Recognize and correct common misalignments in the lower body.
Pilates footwork: simple yet powerful, it is typically the first exercise taught on the reformer. Called the “Pilates fortuneteller” by Amy Taylor Alpers from the Pilates Center in Boulder, Colorado, footwork reveals postural patterns and muscle imbalances of the hips, legs and feet and is an effective exercise for correcting them. If you are a Pilates instructor, this basic, functional movement of closed-kinetic-chain hip and knee flexion and extension allows you to help a client
- correct leg, foot and ankle alignment;
- develop strength in the hips, legs, ankles and feet;
- increase flexibility in the lower limbs;
- create balanced muscle development around the hips, knees and ankles;
- retrain foot, ankle, knee and hip biomechanics for functional activities such as walking, running, dancing and sports;
- prevent injury by balancing stress on the joints of the lower limbs; and
- recover from injuries by training in a closed-chain environment where resistance on affected limb(s) can be carefully controlled.
As a training tool, footwork has the advantage of being a closed-kinetic-chain (or closed-chain) exercise with variable resistance. In closed-chain movements, the limbs are stabilized and the body is moving. In this case, the feet are connected to the bar or jumpboard and the body moves away as the knees and hips extend. Closed-kinetic-chain exercises use multiple muscle systems in coordination, creating more stability in joints than do open-kinetic-chain movements. Closed-chain options are therefore generally safer. They also translate well to functional activities such as walking and running.
The variable resistance of the reformer allows instructors to choose a light resistance for an injured or deconditioned client and a heavier resistance for a client who is working on strength and power.
When a client first lies down on the reformer, you should observe the alignment of the hip, knee, ankle and foot and correct it as far as possible, given the client’s structure. Good alignment allows for balanced distribution of forces leading to more even wear on the joints and a lower likelihood of injury.
In good alignment,
- the pelvis remains in neutral throughout the movement;
- the center of the hip joint (center of the inguinal crease) is directly over the center of the knee, and the center of the knee is directly over the center of the ankle (both legs);
- the patellae (kneecaps) and feet are pointing straight ahead and are in line with each other, the femurs are neither internally nor externally rotated and the tibiae are straight;
- the ankles are aligned over the feet, neither supinated (rolled out to the little toe) nor pronated (rolled in toward the big toe);
- the weight is in the center of each heel for heel work and is balanced between the first and second toes for ball-of-the-foot work; and
- the forefoot is in line with the heel (both feet).
Recognizing correct alignment is relatively simple; helping clients achieve it is more complicated. If your corrections are to create long-term change, clients need to understand what they are being told to do, why it will benefit them and how they can identify proper movements in their own bodies. If people can’t feel something in themselves, they can’t change it, so the most effective cues are those that clients can feel.
Here are a few cues and tips for addressing common misalignments.
In some clients, posterior pelvic tilt is habitual; in others, the pelvis tilts posteriorly every time the client pushes back.
Walking, running and other functional upright activities are best performed with a neutral pelvic alignment, so training this position in footwork on the reformer is important. Many clients don’t have an innate sense of how a neutral pelvis feels when lying supine; by using verbal and manual cues, you can help a client become aware of where the pelvis is and whether it is moving.
Verbal cues. “Feel the weight on the sacrum rather than on the lower back. Keep pressure on the same area as you bend and straighten the legs.”
Manual cues. Have the client place the heels of the hands on the ASIS points (anterior superior iliac spines or hip pointers) and place the second or third finger of each hand on the pubic bone, making a triangle with the fingers. When the pelvis is in neutral, the triangle should be parallel to the floor. Cue the client to hold this position as the knees and hips flex and extend. If a client can’t sense whether the pelvis is level by feeling the hip bones, move on to a stronger tactile cue:
- Have the client place her hands between her waist and the carriage, feel the amount of space that is appropriate for her in neutral and then make sure the size of the space doesn’t change as she moves her legs.
- If it is uncomfortable for a client to hold his hands in this position, use a small roll of sticky-pad material, a towel or a cushion to support the lumbar curve so the client can feel what is happening. The verbal cue to accompany this is, “Don’t increase or decrease pressure on the roll.”
When correcting leg alignment, start by making sure the pelvis is in neutral, the hips are level across the top of the iliac crests (with neither hip high or low), the ASIS points are level (no pelvic rotation) and the pelvis is in the center of the reformer. Provide verbal direction, but let clients move the pelvis themselves rather than moving it for them. It is important for clients to be able to find the right position, and if you move them into it, they do not learn how to find it.
To correct internal or external rotation of the femurs, place them in neutral alignment with the kneecaps pointing straight forward. If there is a bony misalignment, this may cause the lower legs, ankles and feet to move out of alignment. The femurs are the priority, so once they are in neutral, adjust the lower legs, ankles and feet accordingly.
To encourage external rotation, cue activation of the external rotators by cuing a slight engagement of the lower glutes and external rotators:
Verbal cues. “Rotate the kneecaps to the ceiling,” “Squeeze the panty line” or “Shift the weight slightly more laterally on the foot.”
Tactile cues. Have the client place a folded towel at the tops of the legs and gently squeeze the backs of the legs together. Make sure the towel is large enough to maintain neutral alignment of the legs. Depending on the structure of the joints, the position of the feet may need to change for the femurs to line up in neutral. See what works for each client.
To encourage internal rotation, cue a slight internal rotation of the thighs:
Verbal cues. “Roll the thighs toward the center,” “Aim the kneecaps at the ceiling” or “Shift the weight toward the big toe side of the foot.”
Tactile cues. Have the clients place a ball between the thighs and gently squeeze it as the legs flex and extend. The ball should be soft and large enough to enable the client to maintain neutral alignment of the legs. Use the ball only until the client can maintain the position on her own.
Manual cue. Direct the client to place a hand on each thigh and gently roll the femurs in the direction desired.
Ideally, each leg should be lined up so the center of the hip joint is directly over the center of the knee joint, which in turn should be directly over the center of the ankle joint. Common alignment issues around the knee joint include knock-knee (genu valgum), bowlegs (genu varum) and tibial torsion. Tactile cues can address each of these conditions.
- For knock-knee, place a small loop of resistance band on the thighs and ask the client to abduct (not externally rotate) the legs to keep the knees in place.
- For bowlegs, place a ball above the knees and at the ankles to align the legs. Use the props only until the client can learn to maintain the alignment on his own.
- For tibial torsion, line the femurs up in parallel and then internally rotate the lower legs as far as they will comfortably go without changing the placement of the feet or the position of the femurs.
For alignment and muscle balance to change, clients need to exercise in the new position frequently and consistently over time so muscles strengthen and tissues adapt. Don’t worry about getting the alignment perfect; just correct it as much as is currently possible and work with that small change until the body is ready for more. Be sure to work with the new alignment in standing, walking, running or the client’s activity of choice so the learning has real-life application.