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Posted by on Jun 2, 2016 in Anatomy & Physiology, Featured, Pilates, Workshops | 0 comments

Scoliosis – How can Pilates help?

Scoliosis – How can Pilates help?


by Mary Thornton BSc Hons MCSP HCPC

When you get a new enquiry from a client with scoliosis, does it fill you with dread or excitement? Personally, I love the thought of assessing a new client with a scoliosis. As with many other conditions, you never know how the individual will present and what challenges lie ahead.

A scoliosis is a side ways curve of the spine with rotation of the vertebral bodies. It can occur anywhere along the spine and even present as two specific curves. There are many reasons why someone might present with a curvature of the spine: a difference in leg length, a hemi-pelvis to spinal degeneration or even a neuromuscular condition, but the most common curve you will probably see in the studio is a idiopathic scoliosis. This means the cause of the curve is unknown. It generally first appears during puberty and can progress rapidly during this period then generally slows down as the body reaches skeletal maturity.

The medical profession determines the severity of a curve using what is referred to as a Cobb angle. The Cobb angle is measured by looking at the end points of the curve and the angle formed from the intersection of these two lines and a curve greater then 10 degrees is deemed a scoliosis.

On physical examination the client may present with:

  • Rib hump
  • Elevated / winging scapula
  • Pelvic or torso shift
  • Decreased lung expansion
  • Leg length discrepancy

The management of a scoliosis varies depending on the severity of curve, pain and probably location in which they live. Generally surgeons do not intervene unless the curve is greater then 45 – 50 degrees and in the first instance they are generally referred for Physiotherapy, or fitted with a back brace. Traditional fixed braces like the Boston are rigid restrictive devices that are difficult for the client to use but there is a new wave of dynamic braces that are proving very effective and more user friendly.theclinicalpilatesstudio

As a movement therapist, there are many things we can do to help manage the scoliotic spine. While we must not be under the illusion that we can make a curved spine straight, we can certainly help manage the muscular imbalances that occur.

We must also be very aware of the psychological effect of the scoliosis on the client. Though outwardly they may seem ok with their diagnosis, their self esteem and body image can be effected. Avoid the use of negative words and limit the use of mirrors during sessions. Although mirrors give feedback about where the client is in space and can aid the develop of new motor patterns, be sensitive to their reaction. With a little sensitivity, we cannot only help the individual develop a better understanding of balance within their bodies, but also enhance self esteem.

As a teacher, it is easy to get to bogged down by terminology, but with a few basic assessment rules, it can be easy to devise a safe and beneficial exercise regime. However, like all pathologies, to really benefit from Pilates the client initially needs to be seen on an individual basis to determine their specific needs and teach them how to adapt in a group situation.

So the next time someone mentions they have a scoliosis, start to be inspired by the challenges that lay ahead. With a little research and insight, you can make big changes to their life.

To learn more about how to plan a Pilates programme for scoliosis come along to one of Mary’s workshops, advertised on Facebook or contact directly at

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Posted by on Feb 23, 2015 in Anatomy & Physiology, Body & Mind | 0 comments

TENNIS ELBOW aka Lateral Epicondylitis

TENNIS ELBOW aka Lateral Epicondylitis

We all know of someone who has suffered from tennis elbow. Quite often this person will have had steroid injections into the elbow but the symptoms persist or return after a few weeks. It is well known that this condition can take a long time to heal, and conventional medical treatments can be quite ineffective. 

I have been asked to share some insights into Tennis Elbow from the perspective of my skills as an Osteopath and BodyTalk practitioner.


Tennis Elbow conventionally describes a nagging and persistent pain at the elbow, on the lateral side only that may radiate down the forearm into the dorsum of the hand.  The onset may be gradual or sudden.

There are thought t be several types of lesion for this condition – including:

1) soft tissue degeneration at the origin of the common extensor  tendons at the epicondyle, usually microscopic tears at the teno-periosteal interface at the epicondyle, and especially at Extensor Carpi Radialis Brevis, which is a weak muscle and vulnerable to strain. Calcification may subsequently occur and be a further cause of chronic pain.

2) joint pathology  of the radio-humeral joint. Surgery has revealed that often there is degeneration of the cartilage at this site.

The mechanical picture is that of forceful overstraining of the wrist from flexion into extension, as in doing a backhand with a tennis racket. (Remember that the Extensor Carpi Radialis Longus and Brevis insert past the wrist, into the carpal bones). Also excessive repetitive pronation and supination can set it off.

3) The site can be exquisitely tender, with inflammation, crepitous, worse for activity, but when severe, can awaken the person.

The Osteopathic take on Tennis Elbow

Commonly, osteopaths will look at issues in the neck facet joints and muscles, and can get very good results from freeing up the nerve supply to the elbow via the segmental nerve roots and brachial plexus. This in turn encourages energy flow down the arm. Psychologically, the neck, if tense, indicates rigidity in attitude. By mobilising this rigidity, the patient is more able to let go generally, and this in turn will promote the eventual correction of the elbow symptom.

Soft tissue treatment to the relevant muscle origins and to the musculo-tendinous junctions can be useful. Also techniques like Strain-Counter Strain can be used to re-calibrate the muscle spindles. However Muscle Energy Technique would be contra-indicated since that approach tensions the already inflamed muscle. The radio-humeral, radio-ulnar, humeral-ulnar joints and the interrosseous membrane between the radius and ulna must all be balanced (this is best done with the cranial approach).

Lymphatic drainage of the arm and at the thoracic or lymphatic ducts is crucial to the healing at the elbow. This will enable a good drainage of the inflamed area, a reduction of inflammation, and encourage the immune system to heal the area. Lymphatic drainage can be effective without one actually needing to work at the pain site. Again, a tense neck and thoracic inlet will constrict the lymphatic drainage from the upper extremity.

The BodyTalk Take on Tennis Elbow

In BodyTalk we are able look at the consciousness of the elbow, and here it helps to note where the meridians pass through, and look at what the meridians signify. For example The three Yang  meridians that pass laterally are the large intestine, triple heater and small intestine meridians. These relate to the psychological concepts of being intellectually over-challenged, difficulties in deciding what is good and bad or right and wrong in one’s life, and difficulties in letting go and of forgiveness.

So with Tennis Elbow, psychologically, we may be having difficulty (via the colon meridian) in eliminating the wasted parts of our life, and problems in forgiving ourself or others because of some negative (or “wasted”) event. Also, via the small intestine meridian we may be struggling with discerning what is useful for our life or struggling with the ability to judge life in a positive way. Here we tend to develop negative beliefs and attitudes and our clarity of thought becomes muddled.

One of the causes of T.E. can be repetitive movements, eg racket sports, or work-related. This constant repetitive movement will eventually be interpreted by the mind as a chronic tendency to be inflexible in life, ie “life is in a rut”.

A physical implication of large intestine meridian involvement in T.E is chronic constipation. If this is the case, then colonic irrigation, and dietary changes, and abdominal massages can produce excellent results for the T.E.

John Veltheim (founder of BodyTalk) says that “The key word for the elbow is flexibility. Our elbows reflect our flexibility to life; an ability to adapt and be spontaneous without getting bogged down and constipated by life. The more flexible we are, the more we are able to flow with life, forgive, differentiate right from wrong, intellectually process life, and adapt to our surroundings. If our elbows are losing their flexibility through pain, swelling, arthritis or injury, then we are being told to look at those aspects of our life relating to flexibility.”

In BodyTalk we can address reciprocals in the body. These are parts of the body that have an intrinsic relationship with another part and are mutually supportive energetically. So for the elbow the reciprocal is the knee unless otherwise specified by Innate. Tapping out this reciprocal can be very useful in helping reduce the elbow pain. In fact the BodyTalker may be instructed to tap out the reciprocals for the whole upper extremity, for increased effectiveness.

I hope that I have been able to provide some insights into the physical, emotional and psychological implications of Tennis Elbow, and approaches to treatment. I am happy to talk with you individually about any issues arising from this.

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Posted by on Feb 17, 2015 in Anatomy & Physiology, Body & Mind, Featured, Pilates | 0 comments

Hypermobility – Keeping It In The Box!

Hypermobility – Keeping It In The Box!

Hypermobility syndrome or HMS as it is sometimes known covers a large spectrum of symptoms. Hypermobility comes in many forms from someone being able to place their hands flat on the floor and hyperextending their elbows and knees with ease to a more severe presentation effecting the vascular system, digestive tract, heart valves, bladder and many other soft tissues of the body.

Many people walk around most of their lives unaware that they have this pathology as to them having excessive joint range of movement is normal and in some circumstances (as in dancing) it can be an asset. It isn’t until they start to experience muscular skeletal pain that they may seek help and are finally diagnosed, however the condition is still not fully understood and its symptoms can sometimes be dismissed by the medical profession and mismanaged.

Compared to other pathologies hypermobility is a relatively new one as far as diagnosis is concerned. Most clinicians initially use the Beighton criteria to diagnose. This test looks at the flexibility of the spine, elbows, fingers, wrist and knees to determine their range of movement. They use these measures of joint range along with levels of joint pain, recurrent subluxation, levels of fatigue, bruising etc to lead to a diagnosis of a hypermobility syndrome. HMS can be separated into two forms; joint hypermobility syndrome (JHS) or Ehlers Danlos syndrome (EDS) this terminology is often interchangeable with clinicians.

Symptoms can include:

  • general joint hypermobility
  • recurrent subluxation
  • joint pain
  • family history
  • skin involvement/fragility
  • arterial/ heart involvement
  • intestinal problems
  • fatigue
  • congenital hip dislocation • increased spinal curvature • excessive bruising
  • bladder problems

As you can see from the above list the symptoms can be vast and complex depending of the severity of the condition.

As Pilates teachers we have all had a client who never feels the end range of a stretch, presents with excessive joint range and never seem to be able to stabilise. Some of these clients are just hypermobile with no other symptoms, but others may report pain and problems with daily function. As teachers the type of muscular skeletal symptoms that we may see with a hypermobile client are:

  • laxity in joints
  • poor proprioception
  • fatigues quickly
  • subluxation – fingers, elbows, shoulders, patella
  • effusion following trauma
  • fibromyalgia
  • trigger points

When devising a safe and effective Pilates programme for these clients it is important to be aware of any of these symptoms to prevent over working or over stressing the joints as this can cause repetitive micro trauma to these type of tissues. Remembering that if this client has poor proprioception and a decreased awareness of joint position then you have to reeducate their sense of joint position by what I refer to as “keeping it in the box”! This basically means keeping the range of movement small and working where possible with a closed chain pattern to help reeducate this awareness and gain effective control of their movement patterns.

The emphasis of controlling range of movement and postural reeducation can be the key factors when devising a Pilates programme for this type of client. Of course they can also present with tightness, especially in the thorax. This area can get particularly locked up and breathing can be shallow and apical, as they may hold them selves from this region due to the general lack of stability elsewhere, In this instance breath work can be invaluable.

With a more extreme presentation of the condition the client may well fatigue quickly which could mean that a shorter session is required. Often they may not show this during the session as the fatigue could be a delayed reaction, so its alway best to start with a shorter session, then check how they where 48 hours later. Ideally seeing the clients for a couple of shorter sessions a week is best with some basic home exercises to follow through even if its just postural awareness.

Working with this type of client can be extremely rewarding as it can help manage their condition long term, but teachers do need to be aware of adapting and keeping movements basic. Remember, keep it in the box!

To learn more about how to adapt Pilates for HMS Mary will be presenting her workshop “Hypermobility: Keeping it in the box!” later this year.  To find out more contact

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Posted by on Aug 22, 2014 in Anatomy & Physiology, Featured, Health, Pilates | 0 comments

Pilates For Total Hip Replacement: What We Need To Know?

Pilates For Total Hip Replacement: What We Need To Know?

Due to changes in our NHS service more & more Pilates teachers are being referred clients following hip replacement surgery. Once, patients would have been on a hospital ward for at least a week receiving Physiotherapy daily. This ensured that they could confidently perform their post op exercise regime and climb stairs safely. However, these patients are now discharged after 2 – 3 days with an exercise booklet and a quick mobility check.

As a result many patients turn to Pilates looking for an alternative rehab programme to enable them to restore normal hip function and mobility. So what does the Pilates teacher need to know? There are shutterstock_94626565-e1368042178741several hip replacement procedures, the most common of which is the total hip replacement (THR).This involves the removal & replacement of the femoral head with a prosthesis and the acetabulum is deepened and resurfaced. These prosthesis’s are commonly made from metals such as titanium, stainless steel & polyethylene.

During surgery the hip is dislocated to enable the prosthesis to be fitted and as a result post operatively the hip joint will be more unstable. Therefore the main objective is to strengthen the muscles around the posterior & lateral region of the hip to help regain stability. As the muscles start to gain strength the clients balance and mobility also need to be restored.

Due to the invasive nature of this surgery you often find post op that the gluteas maximus & medius as well as the external rotators and abductors will be weak, and that you will also be presented with a protective shortening pattern of the anterior element of the hip around the TFL, rectus femoris and even the psoas. This tends to gives the impression of the ilium hitching and the head of femur sitting forward of the joint. This can often be observed if the client is lying supine with knees flexed, feet on floor & you will also be able to palpate this shortening.

Therefore, as well as strengthening the effected posterior and lateral element of the hip we also need to rebalance the pelvic and femur placement by careful positioning and cueing.

The biggest fear that many patients have is will their hip will dislocate after surgery. This is very rare and with the correct rehabilitation exercises over 6 – 9 months the hip will be as strong as it was before. However, like any recovery process it must be paced. Initially there will be vast improvements but then the pace will slow down as it reaches its potential. So it is important that the client be guided to reach progressive goals.

There are a few contraindications that need to be given attention initially after surgery to prevent dislocation, they are:

• Hip flexion > 90 degrees • Leg adduction
• Hip rotation
• Crossing legs

As a Pilates teacher it is necessary to be aware of these contraindications during the early stages of rehab. However, due to our deep understanding of movement, we are well equipped to take the client through a gradual rehab programme that will address the weaknesses that have arisen during surgery.

As I mentioned earlier the THR is the most common hip replacement available but in the instance of trauma or congenital abnormalities the procedure and contraindications may differ. It is extremely important in this instance that the Pilates teacher liaises with the patients Physiotherapist to check the safely precautions with that specific situation.

To learn more about the steps to follow after hip & knee surgery see Maryʼs workshop; hip & knee post op workshop.


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Posted by on Jul 5, 2014 in Anatomy & Physiology, Featured, Pilates | 0 comments

Movement or Anti-movement? What are you teaching?

Movement or Anti-movement? What are you teaching?

In this article, we are going to go a little sci-fi and talk about an alternate reality. In this alternate reality, the training of movement is actually unknowingly the training of anti- movement. The health and fitness industry inhabits this alternate reality on a regular basis, through all sorts of interesting but not quite accurate takes on what normal movement might be.

In the “Dark Side of Scapular Cuing” article, I looked at the conflict between common cues and shoulder biomechanics, and this time I’d like to extend the discussion on the overhead arm movement to consider a common cue for the central body.

Let us first consider the normal biomechanics of reaching an arm overhead, whether lying down or upright. Think of this as a fern frond unfurling. The trunk is lengthening as the flow of force is directed up into the arm. The trunk lengthening impulse triggers transversus abdominis to respond, creating a foundation of elastic support for the arm motion. The movement impulse travels from the lower trunk up through the spine, with the thoracic spine extending and segmentally rotating to free the shoulder and integrate its motion with the spine. The scapula continues the flow of movement impulse by rotating upwards to create space between the humeral head and the acromion (the bony arch which is the roof of the shoulder joint), thus protecting the sensitive structures on top of the shoulder from being squeezed as the arm is raised. It is a symphony of force management.

Now let’s consider how the abdominal wall is often cued in an overhead movement. A prevalent approach is to maintain a consistent distance between ribs and pelvis. The reasoning behind it is that if the spine extends as the arm moves overhead, the front of the torso is opening and widening, so the cue is intended to prevent that from happening. However, in attempting to prevent one problem, another is created. joanne

When the trunk and ribs are held in a static relationship, the normal accompanying biomechanics of thoracic extension and segmental rotation are blocked. There is no lengthening impulse through the trunk, so the abdomen does not respond automatically to make its elastic connection with the shoulder. The arm is then isolated, disconnected from the whole. It moves like a plastic doll’s arm, stuck onto the body but not integrated with it. The dynamic relationship of force transfer between trunk and arm is compromised, and flow, such a central principle in Pilates, is lost.

The alternate reality of movement has struck. Normal biomechanics have been sacrificed through speaking the language of flow and lengthening, but then cuing actively against it. I meet many people who have acquired secondary shoulder pain through their efforts to address their back pain. Their response is usually to focus even more on their “core” and their “drawing down” of the scapulae, not realising that they are exacerbating the problem by interfering with normal biomechanics. They are practicing anti-movement.

The first step towards recovery for my shoulder patients is learning to establish the elastic supportive relationship between their trunk and shoulder. However, to achieve this, the abdominal wall must not be statically held. The ribs must be allowed to open a little on the moving side, and for the space between iliac crest and lower ribs to expand lengthwise. This idea initially causes panic! How can we prevent inappropriate back extension, people say, if you ask us to release the abdominal wall?

Let us start by reframing the unwanted back extension movement. Back extension in an overhead movement is usually interpreted as lack of control. In fact it is quite the opposite – it is demonstrating that back extensor activation is the person’s dominant control strategy in response to movement. This muscle group fires to provide a stable point to move from. It is a control strategy, but just doesn’t happen to be the ideal strategy from a force management point of view.

Countering this back tension by cuing abdominal tension frequently achieves a generalised increase in overall tension. Simply put, if you fight tension with tension, you get… more tension. More tension means movement compromise somewhere in the system. That is rarely good news when it comes to the free flow of a movement impulse through the body.

The key is not in fighting an unwanted movement, in this case back extension, but in inviting the body to move in a more desirable direction. The optimal impulse of the body in raising the arm is in an axial direction, so the body lengthens and decompresses, allowing the spine to open in response to the raising arm.

How might we achieve this?

Releasing a dominant strategy invites the body to find a new solution for control. In the case of the back extensors, the alternative proposition is the abdominals. Thus, instead of actively countering the impulse to extend the spine by pre setting the positional relationship of ribs to pelvis, we introduce the person to the sense of releasing the back and allowing it to follow the movement impulse along the floor if lying down, or towards the ceiling if sitting or standing. The movement then allows for unrestricted flow, which aligns nicely with Pilates.

The abdominals are still active, but they are simply no longer being used at a fixed length. This allows a person to reach, twist and move freely without restriction, yet remain elastically connected. Without the need to fight a back extension impulse, the abdominal wall is able to achieve a deeper, quieter activation. The result is a very organic sensation which requires minimal muscle activity for control, and allows for freedom of joint motion. This is in essence, the definition of efficiency.

The challenge for any movement practitioner is to constantly re-evaluate the solutions we offer, the cues we use and the purpose for which we use them. As we learn more and more about the body and as new research emerges, cues that were widely accepted may need to be held up to the light and examined carefully to ensure that we are upholding our goals to support and develop our clients’ and patients’ movement, rather than interfering with it.

The purpose of control is, after all, to enable more effective movement, not to limit it. In our practice then, we must ensure that we are indeed training for movement, not anti-movement.

If you’d like to know more about developing healthy, normal, functional movement, the second edition of Joanne’s popular book, Stability, Sport and Performance Movement: Practical Biomechanics and Systematic Training for Movement Efficacy and Injury Preventionis available on

For more information on JEMS, visit , Facebook at JEMSMovementART, or email us at 

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