Tag Archive for: bone stengthening

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The Evolution of Pilates and What It Means for You 

It’s easy to look at modern Pilates with its sleek studios, high-tech Reformers, and trendy apparel – and forget that it was born out of gritty resilience and a fierce dedication to healing. 

He was a man ahead of his time, and his journey from a frail child to a fitness visionary is one of the most fascinating stories in physical culture. 

From Internment Camp to the First Cadillac 

Born in Germany in 1883, Joseph suffered from asthma, rickets, and rheumatic fever as a child. Determined to overcome these ailments, he dedicated his life to physical strength, studying bodybuilding, gymnastics, and martial arts. 

But the defining moment for his method occurred during World War I. While traveling in England, he was interned on the Isle of Man along with other German nationals. Conditions in the camps were bleak, and the physical and mental health of the internees rapidly declined. Refusing to let his fellow inmates waste away, Joseph began teaching them his exercise system, which he called “Contrology”. 

The most incredible part of this era? He didn’t just teach the healthy. He insisted on rehabilitating the bedridden. Using his ingenuity, he dismantled the springs from hospital beds and rigged them to the frames. This allowed patients with weakened muscles to exercise against resistance while lying flat. Without knowing it, he had just invented the earliest precursor to the Pilates Cadillac.

The Dance Connection and Beyond

Photo of Joseph and Clara Pilates in their original studio in Hell’s Kitchen, hanging there today.

In 1926, Joseph emigrated to the United States and opened his first studio in New York City with his wife, Clara. As fate would have it, their studio on Eighth Avenue was in the same building as the New York City Ballet and several dance schools. I visited that original studio this year, and this photograph I took appears there, hanging on the wall.

Word quickly spread about “Uncle Joe’s” ability to rehabilitate injuries, and legends of the dance world – including George Balanchine and Martha Graham – began sending their dancers to him. In a beautiful full-circle moment, my own introduction to Pilates happened during my time performing as a soloist with the Martha Graham Dance Company. I relied on his method to maintain my strength and prevent injuries, and from my very first lesson, I was completely captivated. 

This historical intersection of dance and Contrology cemented the method’s enduring focus on flowing, precise, and centered movement. Yet, while the dance community became its earliest champions, the profound rehabilitative and strengthening benefits of his work could not be contained; over the decades, the method spread far beyond the studio, benefiting people of all ages and abilities across mainstream gyms, hospitals, and physical therapy clinics worldwide. 

Return to Life and the Challenge of Spinal Flexion

In 1945, Joseph Pilates published his seminal book, Return to Life Through Contrology. In it, he laid out his philosophy that modern civilization impairs physical fitness and detailed his original 34 fundamental mat exercises. 

These 34 exercises are brilliant, but if you look closely at the sequence – moves like The Hundred, the Roll Up, Single leg Stretch, Teaser, Scissors, Bicycle, and Jackknife (the move featured on the cover of his book Return to Life)- you’ll notice a distinct pattern: the vast majority of them require deep spinal flexion, or rounding of the back. 

Joseph believed a flexible spine was the key to youth. However, with emerging science and physical therapy insights, we now know that loaded spinal flexion should be avoided for certain individuals such as those with bone density issues like osteopenia/osteoporosis or herniated discs.  

The BoneSmart Pilates® Pivot 

If a condition precludes you from rounding your spine, it can feel  discouraging to look at those classic 34 exercises and think, “This just isn’t for me.” 

Want to know the full story behind how BoneSmart Pilates® came to be? I shared the personal journey—and the research that changed my thinking—in an earlier article called “The Birth of BoneSmart Pilates.“ If you’ve never read it, I think you’ll enjoy seeing how my years as a physical therapist, Pilates instructor, and lifelong learner shaped the bone-safe approach I teach today.

Read About the Birth of BoneSmart Pilates

You shouldn’t have to miss out on the transformative magic of Contrology (which later became known as “Pilates” after Joseph’s death) just because you should avoid certain movements and positions. This is exactly why BoneSmart Pilates® was created. 

I’d love to show you what this pivot actually looks like in practice. In this short video, watch how I use simple props like a resistance band and an inflatable core ball to thoughtfully adapt classic Pilates exercises. You’ll see how to protect your spine while preserving the deep core engagement that makes the method so effective.

The three examples you just saw are only the beginning. Every class I teach is built on the same philosophy: preserving the heart of Joseph Pilates’ method while thoughtfully adapting the movements to reflect what we now know about bone health and safe, effective movement.

But BoneSmart Pilates® is about more than adapting Joseph’s original exercises. It’s also about using the Pilates method safely to help you move confidently through everyday life.

I regularly ask my clients and members of our private Aging Strong Facebook Community what daily physical challenges they struggle with. Those real-life challenges inspire the bone-safe movement strategies I teach in my online programs and live classes.

As your instructor, my goal is to help you build total-body strength and master real-world load management for tasks such as:

  • Lifting a suitcase into an overhead bin
  • Getting up and down from the floor
  • Gardening or reaching into a high cabinet
  • Carrying heavy groceries

Those real-life challenges inspire new bone-safe movement strategies that become part of my online programs and live classes, so you’re not just exercising…you’re building skills that make everyday life easier and safer.

 

That same thoughtful approach carries through every BoneSmart Pilates® program I offer.   

You can jump into short, focused movement videos with our BoneSmart Bursts™️, dive into our curated Specialty Class Series – featuring dedicated programs like:

or explore our comprehensive On-Demand Virtual Library. The library is an incredible resource, home to over 500 30- and 60-minute classes, along with a special 5-video introductory series designed specifically to help those of you with low bone density safely learn the essentials and start your journey. 

I keep the essence of the method – the deep core engagement, the precision, the mindful breathwork, and the control – but revolutionize the biomechanics, so your spine stays safe, supported, and powerfully strong. 

Craving a more personalized touch? You can also join our real-time classes. Whether you log in virtually or step into our studio here in Mountain View, CA, you’ll benefit from live, expert cueing and real-time adaptations tailored specifically to your body. 

Joseph Pilates was, above all, a brilliant adapter. He modified hospital beds to meet his patients exactly where they were, physically.

At BoneSmart Pilates®, I honor that visionary legacy every single day by adapting his method to meet you exactly where you are today.  

 

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Capital Gains for Your Bones: My D.C. Symposium Recap

I just returned from the International Osteoporosis Symposium in D.C., where healthcare providers from around the globe gathered to share the latest research and insights. One fun takeaway? Those of us who specialize in osteoporosis—whether in movement or medicine—are affectionately known as “Bone Heads”! I’m proud to add that to my growing list of quirky titles, right alongside being a “Graham Cracker”.  Yes, that’s what they call dancers who’ve performed with the Martha Graham Dance Company.

The conference kicked off with an energizing keynote by comedian Kay Frances. She had us laughing while delivering a powerful message: take care of yourself, stress less, and embrace life with humor. With wit and wisdom, she reminded us to stay positive, let go of what we can’t control, and not take ourselves too seriously. Her blend of comedy and insight was the perfect reminder that laughter truly is the best stress reliever.

I realize you “BoneSmarties” (yes, that’s what I call you) include people navigating accelerated bone loss as well as physical therapists, health professionals, and movement specialists working with this population. I do my best to address everyone here.

I cover a lot, so to make it easier for you, here are the presentations I highlight:

  • BoneFit™ Training
  • Long-Term Osteoporosis Management
  • Protein for Muscle and Bone Health
  • Trabecular Bone Score- why it’s important
  • The Skeleton as an Endocrine Organ (The Bone is Not Stone)
  • Year in Review
  • Integrating Exercise and Rehabilitation: Enhancing Patient Care

Scroll down to find the topics that interest you and skip those that don’t.

1) BoneFit™ All-Day Training


I recently completed BoneFit™ certification, an evidence-based approach developed in Canada that tailors movement for individuals with low bone density and osteoporosis. What does that mean for you? It means the guidance I provide is grounded in science and designed with safety in mind. You’re in good hands with someone BoneFit™ certified.    (Full disclosure: This is actually my third specialized osteoporosis training for physical therapists—I just wanted to stay current and continue refining my knowledge.)

Key points:

  • 50-70% of fragility fractures occur in people with osteopenia. That’s always a startling statistic for me. It’s a reminder that having osteopenia, (DXA T score between -1.0  to -2.5) doesn’t mean you won’t fracture.
  • A fragility fracture is a broken bone that happens from a low-impact event — something that wouldn’t normally cause a break in healthy bone. Examples are: Falling from a standing height, rolling over in bed, or sneezing or coughing hard (in severe cases)
  • We need to emphasize as movement professionals that our goal is to “prevent fractures” through strength training, balance training, and functional movement education, like hip hinging and the golfer’s lift.
  • As professionals, use verbiage like spine-friendly movement strategies rather than spine-safe, which sounds scary. Many people are already scared by this diagnosis, so we want to empower them to continue to move.
  • Our focus is on preventing the first fracture (or subsequent ones). For example, after a spine fracture, there’s a fivefold risk of having another fracture.
  • For balance training, standing on one leg like a stork is not enough (though it’s a good place to start). We need to mimic real-life situations where we navigate unexpected environmental obstacles and perturbations, such as tripping over a dog toy on the floor or accidentally getting bumped by someone in a crowded store, and be able to maintain our balance.

 

BoneFit™ Updated Movement Guidelines

(The key difference from prior guidelines is avoiding language that states you should “never” do something or that these movements are “contraindicated” because using that vocabulary can be scary and instill a fear of movement.)

Spine movements to Limit:

Repeated/sustained, weighted, end-range, rapid/forceful, or combined:

  • Flexion (crunches or sit-ups, Pilates rollover, yoga plow pose)
  • Rotation (forced twisting of the spine to end range)
  • Side Bending
  • Combinations of above

Hip:

  • Forced, end-range rotations like the yoga pigeon pose
  • Surgeon-dictated post-surgery limitations (need to clarify for how long)

 

Also covered in this BoneFit™ workshop were these two questions that I often hear regarding OsteoStrong and weighted vests.

  • Will OsteoStrong help my bones? The research was poorly done. Here’s a link from a Bones Lab scientist at the University of Waterloo that clarifies the lack of evidence for its efficacy.
  • Are Weighted Vests good for osteoporosis? According to the Bone Health and Osteoporosis Foundation, “The evidence for using a weighted vest to improve bone mineral density or prevent skeletal fractures in women and men is uncertain. Larger studies of older adults with low bone density or osteoporosis over a longer follow-up time are needed to determine whether weighted vest exercise will lead to beneficial outcomes.”

In addition, a weighted vest may not be safe for those who have had a spine fracture, spine surgery, have hyperkyphosis (excessive rounding of the upper back), or are at high risk of breaking a bone.

 

Onto the next presentation 

2) Long Term Osteoporosis Management

Dr. Michael McClung from the Oregon Osteoporosis Center gave an engaging and informative roadmap for long term treatment.  Key points he made include:

The objective of treatment is to reduce the risk of fracture. Drugs can be catabolic – reducing bone breakdown and resorption and Osteoanabolic drugs which increase bone formation and restore disordered bone microarchitecture. Like other chronic diseases, osteoporosis requires long-term management. There are no treatment “cures” for osteoporosis. Anabolic agents are used only for 1-2 years. The effects of all therapies, including bisphosphonates, dissipate when treatment is stopped.

The decision to start medications is when a patient is at high risk of fracture.

He lays out in very technical terms with lots of evidence, why osteoanabolic drugs should be the initial treatment for high fracture risk patients with osteoporosis.

Why?  Osteoanabolic drugs increase bone mineral density more and more quickly than the anti-reorptive drugs (like alendronate/fosomax)  Clinically they are seeing larger increases in bone mineral density if osteoanabolic drugs are give first vs second.  “If cost were not an issue, all patients with osteoporosis and high fracture risk would be candidates for an osteoanabolic agent as initial therapy to optimize bone mass and strength”.  That benefit can then be maintained with anti-resorptive drugs like bisphosphonates or Denosumab (aka Prolia)

As a reminder Anabolic drugs include Teriparatide (Forteo) and Abaloparatide (Tymlos)

Catabolic/Anti-Resportive drugs include Alendronate (Fosomax), Denosumab (Prolia) and Raloxifene (Evista). Zolendronate (Reclast) infusion is a bisphosphonate derivative used for osteoporosis and cancers that spread to bone.


Onto the next presentation

3) “Protein for Muscle and Bone Health”

(presented by Andrea Josse, Ph.D. from York University, Canada)

This presentation focused on how we prevent bone loss through nutrition, though they pointed out that nutrition and exercise go hand in hand.

In a nutshell, adults older than 65 need more protein than the current RDA. On average, adults 65+ are not obtaining adequate amounts of calcium and vitamin D.

Key Takeaways:

  • Bone and muscle are dynamic tissues that turn over at different rates throughout our lifespan. Nutrition and exercise play key roles in their growth.
  • Older adult females are at greater risk for protein and nutrient deficiency (Calcium and vitamin D). It’s recommended that you get your calcium primarily from your diet.

 

 

  • Protein is beneficial for muscle and bone health across our lifespan. Particularly for the prevention of osteoporosis and sarcopenia (age-related muscle loss). Evidence-based recommendations indicate:
  • Older people should consume an average daily intake of 1.2 g/kg/d
  • If they have a chronic disease (such as osteoporosis) – 1.5 g/kg/d

I look at this and my eyes cross since I work in pounds, not kg. How do we apply this to our pound system?

As an example of how to do this, I calculated the protein needs for “Sara,” a 69-year-old with osteoporosis who weighs 140 lbs. You can use this as a template and just plug in your weight to individualize it for you.

✅ Protein needs for Sara, a 140 lb female with osteoporosis at 1.5 g/kg/day

  1. Convert pounds to kilograms:
  • 140 lbs ÷ 2.2 = 63.6 kg
  1. Multiply by 1.5 g/kg:
  • 63.6 kg × 1.5 g = 95.4 g protein/day

🔹 So her target = about 95 grams of protein per day.

🍽️ Sample Menus to Reach ~95g Protein

You want to spread intake across 3 meals and 1–2 snacks, aiming for 20–30 grams per meal to optimize muscle protein synthesis.

🌞 Breakfast

  • 3 eggs (18g)
  • 1 slice whole grain toast with 2 tablespoons cottage cheese (5g)
  • ½ cup Greek yogurt (plain, 2%) (10g)
  • Breakfast total: 33g

🥗 Lunch

  • 4 oz grilled salmon (28g)
  • 1 cup cooked farro (6g)
  • Mixed greens salad with pumpkin seeds (2 tbsp = 5g) and olive oil
  • Lunch total: 39g

🍲 Dinner

  • ½ cup cooked lentils (9g)
  • ½ cup cooked quinoa (4g)
  • Steamed broccoli (1 cup = 4g)
  • Sprinkle 1 oz feta cheese (4g) over veggies
  • Dinner total: 21g

🥤 Optional Snacks (Choose one or two)

  • Protein shake (1 scoop whey protein powder = ~20g)
  • 1 oz almonds = 6g
  • 1 boiled egg = 6g
  • ½ cup edamame = 8g

And the next presentation

4) Trabecular Bone Score (TBS): How it can help you

Presented by Didier Hans, PhD, Switzerland

This relatively new technology complements bone density (DXA) exams (which measure the quantity of bone) and gives you information about the “quality” of your bone. It could help with clinical decision-making, like whether to start prescription meds.

Let’s look at three examples.

“Susan” has a DXA T score in the osteopenia range, and the doctor wants to put her on meds.  The trabecular bone score would give them further insight into the microarchitecture of the bone, helping to understand the quality and strength of the bone. If it’s good, and her other fracture risks are not of concern, Susan would be better informed to make a decision about starting meds or not.

“Rachel” is actually a friend of mine with osteoporosis. She was diagnosed in her 20s, was a dancer, thin, had a delayed menstrual cycle, and many other factors that put her at risk for OP.  With the proper education, strength training, balance, impact, functional training, dietary supplementation combined with an excellent trabecular bone score, she’s been able to approach this naturally and over 2 decades later, has never fractured.

“Monica” is 71 and has many risk factors for fracture, including being thin with poor balance and having a mother with a hip fracture.  Her DXA T score puts her in the osteopenia range, so she thinks she’s ok. Having a trabecular bone score that is poor could help her see that pharmacological intervention might be the right choice, along with proper nutrition and exercise to help prevent that first fracture.

You might ask, “How do you do a TBS test?”

Good question! A TBS test (Trabecular Bone Score) isn’t a separate scan — it’s an analysis done using images from a DXA scan (the standard bone density scan).

Here’s how someone would get a TBS test:

  1. Get a DXA scan: First, you need a regular DXA scan (usually of the lower spine and hip), which measures bone density (gives you the T-score).
  2. Request a TBS analysis: Not all DXA machines or clinics automatically do TBS. You or your doctor would need to ask if the machine has TBS software and specifically request that your DXA images be analyzed for TBS.
  3. Interpret the results: The TBS gives extra info about the quality of the bone’s internal structure (microarchitecture), not just the density. So even if your T-score is “okay,” a low TBS could still mean your bones are fragile.

Tip: If your doctor doesn’t mention TBS, it’s worth bringing it up, especially if you have risk factors like fractures with only mild trauma or borderline bone density.

I spoke with the reps at the conference. For those who live in northern CA, Stanford is in the process of securing this before the end of 2025. Sinomed in San Francisco currently has it. For those living elsewhere, click here to locate a TBS facility near you.

 

next presentation I’m sharing

5) The Skeleton as an Endocrine Organ

I found this fascinating, and it was very techie, but the main points are that:

  • Bone is not Stone. It’s metabolically alive, remodeling all the time.
  • Bone and muscles have cross-talk with each other through hormones secreted by bone.
  • The interrelationship between bone and muscle is under hormonal control in a two-way street. This brings a whole new face to the parallel development of osteoporosis and sarcopenia (age-related muscle loss) with age.

And the next presentation

6) Year in Review

Dr Lewiecki of New Mexico shared many interesting developments.  Here are just a few.

  • Trabecular Bone Score (TBS) is useful to understand fracture risk. The Frax (fracture risk calculator) now has a place to enter your TBS score to better understand your true fracture risk.
  • Medical Coverage of Telehealth is scheduled to expire 03/31/2025. Extended through 09/30/2025 with temporary government funding bill. After that…?
  • Mitigating bone loss for astronauts. Long duration space flights are associated with high bone turnover. An advanced resistive exercise device (ARED) does not totally prevent bone loss. However, ARED in combination with bisphosphonates is more effective.
  • Path of treatment (BMD = bone mineral density from a DEXA scan)

 

  • Here’s a slide of interesting recommended articles

 

 

And the final presentation

7) Integrating Exercise and Rehabilitation: Enhancing Patient Care

This well-crafted, evidence-based presentation by Rebecca Rotstein, NCPT, and Kavita Patel, DPT, approached this subject through the lens of the doctor or health care practitioner. They encouraged practitioners to promote frequent movement and joyful activities. We are reminded to use our words wisely, minimizing terms like “don’t” or “never.”

A movement-based approach for those with compromised bone density should include multiple factors: resistance, balance, functional training, impact, posture, and spine-safe movements in daily activities.

Interprofessional collaboration in bone health was highlighted to improve outcomes. This collaboration encompasses Medical, Physical Therapy, Exercise/Physical Activity, Nutrition, and Pharmacology. Talking with each other as a team is optimal for patient success.

The presenters encouraged doctors to refer their patients for spine-friendly exercise; however, not all physical therapists or movement professionals are knowledgeable about the latest osteoporosis guidelines. The presenters provided sample questions to assist medical professionals in finding a reputable physical therapist or exercise professional who is current with movement-based guidelines. A few sample questions included: “Have you completed advanced training in osteoporosis?”  “Do you know what motions and exercises to avoid and when?” “Are you aware of key elements and exercises to include?”  “Do you work with any bone health associations?”

 

FINAL REFLECTIONS

 

Attending the International Osteoporosis Symposium left me both inspired and energized. The breadth of information—from cutting-edge medical interventions and pharmacological advances to the vital role of targeted movement—reinforced how multifaceted and hopeful osteoporosis care has become. As a teacher and physical therapist, I’m grateful to be at the intersection of science and movement, translating research into practical strategies that help people thrive.

I return to my work with renewed clarity and commitment, knowing that when we blend evidence-based medicine with empowering movement, we not only build stronger bones—we support a life of confidence, vitality, and resilience at every age.

 

 

 

 

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Ottoman Pilates

Have you ever contemplated getting studio Pilates equipment for your home workouts?

What if I told you that you may already own something that lends itself wonderfully to Pilates work? This month I’ll share with you a Pilates workout that I designed to be performed on…an Ottoman!

Perhaps you don’t have the money or inclination to purchase big Pilates equipment for home use. Well I’ve discovered to my delight that my padded ottoman is the perfect surface for so many Pilates exercises. Here’s a way to do some Aging Strong Pilates® in the comfort of your home and notch up the level.

The video below is my personal quick and dirty ~15 min workout that I do in my bedroom before or after a shower about 2-3x a week. I do it in my underwear for maximum skin to leather traction so I have good grip and don’t slide. Some of the exercises are extremely challenging so proceed with caution. They are safe but difficult, so listen to your body and proceed at a level and pace that matches where you are today.

At the end of this blog post I’ve included a full written list of the exercises so you can print it and repeat on your own with your choice of music.

Note: Your ottoman should not be on wheels or have a base that swivels.

My ottoman has a slope to it. Depending on the direction your lying on it, the slope can make a particular exercise easier or harder. If your ottoman is sloped, try and drape yourself on it in the same angle I do in the video. I demonstrate the exercises at the angle that facilitates each movement.

For example, for the beginning chest lift core series I’m positioned on my back with my buttocks on the low edge and the lower tips of my shoulder blades at the top of the slope. This is the easier orientation but you’ll see quickly that it is by no means “easy”. If your ottoman is level, that’s fine as long as it has nice padded edges so it doesn’t dig into you. If you choose not to do it in your underwear then add a shelf liner to the surface so you don’t slide.

This workout includes all ranges of motion, Flexion (just from Extension (back bending) to Neutral (straight line) so it’s safe for conditions where flexion is contraindicated) Rotation, Side Bending, and Extension. I incorporate wonderful stretches after working the muscles in all these planes of motion.

I have to admit this is one of my favorite routines. It’s a Bad A_ _ Core workout that energizes me and makes we feel worked in a short amount of time!

The planks are extremely challenging but if you have stiff feet or bunions that make it difficult to curl your toes under for planks on the floor, having your feet elevated makes that part actually easier since you don’t have to tuck your toes under. Remember, the more leg you have on the ottoman, the easier it will be, so position yourself wisely.

 

The two sections that I do face down (opposite arm and leg reach, swimming and swan) are great for strengthening the muscles that strengthen the hips and support good posture. Firing those upper back muscles has the added benefit of stimulating bone growth in the spine.

 

Here’s a full list of the exercises so you can repeat them on your own with your favorite music. Note that as you see in the video – you don’t have to do a lot of repetitions to make it count. If you want to get feedback from me on your technique, purchase a 30 minute online Skype session and I’ll ensure you’re moving safely and effectively!

Go slowly. Be Precise. Breathe. Have fun!

Ottoman Pilates Exercise List

On your Back (face up)

  • Big X Stretch
  • Chest Lift Series
    • Center
    • Oblique twisting toward the lifted tabletop leg
    • Advanced: knees lift, lift, lower, lower, alternating lead leg
  • Finish with Big X Stretch to lengthen the abdominals

On Your Belly

  • Opposite Arm leg reach (ottoman under pelvis and belly)
  • Swimming
  • Final extension hands interlaced reaching toward feet-rotating head as you breathe w/ease
  • Child’s pose/Rest position (knees open wide if you have osteoporosis or herniated discs)

Side Lying

  • Leg lifts (bottom foot on floor, top leg lifts and lowers) Waist positioned at middle of ottoman
  • Side Kick top leg, keep hips stacked vertically.    Shift body so hips at middle of ottoman
  • Hover body parallel to floor and hold (head in line with spine)
  • Top leg lifts and lowers
  • Side-Lying Stretch (shift yourself so it’s comfortable for you, grab top wrist with bottom hand)

Repeat above on the other side

Face Down

  • Planks (first with lower thigh and shin on ottoman) Hold position
  • Add pushups if desired
  • Walk further out so less leg on the ottoman-increased challenge
  • Side Plank (one on each side-move slowly and hold/breathe)

Face Down

  • Swan (begin with breasts/chest hanging over the front edge, hands on the floor, feet on floor against base of the wall) Activate core and legs then Inhale as  you rise, Exhale as you lower
  • Child pose/rest position

 

 

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Dance for All

Imagine a studio in 2004 at the El Camino YMCA filled with tiny dancers wiggling joyously as their hair bounces wildly to the beat of the music. With smiles beaming on their six-year-old faces, they giggle while holding hands and twirling in circles. To the side is another beautiful, highly active child. This child is different. She has yet to learn how to talk, loud sounds make her prone to outbursts, and rather than controlled little arms, they often flail, accidentally hitting some of the other children. Integrating this precious child is a challenge, for in the eyes of the others, she is not like them. But as the weeks progress, the children begin to see her as one of their own, one to protect and love. The child’s mom looked on and wished all children like hers could have an experience like this—an experience where they feel cared for, accepted, and free. Oh, the beauty of childhood innocence when looking beyond the visual and embracing not just the person, but the soul.

Today there is a space where young and old alike gather to experience the same joy of movement to music with no judgment, no criticism, and no fear. All levels learn at their own pace and are given the freedom to express themselves with no preconceived idea for perfection. This all-inclusive setting has parents dancing with their child with special needs alongside those labeled “normal.” All feel welcomed, included, and safe. This is pure magic—this is Dance for All.

In 2014, Teresa Maldonado Marchok and Mercy Forde, both fitness instructors, teamed up to create this delightful program. As fitness enthusiasts, they know firsthand how important physical activity is for everybody, no matter what age. As mothers to special needs children, they found it difficult to find classes for their children that were not separate from the community because of their challenges. Their children, just like all children, brimming with equal capability. All they needed was an opportunity to participate. And so, Dance for All was born.

The dance class is run similar to other fitness classes, with Teresa and Mercy demonstrating and instructing a variety of movements and techniques that develop and improve core strength, flexibility, and balance. Students not only learn current dance moves in rhythm with the latest music, but there’s also Pilates mat work, and a closing meditation that allows all to center themselves before leaving the studio. Participants are not only welcome but encouraged to interpret the moves as the music flows. Though they might not all be synchronized, they are all united in spirit and fun.

The program’s mission is “Connecting the Community through Movement,” and this inclusive class allows the unique twofold beauty of the program to shine. First, Dance for All gives the special needs participant the tools to conduct themselves in a movement class, thus enabling integration into other classes as well as a sense of belonging to society as a whole. Second, the class creates a fun environment for the typical fitness participant to learn more about and interact with this precious sub-set. Despite initial perceived differences in thought process and language, the typical student begins to see that each member of the class has dreams and desires, just like anyone.

Dance for All is celebrating its fifth anniversary. What started as a dream has morphed into a beautiful weekly event and a studio packed with participants. Whether dancers come alone or with their children, the feedback has been overwhelmingly positive.

Margie Pfister, who attends class with her adult daughter Ellen, summed up their experience, which many can relate to.   “Amidst the ups and downs of our days, Dance for All has been a positive welcoming spot from the moment we entered the class and are greeted by name.

Through the warm-ups, dance, and cool-down, my daughter and I are inspired to be our best as we encourage others to do as well. With the positive music, and Teresa’s and Mercy’s kind encouragement, we not only feel a sense of belonging, but our posture has improved in our daily activities. By the end of class, we feel a sense of accomplishment, have met new friends, and this world feels like a better place, and we feel better in it.”


As for that bright-eyed child in that dance class so long ago, she is Teresa’s twenty-year-old daughter, Katelyn, and I was privileged to be her dance teacher. Today, she takes all kinds of classes at the YMCA and is a joy to watch as her face still beams while dancing. How fortunate is our community to embrace such a program where students come together as equals and friends. Just as Margie said, this experience makes the world feel like a better place, and all feel better in it.

 

If you want to participate in a joyful experience, come check out Dance for All every Saturday from 1:00-2:00 pm. Since the pandemic, class has been mostly on Zoom, but we’re gradually reintroducing in-person classes at the El Camino YMCA/ 2400 Grant Road, Mt. View.   Contact teresa@pilateswithteresa.com to be added to our mailing list and to confirm if we’re on zoom or in person the Saturday you want to join in.

Dance for All – Ages 8-88 gather in the multipurpose room and unite to elevate awareness, promote community acceptance, and just have fun.

 

 

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Written by Jackie Madden Haugh

Critically acclaimed published author, former columnist for The Los Altos Town Crier,  realtor, dance instructor, devoted mom and grandma…and a dear friend.

 

 

 

 

 

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Written by Jackie Madden Haugh

 

Critically acclaimed published author, former columnist for

The Los Altos Town Crier, realtor, dance instructor, devoted mom and grandma…and a dear friend.

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Confessions of a rib flarer!

We all have our postural faults, especially if we lose focus. Mine is rib flaring, that tendency to jut the bottom ribs forward in a faulty attempt to open the chest or lengthen the body. This often results in excess back tension and pain.

With mindfulness and an awareness of this tendency, I can better control this common error and so can you!

The secret is, no surprise, “connection”.  I like to use the image of 2 vertical bungee cords connecting my front bottom ribs with my pelvis.  Watch the video to test if you’re a rib flarer and learn 2 exercises to help fix it.
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Age Happens: Preventing injuries for the aging athlete.

Age happens, regardless of the physical standards you achieved in your youth. Perhaps you were involved in high school or college sports, part of an organized community team, maybe an elite athlete and in great shape. Perhaps you’re still pushing hard but the reality of an aging body that doesn’t rebound as quickly as before, stares you in the face.

We are part of a generation that realizes that we have control of certain aspects of aging and that inactivity plays a huge role in how we feel. Dr. DiNubile, an orthopedic surgeon in Philadelphia, notes that “We have doubled our life expectancy in the last 100 years, but our frames are not designed to last that long. There’s a mismatch between longevity and durability. It becomes a matter of how do you extend the warranty on your frame.”

In 1998, according to the U.S. Consumer Product Safety Commission, boomers – those born between 1946 and 1964- sustained more than 1 million sports injuries, leading to nearly $19 billion in medical costs. Exercise and sports in our best and final act, becomes a dance of injury management where party conversations are peppered with tales of back pain, rotator cuff problems, herniated discs and anything ending in an “itis”. 

The upside of age includes being comfortable in our skin, gaining insight, wisdom, and fostering lasting relationships. In the physical realm, certain things, whether we like it or not, are diminished with age including muscle strength, bone health, balance and flexibility.  Old sports injuries frequently rear their heads as problems later in life, especially arthritis.

Understanding what to do, what to avoid and how to pace ourselves, is essential for remaining strong and healthy over time.

I’m a former professional dancer who pushed my body beyond its limits for decades. Contrary to the image of ease and invincibility presented on stage, dancers, or as Martha Graham used to call us, “Athletes of God”, spent many a night post performance nursing painful body parts with ice packs in hotels around the world. 

As an aging athlete, I’ve had to navigate acute and chronic injuries including rotator cuff rupture and low back disc herniations. In order to continue to do what I love, I’ve learned how to modify movements in Pilates, dance and Bikram yoga, as well as during activities of daily living to spare my spine.

In Bikram yoga, participants tackle the standing head to knee pose which involves holding one leg straight in front of you parallel to the ground with a deeply rounded spine, a difficult task (and one that should be avoided for anyone with low bone density or herniations). I stand instead like a stork with one knee bent in the air, my spine long and vertical. This avoids further debilitation of my spinal discs while still benefitting from single leg weight-bearing balance. 

In that same class, participants perform transitional straight leg sit ups between mat exercises where they explosively round up and do a “double jerk, double exhale” percussive ballistic forward flexed bounce. I’ve modified this instead into a log roll to my side to safely transition to the next exercise.  Medical wisdom now directs us to ditch crunches and straight leg sit ups and choose other, smarter spine sparing techniques, which I’ll share shortly.

I think we all want to keep our bodies as safe, strong and mobile as they can be for as long as possible. How do we work around aging and injuries? 

When I had rotator cuff surgery 3 years ago, I used Pilates to continue to train the rest of my body while avoiding the injured shoulder.  I worked on core and leg strength, flexibility and balance. The beauty of the spring assisted Pilates environment is that it is so modifiable. It’s easy to accommodate for injuries and work around your limitations safely so you can remain fit.  In the following video, I’m one-week post rotator cuff surgery and you can see how I’m able to still get a decent workout despite my arm being in a sling. 

Get Smarter About Exercise

My belief is that we need to physically train to get older. Getting older is not for sissies. We need to get smarter about exercise.  What does smart exercise look like? 

Disregard that old adage of No Pain No Gain.  It’s important to heed the warning signs of any injury. Pain is your body’s signal to back off and give yourself time to recover.  Don’t push through those pain signals or you’ll slip into a continuing loop of pain and inflammation.

Warm up before you exercise and allow more recuperation and stretching time after exercise.

Train smarter not harder which means not overdoing it.  Tom Brady, the aging Patriots winning quarterback has a workout regimen that is 90% focused on resistance bands, not heaving heavy weights.  If you’re planning an intensive golf weekend, practice some swings and controlled spine rotations and ensure good mobility leading up to it. Don’t walk in cold. 

Form and alignment is critical not only with exercise but also with your activities of daily living like how you pick things up off the floor or how you hoist your carry-on luggage into the overhead compartment of a plane. All the little things that you do on a daily basis add up, and if you’re doing them wrong, you’ll experience cumulative insidious injury – the math will work against you.

If you’re like most people, you might have a chronic injury or are dealing with vulnerabilities that put you at increased risk of an injury.  I’ll cover just a few of the common areas where we should demonstrate more caution and care.

Feet/Ankles/Calves

Common conditions I see as a PT working with aging athletes include plantar fasciitis, stiff feet/ankles, and tight cramping calves.

Our feet are what support us and get us from point A to point B.  We need mobile, strong and malleable feet to support a strong and stable body. What do most of us do with our feet during the day? We provide sensory deprivation as we shove them into ill-fitting or stiff shoes that prevent intrinsic movement of the feet. Instead of functional feet, many of us have clubs at the end of our ankles. The feet have the highest percentage of proprioceptors in our body, telling our brain where our body is in space.  If those proprioceptors signals are muffled and under stimulated it creates balance issues and a tendency to lose our footing. 

Tips for Feet: Walk barefoot, use full tennis balls or any of those nubby textured foot mobilizers to massage the different areas of your feet, increasing flexibility and improving healing blood flow and circulation.  Use ½ tennis balls for a gentler safer alternative that won’t roll away. Use resistance bands around the sole of the foot, holding the ends like reins as you slowly point and flex the ankle, strengthening all those underused small foot muscles.

For cramping calves check with your medical professional to see if you have a potassium or magnesium deficiency and supplement accordingly.  Also make sure you’re drinking enough water. Lack of adequate hydration often leads to leg cramps.

Finally be sure to stretch both regions of your calf muscles. Stand at the edge of a step with one heel lowered. The gastrocnemius (the meaty calf muscle that is more superficial and visible) is addressed when the stretching leg has the knee straight.  To stretch the deeper soleus calf muscle, you must bend that knee slightly while stretching the calf.

Knees
Painful knees are often the byproduct of weak leg muscles, tight calf and leg muscles as well as faulty alignment when you bend your knees.

What to do? 

Check your mobility-can you touch your toes with your knees just slightly unlocked?

Can you put the ball of your foot on a step and lower your heel down below the step with ease?   Can you pull your foot behind you to your bottom for a quad stretch with good alignment or do you stick your bottom out behind you when you try this? 

Some of the key remedies for avoiding knee pain include ensuring you’re tracking your knees over the center of your foot every time you bend your knees. Since bending your knees is something you do every time you get up and down from a chair, toilet, car seat etc. it’s imperative that it’s performed with ideal alignment each and every time. This will prevent potential torqueing of the knee.

In addition, strengthening the muscles that attach to the knee is essential as the stronger your leg muscles are, the more they will support and decompress the knee joint.  Include closed chain exercises that incorporate the hamstrings (back of your legs), the quadriceps (front of thighs) and the calves. This is particularly helpful if you’re suffering from pain or arthritis stemming from previous injuries.

One good example is wall sits: stand against a wall with your feet about 6-12in from the wall. Then bend your knees to a point that’s painfree (up to a 90 degree angle) keeping the back of your pelvis, upper back and head in contact with the wall. Hold that position for 30 sec’s slowly increasing the duration over time and varying the degree of knee bend.

If your pain is due to old injuries, notice what movements or activities trigger your pain and try and remove or minimize those triggers.

With aging athletes, studies point to targeting power to improve strength. So, for example rising from a chair explosively (without locking your knees) then slowly lowering your bottom to a hover over the chair and repeating that with good form will create gains.

Be sure you’re stretching your hamstrings, quadriceps and calves on a daily basis to keep them healthy and mobile. This will help mitigate knee problems.

Back Pain

Intermittent or chronic back pain is a common complaint for many aging athletes particularly dancers, gymnasts and other athletes where they are asked to move their spines in ranges that were not intended for the spine.  Keep in mind that the spine is designed for stability with the hips and shoulders created for mobility.

Most people in their lifetime will experience some type of back pain typically caused by injury or degeneration.

Examine what you’re doing on a daily basis and how it might be affecting your spine. 

Are you sitting excessively? This will shorten the muscles that cross the hips affecting the spine.  Do you find yourself commonly in a slumped posture?  This will compress your discs and may cause nerve compression resulting in numbness and tingling down the legs.

Might you have an undiagnosed spine fracture? Be sure to get a bone density (DXA scan) if you’re over 65 and notice any of the red flags like a loss in height greater than 2 inches, being a female with a small frame or if your mom had osteoporosis. Some modifiable risk factors include smoking, drinking excessively and inactivity.

Are you still doing crunches? Dr. Stuart McGill, a Canadian PT, researcher, and world-renowned spine expert recommends avoiding crunches due to the excessive loads placed on the discs and ligaments of the spine during movements involving loaded spine flexion. His book “Back Mechanic: The secrets to a healthy spine your doctor isn’t telling you”, is a practical easy to understand resource for how to find your pain triggers and clear steps to help you improve.  Keep in mind also that if you have low bone density crunches can predispose you to spine fractures and if you have spinal disc compromise, sit-ups and crunches can lead to disc herniations.

Healthy alternative? Instead choose core exercises that keep the spine in a neutral position like planks including forearm, straight arm and side planks. 

Remember to use the spine sparing technique of hip hinging where you fold at your hips, for any lifting or bending to avoid rounding your back. Doing your daily activities including exercising with a neutral-stable spine will spare your back. 

Keeping an injury-free edge as we exercise in middle age

Be willing to modify and accommodate for your body.  If you’re asked to do lunges in a class done barefoot and your metatarsal (toe area) joints just don’t bend that way due to arthritis or surgery, put on your tennis shoes or supportive shoe wear to provide the support needed to accomplish this excellent exercise.

Mindfully improve mobility with flexibility exercises while maintaining good alignment. Give Pilates or Yoga a try.

Cross train to give your body a break from repetitive motions.

Strengthen your core muscles including your abdominals, back, pelvic floor and diaphragm, to support your spine.

Work on your dynamic balance, not just standing still on 1 leg. Most people don’t trip and fall while standing like a stork. Try this exercise to challenge your dynamic balance.

Ignore the mantra “No Pain, No Gain” and replace that with “Feel Pain, Be Sane”

Get enough restorative sleep and pay attention to nutrition.

Prioritize alignment and form during exercise as well as during daily activities.

Warm up thoroughly before your chosen activity.  I’ve noticed that it takes me much longer than before to warm up sufficiently enough to prevent injury before physical endeavors.

Post-exercise static stretching is a useful tool for promoting relaxation (by increasing parasympathetic nervous system activity which controls rest and digestion) and improving flexibility (by causing changes to the mechanical properties of the muscle-tendon unit.)  Research shows minimal effect on reduction of muscle soreness 1-7 days post exercise.

Don’t underestimate the benefit of regular massage to relax muscle tissue. It may also help with reducing pain and improving function.

Work around your injury. If you’ve injured a particular body part, say your foot, don’t ignore the rest of your body. Find ways to incorporate core training and other exercises that work your heart and uninjured areas. It will not only help your body but also your mind and spirit.

If you have low bone density, be sure you’re including weight bearing resistance and impact exercise. Avoid forward bending (flexion) of your spine as that can increase your risk of fracture.

Foam rollers are a popular and effective tool for the aging athlete.  They work with your weight and are easily used on most parts of the body. In addition to massaging tight muscles, rollers can help with myofascial pain by compressing trigger points. They can also improve hydration in your fascia, the connective tissue that acts as a saran wrap around your muscles and organs.  If your fascia develops adhesions, where disorganized tissues don’t glide freely over each other, this can manifest as pain or stiffness. Rolling has been particularly effective for the upper back, the gluteals, and various regions in the legs including the iliotibial band (ITB), a trouble area for runners and often a difficult area to release when tight. View some of my top foam roller exercises.

Small firm balls of all kinds are an inexpensive and handy aid in trigger point release. For instance, placing a ball under the center of one glute and putting your weight into it can release a tight piriformis muscle, a common cause of sciatic pain.

Despite some controversy, ice continues to be a safe and effective alternative for pain management and is still the modality of choice for acute injuries. Pain and swelling can inhibit muscle strength. Cryotherapy continues to play a key role in rehabilitation.

Trust your intuition and your own body wisdom.  No one knows your body and its particular quirks better than you.  If it’s telling you to back off, listen.

We all eventually slow down as we age and we need to recalibrate our expectations creating new goals that keep us motivated and functional.

Whatever it was that drove you to be an athlete in the first place, hold onto that feeling. You can still keep an active lifestyle as you age and maintain that feeling of health, fitness and joy of being alive!

Author-Teresa Maldonado Marchok MPT

Licensed physical therapist, PMA certified Pilates instructor, conference presenter, ambassador for the national organization “American Bone Health“, creator of the BoneSmart Pilates® Method and AGING STRONG Pilates® DVD series and a former soloist with the Martha Graham Dance Company. She’s been affiliated with Stanford’s Health Improvement Program since 1998 as a lecturer and Aging Strong Pilates® instructor. www.BoneSmartPilates.com

 

 

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Give your Feet some LOVE

If your feet were on your face would you take better care of them? Our feet are a marvel of architecture, each one has 26 bones, 33 joints and over 100 muscles, tendons and ligaments.  We shove them into all manner of shoes, some narrow and unaccommodating, pound them endlessly and on occasion adorn them with nail polish. They need more than a pedicure! 
Our feet are what connects us to the earth when we stand.  I believe that when we have strong, malleable feet they become the foundation for a strong and stable body.  If our feet are weak, immobile or out of alignment, it can have adverse affects up the kinetic chain to our ankle, knee, hip and even spine.

You’re never too old to improve your foot health. Even if your feet are stiff now, studies show that your flexibility can be improved at any age. Give your feet a breather and walk barefoot in your home. Make daily outdoor walks a regular habit and include foot strengthening and flexibility exercises into your routine. All 3 of my DVD’s include standing and resistance band exercises that improve the strength of your feet and the malleability of your ankles.  

In my first DVD, BoneSmart Pilates: Exercise to Prevent or Reverse Osteoporosis, I introduce myofascial release of the feet using custom cut 1/2 tennis balls. The goal is to improve blood flow, circulation, resilience and to enhance proprioception (the body’s ability to tell the brain where your body is in space).  This is particularly helpful for improving balance and decreasing your risk of falls. The reason I use 1/2 tennis balls and not full tennis balls is two-fold.  The 1/2 tennis ball is pliable, has give, and will compress when you press your body weight on it making it tolerable for those with sensitive feet.  A full tennis ball, has less give and is more resistant to compression so it may feel more painful than using a 1/2 tennis ball.  The other important reason is that since it has a flat underside surface, it won’t roll and will not pose a trip hazard by slipping out from under your foot. That is a risk when working with a full small round ball.

BoneSmart Pilates AGING STRONG VOL I,  introduces you to the Myofascial release ball (affectionately referred to as the “purple pickle”). 

This prop kicks up the stimulation to your feet with a textured surface and an oval shape that molds to the longitudinal arch of your foot. We focus here on both a light, stimulatory massage and a deep kneading motion that heightens sensory awareness of the soles of your feet, shuttles blood back towards your heart and helps prevent conditions like plantar fasciitis. In addition, we introduce inversion and eversion of the forefoot, a gentle twisting motion, that is helpful for preventing ankle sprains and maintaining a resilient foot and ankle. 

Show your feet some love ❤️. Start your day this way and you’ll feel energized, connected and grounded!

 

 

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Fall Prevention Tips

Falls are a concern for many of us, particularly for my readers with bone density concerns and those living in cold climates with slippery conditions. With 2 million preventable fractures occurring every year, don’t be a statistic. Pick up some quick and easy helpful hints here!

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