Pilates is a wonderful exercise form for fitness as well as physical rehabilitation. Unfortunately, Pilates comprehensive certification program prepare Pilates instructors only to teach “Fitness Pilates”, which is Pilates for healthy bodies (no injuries). So, basic Pilates education does not give enough education about working with musculoskeletal and neurological problems and dysfunctions. Too confident Pilates instructors with lack of education are a dangerous combination. Don’t get me wrong, Pilates is still good for rehabilitation and post-rehabilitation – but only when taught by a skilled Physical Therapist. PT has advanced education about anatomy, physiology, biomechanics and exercise invention and is the right professional to work with regarding different kind of diagnosis and bodily dysfunctions.

In Australia they have wisely separated clinical and fitness Pilates. Clinical Pilates is only taught by Physiotherapist (=Physical Therapist). Fitness Pilates is taught by fitness professionals or dancers. Aussies have understood also how good Pilates exercise is when practiced together with traditional physical therapy. Also in Finland they have separated clinical Pilates education which is only designed for Physical Therapists, and Mat Pilates certification program for fitness professionals. They don’t allow Pilates instructors with dancing & fitness background to work with injuries.

Clinical Pilates aims to correct biomechanical alignment and muscle imbalances which are caused by faulty compensation patterns due pain, disease or injury. Fitness Pilates concentrates only in proper Pilates exercise techniques, nice cuing and body & mind connection, which is definitely not enough for the people with post rehabilitation or rehabilitation needs.

Fitness Pilates:

• Dance-oriented exercises, used for general conditioning and lifestyle
• Strong bias towards flexion, stretching, end-of-range movements, moderate to high loads and low repetitions
•  No evidence to support its use for rehabilitation of low-back pain
• Non pathology-specific exercises

Clinical Pilates:

• Benefit Diagnostic and rehabilitation tool for injury and performance enhancement  
• Progresses from static stabilization to dynamic; trains local then global stability systems.
• Neutral zone stability comes before end-of-range flexibility
• Aims to fulfill established evidence based criteria
• Observes pathology under load and modifies accordingly

More about PilatesWise program in Carlsbad, Oceanside and Encinitas, California, please click HERE

Did you know that 25% of lower back pain is sacroiliac joint related? However, sacroiliac joint pain and dysfunction is often misdiagnosed and overlooked by doctors and chiropractors. Si-joint pain may be referral pain into the lower limp, which can be mistaken for “true” sciatica from a herniated lumbar disc.

Si-joint dysfunction means Sacroiliac joint hypermobility (instability) or hypomobility which causes lower back and buttocks pain and stiffness. If there is hypomobility (too little movement) chiropractors manipulation may help, but if there is hypermobility (too much movement) chiropractors might be the last think what you want to do…you don’t want to increase movement which might cause even more pain. Unfortunately, sacroiliac joint pain is more often caused by SI-joint hypermobility (instability) than hypomobility. Sacroiliac Joint hypermobility may be traumatic, biomechanical, hormonal or inflammatory joint disease. I have been working with many Si-joint pain sufferers (mostly women) and they all have some issues about the lumbar-pelvis region biomechanics, which is very typical cause of SI-joint hypermobility and pain. Pain due to biomechanical injuries will usually come over a period of time and often due to increased activity or a change in occupation/sport.

Common biomechanical problems which cause SI-joint hypermobility are leg length, discrepancy, overpronation, twisted pelvic and muscle imbalances. I’m helping people with the last two cases and podiatric job is to help first two. Usually Si-joint pain clients might have all of those problems. One of my client was a college basketball player who got first sprain ankle then two hamstring pulls and then a terrible SI-joint pain. When she came to me, she got pain all the time and the pain increased when she was active. It was hard to see how she was suffering, not only the pain but also being non-active. Working with her almost a year, she is today PAIN FREE and exercise again – that is the best reward what you can get! I have also been successfully worked with people with inflammatory SI-joint disease like Ankylosing spondylitis. Those clients have also imbalances and compensation of lumopelvic region because of pain. Surprisingly, proper motion is one of the best treatments for Ankylosing Spondylitis clients.

Private Pilates sessions correct muscle imbalances and re-educate your body work more ergonomically, safely and efficiently. Pilates is gentle and whole body exercise form which has therapeutic approach. An experienced Pilates instructor and/or Physical therapist can design an individual pilates program which helps strengthen the key muscles around your lumbopelvic region (deep back and abs muscles, glutealis muscles and hip rotators) and stretches tight muscles around your hip joint which are usually hamstrings, hip flexors and external hip rotators. Not every Pilates instructor has enough knowledge about SI-joint dysfunction, neither back pain, so be sure that your Pilates Instructor has more education than just basic Pilates comprehensive certification program  before you start any Pilates sessions. Therapeutic exercises and Pilates are great way to rehabilitate your Si-joint dysfunction and really increase your quality of life with less pain, or even better – totally pain free. 

Did you know that here in the US the volume of spinal fusion surgeries is the most increased among Orthopedic “procedures”? Since 1996 the number of spinal surgeries has increased as much as 116%. Spinal fusion surgery is not that simple and it’s not always successful either. Sometimes underlying problems which caused your back pain in the first place are still there; poor posture, sacroiliac joint instability, weak supporting muscles, hip and thoracic spine limited rotational movement and shoulder girdle hypo or hyper mobility. Without proper treatment of underlying problems the spinal fusion alone is not the final answer to get rid of your pain longer term.

It is very true that in many cases the lower back pain is caused by lumbar spine instability (and nerve irritation) which basically means that there is too much unnecessary movement between vertebrae. Spinal instability does not come overnight and it is more complicated than how it looks like. One reason to have lower back spinal instability is when your hip rotation is limited or you have limited rotation on your thoracic spine. Lumbar spine does not have rotation or lateral flexion, but if rotation is not happening naturally from the place where it should (hip, thoracic spine), the body starts to compensate with excess rotational movement from your lumbar spine. Lumbar spine has to change it’s functioning and force vertebras, discs and ligaments to work the way that they are not built for, causing nerve compression and PAIN. And if spinal supporting muscles are also weak they are adding unnecessary movement and pain. Research shows that deep stabilizer back muscles are “shut down” those who got chronic back pain.

What happened after spinal fusion then? Spinal fusion limits your spine movement at the place which caused the pain, and that is a good thing, right? Unfortunately, body starts to compensate again and looks for the next place to do those missing movements and guess what, that is above and below fusion point. Those vertebras are now in danger and maybe develop similar spinal instability and nerve irritation to those vertebras which were fused together. What now – new fusion?

However, there is an other way to deal with this and that is to find a Physical Therapist who will assess your posture, muscle balance and whole body functioning, not just isolate back problems alone. Heat/cold pack, massage and back exercises are not working. Main problem might be elsewhere than in your lumbar spine alone. PT will analyze your movement and concentrate on increasing your spine & joints mobility and normal range of motion (especially rotation) and decrease hyper mobility with proper strengthening exercises (spinal stabilization training). Our body is a kinetic chain and all parts have to work together, so instead of just isolating to treat back pain, you must understand and treat the whole body.

Getting lifelong results and better spinal and proper body function, I warmly recommend to try Pilates private training. Pilates is an incredible treatment for all people with or without spinal fusion. If you don’t find a Physical Therapist who can teach Pilates for you, just look for an experienced Pilates Instructor who has education and experience to working with people with back pain and after spinal fusion. Pilates does probably not include that much stretching that people with back pain might need (hamstrings, piriformis, hip flexors), but it is a good way to strengthen your spinal supporting muscles, improve your range of motion and working your whole body more efficiently and safely. And the best part – with good Pilates instructor you will learn BODY AWARENESS. Body awareness is going to be a big help taking care of your spinal health after spinal fusion and back pain – and that is PRICELESS!!

More about PilatesWise Pilates & Spinal Stabilization training for back problems, please check out this video http://www.youtube.com/watch?v=TDzsq7u199s or Visit our website click HERE.

Pilates private sessions are a wonderful tool to rehabilitate your body after injury or Physical Therapy. It’s gentle and low-impact exercise form where your body can heal without putting too much pressure on your injury side but still working out your whole body. After injury your muscles learn to work different, inefficient way and sometimes you will need professional eyes to correct your faulty muscle recruitment and faulty compensation patterns. These two issues make your healing process much more complicated and risk of other injuries increases if you don’t notice how you are actually using your body.

Already about 70 years ago during the second world war Mr. Pilates developed his method to treat soldiers who were injured at the war. He created a specific hospital bed where he used resistance of springs and bands. He was very clever guy and really ahead of his time.  Pilates is today a great and practical tool for rehabilitation and many Physical Therapist as well as Chiropractors have noticed that. However, many Pilates studios are owned by certified Pilates Instructors who unfortunately have very limited knowledgeable about orthopedic rehabilitation or post-rehabilitation. Pilates Instructors might want to grow their businesses so badly that they are willing to take clients who have many health problems, but don’t exactly know how to deal with those problems. I see a big risk of injury or re-injury here! Pilates is a really good rehabilitation tool but Pilates instructors would need much more education about anatomy, biomechanics and orthopedic injuries & rehab than the standard comprehensive Pilates education offers today. For example, all back pain is not the same, and Pilates instructor who has had back pain herself and recovered from it by doing Pilates, is not necessary a good teacher to teach other people with back problems. Pilates is a good tool, but the teacher has to know exactly how to use that tool properly, efficiently and safely for each client. People with back pain have usually more problems and issues than just weak core muscles.

Very often Physical Therapists and Chiropractors don’t know about how long the Pilates instructors education is and how little they actually know about anatomy, injuries and rehabilitation. As a Physical Therapist myself, I was very surprised when I heard that one chiropractor referred his client of age 88, has osteoporosis and two lumbar vertebrae fractures, to a Pilates Instructor. I know that this Pilates instructor was very experienced, but not educated as a Physical Therapist, and I don’t think that this client was general ‘Pilates material‘. Pilates is a great and versatile exercise tool but in this case only taught by a skilled Physical Therapist. Pilates Instructors are expected to know what their skill level is and where their limits are. Unfortunately, today’s economy puts a lot of pressure on Pilates business owners, and even though they don’t have enough education they will take and treat rehab clients as any other normal clients. If you are looking for a Pilates studio to rehabilitate your injury or post-rehab after Physical Therapy, do your homework first and ask questions from studio’s instructors to find out how skilled and experienced they really are for your case. I definitely recommend Pilates for everyone who is looking for rehabilitation or post-rehabilitation after Physical Therapy – just be sure that your instructor is really experienced and educated in that field.

For more about PilatesWise  active back rehabilitation, orthopedic injury rehabilitation and sport injury recover and prevention, please visti our website http://www.pilateswise.com .

Check out also this pilateswise video http://www.youtube.com/watch?v=R40kIPla2Dc

Living in Coastal California allows people to enjoy a year around great weather and barefoot running. There are many opinions about barefoot running, some blame that barefoot running decreases running injuries and some that it increases. However, the fact is that barefoot running technique is totally different from shoe runners. Barefoot runners land on the ball of the foot or middle of the foot when shoe runners land on the heels. Some foot experts say that barefoot running is good for some people because there is really less impact on the heels.

Foot and ankle anatomies are extremely complicated. Foot has 28 bones and 32 joints and two very important arches which are running lengthwise (longitudinal arch) and crosswise (transverse arch).The both archers are important part of proper foot & ankle function. The arches enhance the foot’s flexibility, stability and ability to adapt to uneven surfaces, and also working as a shock absorbance.

If those arches are collapsed, like people with flat feet or over pronated feet, the chance to get overuse injuries increases gradually, especially when running without shoes. Barefoot runners, who run long distances with ball of the foot, tend to have tightness on the Achilles tendon and calf muscles, and prone to have injuries like Achilles tendonitis or calf muscle strain. Barefoot running might also increase risk of other overuse injuries like Plantar fasciitis and Shin splints. On the other hand, barefoot running activates foot and ankle muscles which are usually too supported with shoes. As shoe technologies advance the less people are using their supporting muscles around ankle and foot.

Because the running technique is very different by barefoot runners than shoe runners, I recommend to start carefully and increase running distance gradually. Also barefoot runners have to focus more on ankle & foot stability and proper technique (alignment) while landing to the ball of the foot. People who have problem with their feet and ankles and resent overuse injuries or correction in their shoes, it is probably not a good idea to try barefoot running.

Anyway, whether you are shoe or barefoot runner it is always very important to stretch. Stretching is a better way avoid typical runners’ injuries. The barefoot runners should especially stretch their Achilles tendon and calf muscles after every running. And remember, enjoy the summer and running – with or without shoes!

What is common between Lupus, Rheumatoid Arthritis and Multiple Sclerosis (MS)? They all are autoimmune diseases, where your own cells start to attack your healthy tissues and organs. There are over eighty autoimmune diseases, each with it’s own unique symptoms. Lupus and Rheumatoid arthritis symptoms are similar; painful and inflamed joints, extreme fatigue, anxiety and depression. People with Multiple sclerosis have a little different problems like loss of muscle strength, sensation, coordination and balance. All these three diseases consist of pain which make life more complicated and can make everyday life more challenging both physically and psychologically.

When your muscles and joints hurts, it’s definitely not the first thing on your mind to get up and move. However, a proper exercise program is one of the treatments for all those three diseases. Inactivity and disuse cause more pain and discomfort in your body. Disused muscles become weak by supporting less your joints and making your joints more instable which causes even more pain. Disused joints (while they are stiff and painful), reduce joints’ range of motion which also increases pain. Lack of exercise has also found to be related to fatigue and overall stress of your body which makes it harder to cope with your symptoms. Regular exercise program has many benefits by improving your body function and mood while reducing stress, fatigue and pain.

Pilates is a great exercise form for clients with Lupus, Rheumatoid Arthritis and Multiple Sclerosis. Pilates is low-impact, gentle and gradually progressive. Unfortunately, Pilates exercises should be taught preferably by a Physical Therapist. Pilates Instructors in general do not usually have enough experience in these three conditions and how they affect your joints, muscles and neuro-muscle control. Pilates Instructors who have dancers or fitness background find often difficult to understand Lupus, Rheumatoid Arthritis and Multiple Sclerosis special needs and conditions. You simply can’t teach client who has pain and inflamed joints (Lupus, RA) or who has coordination and balance problems (MS) the same way as regular fitness clients. Pilates Instructors are not therapists and oftentimes a too confident Pilates Instructor without experience can make the client overdo the exercises and cause flare-up because it’s too much too soon. Pilates program should be specifically designed based on every client’s individual condition, limitation and needs. Without a proper education and experience that is obviously pretty hard to do.

If the Lupus and Rheumatoid Arthritis client has painful and inflamed joints, it’s important to maintain proper range of motion of joints and not put too much pressure on inflamed joints. Sometimes it is enough to do just isometric exercises which means muscle contraction without joint movements. Multiple Sclerosis client needs carefully assisted movements due to muscle weakness and co-ordination difficulties. There are many Pilates movements in Pilates repertoire which is very beneficial but maybe sometimes not enough. That’s why I warmly recommended to find a Pilates program where trained Physical Therapist is teaching and makes safely modifications based on each client’s current needs and also uses therapeutic exercise techniques as needed. A well designed Pilates and exercise program will definitely promote your physical and emotional well-being and quality of life.

More abour PilatesWise program for Lupus, Rheumatoid Arthritis and Multiple Sclerosis Please visit our website http://www.pilateswise.com

Spinal Decompression therapy is a non-surgical treatment for people with back pain caused by herniated disc, bulging disc, degenerative disc disease or sciatica. Spinal Depression therapy provides gentle decompression / traction of the disc and let the disc heal itself by helping to get more space between vertebras.

Now, is this magic treatment / therapy as good as advertised for relieve back pain? Well, like every treatments, some people may get help from it but some may feel even more pain after the treatments. Why? Using traction for treatment of bulging and herniated disc may also aggravate the condition. So do your research before starting this treatment.

The advertisement says “Spinal Decompression therapy is the latest non-surgical breakthrough technology”. Really? Believe or not, this “latest” back pain relief therapy / treatment is not new at all! When I was studying Physical Therapy in Finland in mid 80′s, we used to work with very similar spinal decompression table as used today and that treatment was called “spinal traction”. The traction table was exactly like this amazing new technology table. When I graduated at the beginning of 1990, this wonderful spinal decompression therapy method suddenly disappeared. Why? Because the treatment showed to be ineffective and too expensive. One Physical Therapist made some research to see what this “spinal decompression” was all about and found out that since II Word War Physical Therapists have been offering “Spinal Compression” = “Spinal Traction”. Recent studies also found that traction is ineffective for the relief of pain in the lumbar spine – just like Finnish PTs already realized 25 years ago. Seems that old treatment is coming back again but unfortunately this does not make this treatment any better.

Spinal Decompression treatment is also really expensive, about $100-$150 /visit. And if you get some pain relief that might be very short-term because the very underlying problems of your back pain are still there: poor posture, improper body mechanics, weak spinal supporting muscles, and repetitive stress can cause vertebrae to compress the disc or to slip out of their alignment which adds pressure to the discs, thus causing pain. These are really the underlying problems which need to be fixed too. Any spinal decompression therapy or manual therapy is not going to help improve your posture or muscle imbalance.

Almost all of my Pilates clients have back problems and some of them came to me after nothing else was not working. Very often doctors and chiropractors underestimate how important it is that patients take more active role of their own back rehabilitation. Active back rehabilitation with carefully designed exercise program is proven to be much better long-term back pain relief than just handing out home exercises, manual therapy or spinal decompression therapy. Our active back rehabilitation program in PilatesWise is designed and performed by a Physical Therapist. It includes comprehensive assessment, spinal stabilization training, McKenzie method and Pilates training, which does not only help relieve back pain but also keeps your back healthy and strong and prevents from future injuries. You have only one spine and back, so start taking care of it.

For more info, please visit our website http://www.pilateswise.com