strengthening core stability
TRANSCRIPT
IMPORTANT:Customer Service is available weekdays between 6AM-6PM Central time at 800-433-9570 Option 1. For weekend calls, contact Customer Service on the following Monday.
Strengthening Core StabilityUtilizing Functional Exercise Plans to Enhance Function,
Balance, Mobility, and Decrease Fall Risk
Lori Duncan, PT, DPT, MTC, CPT , is a licensed physical therapist, Pilates instructor, and owner of her own outpatient wellness clinic located in Denver, Colorado. In addition to clinical care, Dr. Duncan is a nationally recognized speaker that has devoted her career to educating clinicians on topics ranging from injury prevention to innovative exercise for treating patients.
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Version 3 - 05/19/15
Lori Duncan, PT, DPT, MTC, CPT
P R O G R A M E V A L U A T I O N F O R M
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Please rate the following items on a SCALE of 1 = (poor) to 5 = (excellent).OBJECTIVESAfter attending the program, how well do you feel you are able to:
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Lori Duncan, PT, DPT, MTC, CPT
Strengthening Core StabilityUtilizing Functional Exercise Plans to Enhance Function,
Balance, Mobility, and Decrease Fall Risk
Implement and effectively convey the most important Pilates principles.
Appraise the patient experience, HEP compliance, and quality of movement for each client.
Integrate the concept of “mobility on stability” for all therapeutic exercise.
Identify the common areas of weakness including the diaphragm, scapula, hip and ankle complex.
Develop specifi c treatment plans for common injuries and post-op recovery for all patient populations.
Utilize all 6 Pilates principles for any exercise to improve function and decrease fall risk.
Include evidence-based research and clinical case studies for optimal rehab outcomes.
Strengthening Core Stability
Presented by: Lori Duncan, DPT, MTC, CPT8
Objectives1. Implement and effectively convey the most important Pilates principles.2. Appraise the patient experience, HEP compliance, and quality of movement
for each client.3. Integrate the concept of "mobility on stability" for all therapeutic exercise.4. Identify the common areas of weakness including the diaphragm, scapula, hip
and ankle complex.5. Develop specific treatment plans for common injuries and post-op recovery for
all patient populations.6. Utilize all 6 Pilates principles for any exercise to improve function and
decrease fall risk.7. Include evidence-based research and clinical case studies for optimal rehab
outcomes
“Physical fitness is the first requisite of happiness.” ~Joseph Pilates
History of Pilates
• Joseph Pilates, 1883-1967
• Born in Germany
• Greek name
• Sick Child (asthma, rickets, rheumatic fever)
• Influence: yoga, gymnastics, circus, diving, boxing
9
History of Pilates• Lived in England and placed in Internment Camp
because of German heritage
• 1918 flu epidemic during WWI
‣ All of his trainees survived the epidemic
• “Pilates” originally called “Contrology”
‣ The mind controls the muscles
History of Pilates
• 1925, moved to America
• Opened “Contrology” in New York
• Dance community starting taking note of effects
“I’m 50 years ahead of my time.” ~ Joseph Pilates
10
Our body was designed for movement
Pilates is a MOVEMENT system
Thus, it is functional and effective for rehabilitation
“[Pilates] develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind, and elevates the
spirit.” ~Joseph Pilates
Pilates Enhances Rehabilitation~It masters the ability to teach our bodies how to move through space for
function and sport~
• Teaches dissociation of movement• Stimulates slow motor recruitment > fast motor recruitment• Strengthens eccentrically• Increases ROM/flexibility: multi-planar and multi-joint• Emphasizes movement initiated from core• Increases lung capacity: diaphragmatic breathing• Increases circulation• Improves body awareness, coordination and precision of
movement• Establishes balance throughout the body
11
Pilates Principles
• Centering
• Concentration
• Control
• Precision
• Breath
• Flow
Pilates Principles• Centering
‣ powerhouse
‣ secondary powerhouse
‣ centerline
• Concentration
‣ mind/body connection
‣ focus on the task
12
Pilates Principles• Control
‣ neuromuscular coordination: harmonious interaction of muscles and CNS
‣ smooth and efficient movement patterns for safety
• Precision
‣ accuracy to accomplish the task
• Flow
‣ lightness of movement
‣ control of acceleration and deceleration (function!)
Pilates Principles• Breathing
‣ The most important principle
‣ Diaphragm muscle
‣ Inhalation- to open
‣ Exhalation- to close
‣ Consider rib/thoracic mobility
“Above all, learn how to breathe correctly.” ~ Joseph Pilates
13
Pilates Equipment
Pilates Equipment
14
Pilates Progression1.Center of Gravity
2.Base of Support
3.Surface Stability
4.Exercise Complexity
5.Rhythm and Tempo (pace)
“[Pilates] is not a fatiguing system of dull, boring, abhorred exercises repeated daily ‘ad-nauseam’.” ~ Joseph Pilates
Rehab Progression1. NWB
2. WB double support (static)
3. WB single support (static)
4. WB double support (dynamic)
5. WB single support (dynamic)
6. WB double support (ballistic)
7. WB single support (ballistic)
8. Sports Specific Training
15
Mobility with Stability• Mobility with stability is the KEY to healthy function
‣ FUNCTION: integrated, multi-planar movement that requires acceleration, deceleration and stabilization.
• Pilates is brilliant at teaching this concept
• Natural progression in childhood
1. mobility: flexibility, ROM
2. stability: neuromuscular control of movement, also termed motor control
3. mobility with stability = function!
Pain and StabilityComeford and Mottram, authors of Kinetic Control (2011), explain the effect of pain on the muscle system
• Pain affects slow motor units more significantly than fast motor units
• Athletes can still generate power and speed
• 90% of sport world records broken by athletes with chronic or recurrent musculoskeletal problems
• In a pain-free state, the CNS is able to utilize a variety of motor control strategies to perform coordinated and efficient movement patterns
• In pain, subjects employ strategies of muscle recruitment normally reserved for high load function (lifting, pushing, throwing, jumping) and use these for normal low threshold, postural activities (Hodges et al, 2009)
16
Pain and Motor Control• Motor Control = Stability
• Hodges and Tucker (2011) have proposed a new theory for pain adaptation:
1. Redistribution of muscle activity occurs within and between muscles
2. Altered mechanical behavior is present
3. Protection from further pain or injury is the main goal...at any cost
4. Changes occur at multiple levels of the motor system
5. Short-term benefits may have long-term consequences
• Take-away note from research: pain does not have a uniform effect
The “Core” Muscles of Pilates
17
Abdominal Muscles• Transverse Abdominis‣ Stabilization
• Internal Abdominal Oblique‣ Stabilization
‣ Rot/SB
• External Abdominal Oblique‣ Posterior Pelvic Tilt
‣ Rot/SB
• Rectus Abdominis‣ Posterior Pelvic Tilt
‣ Trunk flexion
Glute Muscles• Gluteus Maximus
‣ Hip Ext, Abd, ER
• Gluteus Medius
‣ Hip Abd, Stability
• Gluteus Minimus
‣ Hip Abd, Stability Assistant
18
Scapula Muscles• Serratus Anterior
‣ Stabilizes scapula‣ Protracts scapula
• Latissimus Dorsi‣ Depresses scapula‣ Extends, adducts, IR arm
• Lower trapezius‣ Stabilizes scapula‣ Depresses scapula
• Rhomboids‣ Stabilizes scapula‣ Retracts scapula
• Middle Trapezius‣ Retracts scapula‣ Stabilizes scapula
Other Key Muscles• Lumbar Multifidus
‣ Segmental stabilizer of spine
• Diaphragm‣ Expands rib cage, increases intra-abdominal pressure
• Pelvic Floor‣ Stabilizes the coccyx, supports pelvic viscera by elevating pelvic floor
19
Muscle Roles• Local Muscle System: responsible for segmental stiffness and
decreasing excessive intersegmental motion. These maintain activity in the background for all motion. (TA, VMO, multifidus, foot intrinsics)
• Global Muscle System: produces ROM and control of load. These usually have a primary role of either:
1. Stability: external abdominal oblique2. Mobility: rectus abdominis, hamstrings, rectus femoris
• Multi-Task Muscles: these muscles act as a local stabilizer, global stabilizer and global mover (gluteus maximus, infraspinatus, subscapularis)
“...it is in principle a wrong approach to try to understand impairments of different parts of the motor system separately, without understanding the function of the motor system as a whole.” -
Vladimir Janda
The Body as a Whole System
20
Vladimir Janda• Czech neurologist and physiatrist
• CNS is highly important to mediate pain because of neuromuscular imbalance
• Posture muscles - become tight with dysfunction
• Phasic muscles - become weak with dysfunction
• Upper Cross and Lower Cross Syndromes
Janda’s Philosophy• Sensorimotor system: the health and tone of the muscle system
reflects the state of the sensorimotor system because it receives input from the muscle system and the CNS
• Tonic and Phasic muscles are based on phylogenic development
‣ Tonic: flexors, older and dominant. Emerge in flexor synergies, usually spastic.
‣ Phasic: extensors, develop after birth. Emerge in extensor synergies, usually flaccid.
- These muscles work eccentrically against gravity
21
The Janda Approach1. Normalize the periphery: joint mobility, biomechanics,
swelling control
2. Restore muscle imbalance: Sherrington’s law of reciprocal inhibition (1907)
3. Increase afferent input to facilitate reflexive stabilization:create automatic coordinated movement
4. Increase endurance in coordinated movement patterns: repetition, low intensity, high volume
Tonic Muscles• Become tight with dysfunction
✴SCM, scalenes
✴Upper trapezius, levator scapulae
✴Pectoralis major/minor
✴Hamstrings, adductors, iliopsoas
✴TFL
✴Piriformis, erector spinae
✴Gastroc
22
Phasic Muscles• Become weak with dysfunction
✴Peroneals
✴VMO
✴Glutes
✴Abdominals
✴Deep neck flexors
✴Serratus anterior, lower trapezius
Upper Crossed Syndrome
23
Lower Crossed Syndrome
“Muscles We Don’t See in the Mirror” Syndrome
• Adults rely on vision for body awareness and proprioception
• Common muscles that require attention in rehab:
‣ Soleus
‣ Scapular muscles
‣ Glutes
24
Specific Injuries
Common Links to Pain and Injury
• Previous Injury
‣ this is the main risk factor for injury, especially within the last 12 months
• Poor dissociation of movement
‣ especially the scapula and hip complex
• Compensation patterns
‣ upper trap, TFL, VL
• “Muscles We Don’t See in the Mirror” Syndrome
25
Foot and Ankle• Ankle instability / chronic sprains
‣ Hip stability just as important as ankle stability
• Achilles Tendonosis‣ Eccentric training to remodel the tendon from type III collagen to type I
• Plantar fasciitis‣ Restore the windlass mechanism
✴This region requires foot intrinsic and eccentric training
Knee• PFPS
‣ Optimal hip mechanics are key
• IT Band Syndrome‣ IT band may be considered tendon of glute max, based on histology research
‣ VMO to balance glute max
• ACL - pre and post surgical• TKA - pre and post surgical
✴ This region requires glute and VMO training
26
Hip• THA - pre and post surgery
• Hip fractures
• Myofascial Pain - poor dissociation and proprioception of hip complex
✴This region requires core and glute training
Back Pain• Low Back Pain
‣ Post surgical: discectomy, laminectomy, fusion
‣ Lumbar multifidi atrophy with chronic LBP
• Scoliosis
• Postural Pain
✴ This region requires glute, core and scapular training
“A man is as young as his spinal column.” ~ Joseph Pilates
27
Shoulder• Rotator Cuff - surgical and non-surgical
‣ Internal rotation may be more important than external rotation
• Scapular dyskinesia• Shoulder impingement
‣ Posture? Rotator cuff laziness? Structural?
• Myofascial Pain - poor dissociation and proprioception of shoulder complex
✴ This region requires scapular stabilization and RC training
Cervical• Cervical pain
• Deep neck flexor training is important
• Cervical fusion - pre and post surgery
• Myofascial Pain - usually associated with scapular myofascial pain
✴This region requires deep neck flexor and scapular training
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Pilates in Research
Gait and LBP
• daFonseca et al. (2009): Laboratory gait analysis in patients with low back pain before and after Pilates intervention.
• Study: measured VGRF at natural and increased walking speed
• Groups: Control group, LBP group without Pilates, LBP with Pilates
• Result: Pilates group able attenuate VGRF with decreased LBP
29
Breathing and COPD• Cancelliero-Gaiad et al. (2014): Respiratory pattern of diaphragmatic breathing and
pilates breathing in COPD subjects
‣ 15 subjects with history of COPD, current or former smokers, 40-80 years old
‣ Diaphragmatic Breathing - movement of abdominals with diaphragm breathing
‣ Pilates Breathing - contraction of TA and pelvic floor with diaphragm breathing
‣ Diaphragm Breathing - increased lung volume, respiratory motion and decreased respiratory rate for COPD patients
‣ Pilates Breathing - increased lung volume in healthy patients and increased oxygenation in both groups
Elderly: Gait and Balance
• Newell D et al. (2012): Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme.
• Observational Study, n= 9
• Mat exercises with theraband and physioball for core, LE emphasis
• Results: After 8 weeks, subjects had improved walking speed, step cycle, step length and FRI (fall risk index) along with decreased anterior/post trunk sway.
30
Chronic LBP• Natour et al. (2015): Pilates improves pain, function and quality of life in
patients with chronic low back pain: a randomized controlled trial.
• n=60 subjects with LBP randomly assigned to two groups:
• Experimental group: NSAID’s and Pilates
• Control group: NSAID’s only
• Data collected at 0, 45, 90 and 180 days
• Pain (VAS), function (Roland Morris), quality of life (SF-36) were significantly improved with Pilates group and they reported less NSAID use.
Other Areas of Research
• Ankylosing Spondylitis
• Breast Cancer
• Amputees
• Fibromyalgia
31
Case Studies• 40 year old patient with CONGENITAL SCOLIOSIS
‣ Rod since she was 12 years old
‣ Neck, low back and SI pain
‣ Findings
- Significant hamstring flexibility
- Poor lumbar mobility
- Poor dissociation of leg/pelvis/trunk
- No awareness of scapular motion: retraction or depression
Case Studies
32
Case Studies• 64 year old TRIATHLETE WITH HIP FRACTURE
‣ Fell off bike in April, didn’t seek PT until July
‣ Difficulty with walking and wanted to return to swim, bike, run
‣ Findings
- Antalgic gait - poor LLE stance time and hip stability
- LLE muscle weakness - VMO, glutes, VL, HS
- Poor hip mobility
- Low back pain
Case Studies• 45 year old yoga instructor with UNEXPLAINED FOOT DROP
‣ Sudden onset 4 years ago, had seen 3 neurologists without any relief
‣ Significant R hip and back pain
‣ Difficulty with walking (no AFO)
‣ Findings:
‣ DF 2-/5 with significant gastroc/soleus tightness
‣ SLS less than 1 sec
‣ Poor glute, core awareness and activation
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Case Studies• 67 year old GOLFER WITH HIP PAIN
‣ Poor dissociation of leg on pelvic on trunk
‣ R back, hip and lateral thigh pain
‣ Wanted to be able to walk on golf course without pain
‣ Findings:
‣ Very weak intrinsic core
‣ Poor lumbar and thoracic rotation
‣ Difficulty sitting out of pelvis
Case Studies
• 44 year old athletic woman with CHRONIC HEADACHES
‣ Chronic neck pain with HA’s, history of disc herniation without surgery
‣ History of R subclavian bloot clot 3 years prior
‣ Findings:
‣ Recruited big muscles for small tasks
‣ Biceps curls- used SCM for stability on BOSU, not core
‣ Significant UT hypertonicity
34
Pilates References
• www.peakpilates.com
• www.merrithew.com (Stott Pilates)
• www.junekahn.com (June Kahn Bodyworks)
Thank you!
Physical Fitness is: “the attainment and maintenance of a uniformly developed body with a sound mind fully capable of naturally, easily and satisfactorily performing out many
and varied daily tasks with spontaneous zest and pleasure.” ~ Joseph Pilates
In 10 Sessions You’ll Feel Different. In 20 Sessions You’ll Look Different.
And In 30 Sessions, You’ll Have A New Body.
~Joseph Pilates, 1941
35
Pila
tes E
xerc
ises
A fe
w w
ell-d
esig
ned
mov
emen
ts, p
rope
rly p
erfo
rmed
in a
bal
ance
d
sequ
ence
, are
wor
th h
ours
of d
oing
slop
py c
alis
then
ics o
r for
ced
cont
ortio
n.”
~Jos
eph
Pila
tes
37
Diap
hrag
mat
ic B
reat
hing
•
Supi
ne-
Lay
on y
our b
ack,
kne
es b
ent a
nd h
ead
rela
xed
-Cr
oss y
our a
rms a
nd p
lace
you
r han
ds o
n th
eou
tsid
e of
you
r rib
s -
Keep
the
neck
rela
xed
and
brea
the
into
you
rha
nds t
o ex
pand
the
rib c
age
-Pr
actic
e 1-
2 m
inut
es.
-Ad
d co
re a
ctiv
atio
n w
hen
read
y
•Si
ttin
g-
Sit t
all w
ith y
our f
eet o
n th
e flo
or-
Cros
s you
r arm
s and
pla
ce y
our h
ands
on
the
outs
ide
of y
our r
ibs
-Ke
ep th
e ne
ck re
laxe
d an
d br
eath
e in
to y
our
hand
s to
expa
nd th
e rib
cag
e -
Prac
tice
1-2
min
utes
in th
e m
irror
-Ad
d co
re a
ctiv
atio
n w
hen
read
y
•St
andi
ng w
ith O
fferin
g-
“Lea
n in
to th
e W
ind
and
Brea
the”
-St
and
in P
ilate
s st
ance
, eng
age
your
core
and
le
an sl
ight
ly fo
rwar
d -
Brea
the
in a
s yo
u m
ove
your
arm
s up
-Br
eath
e ou
t as
you
low
er th
em d
own
-Pe
rform
10-
12 re
petit
ions
38
Fund
amen
tal
Cerv
ical
Exe
rcise
s •
Cerv
ical
Nod
-“C
url y
our c
hin
to y
our c
hest
”-
Lay
on y
our b
ack,
kne
es b
ent
-He
ad is
rela
xed
and
neut
ral
-Ge
ntly
cur
l or n
od y
our c
hin
to y
our
ches
t with
out l
iftin
g yo
ur h
ead
-Fe
el th
e “t
hroa
t mus
cles
” w
orki
ng-
Prac
tice
1-2
min
utes
•Ce
rvic
al N
od +
Lift
-“C
url y
our c
hin
to y
our c
hest
and
lift
your
hea
d, lo
ok a
t you
r nav
el a
nd
leng
then
thro
ugh
the
crow
n of
the
head
” -
Perf
orm
a c
ervi
cal n
od-
Lift
you
r hea
d up
and
com
e to
rest
on
the
bott
om o
f you
r sho
ulde
r bla
des
-Yo
ur h
ead
shou
ld fe
el a
ncho
red
into
your
core
at t
he st
ernu
m
-Pe
rfor
m 2
-5 re
petit
ions
39
Fund
amen
tal
Abdo
min
al E
xerc
ises
•TA
sett
ing
+ he
el sl
ides
-
“Mov
e yo
ur le
g fr
om y
our c
ore”
-
Lay
on y
our
back
, kne
es b
ent i
n ne
utra
l spi
ne
-Pl
ace
two
finge
rs o
n in
side
of y
our h
ip b
ones
an
d dr
aw th
e be
lly in
with
out m
ovin
g an
y bo
nes.
-
Feel
mus
cles
“po
ke”
into
you
r fin
gers
. -
Slid
e yo
ur ri
ght h
eel o
ut a
nd in
slow
ly, fe
elin
g th
e le
g an
chor
ed in
to th
e co
re. R
Rep
eat o
n th
e le
ft sid
e -
Perfo
rm 5
-10
repe
titio
ns, a
ltern
atin
g
•Pi
late
s Brid
ging
-
“Sna
ke th
roug
h th
e sp
ine”
-
Star
t with
TA
sett
ing
-
Brea
the
in, t
hen
brea
the
out a
nd u
se y
our c
ore
to p
ress
you
r low
bac
k in
to m
at/f
loor
-
Gent
ly p
eel t
he sp
ine
off v
erte
brae
by
vert
ebra
e an
d re
st o
n yo
ur sh
ould
er b
lade
s -
Brea
the
in a
t the
top
and
brea
the
out a
s you
pa
ste
the
spin
e do
wn
vert
ebra
e by
ver
tebr
ae.
The
tailb
one
is th
e la
st b
one
to h
it th
e m
at
-Pe
rform
5-8
repe
titio
ns
40
Fund
amen
tal
Abdo
min
al E
xerc
ises
•Kn
ee C
ircle
s-
“Mov
e yo
ur k
nees
from
a st
able
cor
e”-
Lay
on y
our b
ack
with
kne
es in
tabl
e to
ppo
sitio
n
-M
ake
very
sm
all c
ircle
s (s
ilver
dol
lar
size)
-
Feel
the
knee
s an
chor
ed fr
om a
ver
yde
ep c
ore
sens
atio
n -
Perfo
rm 5
-8x
each
dire
ctio
n
•Hu
ndre
d-
“War
m u
p th
e bo
dy w
ith th
e co
re”
-La
y on
you
r bac
k w
ith k
nees
ben
t, fe
eton
floo
r, ar
ms a
t you
r sid
e -
Perfo
rm a
cer
vica
l nod
and
look
at y
our
nave
l -
Begi
n pu
mpi
ng y
our a
rms q
uick
ly fo
r10
0 br
eath
s. B
reat
he in
5 co
unts
, br
eath
e ou
t 5 c
ount
s.
-Le
g po
sitio
ns: f
eet o
n flo
or, l
egs i
n ta
ble
top,
legs
stra
ight
up,
legs
at 4
5 de
gree
s (p
ictu
re s
how
n)
41
Fund
amen
tal
Arm
Exe
rcise
s •
Arm
Circ
les
-“M
ove
your
arm
s fro
m y
our b
ack”
-La
y on
you
r bac
k, k
nees
ben
t, fe
et o
nth
e flo
or, a
rms o
ver y
our s
houl
der j
oint
s -
Keep
you
r rib
cage
tuck
ed in
and
conn
ecte
d to
the
mat
-
Mov
e yo
ur a
rms i
n th
e so
cket
, fee
ling
the
conn
ectio
n to
you
r bac
k an
d co
re
-He
ad o
ptio
ns: r
elax
ed o
n th
e m
at o
rlif
ted
-Pe
rform
5-8
repe
titio
ns e
ach
way
•La
t Ove
rhea
d w
ith R
ib S
tabi
lity
-“M
ove
your
arm
s fro
m y
our b
ack”
-La
y on
you
r bac
k, k
nees
ben
t, fe
et o
nth
e flo
or, a
rms o
ver y
our s
houl
der j
oint
s -
Turn
you
r pal
ms t
owar
d ea
ch o
ther
and
reac
h ov
erhe
ad w
ithou
t let
ting
your
ribs
“p
op”
-Re
turn
the
arm
s ove
r you
r sho
ulde
rjo
ints
usin
g yo
ur c
ore/
lat c
onne
ctio
n -
Perfo
rm 1
0-15
repe
titio
ns. A
dd 3
or 5
lb.
wei
ghts
whe
n in
dica
ted
42
Fund
amen
tal
Leg
Exer
cise
s •
Frog
s with
Ban
d-
“Mov
e yo
ur le
gs fr
om y
our c
ore”
-La
y on
you
r bac
k w
ith y
our f
eet i
n a
frog
posit
ion,
ban
d w
rapp
ed a
roun
d yo
ur
arch
es
-En
sure
you
r tai
lbon
e is
on th
e m
at a
ndth
e co
re is
eng
aged
-
Feel
ing
your
legs
anc
hore
d in
to y
our
core
, pre
ss y
our l
egs o
ut to
45
degr
ees
and
“zip
up
your
legs
” -
Perfo
rm 5
-8 re
petit
ions
•Si
ngle
Leg
Circ
les
with
Ban
d-
“Fee
l the
hip
mov
e in
the
sock
et”
-La
y on
you
r bac
k w
ith o
ne le
g in
the
band
, the
oth
er le
g be
nt o
r str
aigh
t -
Keep
ing
the
pelv
is st
able
(do
not l
et it
rock
and
roll)
, mak
e le
g ci
rcle
s in
a
cont
rolle
d m
otio
n -
Perfo
rm 5
-6 re
petit
ions
eac
h w
ay, b
oth
legs
43
Fund
amen
tal
Leg
Exer
cise
s •
Sing
le L
eg N
M c
ontr
ol-
“Con
trol
the
knee
from
the
hip”
-La
y on
you
r bac
k w
ith o
ne fo
ot in
the
band
, the
oth
er le
g be
nt
-Be
nd y
our k
nee
to 9
0 de
gree
s and
pres
s the
foot
thro
ugh
the
band
to
stra
ight
en th
e le
g -
Keep
ing
the
leg
stra
ight
, slo
wly
raise
the
leg
up a
nd th
en lo
wer
-
With
cont
rol,
bend
the
knee
to th
est
artin
g po
sitio
n -
Perf
orm
8-1
0 re
petit
ions
eac
h le
g.
•Si
ngle
Leg
NM
con
trol
+ b
ridge
-As
abo
ve, b
ut in
a b
ridge
pos
ition
-Ke
ep th
e pe
lvis
leve
l dur
ing
the
exer
cise
-
Perf
orm
8-1
0 re
petit
ions
eac
h le
g.
44
Post
erio
r Pel
vic
Tilt
Is
olat
ion
•
Roll
dow
ns
-“T
uck
your
tailb
one
and
slow
ly ro
ll do
wn”
-
Sit w
ith y
our k
nees
ben
t, fe
et re
laxe
d on
gr
ound
-
Gent
ly p
lace
you
r fin
ger t
ips b
ehin
d yo
ur k
nees
-
Draw
you
r bel
ly in
, tuc
k yo
ur ta
ilbon
e an
d slo
wly
pas
te y
our s
pine
dow
n w
hile
kee
ping
the
feet
on
the
floor
-
Usin
g yo
ur c
ore
and
gent
le fi
nger
tip
touc
h,
retu
rn to
sitt
ing
-Pe
rform
5-8
repe
titio
ns. P
re-c
urso
r for
sit-
ups
•Q
uadr
uped
PPT
isol
atio
n -
“Iso
late
d pe
lvic
tuck
, not
cat
” -
Posit
ion
your
self
on y
our h
ands
and
kne
es,
hand
s und
er sh
ould
ers,
kne
es u
nder
hip
s.
-Fi
nd n
eutr
al sp
ine
and
enga
ge y
our c
ore
-U
sing
your
cor
e, tu
ck y
our p
elvi
s und
er a
nd
roun
d yo
ur lo
w b
ack.
-
Mak
e su
re y
ou’re
not
roun
ding
you
r mid
-bac
k -
Perfo
rm 8
-10
repe
titio
ns.
Yes:
Lon
g C
Curv
e
No:
Upp
er B
ack
Onl
y
45
The
Ab S
erie
s Th
e Ab
Ser
ies
is pe
rform
ed c
onse
cutiv
ely.
Cl
assic
ally,
thi
s is
perf
orm
ed w
ith t
he h
ead
lifte
d of
f. Ho
wev
er, i
t can
be
effe
ctiv
e w
ith th
e he
ad re
laxe
d on
the
grou
nd. L
ay o
n yo
ur b
ack
to st
art.
Perf
orm
5-1
0 re
petit
ions
eac
h.
•Si
ngle
Leg
Str
etch
-O
ne k
nee
stra
ight
ens a
nd re
ache
s out
of th
e hi
p so
cket
whi
le th
e ot
her
knee
pul
ls in
, han
ds g
ently
on
top
of
knee
pul
ling
in
•Do
uble
Kne
e St
retc
h-
Both
kne
es h
ug in
, the
n th
e le
gsst
raig
hten
out
to 4
5 de
gree
s whi
le
the
arm
s ext
end
by th
e ea
rs
46
The
Ab S
erie
s •
Sciss
ors
-Bo
th le
gs st
ay st
raig
ht a
s the
yal
tern
ate
in a
split
-like
act
ion,
han
ds
gent
ly b
ehin
d th
e le
g cl
oses
t to
the
body
•Do
uble
Leg
Low
er /
Lift
-Ke
epin
g th
e pe
lvis
leve
l, bo
th le
gslo
wer
. Han
ds a
re b
y hi
ps o
r beh
ind
head
•Cr
iss-C
ross
-Ha
nds b
ehin
d he
ad a
nd ro
tate
out
erel
bow
to o
utsid
e of
mat
. “Ke
ep th
e w
ings
pan”
-
Mod
ifica
tion:
try
with
legs
at t
able
top
to w
ork
on u
pper
trun
k iso
latio
n
47
Glut
e Ex
erci
ses:
Cl
ams
•Cl
ams
-“M
ove
your
leg
on a
stab
le b
ody”
-La
y on
you
r lef
t sid
e an
d lin
e up
you
rhe
els,
hip
s and
shou
lder
s to
be
in o
ne
line
-Be
nd y
our k
nees
to 9
0 de
gree
s an
d st
ack
your
hip
s.
-En
gage
you
r cor
e-
Keep
ing
your
hee
ls co
nnec
ted,
ope
n th
eto
p le
g to
act
ivat
e th
e gl
ute
-Pe
rform
15-
20 re
petit
ions
on
each
side
-Ad
d a
ther
aban
d at
the
thig
hs w
hen
indi
cate
d
•Cl
ams -
feet
off
-La
y on
you
r lef
t sid
e an
d po
sitio
nyo
urse
lf fo
r the
cla
m
-Ke
epin
g th
e kn
ees
on th
e gr
ound
, lift
your
feet
off
-Ke
epin
g yo
ur h
eels
conn
ecte
d, o
pen
the
top
leg
to a
ctiv
ate
the
glut
e -
Add
a le
g ex
tens
ion
(str
aigh
ten
the
leg)
afte
r a fe
w re
petit
ions
-
Perfo
rm 1
0-15
repe
titio
ns o
n ea
ch si
de
48
Glut
e Ex
erci
ses:
Th
e Si
de S
erie
s Th
e sid
e se
ries
is pe
rform
ed
cons
ecut
ivel
y. L
ay o
n yo
ur le
ft s
ide
with
yo
ur h
ips
and
shou
lder
s in
one
line
, the
le
gs a
re s
light
ly f
orw
ard
at a
n an
gle.
Pe
rform
5-1
5 re
petit
ions
of e
ach.
•U
p / D
own
-Ke
ep th
e he
el tr
acki
ng o
ver t
hehe
el
-Fl
ex y
our f
oot a
nd li
ft y
our l
eg,
poin
t you
r foo
t and
low
er y
our
leg
•U
p / D
own-
Sw
itch
-Po
int y
our f
oot a
nd li
ft y
our l
eg,
flex
your
foot
and
low
er y
our l
eg
49
Glut
e Ex
erci
ses:
Th
e Si
de S
erie
s •
Circ
les
-Po
int o
r fle
x yo
ur fo
ot a
nd m
ake
plat
e siz
e ci
rcle
s aro
und
your
he
el. I
ncre
ase
the
circ
le s
ize
whe
n in
dica
ted.
•Bi
cycl
e-
Brin
g yo
ur k
nee
into
you
r che
st,
exte
nd y
our l
eg o
ut a
nd sw
eep
it be
hind
with
you
from
you
r glu
te.
-Re
peat
the
othe
r dire
ctio
n
50
Glut
e Ex
erci
ses:
Gl
ute
Max
Tra
inin
g •
Glut
e Li
ft-
“Fin
d yo
ur g
lute
, not
you
r ham
strin
g”-
Posit
ion
your
self
on y
our e
lbow
s an
dkn
ees.
Elb
ows
unde
r sho
ulde
rs, k
nees
un
der h
ips
-Ki
ck y
our g
lute
up
with
con
trol
,co
ncen
trat
ing
on th
e en
d ra
nge
mot
ion
-Pe
rform
12-
15 re
petit
ions
•Gl
ute
Circ
les
-“R
otat
e yo
ur h
ip in
the
sock
et”
-Po
sitio
n yo
urse
lf on
you
r han
ds a
ndkn
ees.
Han
ds u
nder
shou
lder
s, k
nees
un
der h
ips
-O
ptio
n 1:
Rot
ate
a lo
ng le
g be
hind
you
with
stab
le tr
unk
-O
ptio
n 2:
Ben
d th
e kn
ee a
nd ro
tate
you
rhi
p in
the
sock
et, k
eepi
ng th
e kn
ee in
lin
e w
ith th
e an
kle
-Pe
rform
4-5
repe
titio
ns e
ach
way
51
Pila
tes P
lank
•
Plan
k Pr
ep-
“Len
gthe
n yo
ur to
rso
forw
ard”
-Po
sitio
n yo
urse
lf on
you
r han
ds a
ndkn
ees.
Han
ds u
nder
shou
lder
s, k
nees
un
der h
ips
-Fr
om y
our c
ore,
leng
then
or t
orpe
doyo
ur to
rso
over
you
r han
ds
-Fe
el th
e en
tire
body
kic
k on
and
hol
dfo
r 5-1
0 se
cond
s -
Perf
orm
4-5
repe
titio
ns
•Pi
late
s Pla
nk-
“Eng
age
from
hea
d to
toe”
-U
sing
the
Pila
tes P
rep,
find
you
rpl
ank
posit
ion
-St
ay lo
ng, e
ngag
ed a
nd st
rong
as l
ong
as y
ou ca
n be
fore
you
r fee
l pai
n in
yo
ur b
ack.
15-
90 se
cond
s
52
Pila
tes S
ide
Plan
k •
Side
Pla
nk-
“Anc
hor y
our s
houl
der d
own
your
bac
k an
d pr
ess u
p fro
m
your
obl
ique
s and
scap
ula”
-
Sit o
n yo
ur le
ft s
ide,
pos
ition
your
han
d so
it is
slig
htly
out
fro
m y
our s
houl
der
-In
itiat
e th
e m
ovem
ent b
y ro
lling
your
shou
lder
dow
n yo
ur b
ack
-U
sing
your
cor
e an
d sc
apul
arm
uscl
es, l
ift u
p in
to a
pla
nk. T
he
hand
shou
ld e
nd u
p be
low
the
shou
lder
whi
le y
ou re
st o
n yo
ur
knee
s -
Opt
ions
: sta
rt o
n yo
ur e
lbow
,pr
ogre
ss o
nto
your
feet
-
Perfo
rm 2
-5 re
petit
ions
, hio
ld 5
-30
seco
nds
53
Scap
ular
+ S
houl
der
Exe
rcise
s •
Ches
t Exp
ansio
n-
“Ope
n yo
ur c
hest
with
the
back
”-
Stan
d w
ith fe
et h
ip w
idth
apa
rt, t
all
post
ure,
ribs
tuck
ed in
, cor
e en
gage
d -
With
stra
ight
elb
ows,
pul
l the
arm
s to
the
sides
of y
our h
ip
-To
fini
sh th
e m
ovem
ent,
sque
eze
your
shou
lder
bla
des t
oget
her a
nd o
pen
your
ch
est.
The
arm
s will
mov
e fu
rthe
r bac
k.
-Fe
el th
e m
uscl
es u
nder
you
r arm
pit e
ngag
e-
Perf
orm
10-
15 re
petit
ions
•Ro
w +
Rot
atio
n-
“Row
and
Rot
ate”
-St
and
with
feet
hip
wid
th a
part
, tal
lpo
stur
e, ri
bs tu
cked
in, c
ore
enga
ged,
kn
ees b
ent
-Be
nd o
ne e
lbow
and
“row
” it
back
, whi
lero
tatin
g th
e up
per s
pine
on
a st
able
low
er
spin
e -
Gaze
the
eyes
ove
r the
elb
ow-
Retu
rn to
star
t and
repe
at th
e ot
her s
ide
-Pe
rform
10-
12 re
petit
ions
eac
h sid
e,al
tern
atin
g
54
Scap
ular
+ S
houl
der
Exer
cise
s •
Shav
e th
e He
ad-
“Lea
n in
to th
e w
ind
and
exte
ndyo
ur a
rms”
-
Sit i
n a
criss
-cro
ss p
ositi
on, t
heba
nd p
lace
d ev
enly
und
er y
our
glut
es
-Le
an fo
rwar
d an
d pl
ace
your
thum
bs a
nd in
dex
finge
rs
toge
ther
to m
ake
a tr
iang
le
behi
nd y
our h
ead
-W
ith a
long
, neu
tral
spin
e, ra
iseyo
ur a
rms
up a
t an
angl
e. K
eep
your
fing
ers
and
thum
bs
conn
ecte
d -
Perfo
rm 8
-10
repe
titio
ns
-O
ptio
n: s
it on
ban
d at
the
edge
of a
cha
ir an
d pe
rform
as
abo
ve.
55
Scap
ular
+ S
houl
der
Exer
cise
s •
Offe
ring
-“F
ind
your
lat t
o co
re c
onne
ctio
n w
ithpo
stur
e”
-Si
t in
a cr
iss-c
ross
pos
ition
, the
ban
d pl
aced
even
ly u
nder
you
r glu
tes
-Le
an fo
rwar
d an
d lif
t the
ban
d at
a 4
5de
gree
ang
le fr
om y
our t
runk
up
tow
ard
your
ear
s to
feel
you
r pos
ture
, lat
and
cor
e.
-Pe
rfor
m 4
-5 re
petit
ions
-O
ptio
n: s
it on
ban
d at
the
edge
of a
ch
air a
nd p
erfo
rm a
s ab
ove.
•Ro
tato
r Cuf
f Tra
inin
g - P
ilate
s-
“Mov
e th
e sh
ould
er in
the
sock
et”
-St
and
with
feet
hip
wid
th a
part
, tal
lpo
stur
e, ri
bs tu
cked
in, c
ore
enga
ged
-Ke
epin
g th
e w
rist n
eutr
al, r
otat
e th
e ar
mou
t with
out m
ovin
g yo
ur sh
ould
er b
lade
-
Perf
orm
10-
15 re
petit
ions
-Tu
rn 1
80 d
egre
es a
nd re
peat
for i
nter
nal
rota
tion
56
Leg
Exer
cise
s •
Frog
with
Bal
l-
“Mov
e yo
ur le
gs fr
om y
our c
ore”
-La
y on
you
r bac
k w
ith y
our f
eet i
n a
frog
pos
ition
, bal
l bet
wee
n fe
et
-En
gage
you
r cor
e an
d pr
ess t
he b
all
out t
o 45
deg
rees
-
Perf
orm
10-
15 re
petit
ions
•Br
idgi
ng o
n Ba
ll-
“Brid
ge fr
om y
our g
lute
s and
core
”-
Plac
es a
rche
s on
the
ball
and
peel
your
spin
e of
f ver
tebr
ae b
y ve
rteb
rae
-At
the
top,
eng
age
your
glu
tes a
ndlo
wer
a fe
w in
ches
, the
n ba
ck to
the
top
to fe
el y
our g
lute
s and
not
you
r ha
mst
rings
-
Perf
orm
10-
15 re
petit
ions
57
Leg
Exer
cise
s •
Arab
esqu
e Se
ries w
ith B
all
-Pl
ace
your
han
ds o
n a
stab
ility
ball,
one
leg
on fl
oor,
one
leg
exte
nded
beh
ind
-“S
tork
”: b
ring
your
kne
e to
you
rno
se a
nd e
xten
d ba
ck
-“A
bduc
tion”
: kee
p th
e le
gst
raig
ht a
nd m
ove
it ou
t to
the
side
-“H
alf M
oon”
: ope
n yo
ur h
ip to
stac
k yo
ur h
ips o
n to
p of
eac
h ot
her
-Pe
rform
3-5
repe
titio
ns e
ach
58
Foot
Exe
rcise
s •
Runn
ing
-“P
ranc
e”-
Plac
e yo
ur fe
et u
nder
you
r hip
s and
try
toar
ticul
ate
thro
ugh
all 4
laye
rs o
f you
r foo
t -
Ensu
re y
our f
oot p
rogr
esse
s bet
wee
n th
e 1s
tan
d 2n
d to
e at
the
top
-Pe
rform
10-
12 re
petit
ions
•Te
ndon
Str
etch
- Ec
cent
rics
-“T
he d
eepe
r the
scoo
p, th
e lo
wer
the
drop
”-
Plac
e yo
ur fe
et h
ip w
idth
apa
rt a
t the
the
end
of a
step
-
Enga
ge y
our c
ore
-Sl
owly
low
er o
n 3
coun
ts a
nd li
ft o
n 1
coun
t-
The
deep
er y
ou sc
oop
your
bel
ly, th
e lo
wer
your
hee
ls w
ill d
rop
-Fe
et in
neu
tral
, toe
s ou
t and
toes
in-
Perfo
rm 1
0-15
repe
titio
ns e
ach
59
Post
ure
•Sp
ine
Twist
at W
all
-“M
ove
uppe
r spi
ne o
n lo
wer
spin
e”-
Plac
e yo
ur fe
et fl
at a
gain
st th
e w
all,
legs
sligh
tly w
ider
than
hip
s -
Exte
nd y
our a
rms o
ut in
fron
t and
find
your
tall
spin
e -
Brea
the
in a
nd ro
tate
you
r rig
ht a
rmba
ck a
nd lo
ok o
ver y
our
mid
dle
finge
r. Br
eath
e ou
t to
retu
rn.
-Do
not
allo
w th
e fe
et to
mov
e aw
ay fr
omth
e w
all
-Pe
rform
3-5
repe
titio
ns e
ach
way
•Po
stur
e at
Wal
l-
“Sit
out o
f you
r pel
vis
and
lift y
our r
ibs
from
you
r hip
s”
-Pl
ace
your
bac
k ag
ains
t a w
all w
ith y
our
sole
s of
feet
touc
hing
-
Exte
nd o
ne a
rm u
p w
ithou
t any
rib
mov
emen
t -
Exte
nd th
e ot
her a
rm u
p-
Exte
nd b
oth
arm
s up
and
try
to re
ach
your
ribs
aw
ay fr
om y
our h
ips
-Pr
actic
e at
leas
t onc
e a
day
60
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© Copyright 2016 Lori Duncan, PT, DPT, MTC, CPT & Summit Professional Education. No part of this workbook may be reproduced in any manner without the expressed written consent of Lori Duncan, PT, DPT, MTC, CPT and Summit Professional Education.
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Workshop Manual ID:
2194