Osteoporosis and Pilates

I’ve done several Pilates trainings on working safely with clients with osteoporosis, most recently with PT and Pilates Instructor Zeina Grifoni, the founder of Synergy Pilates, and given how prevalent it is wanted to share some information about the condition and ways we can work to maintain and build bone safely.

Osteoporosis means “porous bone” and is a condition where the density of the bone decreases, especially in the spine, hips and wrists. What’s most challenging about this condition is that people with Osteoporosis don’t experience any pain until a first fracture, and then the likelihood of subsequent fractures increases dramatically. The goal is to prevent that first fracture! Osteoporosis is also incredibly widespread. “30% of all post menopausal women have osteoporosis and 1 in 5 men are at risk of an osteoporotic fracture. After a first fracture there is an 86% chance of a second fracture.”  

Because there are no other indications, bone density testing is the only way to diagnose Osteoporosis. The National Osteoporosis Foundation recommends testing for:

  • Women 65 and over
  • Men 70 or older
  • Women/Men who break a bone after age 50
  • Women of menopausal age with risk factors
  • Postmenopausal women under the age of 65 with risk factors
  • Men 50-69 with risk factors

There are a range of risk factors, including age, family history, sex (women are more likely then men to get Osteoporosis), race (White and Asian women are at higher risk), size of body frame. Smaller-framed people are at higher risk. There are also a range of other risk factors – dietary, medications, and medical conditions that put a person at higher risk. To read more see Risk Factors (Mayo Clinic). 

As a Pilates instructor my goal is to support bone building (especially around the thoracic spine, hip and wrists) through muscle strengthening, balance training, and, critically, to work in positions that don’t put clients at risk for fractures. This means NO Loaded Spinal Flexion (forward bends in standing, rolling up into an abdominal curl, rolling like a ball, any position that rounds head towards feet or takes legs over the head, e.g. shoulder stands). If you look at the image below you see that Osteoporosis tends to cause us to round forward (into increased kyphosis) bringing the front of the vertebrae closer together. 

Loaded spinal flexion increases that rounding, putting pressure on fragile bones, which is why the majority of osteoporatic spinal fractures happen in the thoracic spine. It’s also clear from this image that extension exercises are one of the best things we can do to support not only postural changes to prevent fractures, but bone building as well. Swans, Cat Stretch, upper back lifts, swimming are all great extension exercises. 

For those of you who do other forms of exercise, yoga, weightlifting consider any exercises that ask you to bend forward and ask your instructors for modifications that allow you to stay in neutral spine (the natural curves of the spine).

If you have any concerns, talk to your doctor about a bone density exam. For more information you can also visit the Bone Health and Osteoporosis Foundation.

Bone Remodeling

“The remodeling cycle consists of three consecutive phases: resorption, during which osteoclasts digest old bone; reversal, when mononuclear cells appear on the bone surface; and formation, when osteoblasts lay down new bone until the resorbed bone is completely replaced. Bone remodeling serves to adjust bone architecture to meet changing mechanical needs and it helps to repair microdamages in bone matrix preventing the accumulation of old bone.” PubMed. Through weight-bearing, strength training – we activate bone remodeling that builds stronger bones. The more we ask of our bones, the more they give us!

August 2021 Theme – Snaking the Spine

“Historically, serpents and snakes represent fertility or a creative life force. As snakes shed their skin through sloughing, they are symbols of rebirth, transformation, immortality, and healing. ” (Wikipedia)

“80% of adults (from adolescents to the elderly) are estimated to experience a back injury in their lifetime….the top reasons identified by the Mayo Clinic:

  • Muscle or ligament strain
  • Bulging or ruptured disks
  • Arthritis
  • Skeletal irregularities
  • Osteoporosis” (thegoodbody.com, mayo clinic).

Back injuries are painful, debilitating and likely to reoccur. In addition to the above list, I have worked with several people whose back pain flares up during stressful, highly emotional periods, which we are having plenty of these days. Back pain is often why people end up in a Pilates studio. Pilates’ focus on strengthening the core (abdominals, diaphragm, pelvic floor, hip and back) can be tremendously healing and an excellent way to ward off future back injuries. We, for example, can strengthen the deep abdominals to help create length through the low back and lift out of the pelvis. This lift out of the pelvis helps us to unweight through the joints of the hips, knees and feet.

In the Yamuna Breath Work training I did last fall we explored using the breath to stretch from the inside out, e.g. using the breath to expand the lungs to move the ribs to the side and back, and to direct the breath into different parts of the torso to create space and release. Connecting back to the healing potential of our breath adds to our healing and well being. During the breath work training I slept deeply and felt an ease and space in my low back, which can tend to get tight, not to mention feeling grounded and present. Our breath is a powerful medicine!

Conversations with Latanya Tigner, and her, Colette Eloi and Ebonie Barnett’s Back to the Root Series: Healing and Spiritual Power of the Spine and Pelvis in African Rooted Dance and my training with Thomas Presto on his Talawa Technique opened an exploration into the how the spine heals us through movement. In observing and learning some of the highly refined movements of the spine, foundational in many traditional African/Diasporic dances, we learn to move parts of our spines in isolation, thereby activating muscles at different levels of the spine. This increases our proprioception (awareness of our body’s position in space) and muscular support and so the health of our spines. Watch Joel Ramirez (facing front) and Luciano Wollman Michelle (side view) moving through the 7 levels of the spine as synthesized by Thomas Presto in his Talawa Technique.

I cite this conversation with Latanya Tigner all of the time because the question is profound. She asked me to reflect on the question, “How did enslaved people do back breaking work 14 hours a day in the fields and then dance at night?” We don’t know how many enslaved people experienced back pain, but it does seem that our culture of sitting all day and driving has wreaked a disproportionate havoc on our backs. While Pilates is important for learning how to stabilize our backs, to activate the full potential and healing of our backs, and I’d argue our creative life force, we need to move our spines – to get the snake into our spines!

This month and building on June’s focus on the breath and core, and July’s focus on the pelvis, we will focus on developing the strength and support for our spines, activating our breath as medicine and movement for healing.

Anatomy of the Pelvis

Pelvis, also called bony pelvis or pelvic girdle, in human anatomy, basin-shaped complex of bones that connects the trunk and the legs, supports and balances the trunk, and contains and supports the intestines, the urinary bladder, and the internal sex organs.” (Britannica).

For a super in depth look at the pelvis, check out Physiopedia’s Article – The Anatomy of the Pelvic Girdle

July Theme – The Pelvis

Pelvis, also called bony pelvis or pelvic girdle, in human anatomy, basin-shaped complex of bones that connects the trunk and the legs, supports and balances the trunk, and contains and supports the intestines, the urinary bladder, and the internal sex organs.” (Britannica)

Last Fall I had the great privilege of participating in a Talawa Technique training led by its creator, Thomas Presto, and two of his dance collaborators, Luciano Wollman Michelle and Joel Ramirez. The Talawa Technique synthesizes movements from close to 400 dances from African and Caribbean movement traditions into a set of arm, foot and spine positions. It was an enormous undertaking by Thomas Presto and a precious gift. For me, someone who hadn’t formally studied dance within any African dance tradition, it was an opportunity to enter into the language and healing wisdom African dance has developed over many thousands of years. I will forever be grateful to Latanya Tigner for bringing Thomas’ work to us through her, Colette Eloi and Ebonie Barnett’s Back to the Root series and for helping coordinate the training for us West Coast folks – Thomas is based in Norway.

On this particular day, several weeks into our online training, we were learning the Bird (foot) positions combined with Snake (spine) positions, specifically Snake 7, the pendulum swing of the pelvis. Below Joel (facing front) and Luciano (side view) demonstrate all 7 levels of the Snake.

We were using Snake 7 to move through the 15 foot positions. We did them over and over again swinging our pelvis’ to move two feet to one. Well into hour two of this work I was sweating, my quads were trembling and my brain was just about to explode (in a good way) with the physical and mental work. By the end of the session all I could imagine was collapsing onto my bed, but Thomas recommended we take a walk and so I did. My intention was to just walk around the block and then collapse, but I started walking and found I wanted to keep walking and keep walking. I felt this energy localized around my sacrum propelling me forward. My back felt loose and lubricated and I felt light and strong.

I wasn’t the only one in the training who felt that release/generation of energy. Latanya had once posed the question to me – how were enslaved people able to do back breaking work 14 hours a day and then dance, really dance at night? In the discussion following that session, Thomas described that undulating the spine generates energy at the cellular level. The dances as Latanya already knew and Thomas demonstrated were healing and restorative. The Talawa Technique training and Latanya, Collette and Ebonie’s Back to the Root: Healing and Spiritual Power of the Spine and Pelvis in African Rooted Dance opened up an inquiry into the healing traditions of what Thomas refers to as Africana movement.

The pelvis is critical to movement. It transfers force from the trunk down to the lower body and disperses force from the lower extremities up into the spine. In Congolese movement traditions, the pelvis, loketo, expresses our relationship to the Earth. My exploration continues with my friend and collaborator Byb Chanel Bibene, Artistic Director of Kiandanda Dance Theater through a slowed down, in-depth exploration of Zebola, a dance of the Mongo People of the Democratic Republic of Congo.

I am coming to understand the importance of the pelvis and to have reverence for its mystery. Releasing, strengthening, moving the pelvis are critical to my practice and are the focus of July’s classes. Using Yamuna routines we will release the muscles that connect the pelvis to the lower extremities and the trunk. We will use Pilates to strengthen and Talawa Technique to move the pelvis, build proprioception and generate energy!

This release focuses on releasing the back of this hip and finding movement of the pelvis using the support of Yamuna balls. I find that understanding the anatomy also helps. Check out the post with the anatomy slide show to learn more about the bones and muscles of the pelvis.

The Anatomy of the Pelvis — The Bones and Muscles