CORRECT RESTING BODY POSITIONS

HEAD AND CERVICAL SPINE ALIGNMENT

General points

The position should feel comfortable with the neck muscles appearing relaxed. It may be necessary to try a variety of supports (e.g. neck or small pillow, rolled towel) to achieve correct resting alignment. These may need adjusting as exercises progress – for example, head supports can restrict spine movement when progressing from small pelvic tilts to full pelvic curls. The use of head supports for an individual should be continuously reviewed as spine mobility and overall posture improve.

PECTORAL GIRDLE AND SCAPULAR ALIGNMENT IN STANDING AND SITTING

Viewed from front

The ribcage should be centred over the pelvis and lower limbs with the shoulders facing directly forwards.

Viewed from back

The scapulae lie flat against the ribcage between the second and seventh thoracic vertebrae with their vertebral borders parallel to and approximately 7.5 cm from the midline of the spine.

They are rotated approximately 30 degrees anterior to the frontal plane to follow the curve of the ribcage (Sahrmann 2002).

NEUTRAL SPINE IN STANDING, SITTING AND SUPINE

The pelvis is in neutral and the normal spinal curves are intact but not exaggerated (Figs 4.4 & 4.5).

Figure 4.4 Neutral pelvis in standing.

Figure 4.5 Neutral pelvis in sitting.

Neutral spine in standing

Viewed from side

The cervical, thoracic and lumbar curves are intact.

NEUTRAL PELVIS

When the body is supine the pelvis lies in the transverse plane. Using the anterior superior iliac spine (ASIS) and pubis as landmarks, a triangle traced with the fingers between these points lies parallel with the floor.

IMPRINTED SPINE (RELAXED BACK POSITION)

When the body is supine the pelvis is positioned with a posterior tilt to eliminate the normal lumbar curve. Using the ASIS and pubis as landmarks, the pubis is positioned at a higher level than the ASIS (Fig. 4.7).

Figure 4.7

SUPINE POSITION: NEUTRAL LUMBAR SPINE AND PELVIS

Body position

Lying on the back with the hips and knees flexed approximately 90 degrees and the hips neutral in rotation. The heels are aligned with the axes of the hip joints. The normal spinal curves are intact (Fig. 4.8).

Figure 4.8 Neutral lumbar spine and pelvis.

General points

The position should be stable and comfortable. To achieve the best possible alignment and comfort, use supports with discretion under the head, back, hips, shoulders or feet. If the arms are not comfortable with the palms to the floor, allow them to turn to face the palms to the ceiling. To assist pectoral girdle alignment and stability, cue to press the little fingers lightly into the floor. To correct lower limb alignment, place a chi ball or cushion between the thighs or instruct the student to gently activate the short leg adductor muscles (brevis and magnus). To maintain lumbar spine alignment, cue to reach the ‘sitting bones’ and crown of the head in opposite directions and relax the lower back muscles.

Equipment

Neck pillow, pillow, rolled towels, chi ball; yoga blocks or a small box may be used to raise the feet.

Common problems

Rounding the shoulders: Use tactile cues to encourage breadth across the collarbones.

Tensing the back, extending the spine and pushing the ribcage away from the floor: Use the breath to improve relaxation of the spinal muscles so that the breastbone can drop back towards the spine and the ribs can align correctly with the pelvis; this allows the abdominal muscles to achieve their optimum length and tone.

Tightening the hip flexors: Cue to relax the toes, feet, thighs and posterior hip muscles; cue to release and lengthen through the groins.

See Table 4.1 for Teaching points.

Table 4.1 Teaching points – Supine position: neutral lumbar spine and pelvis

Focus on	Examples of verbal/visual cues
Creating a correctly aligned and relaxed, comfortable position	Centre yourself on the mat Use sufficient head support to achieve relaxed neck muscles and comfort Align the heels with the sitting bones Reach the sitting bones for the heels Lengthen from the crown of the head through to the sitting bones On breathing out, relax the tongue in the throat and imagine your body and limbs sinking into warm sand
Achieving a neutral spine and pelvis	Trace your fingers along a triangle formed between the pubic bones and the hip bones. The triangle is to lie parallel with the floor
	Imagine a small space under the lower back – just enough to allow a glimmer of light to shine through
	Imagine the pelvis as a bowl of water and the surface of the water is absolutely level and still

SUPINE POSITION: IMPRINTED LUMBAR SPINE

This position is used during exercising when abdominal muscle strength is insufficient to stabilize the lumbar spine, or when first attempting more challenging exercises.

Body position

Lying on the back with the hips and knees flexed approximately 90 degrees and the hips neutral in rotation (Fig. 4.10). The heels are aligned with the axes of the hip joints. The pelvis is in a slight posterior tilt with the lumbar spine flattened.

Figure 4.10 Imprinted spine.

General points

The position should be stable and comfortable. To achieve the best possible alignment and comfort, use supports with discretion under the head, back, hips, shoulders or feet. If the arms are not comfortable with the palms to the floor, allow them to turn to face the palms to the ceiling. To assist pectoral girdle alignment and stability, cue to press the little fingers lightly into the floor. To correct lower limb alignment, place a chi ball or cushion between the thighs or instruct the student to gently activate the short leg adductor muscles (brevis and magnus). To create and maintain a flattened lumbar spine, cue to gently activate the pelvic floor and lower abdominal muscles.

Equipment

Neck pillow, pillow, rolled towels, chi ball; yoga blocks or a small box may be used to raise the feet.

Common problems

Using the legs to push the back to the floor: Cue to maintain relaxed hamstring and gluteal muscles.

Tightening the hip flexors to create or maintain the ‘imprinted’ position: Cue to relax the toe, thigh and posterior hip muscles; cue to think of making deep valleys in the groins.

Poor relationship between the ribcage and pelvis due to thoracic spine extension and/or lumbar spine lordosis: Consider using a pillow behind the upper body to curl it forwards to facilitate abdominal control.

See Table 4.2 for Teaching points.

Table 4.2 Teaching points – Supine position: imprinted spine

Focus on	Examples of verbal/visual cues
Creating a correctly aligned and relaxed, comfortable position	Centre yourself on the mat Use sufficient head support to achieve relaxed neck muscles and comfort Align the heels with the sitting bones Reach the sitting bones for the heels Imagine the groins as deep valleys On breathing out, relax the tongue in the throat and imagine your body and limbs sinking into warm sand
Using abdominal muscle activation and relaxation of the lower back muscles to create the posterior pelvic tilt	Imagine the pelvis as bowl of water. Using the pelvic floor muscles and lower abdominal muscles, tilt the bowl to spill one drop of water towards your navel Keep the lower back muscles relaxed and the abdominal muscles gently working to maintain this position Trace your fingers around the edges of the triangle to see if the pubic bone is higher than the hip bones Use your fingers to see if your normal lower back curve has flattened to the floor

Focus on

Examples of verbal/visual cues

Creating a correctly aligned and relaxed, comfortable position

Centre yourself on the mat

Use sufficient head support to achieve relaxed neck muscles and comfort

Align the heels with the sitting bones

Reach the sitting bones for the heels

Imagine the groins as deep valleys

On breathing out, relax the tongue in the throat and imagine your body and limbs sinking into warm sand

Using abdominal muscle activation and relaxation of the lower back muscles to create the posterior pelvic tilt

Imagine the pelvis as bowl of water. Using the pelvic floor muscles and lower abdominal muscles, tilt the bowl to spill one drop of water towards your navel

Keep the lower back muscles relaxed and the abdominal muscles gently working to maintain this position

Trace your fingers around the edges of the triangle to see if the pubic bone is higher than the hip bones

Use your fingers to see if your normal lower back curve has flattened to the floor

PRONE POSITION

Lying prone, preferably on a mat or a raised bed that enables the ankles to relax as the feet drop over the edge (Fig. 4.11). The arms are bent with the elbows pointing to the side, and the hands resting one on top of the other to make a support for the forehead. The spine is lengthened and the limbs are symmetrically aligned. The abdominal muscles are drawn gently towards the spine, supporting the natural lumbar curve and the groins are soft and lengthened.

Figure 4.11

General points

The position should feel comfortable and be stable so that correct body and limb alignment may be maintained during exercising. Supports may be placed in the axillae for upper body comfort. A small pillow may be placed under the body to reduce an exaggerated lumbar lordosis. A rolled towel may be place between the thighs to maintain leg alignment.

Initially, it may be necessary to allow a student with tight hip flexors to slightly abduct the hips to achieve a comfortable, stable position. Where possible, maintain the hips neutral in rotation unless otherwise stated.

Equipment

Neck pillows, small pillows, rolled towel. Note : Large pillows should not be used between the lower ribs and the pelvis as this may affect the breathing effort, particularly in those individuals with pathology that compromises breathing such as asthma, respiratory disease, etc.

Common problems

An exaggerated lumbar lordosis: For students with poor abdominal muscle control or tight hip flexors it may be helpful to place a small pillow under the body to support and lengthen the lumbar spine.

For students with neck problems, position on a stack of mats at least 8–10 cm high so that the elbows fall lower than the chest and the head can drop forwards onto the hands; this allows the cervical spine to lengthen.

For students with shoulder problems, supports may be placed in the axillae whilst the head rests on the hands, or a small support may be placed under the forehead whilst the arms remain at the sides of the body.

See Table 4.3 for Teaching points.

Table 4.3 Teaching points – Prone position

Focus on	Examples of verbal/visual cues
Correct spine alignment	Centre yourself on the mat
Creating a comfortable rest position for the student	Use supports appropriately
Lengthening through the groins	Lift the right leg slightly, stretch through the groin and reach the right leg out of the hip then return it to the mat Repeat with the left leg Think of lengthening through the groins and lower back
Sufficient abdominal muscle engagement to support the lumbar spine	Imagine creating a space under the navel large enough for small piece of chocolate Maintain sufficient abdominal muscle work to prevent squashing or melting the chocolate

SIDE LYING POSITION FOR EXERCISING THE UPPER LEG

Body position

Side lying with the lower leg flexed approximately 90 degrees at the hip and knee (Fig. 4.12). The upper leg extends in line with the body or slightly in front of the hips (with no more than 10 degrees of flexion) and rests on the floor or a support at about hip height. The lower arm reaches along the floor in line with the shoulder and the upper hand is placed on the floor in front of the body or on the upper hip to help keep the side of the body lengthened. (Alternatively, the upper arm may be supported by placing it on yoga blocks, a pillow or small soft ball, or magic circle.) The head rests on the extended lower arm or on a suitable support to establish correct head, neck and thoracic spine alignment.

Figure 4.12

General points

The position should feel comfortable and be stable so that correct body and limb alignment may be maintained during exercising. For beginners and those with limited core control it may be necessary to flex the thoracic spine just enough to allow the sternum to drop down and back towards the spine. This can improve abdominal muscle control during exercising.

Equipment

Neck pillow, pillow, rolled towel, triangle, yoga blocks, chi ball, magic circle.

Common problems

Extension of the cervical, thoracic or lumbar spine and subsequent loss of the correct relationship between the ribs and the pelvis: Place the student against a wall or other back support; cue for stronger abdominal muscle control.

Rounding of the upper shoulder: Cue to broaden across the collarbones and slide the shoulder blades down the back.

Twisting from the waist and rotating the pelvis forwards or backwards: Place the student against a wall or other back support; support the upper arm with a stack of blocks.

Flexing the spine laterally such that the waist drops to the floor: Instruct the student to place a hand on the upper hip together with contracting the lower abdominal muscles more strongly; consider placing a support such as a small rolled towel under the waist.

Placing the upper leg in a position of hip extension with lumbar spine extension: Cue for stronger abdominal muscle control; instruct the student to be aware that the upper foot should be lying within their range of peripheral vision when looking straight ahead; consider stretching the gluteal and lower back muscles.

See Table 4.4 for Teaching points.

Table 4.4 Teaching points – Side lying position for exercising the upper leg

Focus on	Examples of verbal/visual cues
Comfort	Lie along a mat, lining the body up with the edge of the mat, or place your back against a wall Use neck supports and waist supports as required – a pillow between the head and arm, a small towel under the waist
Good pectoral girdle alignment and stability	Imagine the shoulder blades sliding down the back into rear hip pockets on the opposite sides
Alignment and length of the spine and lower limbs	Imagine the sitting bones and the crown of the head reaching in opposite directions Reach the upper leg out of the hip joint Feel that a hand could slide between the waist and the floor
The optimum position for torso stability and effective upper limb movement	Imagine the body stretched between two panes of glass that might shatter if the body leans forwards or backwards Imagine you are lying with your back against a wall

SIDE LYING POSITION FOR EXERCISING THE LOWER LEG

Body position

Side lying with the upper leg in approximately 90 degrees of hip and knee flexion, the knee resting on a support at about hip height (Fig. 4.13). The lower leg is extended in line with the body or slightly in front of the hips (with no more than 10 degrees of hip flexion). Both knees face directly forward. The lower arm reaches along the floor in line with the shoulder and the upper hand is placed on the floor in front of the body or on the upper hip to help keep the side of the body lengthened. (Alternatively, the upper arm may be supported by placing it on yoga blocks, a pillow or small soft ball, or magic circle.) The head rests on the extended lower arm or on a suitable support to establish correct head, neck and thoracic spine alignment.

Figure 4.13 Side lying position for exercising the lower leg.

General points

The position should feel comfortable and be stable so that correct body and limb alignment may be maintained during exercising. For beginners and those with limited core control it may be necessary to flex the thoracic spine just enough to allow the sternum to drop down and back towards the spine. This can improve abdominal muscle control during exercising.

Equipment

Neck pillow, pillow, rolled towel, triangle, yoga blocks, chi ball, magic circle.

Common problems

Extension of the cervical, thoracic or lumbar spine and subsequent loss of the correct relationship between the ribs and the pelvis: Place the student against a wall or other back support; cue for stronger abdominal muscle control.

Rounding of the upper shoulder: Cue to broaden across the collarbones and slide the shoulder blade down the back.

Twisting from the waist and rotating the pelvis forwards or backwards: Place the student against a wall or other back support; support the upper arm with a stack of blocks.

Flexing the spine laterally such that the waist drops to the floor: Instruct the student to place a hand on the upper hip together with contracting the lower abdominal muscles more strongly; consider placing a support such as a small rolled towel under the waist.

Placing the lower leg in a position of hip extension with lumbar spine extension: Cue for stronger abdominal muscle control; instruct the student to flex the lower hip to about 20 degrees.

See Table 4.5 for Teaching points.

Table 4.5 Teaching points – Side lying position for exercising the lower leg

Focus on	Examples of visual/verbal cues
Comfort	Lie along a mat, lining the body up with the edge of the mat, or place your back against a wall Use neck supports and waist supports as required – a pillow between the head and arm, a small towel under the waist
Good pectoral girdle alignment and stability	Imagine the shoulder blades sliding down the back into rear hip pockets on the opposite sides
Alignment and length of the spine and lower limbs	Imagine the sitting bones and the crown of the head reaching in opposite directions Reach the lower leg out of the hip joint Feel that a hand could slide between the waist and the floor
The optimum position for torso stability and effective lower limb movement	Imagine the body stretched between two panes of glass that might shatter if the body leans forwards or backwards Imagine you are lying with your back against a wall

QUADRIPED POSITION

Body position

Four-point kneeling with the hips and knees flexed 90 degrees and the knees approximately hip distance apart (Fig. 4.14). The hips are neutral in rotation and the limbs are parallel and aligned so that the top of the feet face to the floor. The hands are in line with or just in front of the glenohumeral joints (if the arms are comparatively long). The glenohumeral joints are in slight lateral rotation and the arms are extended with the elbows softened to prevent hyperextension of the elbow joint. The little fingers press lightly into the floor to assist engagement of the pectoral girdle stabilizing muscles. The normal spinal curves are intact, with the back of the neck lengthened and the crown of the head reaching forward. The gaze is between the thumbs.

Figure 4.14 Quadriped position.

Extension of the cervical, thoracic or lumbar spine and subsequent loss of the correct relationship between the head, neck, ribs and pelvis: Cue to lengthen through the back of the neck and to imagine holding a soft peach between the chin and the sternum; use the hands to direct the ribs to ‘funnel down towards the pelvis’; cue to reach the crown of the head and the ‘sitting bones’ in opposite directions; trace the fingers along the spine to promote space between each vertebra.

Hanging head: Cue to lift or float the head towards the ceiling whilst thinking of dropping the chin.

Wrist pain: Decrease wrist extension by placing supports under the heels of the hands.

Thoracic spine sagging down between the scapulae: Use the fingers to direct the sternum upwards towards the spine to establish the normal thoracic curve and allow the scapulae to flatten on the ribs; cue to slide the shoulder blades down and across the back.

An exaggerated lumbar lordosis with poor abdominal muscle control over the lumbar spine: Cue to increase pelvic floor and lower abdominal muscle activation and to reach the ‘sitting bones’ and the crown of the head in opposite directions.

Poor proprioception of body alignment in space: Initially consider the use of props such as a mirror, or by using a stick placed along the spine to feel where the normal spinal curves would lie; use visual imagery to cue the neutral pelvis alignment – for example, imagine the hip bones as lights shining directly to the floor below or the sitting bones as lights shining directly backwards.

Should the contour of the paraspinal muscles be asymmetric, there could be a postural rotation of the lumbar vertebrae or uneven rotation in the hip joints. The latter is confirmed by asking the subject to rock back onto the heels. If lumbar spine rotation increases further as the subject reaches their end range of hip flexion motion, asymmetry of hip joint mobility is likely.

See Table 4.6 for Teaching points.

Table 4.6 Teaching points – Quadriped position

Focus on	Examples of visual/verbal cues
Achieving a well-balanced position with the body weight distributed between the hands and the lower limbs	Kneel down and sit your bottom on your heels Keep the bottom in contact with the heels and curl the body, reaching the arms as far forward as possible along the floor Spread the fingers, push the hands into the floor and simultaneously slide the shoulder blades down the back Maintain shoulder girdle stability to draw the crown of the head forwards until you are supported over your hands and knees Adjust your position so that the shoulders are directly over the hands and the knees are over the hips
Good pectoral girdle alignment and stability	Draw the breastbone up towards the spine Imagine the shoulder blades sliding down the back into rear hip pockets on the opposite sides
Alignment and length of the spine and lower limbs	Imagine the sitting bones and the crown of the head reaching in opposite directions Reach the knees towards the floor

The classic Pilates repertoire

The Hundred, Roll-Up, Roll-Over, Leg Circles, Rolling Back, Single Leg Stretch, Double Leg Stretch, Spine Stretch, Open Leg Rocker, Corkscrew, See-Saw, Swan Dive, Single Leg Kick, Double Leg Kick, Neck Pull, Scissors, Bicycle, Shoulder Bridge, Spine Twist, Jackknife, Side Kick, Teaser, Hip twist with outstretched legs, Swimming, Leg Pull Front Support, Leg Pull Back Support, Side Kick Kneeling, Side Bend, Boomerang, Seal, Crab, Rocking, Control balance, Push-Up.

PREREQUISITE PREPARATORY EXERCISES

This covers basic sequences to achieve correct posture and efficient movement, thus providing the fundamental elements of the Pilates’ mat and equip-ment repertoires.

In the following exercises and stretches these principles are implied and may be easily identified within each specific exercise ‘aim’.

CONTROLLED BREATHING

Equipment

Exercise mat, gym ball, chair, dynaband; head supports to correct head/neck alignment and prevent neck and upper back tension.

Target muscles

Inspiration	Expiration
Diaphragm	Transversus thoracis
Intercostals	Subcostals
Levatores costarum	Serratus posterior inferior
Serratus posterior superior	External obliques
	Internal obliques
	Transversus abdominis
	Latissimus dorsi

Principles derived from Joseph Pilates’ original tenets

1. Efficient breathing implies both efficient pulmonary ventilation and cardiovascular function. Controlled breathing patterns before and during exercise assist mental concentration and physical relaxation and may improve spine stability or mobility.

2. Mental concentration and control imply the exclusion of unrelated thinking so as to concentrate on and be fully aware of what one is feeling and doing.

3. Relaxation implies the simultaneous release of bodywide muscle tensions. Alternatively, it can refer to the relative relaxation of specific muscles of which their opposing muscles can then function efficiently.

4. Correct spine elongation and alignment are intrinsically linked to correct spinal stabilization, mobilization and underlying musculoskeletal function, so as to achieve ideal static and dynamic postures.

5. Correct abdominal muscle control over spine stability and mobility implies correct lumbar spine function through appropriate abdominal muscle activity.

6. Correct function of each upper limb requires a combination of correct pectoral girdle alignment and stability upon an underlying correctly aligned and stabilized spine.

7. Correct function of each lower limb requires a combination of correct pelvic girdle alignment and stability upon an underlying correctly aligned and stabilized spine.

8. Precision implies the ability to sense and identify the basic components of an action and then perfect the way they are performed.

9. Flowing integrated movement. Having achieved precision this implies an ability to perform the components correctly in sequence.

10. Achieving muscular strength and stamina requires adherence to all the above principles so as to eliminate any superfluous activity.

Sequence 1 – Relaxed breathing

Sequence 4 – Controlled breathing to assist spine stabilization and mobilization as required

During the breathing cycle there is normally slight spine extension on inhalation and passive flexion on exhalation. These unconscious motions can be harnessed to help elongate, stiffen and stabilize the spine during hip and shoulder joint mobilization (particularly the lumbar spine during hip flexion) or to assist segmental vertebral column mobilization during spine extension as well as flexion.

Active breathing can be used to assist control over spine stability during hip and shoulder joint mobilization (e.g. in the basic core stability exercises BCS4 and BCS5 the ‘in breath’ helps control lumbar spine stability during hip joint flexion), or it can be used to improve spine elongation and mobilization (e.g. as in the spine mobilization exercises). These exercises can be selected as required.

See Table 4.7 for Teaching points.

Table 4.7 Teaching points – Controlled breathing

Focus on	Examples of verbal/visual cues
Correct head and spine alignment without neck tension	Ensure the head is sufficiently supported to allow the neck and upper back to relax Allow the tongue to loll in the mouth and imagine the muscles of the face melting away
Correct pectoral girdle and lower limb alignment	Spread the collarbones apart and imagine the shoulder blades as skis sliding diagonally down and across the back Imagine the knees are suspended from the ceiling with strings
Relaxing the body throughout	Imagine the head, arms, back and feet sinking into warm sand Sense the weight of the whole body and allow it to drop into the floor
An efficient breathing cycle: inspiration	On ‘breathing in’: – imagine the shoulder blades as wings unfurling and preparing for flight – imagine the diaphragm as a dome-shaped leaf floating down into the pelvis – imagine the back and side ribs opening as louvre blinds that allow light into the lungs – sense the weight of the body spreading across the floor
An efficient breathing cycle: expiration	On ‘breathing out’, imagine: – the breastbone as a stone falling into the chest – the diaphragm as a hot air balloon floating gently up into the chest – the ribs closing together as louvre blinds – the shoulder blades sliding down across the back and sense the weight of the body dropping into the floor – the ribs as a concertina squeezing air from the lungs
An efficient breathing cycle: more active expiration	On ‘breathing out’, draw the lower abdominal muscles further back towards the spine

BASIC CORE STRENGTHENING EXERCISES

EXERCISE LIST

Supine lower abdominal muscle strengthening (Exercises BCS1–5)

BCS1	Pelvic floor muscle toning
BCS2	Lower abdominal muscle activation
BCS3	Hip rolls
BCS4	Leg slides
BCS5	Thigh arcs

Prone posterior hip muscle strengthening (Exercises BCS6–8)

BCS6	Gluteal squeezes
BCS7	Gluteal strengthener with flexed knee
BCS8	Hamstring curls

Side lying posterior hip muscle strengthening (Exercises BCS9–12)

BCS9	The oyster
BCS10	Upper leg lifts
BCS11	Lower leg lifts
BCS12	Body lengthening

Spine, hip and shoulder stabilization and mobilization – quadriped series (Exercises BCS13–19)

BCS13	Head nodding
BCS14	Head turning
BCS15	Rocking
BCS16	Arm lifts
BCS17	Leg lifts
BCS18	Arm and leg lifts
BCS19	Cat

Supine spine mobilization (Exercises SSM20–22)

SSM20	Pelvic tilt
SSM21	Pelvic curls
SSM22	Pelvic curls with arm lifts

Supine upper abdominal muscle strengthening (Progression from lower abdominal muscle strengthening) (Exercises SAS23–24)

SAS23	Sit ups series
SAS24	Sit ups with twist series

Prone spine mobilization (Exercises PSM25–26)

PSM25	Cobra
PSM26	Arrow

Side lying spine mobilization (Exercise SLM27)

SLM27

Chest opener with spine twist

Knee strengthening (Exercise KS28)

KS28	Quadriceps strengthening

Fastest Musculoskeletal Insight Engine

Exercises for core stabilization and efficient movement

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