A diagnosis of severe Degenerative Disc Disease (DDD) and a new physiotherapist did not end Laura’s problems. She continued to feel pain in her buttock and left leg; and she still had to heal her body before upcoming film work. She liked the new physio, and had seen him twice in person (both of them wearing masks), but sheepishly confessed to me that she was not keeping up with her at-home physio exercises.
There is a psychological component to doing physio exercises correctly and persisting in them—daily. Pain leaves people scared to perform certain movements, and this makes it harder to get started. When done alone at home with no supervision and when you are struggling with pain or stiffness, physio exercises can be unappealing, boring, and overwhelming.
I asked to meet with Laura on Zoom to go through the exercises with her. She had positioned her iPad on the floor so that I could see her, and on the mat in front of her were the pages of exercises from the new physiotherapist (she had emailed copies to me). But when I asked her to show me the exercises she had been prescribed, she hesitated, as if she did not know where to begin or in what order to do the exercises. Nor could she remember from looking at the photos what exactly were the movements she should perform.
This is a problem I see often. The exercises given by a physiotherapist are easy to follow when the patient is with the physio online or in person. But not when alone. Even I, an exercise enthusiast, who was given exercises for shin and hip pain by a physio, balked at the idea of lying on my mat at home and doing the recommended sets of each movement.
The other problem I see is that people rush through their prescribed exercises, and Laura was no exception. She had done versions of these exercises with me for 15 plus years but now, as soon as I asked her to show me Single Leg Lift (shown in the video that follows), she raced through the repetitions. I had to wonder if people speed through these exercises simply to get them over with. The other problem with physio exercises can be that students are sometimes encouraged to only work one side—the weak side. As a result, when they recover, their muscles can be imbalanced.
Neutral Pelvis, ‘Not a Pelvic Tilt’
I asked Laura to lie on her back so we could begin with the core exercises. Her physio had scribbled ‘Not a Pelvic Tilt’ in large letters at the top of the first page. What he wanted was for Laura to do the core exercises keeping her pelvis in ‘neutral’ and not tilt it as she performed the movements. This concept is called neutral pelvis. Finding neutral is a concept that even Pilates teachers can have trouble with, since neutral pelvis looks different on each person depending on the shape of your buttock and spine. Neutral pelvis is simply the natural curve in your low back. If you are walking down the street you have a small curve in your low back. The aim is to maintain that small curve when lying on your back on the mat or when standing.
To confuse you more: some physios or movement practitioners recommend an imprinted pelvis (a small pelvic tilt) if the patient is not strong enough to maintain the pelvis in neutral while performing core exercises. Imprint is when the low back presses gently down into the mat. Think of your hand pressing gently into sand—what is left in the sand is a gentle, not forced, imprint.
In Laura’s case, I started with a short relaxation and then tried to help her coax her pelvis into a pain-free position, as close to neutral—her neutral—as possible. The goal was to try not to shift her pelvis as she performed the core exercises. And this was done by a gentle activation of the abdominals, also called ‘belly button to spine’ or ‘bracing’ the abs. Slowly and steadily we made our way through the exercises. Afterwards I asked her how she felt. Good, she said: it felt like a real class. But the problem remained that when she was left alone, working out was hard to do.
I told Laura I would tape a short class for her to follow. I would add Pilates breathing and cueing to make the session as clear, fluid and pleasurable as possible. I wanted the ‘physio’ session to double as a chance for Laura to not only do the essential exercises she needed to build back endurance in her core, but also to stretch and relax. Below is the tape.