It was just like any other day. Renee was leaving for work, tote in one hand and lunch bag and coffee in the other, when she stepped over her dog gate and onto her flight of stairs. But this time, she missed her footing and fell down 15 flights of stairs.
“My body immediately went into shock, and I could barely breathe,” she says. “I tried to move but was completely unable to. My boyfriend helped drag me back up the stairs, where I lay on the floor in excruciating pain. I was convinced nothing could be broken; after all, I’m relatively young, active and healthy. I lay there on the floor with ice, hoping to feel a bit better. A few hours passed, the shock wore off, and then I knew this was serious. We went to the emergency room, and I was admitted with a broken pelvis.”
Specifically, Renee had suffered a left sacral fracture and left iliac wing fracture. “From that day forward, my life hasn’t been the same,” she says. “I live in constant pain, every day. I deal with continuous chronic back and hip pain, and I am only 44 years old. I occasionally get relief from my TENS unit [a small device that delivers electrical impulses], but it is brief, and the pain returns almost immediately after I turn the unit off. I barely sleep, because the pain wakes me numerous times throughout the night. I have tried many pain medicines, but they only make me nauseous. I’ve tried countless physical therapy sessions, acupuncture, yoga, chiropractic care, massage therapy, walking, working out, etc. However, the only thing that has started to [give me] some relief is Pilates.”
Pilates and Stabilization
I believe that Pilates is helping Renee, who is my client, because it emphasizes pelvic and lumbar-spine stabilization. We’ve been focusing on the areas surrounding and supporting the pelvis, specifically the pelvic floor (the pubococcygeus, iliococcygeus, ischiococcygeus and levator ani), the abdominal muscles (transversus abdominis, rectus abdominis, and internal and external obliques) and the hip muscles (quadratus lumborum, gluteus minimus, gluteus medius, external and internal rotators, adductors, abductors, hamstrings and iliopsoas).
Footwork on the reformer is challenging for Renee. She finds it difficult to maintain a neutral pelvic position. I cue her through all the foot positions (parallel, laterally rotated and medially rotated) and watch carefully to make sure her hips remain square and even. Over time she has increased her strength, and her pelvis has become more stable.
Bridge, or pelvic peel, has proven pertinent in developing hip and gluteal strength, as well as abdominal strength. After a few weeks of performing the exercise on the mat, Renee was ready to take it to the reformer. I put a ball between her knees to encourage adduction and stability and cued her to slowly roll her hips high, first through an imprint position to help engage the pelvic floor and transversus abdominis, then slowly continuing up through the vertebrae until her knees and shoulders were in alignment.
After a few sets of simply rolling up and articulating back down with breath control, we added the single-leg variation with hips lifted, which increased the pelvic-stability challenge. After working both legs evenly, we added the third variation: extending the reformer carriage outward and returning inward (with both feet on the foot bar) for a set of 10 extensions before lowering the hips back down to neutral.
I also used leg pull and saw, two amazing exercises that improve pelvic and hip region function and strength. For leg pull, I cued Renee to get in a hands-and-knees position on the box, and I placed the foot strap on her outside foot. From a bent-knee position, she stretched her leg out “long and strong” behind her while maintaining a stabilized, neutral pelvis. (I call these “donkey kicks.”) After a set of 10, I cued her to keep her leg straight, swing it forward alongside the box (until her foot was pointing straight down to the floor) and then bring the leg up again until it was pointing straight out from her hips. She did a series of 10 leg pulls.
For standing saw, Renee stepped onto the reformer with a moderate spring load and did 10 side splits to encourage abduction. I lightened the spring load slightly, and she performed saw to both sides while maintaining carriage and pelvic stability.
We did moves off the reformer as well. I used the foam roller to help create a lateral plank challenge. Renee placed both feet on the roller (one stacked on top of the other) at the ankles, with her forearm flat on the mat at a 90-degree angle. I cued her to use her core strength (specifically her obliques) to lift her hips off the floor, reaching toward the sky with the top hand.
Stair climb is a great exercise to develop hip and pelvic-floor strength. Renee placed one foot on the pedal and the other on top of the chair. I then cued her to stay out of her top standing quadriceps muscle by keeping her weight off the ball and onto the heel. I encouraged her to use her core as well as her back standing gluteals to lift the pedal beneath her.
Finally, I found that a great way to end a session was with a standing exercise utilizing the Pilates ring (magic circle). Renee placed the ring between her ankles as I cued her to shift her weight to one standing leg and squeeze the ring 10 times without losing her balance, and then switch sides. This exercise is challenging even without a broken pelvis!
Pilates is a wonderful form of exercise for someone trying to rehabilitate a broken pelvis; however, always make sure you have medical clearance before working with a client who has serious injuries. Pelvic stability is a basic Pilates principle, and Pilates offers many exercises that improve pelvic and core function and strength.
Thankfully, Renee has found renewed hope. “I feel Pilates is helping me strengthen my body and [I am hopeful it will] help me get my life back again,” she says. “While I have only been doing Pilates for a short period of time, I feel it is improving my quality of life.”
PHOTOGRAPHY: Meghan Meredith Photography
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