The following Pilates exercises will help your clients develop and maintain happy, healthy knees. The moves are described by Nora St. John, MS, currently the education program director for Balanced Body®.
Single-Leg Knee Stretch and Double-Leg Knee Stretch
Single-leg knee stretch is useful for working on knee flexion and extension in a standing position and on correcting alignment and improving the balance of the standing leg. To increase the balance challenge, take the hands off the bar and stand upright using a gondola pole for balance. Once you master that, take the pole away and then add an unstable surface such as a balance pad under the standing foot.
Setup: one to two springs, foot bar up. Stand beside reformer with close foot on shoulder rest and hands on foot bar. Press carriage back by extending hip and knee. Maintain leg alignment and pelvic stability. Variations: round back (flex spine and focus eyes on pelvis); flat back (maintain neutral alignment of pelvis and lumbar spine); with hand off foot bar, use pole for balance or stand on balance block for challenge.
Double-leg knee stretch is an advanced exercise for clients with knee issues because it puts pressure on the knee from kneeling on the carriage and from deep knee flexion. Once a client is ready to progress to full knee stretch, pad the carriage and place a small ball between the thighs to engage the adductors and inner-thigh muscles. This helps the client to lift out of the knees and decreases stress on the knees.
Setup: two to three springs, foot bar up. Kneel on carriage with feet against shoulder rests and hands on foot bar. Press carriage back by extending hip and knee. Maintain pelvic stability and leg alignment. Variations: round back (flex spine and focus eyes on pelvis); flat back (maintain neutral alignment of pelvis and lumbar spine).
Long Box Hamstring Curls
Hamstring curls on the long box strengthen the hamstrings and are used to correct strength imbalances between the medial and lateral hamstrings. To target the medial hamstrings, slightly internally rotate the tibia before performing the curl. To target the lateral hamstring, slightly externally rotate the tibia before beginning the curl.
Setup: one to two springs, foot bar down. Lie prone on long box facing foot bar with straps around arches of feet. Shorten straps to create tension in starting position with knees flexed approximately 45 degrees. Pull straps toward hips by flexing knees. Keep anterior pelvis on box. Variations: legs parallel; tibia rotated slightly medially; tibia rotated slightly laterally; single leg.
Standing exercises are extremely important on the reformer because in this functional position a client’s real posture is not hidden by lying supine and because it is one of the few exercises that target the abductors and lateral hip muscles, which stabilize the hips in walking and running. Use light or no weight to target the adductors and heavier weight to target the abductors. Work with the knees straight and bent to get the most out of this exercise.
Setup: one to two springs (lighter weight for targeting adductors, heavier weight for targeting abductors), foot bar down. Stand on reformer with one foot on standing platform and place other foot on carriage. Press carriage out and bring it back to starting position. Variations: legs parallel; legs turned out; knees straight; knees bent.
Stretching the hip flexors and especially the quadriceps is essential for happy knees. When the quads are tight, they press the patella deeper into the groove of the femur, increasing wear and tear on the joint. To maximize the quad stretch, place the knee against the shoulder rest with the lower leg pointing toward the ceiling. Press the carriage back and breathe into the stretch!
Setup: one spring, foot bar up. Stand beside reformer with close foot on shoulder rest, knee on carriage and hands on foot bar. Press carriage back by extending hip and knee. Maintain leg alignment and pelvic stability. Move in and out of position three times, then hold for 45 seconds.
Photography courtesy of Balanced Body.