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:

• postural education & neutral spine 
• breath & its function with movement 
• alignment & organization of the body 
• core control & pelvic stability in multiple planes of movement 
• correcting muscular imbalances by stretching and strengthening of the appropriate muscles
• focus, control, & coordination 

 
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.