A lesson begins the minute your student walks into the room. You should take this time to notice their overall mood, energy, tension or contentment on their face and in their eyes. A teachers’ mind should formulate the needs of the session with the understanding that each day is a new day – for each client – even the consistent ones that you feel you know well. It is important to try to always look at them as new, as their bodies will speak the truth of what they are weathering.
One area that shows great stress and tension, more than any other and which you can easily observe, is in the shoulders. Shoulders are subject to injury and it is fairly easy to recognize movement substitutions caused by injury or tension. A common shoulder-related complaint is rotator cuff pain, of which there are many causes: sleeping incorrectly, overuse, poor posture and overall imbalance or injury. No matter the reason for injury, there are guidelines to follow that will lead you safely through your session. Let’s review them in relation to PPS-I exercises.
Remember three important concepts: active, active assisted and passive and use them in your sessions:
Active: The client does the movement entirely on their own – can be difficult with an injured shoulder. The injured shoulder won’t move the same as the uninjured one and this is when you can see what movement patterns are altered, especially with bilateral arm movements. In these cases, keep the uninjured arm moving the same as the compromised one. Do not allow any asymmetry.
Active assisted: The client moves the arms with an outside assistance. In Pilates it is the equipment that offers the assistance for regaining range of motion and neuromuscular education.
Passive: The client relies solely on another individual or machine to move the injured arm. In most cases Pilates instructors don’t use this method but it is applied in more therapeutic settings. However, there are times when moving a limb helps set the right pattern and so it’s important to do this. With shoulders issues, lifting an injured arm allows for the teacher to get circulation and movement in the joint without causing pain. An instructor must be extremely careful to do this.
Keep the affected arm close to the core of the body and in the Saggital plane as much as possible.
For instance, this might mean eliminating Arm Circles and Alternating Arms in the Wall Series, keeping the palms on the floor in Spine Stretch, lowering the back arm toward the floor in Saw or bending the support elbow during Sidekick Series. Avoiding Mermaid Stretch and Push Up Series. On the reformer, Twist during Stomach Massage should be avoided. Pulling the Straps II, Elephant and Stork should be performed cautiously, if at all. Most of the Power Circle exercises should be eliminated for some time – with the exception of Low to the Thighs and Chest Height, where they are kept in front of the body and or in line with the shoulders. The arms may need to rest on the mat during Leg Circles on the Cadillac. If the hands are on the vertical poles, make sure the elbows point to the ceiling thereby securing the shoulders in the joint. The vertical poles offer some support in this overhead position and aid in stability and connection. This also applies to Knee stretches where the arms are flexed with the body rounded where the footbar acts a as a support.
Avoid 180 degree movements.
During Roll Up, the arms are at a 180-degree flexion as they move over the head when supine and in the forward position as the body rounds upward and the arms align by the ears. Both of these positions should be either altered or avoided all together. The former by keeping the arms over the shoulder to begin and end the exercise and the latter by lowering the arms and bending the elbows when forward with the hands on the floor. Consider the efficacy of using a weighted exercise pole or dowel. Teaser-One leg and Teaser are performed with the hands in line with the shoulders or a bit above them but avoiding the progression with the arms over the head. Swimming–Prep arm movements should be eliminated completely; however leg movements could be executed safely enough. Flat, Side-to-Side and Twist on the Short Box would need to be done with the arms crossed in front of the body or while holding a Power Circle in front of the chest.
Eliminate extension movements behind the vertical plum line.
During Saw, for instance, the back arm not only extends but it internally rotates and is potentially dangerous for the shoulders if not done correctly, especially those already compromised. Avoid the back arm movement if in doubt and let the client rest the back arm hand on the floor and support the twisting action with it. Swan I- Neck Roll begins with the arms in extension and is troublesome for shoulder issues. Try keeping the elbows flat and maintaining the arms in front of the body to lift up. This is a good position for the shoulder. Have the client start the exercises on a high mat or barrel so the arms are not extended initially, otherwise leave it out all together. On the reformer, Short Spine should be eliminated and Monkey or Tower done in place of it. Even though the arms aren’t moving the trunk is, and essentially this places the arms in extension. Additionally, as the body moves upward, the arms are used for support with a pressing down motion. This action places stress on the anterior portion of the shoulder and can prove problematic for rotator cuff issues. This is true for Bride Prep as well. Stomach Massage Hands Back is to be avoided along with Long Stretch Arms on the Tower End and Behind the Back Power Circle exercises.
You can extrapolate on these guidelines and the respective restrictions to the more strenuous exercises in PPS-II, PPS-III and more advanced comprehensive work. They do pose a challenge and it is sometimes difficult to keep your clients’ session exciting and productive but not all is lost. You can still give a beneficial session, here’s how:
Notice what they can do and work deeply in those areas of strength and get new connections. You may have noticed the exercises with the arms in front of the body were good ones, they weren’t eliminated or avoided. This applies, in some degree, to weight-bearing exercises such as Leg Pull Front-Front-Support Only and Long Stretch. In holding these positions, you strengthen the shoulder. Most exercises working in the Sagittal plane are helpful if they are kept shoulder height and below. There is a fantastic exercise done on the outside of the Tower End I call the shoulder press, for lack of a better name and memory of its original one, and it is extremely healing. I’ve used it for many, many years with great success along with other traditional rotator cuff exercises and stretches. Here’s how it looks:
Set Up:
Attach the safety chain on the Push through Bar on the outside, not on the inside as is normally done. Then spring load it from below as you would in Monkey but again on the outside. Stand in front of it with an open leg stance and bend your knees to get a little under the Push through Bar. Standing close to it, hold the Push through Bar palms up with the elbows bent and into your body.
Execution:
Bend the elbows and straighten them. Move as far as you can without lifting the Push through Bar up too high. It is a small but intense range below the shoulders. Do this four to six times. Then holding the Push through Bar at the end range of that movement, push it up higher so the elbows reach shoulder height to a 90 degree angle. Then bring it back to the starting position. Do this three to six times. Lastly, hold the Push through Bar at the 90 degree angle and press up above shoulder height just a bit and back again with the same number of repetitions. You are gradually working up higher and higher getting the shoulder stronger.
This corrective exercise also aligns the shoulder joint and strengthens the scapula depressors’ thereby stretching the upper trapezius. Try it out and see how much your clients like it even if they don’t have a rotator cuff issue. When working with rotator cuff injuries it is important to work the entire body in a balanced manner from the Power House out. Remember to use the guidelines stated. Let your intuition and teachers’ mind steer your observation. Trust your strong foundation and education. This will ensure you have a successful session, not just once but rather each time you deal with the more challenged client.
- Colleen Glenn, Peak Pilates Master Trainer