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Posted by on Jun 7, 2016 in Business & Education, Featured, Pilates | 0 comments

Compliance – Alliance

Compliance – Alliance

Adhering to your home program

Being a practitioner of the healing arts is a great job. It is immensely satisfying to precipitate a client’s recovery or improvement and then nurture them along the way to full function. But…it is probably safe to say that one of the most frustrating aspects of being in the field of injury and pain rehab is client compliance with home programs and prescribed exercises.

Before I launch headlong into a mini-rant, I must preface it with a little story about someone I know quite well.

A few years ago I was suffering from a chronic eye infection that I nursed myself with home remedies until it became clear that it was not going to shift without professional help.

I went along to a highly respected ophthalmologist, paid vast amounts of money for his expertise and 2 separate prescriptions (one bottle of eye drops and a scrip for a very specific antibiotic) and then proceeded to do it my way. Which is to say I used only the drops.

Initially my eyes improved using only the drops. Wonderful. The tablets were known to cause photosensitivity and it was summer so no time for sun-avoidance! But within a few weeks, my eyes started to go red, sore and swollen again. I took my gritty, bloodshot eyes back to the ophthalmologist who admitted that he was surprised that his prescribed remedy didn’t work.

Doc: “Did you use the drops I gave you and finish them?” he said rubbing his chin with puzzled medical gravitas.

Me: “Yes!”

Doc: “Strange. This type of infection usually responds well to the tandem protocol of the drops and the tablets.”

Me: “Oh. I didn’t bother with the tablets. I wanted to go to the beach.”

The doctor peered at me intently. Scary.

And then he asked me to leave.

Yes. Leave.

I was horrified to be thrown out of a doctor’s surgery. After apologising and promising to be a good girl, I convinced him to keep me on and he issued another prescription for the drops and told me to take both medications as directed.

I did. My eyes cleared up and the painful infection never came back.

Blink, blink.

Now I never have (nor will I ever) throw anyone out of my studio, but that anecdote illustrates the frustration of pulling everything possible out of the professional toolbox to help your patients or clients only to have them fail to help themselves.

I am as guilty of being lazy (and human) as anyone and it usually takes blinding pain or the price of a Lamborghini to induce me to assiduously follow health care advice – in other words, desperation – but I am getting better as the cavalier luxury of youth slithers ever farther away.

Oh, for the magic bullet or elixir that you could take once and be done with it.

Unfortunately, the time required to correct a postural issue or an injury is generally commensurate with its chronicity – that is to say how many months or years the faulty pattern or injury has had time to embed itself into your body

And the moral of this story?

If you’re the patient, comply with your healthcare provider or therapists advice. After all, you’ve likely paid handsomely for it and they have trained and studied long and hard to bring it to you. Make the most of the time and money you’ve spent. If, after complying with your prescribed program, you do not see the desired or expected progress, discuss it with your practitioner but please, DO YOUR HOMEWORK, so that if nothing else your practitioner will be able to adjust your program or refer you to someone who may be better able to help. If you don’t do your home program, you’ll never know if it works.

If you’re the practitioner, ask your patients/clients questions they must answer, e.g. “Will you do your home program at least three times a week?” instead of, “Don’t forget to do your homework.”

Studies show that asking people to state their intention out loud helps encourage compliance. Enter into a written agreement or ‘contract’ with your client. Make it clear that you are in their recovery TOGETHER. “Fix me” is not part of the therapist/client lexicon.

If all else fails, try scare tactics – cue sinister laugh – for example, “What colour would you like your mobility scooter?” For some, fear of the negative is more incentivising. It worked on my father. He now religiously walks 1.5 miles everyday, rain or shine.

The threat of an incontinent future also works a treat. Try it on your women clients. Incontinence pads are NOT sexy.

All kidding aside, set aside the time in your busy schedule of juggling plates to invest in you. You’ll be a better mother, father, provider, employer, employee, and lover, –whatever – if you and your body are happy companions.

Please get in touch if you have any tips or helpful hints on this blog topic!

Until the next time…

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Posted by on Jan 26, 2014 in Anatomy & Physiology, Featured, Pilates | 0 comments

We Don’t Know Squat

We Don’t Know Squat

A Physiotherapist pal of mine told me years ago that the beginning of  our modern low back pain woes can be blamed on a man named John Crapper, inventor of the modern toilet.   In developing countries that have yet to embrace “the Crapper” there is very little incidence of back pain and some of these cultures do not even have a vocabulary for back pain. Hmmm.

Squatting to eliminate is not only one of the best ways to maintain and improve spine, hip and knee health, it is the best way to avoid constipation and piles (hemorrhoids) and maintain an easy and regular transit. Wow.

My Physio pal went on to say that when her patients have “trouble”, she pops them on the loo, pulls up a stool for them to put their feet on and – bingo – success. Raising the knees flexes the spine, creating the optimal position for comfortable elimination without the, erm…strain.

In 2013 I had the pleasure of travelling around Burma (Myanmar) – a beautiful, unspoiled country with a population of happy, smiling and remarkably flexible people. Even the rice farmers who spent entire days bent over their paddies had good posture and were seemingly pain-free with none of the telltale signs of postural pain and deviations e.g. hump at the base of the neck, forward head position, flexed forward at the hip, etc.

L1000783  A lifetime of squatting or sitting cross-legged to perform every daily task from cooking and crafting, to eating and eliminating, has kept their spines and joints much healthier than ours in the west. What appeared at times to be backbreaking work was actually keeping them healthy until much later in life. In addition, with no distracting ‘smart’ gadgets, computers or mobile phones, the elders spent their days alongside the youngsters, which had the added advantage of keeping the elders active, engaged and socially included. In Burma, people in their 80s sit comfortably on the floor, one knee tucked under the chin, the other leg folded underneath their bottoms, weaving silk, painting lacquer ware, and preparing food. During my entire visit, I cannot recall seeing anyone sitting in a chair except in the airport where they had little other choice. They do not even have chairs in their homes.

Nerd Alert* In terms of its spinal benefits, squatting separates the spinal segments, creating pressure changes through the intervertebral lumbar discs that stimulate metabolic activity. Squatting is a quick, simple way to decompress the spine throughout the day to undo the compressive forces of sitting and standing.  If you can’t squat without support, hold on to a stable base (desk, heavy secure chair or rail) and “hang” into the squat. After awhile it will become easier as your knees and hips get used to it (they will eventually reward you) and you may even be able to do it without support and with your heels on the floor. As you progress to a hands-free squat, it may be useful to put a book under your heels until your Achilles tendon and calf muscles become accustomed to the stretch and begin to ‘give.’ You can place the hands on the floor in front of you to offload any strain in the upper back and neck. As you breathe, visualize the low back expanding on inhaling and as you exhale, allow yourself sink a little more into the squat. This is not a gym-type squat that brings you into squatting and standing repeatedly. This is a relaxed, releasing, somewhat static pose.

Although theoretically brilliant, I do concede that squatting to toilet in London or anywhere else in the Western world (apart from some parts of France and Turkey) is a big and potentially messy ‘ask,’ so use the stool trick (no pun intended) mentioned above.

squatty potty

If you’re someone who likes things “just so” you may like The Squatty Potty designed for purpose. You can check it out on

Other than that, try to squat every day. It’s imperative that we do not lose this ability as we age. While I teach the importance of squatting to all of my clients as an exercise, I incorporate it into my functional life while shampooing my hair. I just squat in the tub or shower, bend my head forward and kill two birds with one stone!


I am not a medical professional. The advice above has been obtained in good faith from trusted professional sources. I am in no way affiliated with Squatty Potty.

Always follow your doctor’s advice and consult your GP or other healthcare provider before embarking on a course of exercise. Exercise caution if you are pregnant or have any condition that may affect your ability to exercise safely.


¹ “The ideal posture for defecation is the squatting position. In this way the capacity of the abdominal cavity is greatly diminished and the intra-abdominal pressure increased thus encouraging expulsion.” William S Haubrich MD Bockus Gastroenterology

² Sarah Key Keep Your Joints Young, (London, Vermillion, 2009), 53.


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