Giving your body the standing

ovation it deserves

Natalie Beaver

17th January 2017

BASI CTTC commenced: September 2016

The Pilates Clinic, Wimbledon

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Abstract

Copious amounts of research point to the same conclusion that, simply put, “sitting is killing

you”. (Pearce, 2013)

Our bodies weren’t biologically made for sitting all day, yet many of us spend more time

sitting than we do sleeping. People feel exhausted at the end of the day however “unlike

our ancestors, that tiredness is not the result of exercise.” (Anon, Desk Jockey)

Striving for balance, a fundamental principle of the BASI method, is key. While of course

people may suffer from structural asymmetries, many are functional and a result of our

sedentary lifestyle.

This paper highlights the benefits of restoring balance back into the body through a BASI

Pilates conditioning programme, to ease hip flexor tightness and pathology, a result of being

‘desk bound’. Even with today’s busy lifestyle, Rael Isacowitz himself concludes that “we

should be practicing Pilates even when we are sitting at our desks.” (Isacowitz, 2015)

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Table of contents

Title page ------------------------------------------------------------------------------------------ 1

Abstract -------------------------------------------------------------------------------------------- 2

Table of Contents -------------------------------------------------------------------------------- 3

Anatomical Description ------------------------------------------------------------------------ 4

Introduction --------------------------------------------------------------------------------------- 8

Case Study ----------------------------------------------------------------------------------------- 9

Conditioning programme and desired results -------------------------------------------- 10

Conclusion ----------------------------------------------------------------------------------------- 13

Bibliography --------------------------------------------------------------------------------------- 14

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Anatomical description of the chosen body area

For ideal postural alignment; the earlobe, middle of the tip of shoulder, middle of ribcage,

greater trochanter, area in front of knee and area in front of ankle should all fall on the

plumb line. To summarise, ideal alignment is recognised as:

Image Source: Pilates Anatomy, Isacowitz and Clippinger, 2011

Any deviations from ideal postural alignment, noted in the sagittal plane, will most likely

mean an imbalance is present. This imbalance is likely to place undue stress on the body,

resulting in pathology or even damage with no pathology at all. Whether muscles be

overworked, tight or weak, we should strive for ‘balance’, one of the core principles of the

BASI Pilates method.

People may be born with structural asymmetries, however many functional asymmetries

are now occurring as a result of the sedentary lifestyle that we lead, with the main culprit

Feet neutral, not rolled (pronated) or out (supinated)

Knees straight but not straightened so far they bow

backward

Pelvis neutral, not anteriorly or posteriorly tilted

Spine with normal curve, not decreased or increased

Scapulae neutral and shoulders open, not rolled

forward

Head above shoulders, not jutting forward

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being due to our occupational activities, or more specifically, being bound to that dreaded

desk.

The diagram below summarises the most predominant strains that are placed on the body

as a result of sitting at a desk for prolonged periods.

Image Source: The Hazards of Sitting, Berkowitz and Clark, 2014

As sitting at a desk all day appears to be so prevalent and problematic, we do see companies

now attempting to reinforce positive changes. “Employers have a legal obligation” (Anon,

HSD.GOV) to protect the health and safety of their workforce, with numerous work station

assessments and ergonomic chairs/desk equipment now available.

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In the smaller diagram (above right) it is also possible to see ‘the right way to sit’. Clearly

ergonomic chairs will aid better posture and support for the upper body, however the

impact on the lower body, more precisely on the hip flexors, is still likely to be prevalent. In

an interview with Rael Isacowitz, he confirms that along with rounded shoulders, when it

comes to sitting all day, tight hip flexors are one of the main issues.

Due to the constraints of this paper, the tightening of the hip flexors will be the

predominant focus, though it is important to note that sitting causes imbalances throughout

the entire body, and we should consider the body as a “whole” within the BASI method.

Rounded back and shoulders, a forward thrusting neck, weak abdominals and gluteal

muscles as well as tight hamstrings are also associated with sedentary lifestyles.

A neutral pelvis is defined as “when the anterior iliac spine (ASIS) on each side of the pelvis

and the public symphysis (PS), are in the same horizontal plane (coronal plane when erect)

and the two ASIS are in the same transverse plane”. (Isacowitz, 2016). When people sit all

day and hip flexors become tight and weak, an anterior tilt of the pelvis may occur. The

diagram below very simply shows this anterior pelvic tilt compared to the desirable neutral

pelvis.

a) Neutral pelvis b) Anterior pelvic tilt

Image Source: Pilates Anatomy, Isacowitz and Clippinger, 2011

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When people sit they may do so in awkward positions, like crossing the legs over, which

may exacerbate the issue and result in the ASIS on one side of the pelvis sitting higher than

the other side. This imbalance would be visible in the transverse plane.

The hip flexor muscles are complex and comprise of the; iliosoas, rectus femoris, Sartorius,

tensor fascia latae, pectineus, adductor longus and brevis and gracilis. The deepest hip

flexor muscle is the psoas, and when people sit for prolonged period, they “rarely extend

the hip flexor muscles” causing them to become “short and tight.” (Berkowitz and Clark,

2014) This shortening of the psoas muscles in the hip can result in the anterior pelvic tilt as

discussed above.

The balance between antagonist muscles groups is identified by Isacowitz is key, as most

muscles work in pairs, meaning that simply strengthening and stretching out the hip flexor

muscles will not correct the deviation and imbalance caused by sitting. Weak gluteus,

abdominals and hamstrings as well as a tight erector spinae can all contribute to a

shortening or weakening in the psoas. Therefore strengthening and stretching out the hip

flexors, should also go hand in hand with stretching the erector spinae and strengthen the

gluteus and abdominals.

Pilates is understood to “not only strengthen the body, but it also results in more flexibility

and a better range of movement.” (Anon, The benefits of Pilates) So strengthening and

stretching different muscles throughout the body is certainly something a well-designed

Pilates conditioning programme can deliver.

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Introduction

The NHS suggest that “studies have linked excessive sitting with being overweight and

obese, type 2 diabetes, some types of cancer, and early death.” (Anon, NHS) Suddenly I

don’t feel so desperate for that seat on the train, do you?

Sitting for prolonged periods of time is not natural for the body, with research suggesting

that “this sedentary lifestyle is contrary to our biological needs and destructive to our

overall well-being” (Pearce, 2013). These evolutional changes and strains placed on the

body can be identified within a movement analysis and it is believed that the negative

movement patterns associated with sitting are impacting the quality of life we lead. And we

are doing this to ourselves!

“The human body has evolved and is biologically designed to be mobile, not sedentary”

(Pearce, 2013), with Pearce continuing to state that “across the developed world, sitting is

rapidly becoming the new smoking. In fact, we sit an average of 9.3 hours a day, more than

we spend sleeping.” (Pearce, 2013) We sit at work, on our commute, while eating, relaxing

and socialising…there isn’t much we don’t do sitting down now. Getting people up and out

of their chair is critical, yet we hear so many people saying they are too busy to exercise.

Funny that people can’t find one hour a day to exercise when “the average TV viewing time

in adults in the UK today is 3hrs 6mins.” (Siddique, 2016)

This paper will focus on a conditioning programme that will enable my client to cope with

the demands of her sedentary lifestyle, especially being sat at a desk for prolonged periods.

We can’t necessarily change the world we live in but we can help people to reverse and fend

off any negative effects. In the words of Rael Isacowitz himself, sitting at a desk for hours “is

the reality we live in and we must deal with it as best we can.” (Isacowitz, 2015)

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While tight hip flexors have been identified as the primary issue by my client, the Pilates

programme that has been developed will of course be beneficial to my client’s entire body

and aims to correct all deviations from ideal posture over time.

Case Study

Client: Pippa (female, age 31)

Background: No limitations or injuries, not pregnant and not undergoing any treatment.

Overall health is good, suggesting no contraindications.

As part of the initial client assessment I carried out a postural assessment from the

front/back and side views, I also watched to see how Pippa moved during a roll down as well

as movements in different planes, to assess her range of motion and any deviations. It was

very clear that Pippa has weak and tight hip flexors that actually cause her a lot of pain. In

the postural assessment it was clear to see the anterior tilt in her pelvis. Pippa’s walk was

also vert telling as she takes short and hurried strides. She has been working at a desk for

over 11 years. Pippa also sits during her hour long commute, while socialising and when

reading or watching TV, meaning she could often be sitting for 12+ hours each day. She

enjoys walking and HIIT classes, however she does little to strengthen her deep transverse

abdominals or stretch out tight muscles. We often see people practice what they enjoy and

as Pippa feels pain while stretching, she tends to shy away from it.

Pippa has an ergonomic chair at work as she is aware of changes to her body as a result of

sitting for prolonged periods at her desk, however the pain in her hip flexors persists. Pippa

also has a dominant leg that she crosses over the other, again further exacerbating the

imbalances throughout her body.

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BASI Block system and conditioning programme:

Pippa’s sessions vary and we will continue to progressively layer up her BASI conditioning

programme. Below is an illustrative example of what a typical lesson might look like at each

stage of the layering process, though each session in reality has varied. Included in the table

below is also an explanation for why these groups of exercises have been chosen to achieve

the desired results. While the grid below does not detail them all, assists and modifications

were used during exercises where the tight hip flexors caused problems, for example,

softening of the knees when sitting with legs out straight.

BLOCK SESSION 1-10

SESSION 11-20

SESSION 21+

NOTES

Begin session with Roll Down

Postural assessment and opportunity for mind-body connection for the client

WARM UP (Fundamental on mat) Pelvic Curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation

(Intermediate on mat) Roll Up, Spine Twist Supine, Double Leg Stretch, Single Leg Stretch, Criss-Cross

Pelvic Curl plus (Cadillac Warm Up Series): Roll-Up with RU Bar, Spine Twist Supine, Mini Roll-Up, Mini Roll-Ups Oblique, Roll Up Top Loaded

To warm the muscles up and prepare the body for movement. Focus predominantly placed on the larger muscle groups; abdominals and hamstrings, with the aim of pelvic lumbar stabilization as well as articulation through the spine

FOOT WORK (Reformer) Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Single Leg Heels, Single Leg Toes

(Wunda Chair) Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Single Leg Heels, Single Leg Toes

(Cadillac) Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Single Leg Heels, Single Leg Toes

Focus on the hamstrings and quadriceps with the primary objective of knee extensor control. Moving the ankles and knees through a full range of motion is key for Pippa, as her sedentary lifestyle often means her legs are not extended for prolonged periods of time

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ABDOMINAL WORK

(Reformer) Hundred Prep or Hundred, Co-ordination

(Wunda Chair) Standing Pike, Cat Stretch Kneeling

(Cadillac) Breathing with Push Through Bar

Weak abdominals can be a contributing factor to weak or tight hip flexors, therefore connection with the deep Transverse Abdominals is key for Pippa. Fewer on the Cadillac due to the warm up already completed

HIP WORK (Reformer: Supine Leg Series) Frog, Circles Down, Circles Up, Openings

(Step Barrel: Supine Leg Series) Scissors, Bicycle, Bicycle Reverse, Openings, Helicopter

(Cadillac: Supine Single Leg Series) Frog, Circles Down, Circles Up, Hip Extension, Bicycle

For Pippa's tight hip flexors, focus on hip extensor control is key. Pelvic stability and hip disassociation is essential and while this was difficult at the beginning of the programme, great progress has been made here

SPINAL ARTICULATION

Introduced later

(Reformer) Bottom Lift (progressing to Bottom Lift with Extension)

(Reformer) Long Spine

Articulating throughout the entire spine is important for someone who may be suffering from a rounded back, a result of being desk bound. Articulation through the spine with a focus on hip extensor control also makes this a challenge for Pippa

STRETCHES (Ladder Barrel) Hip Flexors, Adductors

(Reformer) Kneeling Lunge

(Reformer) Full Lunge

Stretching out Pippa's tight hip flexors was extremely painful to begin with, however these exercises are key in order to lengthen the hip flexor muscles, which are often ignored when sitting all day

FULL BODY INTEGRATION (F/I)

Introduced later

(Reformer) Scooter

(Reformer) Reverse Knee Stretch

Trunk Stabilization while also increasing hip flexor strength is particularly effective for Pippa within the Reverse Knee Stretch

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ARM WORK (Ped-A-Pull: Arms Standing Series) Extension, Adduction, Circles Up, Circles Down, Triceps

(Reformer: Arms Sitting Series) Chest Expansion, Biceps, Rhomboids, Hug-A-Tree, Salute

(Reformer) Shoulder Push Single Arm

Although Pippa enjoys HIIT classes, she has little upper body strength. The objective of trunk/scapular stabilization is crucial within arm work, aiding those who lead a sedentary lifestyle to keep ideal posture when sitting

FULL BODY INTEGRATION (A/M)

Introduced later

(Reformer) Long Back Stretch

Although the muscle focus here is triceps, the objective of hip extensor control is particularly important for Pippa. This was only performed once Pippa was able to demonstrate she had enough strength in the upper body

LEG WORK (Magic Circle) Adductor Squeeze

(Legs Weights: Gluteals Kneeling Series) Hip Extension Bent Knee, Hip Abduction Bent Knee, Hip Extension Straight Leg

(Wunda Chair) Hip Opener

The key here is pelvic lumbar stabilization while strengthening the hip extensors and abductors. Maintaining a neutral pelvis throughout is crucial and getting the legs moving felt great for Pippa, who is used to sitting in the same position for hours of the day

LATERAL FLEXION/ ROTATION

(Ladder Barrel) Side Over Prep

(Wunda Chair) Side Stretch

(Wunda Chair) Side Kneeling Stretch

Getting Pippa moving in a full range of motion is key, therefore stretching out the oblique’s felt great for Pippa, who is used to living her life in the sagittal plane

BACK EXTENSION

(Ladder Barrel) Swan Prep

(Wunda Chair) Swan Basic

(Wunda Chair) Back Extension Single Arm

Strengthening the back extensors will aid better posture for someone who leads a sedentary lifestyle. These exercises also leave Pippa feeling 'open' after each session

End session with Roll Down

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Conclusion

Integrating Pilates into Pippa’s sedentary lifestyle has certainly had a profound effect

already and we hope to see further improvements as we progressively layer up her

programme. Physically, Pippa has confirmed she is feeling much less tight in her hip flexors,

though as expected the effects have been felt throughout her entire body, the ‘whole’.

BASI Pilates is “often referred to as a mind-body work” (BASI Study Guide, p68) and it is

great to see Pippa really encapsulate this. As well as these physical improvements, it is also

encouraging to hear that Pilates is educating Pippa to be more mindful in the choices and

changes she is implementing to her lifestyle. Pippa’s body awareness has improved, she now

takes regular stretching breaks away from her desk and thinks about her posture when she

is having to sit for prolonged periods. Pippa is enjoying incorporating more stretching to her

day, something she used to actively avoid.

As with Pilates, life is all about balance, while people may not be able to avoid sitting, we

need to encourage people to get up and out of that chair, in order to counterbalance the

damaging and lasting effects a sedentary lifestyle can have.

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Bibliography

Websites:

Pearce, Kyle. Sitting is killing you: The Truth about sitting down. DIY Genius, 10 Feb 2013

Anon. The Hidden dangers of sitting: Desk Jockey (date not referenced)

Anon. Sitting and sedentary behaviour are bad for your health. NHS Choices – Live well and Fitness. Page last reviewed 10 Oct 2016

Berkowitz, B and Clark, P. The Hazards of Sitting: The Washington Post, 20 Jan 2014

Levine, J. (M.D., Ph.D). What are the risks of sitting too much?: Mayo Clinic, 4 Sept 2014

Siddique, H. One hour of activity needed to offset harmful effects of sitting at a desk: The Guardian, 27 Jul 2016

Anon. Benefits of Pilates: BASI Pilates United Kingdom, (date not referenced)

Isacowitz, Rael. Ask Rael Q&A 7th Edition: BASI Pilates, 14 Jul 2015

Anon. Risk Assessment: HSD.GOV, (date not referenced)

Books:

Isacowitz, Rael and Clippinger, Karen. Pilates Anatomy: Human Kinetics, 2011

Alpers, A and Segel, R. The Everything Pilates Book; F + W Publications, 2002

Isacowitz, Rael. Study Guide: Comprehensive Course: Body Arts and Science International,

2000-2014

Isacowitz, Rael. Wunda Chair: Ladder Barrel Movement Analysis Workbook: Body Arts and

Science International, 2000-2014

Isacowitz, Rael. Mat Movement Analysis Workbook: Body Arts and Science International,

2000-2014

Isacowitz, Rael. Cadillac Movement Analysis Workbook: Body Arts and Science International,

2000-2014

Isacowitz, Rael. Reformer Movement Analysis Workbook: Body Arts and Science

International, 2000-2014

Isacowitz, Rael. Auxiliary Movement Analysis Workbook: Body Arts and Science

International, 2000-2014