close. Now, we also know in the ribs that some ribs move in this plane better.

The lower ribs are what we call bucket handle motion. So it's easier for the lower ribs to do this expansion, harder for the one through seven to do that expansion. So our goal is let's find a little bit of movement in each one of these segments up above and really feel the shoulder girdle creating that expansion of space in between those ribs. What happens with that is it allows us then, relax the arm, to have more rotation and extension in the thoracic spine, which are essential if she was a left handed pickleball player or volleyball player, gonna do a spike. Right? Now I have motion coming from the thoracic spine in the lateral rotation, and extension combined motions. There's no such thing as human movement in a sagittal plane or a coronal plane, uni planar. That doesn't exist.

It's a it's a very false interpretation of movement of the human body. It really is always multi planar multidirectional. So if we don't address the lateral flexion that we're doing in mermaid and we don't address the upper levels of that, then everything again is gonna go into the lumbar So it's really important for us to find that motion. The last thing I'll mention is if you make your hands like they are the scapula, the scapula are designed naturally to elevate, depress, protract around the rib cage, retract around the rib cage, and they also can do an upward rotation and a downward rotation. What they do not do is an extension They don't go here, right? And they don't do rotation this way.

So those two movements, if you were gonna you're right handed, imagine that you were actually spiking a a volleyball, right? You need both the extension, and the rotation that's gonna come from the rib cage. So when we look at a lot of our adults that have low back and shoulder pathology, playing tennis and, golf and pickleball and, volleyball, the rotator cuff injuries are due to the lack of thoracic mobility. In the literature, it often will state that this is a normal dysfunction of adult athletes. Well, there's nothing normal about it.

What's what's abnormal is that the thoracic spine is not doing its part with the ribs to provide a nice environment for the shoulder blade to maintain congruency through, an aggressive range of motion like you would have in tennis or pickleball. So it's really important that we can get that segmental movement in the coronal plane distributed across the whole spine. Use your eyes to look at and see if there's any hinge points in the coronal plane. The next one I wanna go into is spine extension. So we're gonna have Aaron go prone, and we're gonna look at, on your tummy, your other prone. Yep.

You and I have this fun little, you know, right, left, prone circles out, circles in. It's beautiful. So let's go through a series. I'm gonna have you take glasses off so it's actually a little bit easier too. Rest your head on your hands and the elbows out to the side. I'm gonna go through a little bit of a progression of how we look at spine extension using exercises we all know.

So in a pre swan or a preparation for things like dart or swimming, we can have the elbows, and we wanna send the elbows out as wide as we can and make as much space in this triangle of the elbow into the head. Right? And from here, we can feel the pressure of the forearms and the hands into the mat and just lifting the head up to where my finger is at the CT junction. So I don't want anything changing or moving here. It's just that very top part, and we can control that by where the eye gaze is. So, Erin, go ahead and lift your eye gaze up looking forward. We're gonna get hyper extension in the neck. If I'm looking down towards the belly, right? I'm not gonna get any extension in there.

I'm just gonna get flexion. So having the eyes on the hands as you come up, I'm gonna get that gentle extension trying to reach into this CT junction area here that's so hard to get movement. And if we can prepare that area first, it makes the next variables that we're doing going down into the mid thoracic so much easier if we can learn that. So let's come down here, let the hands go back into the push up position, right? And without coming up, just see if you can lift the head up, eyes looking down, right? So eyes are looking down, lift up a little bit higher, just the head. There it is. Right? So I have her in that nice preparatory position, I don't need any more motion out of the neck or that upper CT area. Right? So now I can have her send her elbows down, and I'm still keeping that nice length, and I'm going up just to the base of the ribs.

The base of the ribs are suspending her. Aaron, if you want to lift your hands up off there, can you maintain that height? Just lift the hands up, put it back down. Beautiful. So our goal, we don't need to increase anything in the lumbar spine. The lumbar already is in a lordotic position. This is the most common mistake that happens in extension exercises. If we just hang on the low back, we're creating a massive amount of shear force.

The other place that shear force comes from is the legs themselves so that the body come back down, rest your head on your hands, cock the toes underneath your ankles and reach the heels away until you feel the knees coming off. Now from here, still reaching the head long, tailbone reaching down low, What happens if you just point your toe keeping it at the same height? Yes. So that gives me the engagement of hip extensors without increasing that low back extension. This is what we want to prevent. Alright? Relax the legs. Let's put it all together for a swan, right? So hands are coming back down to push up position, elbows take you down to a pre swan, back of the neck is long, cocked the toes underneath, reach the legs. Good, point the toes.

And now from here, all we're doing is just rocking up onto our knees. Nothing else is changing. Yep. Lowback stays that same distance. We've we've established a nice thoracic extension and hip extension.

Come back down. As she comes down, the legs come back up. Perfect. Let's go back up one more time, and really realizing we're keeping the length there, and we've incorporated that idea of length across the front of the hips. If the hips can't go into extension, She's gonna collapse in her low back. Let's show what that might look like. Yes.

Where the hips can't extend, the low back collapses. We wanna be in this position, maintain that nice, long curve. So you can see it now with your eyes. It's not how big the curve is. It's how continuous it is that I know I have ample thoracic mobility here for Aaron to be able to do the more advanced spine extension and work like swan two and swan three without compromising the integrity of her low back.

Go ahead and relax. Let's go into the last position that I wanna share in this workshop series, which is long sit. So we're gonna look at things like short, spine stretch, and we're gonna look at rote sitting twist, and also the saw. So let's have you come up into a long sit position feed here. And in this one, we have to be very careful that if somebody doesn't have the relationship of the pelvis and the femur, that the sacrum can at least stand up vertical. We need to lift the bottom up high enough that we're not starting them already in a lumbar flexion position.

This is a common mistake. I teach my students and clients to be responsible for themselves. You're coming to my class, you know we're gonna do a long sit exercise, bring your box, bring whatever you need, whatever height, the blanket that folds up. You might need one inch, two inches, four inches. I have some people to do it in a chair because they just don't have the ability to long sit. Aaron does, and so we're gonna make the assumption that we're good in that position, her sacrum is vertical, and in spine stretch. One of the things we often do, we see two extremes of it. One, Aaron showed it of just not having enough range of motion, and we go forward and we end up putting a tremendous stress on the back of the spine.

The other is sort of the dancers attitude where it just hinges and they can drop down and flop onto their legs. Right? That's not spine stretch either. So come on up here, let the hands be down to the side, and I like to walk the hands out. So I'm really getting that coronal plane alignment. And from there hugging this imaginary tree first, let's hug that tree, right? And now I'm looking at let's imagine there's a ball right here, and we're gonna just like we practice with mermaid and coronal playing, we're gonna go up and over the ball, right? And so the way I feel this is sit bones are reaching down, head is reaching long, and the spine's going over it. I know she has enough hamstring length to flop onto her legs.

That's not the that's not the work. We're looking to distribute that motion up into this upper thoracic. That's our goal, and that she has enough control in the pelvis to be able to maintain stability why the upper spine goes into flexion. And you can imagine if somebody has this amount of flexion up in their upper spine, look how little flexion is happening in the actual lumbar spine, right, of much healthier way. From here, I have my own little technique, but I'll put my hands down to the side, palms up. Start off with a breath, inhale, and as you exhale, we're gonna restore the natural curve of the spine.

So you can feel l three coming towards the naval, as the spine stacks up in its normal position. Let's do it one more time a little more fluid. Arms come out. We hug the imaginary tree. We come up and over, right? Arms come down, palms up, deep breath in. And stack and restore the curve of the spine.

What I see sometimes is in the original work, I've seen it where you just keep pulling back through flexion, pull back, pull back, pull pull back. We have way too much flexion in our life. So I want people to feel what it feels like to stack the spine up in a neutral lordosis, you know, thinking of that relationship between the naval and the l three or the apex of that lumbar spine. That makes sense? Let's look at rotation now. Come into eye dream a genie position. Yep. And we can take the legs out wide as the as the table. And in this one, the whole key is where does rotation primarily come from, thoracic, right? And it's not gonna come from the lumbar because of the way the orientation of the facets are.

The thoracic has an orientation of rotation. So from here, if we think of the axial rotation, off the crown of the head, and the weight into the sit bones, we're just gonna spin around that axis. Right? And one thing that I could tell you is if you're having trouble with that, push the heel into the mat a little bit, and you'll feel that you can actually stabilize here, which is going to give you more motion up here that you can free up. And the more that we can emphasize where that rotation comes from in the thoracic, again, thinking of all those activities like swimming, running, tennis, golf. I mean, humans are made to have that multi planar movement and rotation.

This is something I've taught with, Victor for many years of looking at with his system and how we can really incorporate that rotation and that reciprocal motion in our human bodies, right? And then come back. And let's go to the other side. Another little trick we can play with is the eyes. You know, something called the vestibular ocular reflex. Let's rotate back to the left.

The vestibular ocular reflex job is to maintain steadiness in the head so the eyes can focus. Sometimes we start losing our proprioception, and so the vestibular ocular reflex takes over, and it starts over stabilizing neck and ribcage to maintain focus. So we can do a little trick. We can take just the eyes in this rotated position and move the eyes to the left, to the right, to the left, to the right, to the left, to the right, go a little bit faster, left, right, left, right, left, right, until you feel a little bit of a relaxation, and then find an extra five, ten degrees sometimes of available rotation that was just being guarded by the brains trying to brains trying to focus the eyes, right? That's not gonna mess with you. It's not gonna hurt your eyes.

It's not gonna make it hard for you to find balance, but it will get rid of unnecessary guarding that is limiting your thoracic rotation, that is not a structural limitation. Okay? Come back to center. Let's now combine this with a more functional movement, which is the saw, which is gonna be flexion, extension, rotation, side bending, all of those together. We'll do it by combining those two exercises. Spine stretch and spine twist.

So go into the spine twist to your left. Yep. Good. And now all we're doing is spine stretch to reach out. Unhinge the spine stretch, spine twist, spine stretch, stack it back up, spine twist, and stretch. So now we're creating a very functional motion that would be available in throwing a ball, tennis racket, swimming, and really trying to incorporate a sense of control and stability through the trunk with mobility. And remember that stability is the control of mobility. You cannot have stability, you cannot have control if you do not have mobility first. Otherwise, we are just rigid, and rigid is not about movement. Right? We never want our human body to be rigid.

We want the appropriate amount of stiffness for the anticipated load. If I was to speed up the activity or I was to increase the resistance, putting a pulley or something in your hand, we would see two things, increased stiffness, naturally, and probably a decreased range of motion. And that is a normal response to load and to tempo changes in any human movement, and it's expected. So we can practice and become more and more efficient, start off slow, discover the mobility first, then create the control of that mobility, the distribution of that mobility will greatly reduce the stressors that are causing the low back pain or reoccurring low back pain and return our good clients to health and to happiness, through that motion. I hope these sort of hints of how to facilitate movement in different orientations in gravity can make a big difference for you and your practice.

And in your own, teaching opportunities for those of you that are teachers, make the world a better place, motion is lotion, and, thank you applies anytime for, another opportunity to share some good gems of, knowledge.