Have you ever experienced shoulder pain? Often it just creeps up on us after waking from a full nights sleep on your side. Other times you’ve played a game of tennis for the first time in awhile.
A very common cause of shoulder pain is from a condition called "impingement syndrome." In this condition, the shoulder bursa (subacrominal bursa) or one of the rotator cuff tendons (the supraspinatus), or both, are essentially being impinged or compressed within the shoulder (under the acromial arch) as we lift our arm overhead.
Daily actvities, such as washing your hair, lifting laundry or groceries, or reaching upward and outward, can become painful.
The good news is this is a very treatable condition. As a physical therapist, we will often perform hands-on manual therapy to soft tissues, which appear restricted (such as the latissimus and pectoralis muscles.) We will also treat strength deficits in your shoulder blade (scapula) and shoulder (glenuhumeral joint) muscles. Video examples of stretching and strengthening exercises for shoulder impingement symptoms listed below.
Please do reach out with any specific questions.
Ariel Lehaitre MSPT
Many of our patients with neck and low back pain come to us with a diagnosis of degenerative disc disease, but are not clear on what this means. Degenerative Disc disease (DDD) is the process of losing disc height The inner most part of the intervertebral disc called the nucleus pulposus, looses fluid and often small cracks or fissures develop in outer annulus of disc.
DDD is not necessarily a "normal" process of aging, but a common process. It is often a progression of previous disc herniation or bulge, but can occur at the same time. DDD can occur in individuals as young a 30 years old ,and into 90 years of age.
Common Symptoms of DDD include :
DDD is most commonly diagnosed by an MRI. Treatment can include oral anti-inflammatories, cortisone injection into the spine, spine traction, and physical therapy.
Nearly 90% of our patients at Pilates Sante have DDD in their neck and pain. Very often these clients improve with lifestyle adjustments and specific therapeutic pilates exercises.
A couple of common exercises we might give include :
For any questions or concerns about your spine pain, feel free to contact us at Pilates Sante!
What is inflammation? We generally have two different inflammatory responses. Acute inflammation is a necessary (and helpful) short term immune system response to ward off “invaders” such as pathogens, bacteria, viruses, etc. Immune cells will rush to the site of injury or pathology to help heal and recover. This occurs with musculoskeletal injuries.
Chronic inflammation is long term, sustained inflammation in various systems of the body caused by repeated “hits” to the immune system such as poor diet, lack of sleep, sedentary lifestyle, and high stress levels. Chronic inflammation is the root of most diseases and health conditions such as heart disease, arthritis, chronic pain, IBS, high blood pressure and even depression. Chronic Inflammation is typically the cause of pain.
“All acute and chronic disease states have pathophysiology that is multifactorial, but nearly all have an inflammatory component to them”
Generally our new patients or clients come to Pilates Sante with symptoms and pain due to excessive inflammation. The inflammation of their condition prevents us from being able to effectively apply pilates therapeutic exercise to improve their condition. Therefore an immediate anti inflammatory regime is needed. This generally includes postural changes, ice, & oral medications such as NSAIDs.
Many clients are allergic to NSAIDs or have been on them long term, and are not tolerating them. It seems we have found the solution with Inflammatone.
This is a holistic anti-inflammatory supplement which consists of a protein enzyme blend which assists the breakdown of the inflammatory process. Many of our clients have experienced significant decrease in symptoms and increased tolerance for exercise, as well as daily activities.
We also recommend changes in lifestyle such as diet & stress management.
Please let us know of you have any questions about your level of inflammation , & whether you could benefit from an anti inflammatory regime.
Source: Jackie Miller Designs for Health
Breathing is the first thing we do once we are born, and the last thing we do before we die, but how much attention do we often give to our breath? Most of us don’t think about our breathing, likely because it is automatic and occurs nearly 20,000 times per day. Breathing of course is vital to our existence, and provides for all of our body’s systems. Physiologically, breathing provides oxygen to our all of our vital organs, as well as elimination of toxic substances from our bodies. For our emotional system, it provides control and clarity. In exercise, it provides for efficiency and organization of our musculoskeletal system.
Breath is one of the fundamental principles of pilates. Breath with pilates therapeutic exercise creates flow and ease of movement, encourages proper engagement of our deep core musculature, allows for axial elongation or decompression of our spinal segments, and general efficiency and strength of our musculoskeletal system.
At Pilates Santé we focus on two types of breathing patterns: diaphragmatic breathing and lateral breathing.
Diaphragmatic breathing involves inhaling through your nose, while expanding and relaxing your abdomen, then exhaling through the mouth while engaging your lower abdominal muscles. We often teach this breath technique initially to clients to create a connection to the lower abdominal muscle (transverse abdominus) to facilitate core control. This breath pattern also allows for relaxation and focus for our clients learning the pilates fundamental exercises.
Lateral breathing focuses on the expansion of the rib cage and breathing into the sides and back of the ribs. In lateral breathing, we maintain a consistent inward contraction of the deep abdominal muscles, through the inhalation and exhalation. This encourages us to keep our “corset” engaged by recruiting our intercostal muscles (the muscles between each of the ribs). Lateral costal breathing is the primary breath pattern implemented by our rehabilitative pilates clients, so that maximum core support and engagement is maintained through exercise.
The timing and direction of inhalations and exhalations we cue are based on the type of movement being performed. Inhalation is often cued to facilitate extension of the spine, while exhalation is for flexion. Inhalation is cued for axial elongation or relaxation, while exhalation is cued for engagement or facilitation. However, as Brent Anderson Polestar Pilates says, “Breath is a tool, not a rule, “ therefore cues should be based on the movement quality of the exercise you are observing in your client.
For more on these breath techniques, please refer to our website videos.
Nearly all of us have been told we need to have good posture to avoid injury, but what does that really mean? It means that when the spine is in its natural position, all 3 curves of the spine, cervical (neck), thoracic (middle) and lumbar (lower), are present and in properalignment. In this position the spine is able to withstand the greatest amount of gravitational stress during our daily activities. It is also the position in which we can most safely exercise.
Are we harming our bodies by moving out of neutral spine? No. Throughout the day, we have to move within a safe spinal range of motion that will not always be neutral spine. Therefore, we need spinal extension, flexion, side bending and rotational mobility in our spines. The beauty of pilates is that we work on both neutral spine stabilization and controlled spinal mobility in all exercises. This is the primary reason pilates can be so beneficial in both prevention and treatment of low back pain.
How do we find neutral spine? Pilates instructors use many different cues to teach alignment and awareness. In my opinion it’s a matter of finding what's most successful for each individual. I find cueing for axial elongation, or spinal length, is a nice way for people to achieve proper alignment and decrease stress on their spine. Often finding a neutral pelvic position first will help clients to stack their spine appropriately. An exercise to find pelvic and lumbar spine neutral is the pelvic clock.
Once you have performed these tilts and circles, find neutral spine on the clock face by being balanced on the center of the sacrum and feeling minimal effort of the abdomen and lower back muscles.You can practice just the vertical pelvic tilt both in sitting and in standing to find neutral in more functional positions, and to practice throughout your day.
One of the most common things new pilates clients tell me is how much more aware they are becoming of their posture during functional activities. Finding better alignment during your daily life will not only help prevent injury, but will also allow for more efficient use of your muscular support system.
Low back pain is second only to the common cold as a reason for doctor office visits in the United States. Why is low back pain so common? Today’s jobs and functional activities are contributing to worsening posture and body mechanics, causing increased load and stress to the spine.
There are a variety of problems and pathologies that cause low back pain. These range from joint inflammation, soft tissue and facial tightness, disc herniation, degenerative disc disease, stenosis and lumbar nerve root inflammation or impingement.
All current research concludes that the only long-term effective treatment for low back pain of all pathologies is therapeutic exercises. Unfortunately, research does not support massage, joint mobilization, or any other supportive modalities at this time.
What is therapeutic exercise? It is exercise which helps to facilitate support and healing of the injured tissue. The specific exercises prescribed must be related to the type of pathology or structure creating the low back pain.
Pilates has become one of the most commonly prescribed therapeutic exercise treatments for low back pain. The movement principles of Pilates align with what allows for the healing of low back pain.
Principle 1: Core control. The ability to initiate the deep muscles of the trunk (transverse abdominis, obliques, multifidi, pelvic floor, diaphragm) to control outside forces, such as gravity, from stressing spine structures.
Principle 2: Axial elongation. The ability to lengthen the spine decreases gravitational stress again by creating more space or openness between vertebral segments.
Principle 3: alignment and organization of the body. This is essentially learning how to properly place our rib cage, pelvis, and hips to improve posture in all positions, which again decreases stress to the spinal segments.
At Pilates Sante we develop an integrated whole body exercise program with the above principles in mind, which has given us an extremely high success rate in treating patients with a variety of low back conditions. Our clients feel the benefits of pilates mat and equipment exercise early on in their program, and most often continue as a wellness client once symptoms have resolved. Our primary goal is to allow our clients to heal and return to a fulfilling pain-free lifestyle.
I was introduced to pilates mat and equipment exercise in 1985 while rehabilitating a knee injury. As a pre-professional ballet dancer, I experienced a myriad of injuries in which pilates assisted my recovery. Since experiencing the benefits in my own body, I have seen the unbelievable changes my patients have experienced over the last 18 years. The variety of patients and conditions that pilates-based exercise can be applied to is vast, including, but not limited to, conditions such as osteoarthritis, osteoporosis, fibromyalgia and chronic pain.
The primary reason that so many conditions can benefit from this work is the incredible repertoire of exercises included in the pilates method, with common principles which can be applied to all experiencing pain.
Some common principles include:
The skill of the pilates instructor is to be able to select and administer the appropriate exercises for the given client and their condition. For example, for our osteoporotic clients, we avoid thoracic flexion, and focus on core control, hip strength and balance. For our osteoarthritis clients we might focus on pain management, posture and body mechanics, and flexibility for the joints involved.
At Pilates Santé, the certified pilates instructors are required to complete an injury pathology curriculum taught by physical therapists so that they can offer safe and specialized sessions to clients with a variety of conditions. The application of knowledge and pilates based therapeutic movement creates an incredible healing environment, which I have seen clients thrive in for nearly 18 years.