Pilates to enable a joyful menopause · 8.Arm work Arm work is essential for clients in menopause, as they lose fat deposit in the arms and the skin gets saggy especially in the triceps

Pilates to enable a joyful menopause

Perli Zuchowicki April 2015

Abstract Menopause is a stage of life, when women become deeply concerned about aging. They feel the best of life is now behind them, as their body starts demonstrating unpleasant changes and their emotions seem to run out of control. Many of these changes impact how women feel about themselves, their ability to perform regular activities, and bring scary thoughts and emotions about becoming old. Menopause occurs generally at a time when women are also experiencing less demands from their families and daily life. This opens up the possibility of a new beginning, in which they are able to focus on themselves, pursue their passions and live life at its fullest.

Pilates is unique in its ability to impact body, mind and spirit. Working on exercises to bring awareness and conditioning of key areas of the women physiology, there is a possibility to diminish several of the symptoms from menopause. Overcoming these challenges can provide a sense of empowerment and the positive energy to approach this wonderful stage of life with a joyful attitude.

This paper delivers a program to work with clients who are experiencing the symptoms of menopause. It is focused on conditioning several key areas of the body focusing on improving clients’ sense of confidence with their appearance, their ability to continue performing their daily activities and shift their emotional state towards living a present moment full of possibilities.

Table of Contents 1. Introduction to Menopause

2. Pilates benefits for Menopause

3. Case Study

4. Conditioning program

5. Conclusion

6. Bibliography

1. Introduction to Menopause Menopause is also called the “change of life”. It is a time when certain female organs start acting in different ways. Women start realizing they are approaching menopause as they start experiencing changes with their period. These changes generally happen several years before the actual menopause begins. This transition phase is called perimenopause. The period first shows irregularities and eventually it ends. After 12 consecutive months without the period, menopause begins.

The functioning of the ovaries and the secretion of the female hormones estrogen and progesterone decline. Diagram 1 below shows the different stages in women’s life in relation to the concentration of estrogen in their body. The reductions in the levels of estrogen create a hormonal imbalance that results in several physical and psychological symptoms.

Diagram 1

Hormones carry information and instructions across the cells of the body. They influence almost every cell, organ or function of the human body, regulating our growth, the functioning of tissues, the processing of food, sexual activity and even our emotional reactions. Estrogen has many effects in the body. It is responsible for the growth and development of female sexual characteristics and reproduction. It also has anti-inflammatory effects. Please refer to Diagram 2 below, representing the effects of estrogen. Progesterone has the tendency to retain fluids in the body, especially in the ligaments and connective tissues, providing flexibility to muscles, tendons and ligaments.

Diagram 2

Diagram 3 below, presents most of the symptoms experienced during menopause as a result of the hormonal imbalances in the body.

Diagram 3

In addition to the biological and physiological changes, women at this stage in life are generally experiencing changes in their family structure, as their grown children have started to leave their home and their parents are approaching the end of their life. This has the potential to generate incremental levels of stress and despair.

At the same time, this is a time when women finally have more time to dedicate for themselves. To pursue their interests and passions, to connect with their friends and loved ones, to experience a sense of freedom that was unreachable until this moment.

2. Pilates benefits for menopause Pilates exercises can improve brain activity, improve the general attitude towards life, increase alertness during the day and enable restful sleep at the end of the day.

Women experiencing the symptoms of menopause will benefit from Pilates exercises focused on Breathing, Strength, Balance, Flexibility, Endurance and Coordination.

Breathing and Relaxation:

Breathing reduces stress and helps to attain calm and enhance focus. Deep breathing may also help with anxiety attacks, which could be characteristic of menopause. It may also help to relax before sleep.

Strength:

Exercises bearing resistance may help reduce and even reverse the decline in bone density resulting from lower estrogen levels.

Balance:

Balance exercises focus on enhancing posture, improving flexibility and body awareness. These can help prevent falls and avoid injuries.

Flexibility:

These exercises are important to keep muscles flexible and to reduce pain and stiffness in the body.

Coordination:

Coordination exercises help to improve concentration, challenge your memory and increase brain activity.

3. Case Study

The client was a 50 years old woman experiencing initial symptoms of menopause. She had not had her menstrual period for the past consecutive 6 months. Her weight had increased by 7 pounds during this period of time. She felt moody, very sad and insecure. Complained about hot flashes, forgetting things and was scared and threatened by the changes she was experiencing. There was strong evidence of emotional stress, such as difficulties with sleep and some instances in which she had panic attacks.

The client felt she should be making some changes in her life. She explained that, until a year before, she used to live a moderately active life. She loved to dance and used to enjoy Zumba classes 3 times a week. She also walked twice a week for 30 minutes. A few years ago she had tried Pilates on reformer for 6 months and enjoyed it but didn’t continue with it.

Lately, as a result of the changes she had being going through, had experienced lower motivation levels to exercise. Her doctor recommended to do some kind of yoga or Pilates to reduce stress. She needed to start a physical reconditioning program and wanted to try Pilates again.

Her goals were: i) feeling better with herself physically and emotionally, ii) improving her posture, iii) managing better these new feelings she was experiencing, and iv) reducing and controlling her weight.

The client had a healthy appearance and looked athletic. Her posture seemed to reflect a slightly tight chest, with weak back extensors muscles. She had not taken a bone density test yet.

4. Conditioning Program Applying the BASI block system, I developed a comprehensive Pilates program to address the specific needs of the client. The main focus was on both stabilization and mobilization seeking different types of muscle contraction: (isometric, concentric and eccentric), in the coronal, sagittal and longitudinal planes, using all ranges of motion (flexion, extension, lateral flexion and rotation). Special attention was given to those areas of the body where menopause produces undesirable changes: pelvic floor, abdominal muscles, hips, gluteus, arms and back extensors. Balance is another important area we worked on, as this becomes challenging during menopause.

The conditioning program involved the following blocks:

1. Warm Up:

At the beginning of the sessions we started focusing on breathing and relaxation to calm body and mind. This is key to reduce tension and enable deeper work to strengthen muscles and maximize the benefit from the class. We focused on starting the activation of the pelvic floor and abdominal muscles, placing attention in achieving a good alignment. The warm up also seeks spinal articulation, hamstring control, pelvic lumbar stabilization as well as spinal rotation, abdominal control emphasizing the obliques.

2. Foot work:

The weight bearing work is very important to help prevent or delay osteoporosis. Foot work was started on the reformer, with sufficient resistance yet making sure the client could maintain the pelvic lumbar stabilization. The program also included foot work on the chair, equipment with less base of support. It required pelvic lumbar stabilization. This challenged the posture of the client while performing the foot work. Back extensors working in synch with the abdominals to hold the client upright, both of which needed to be strengthened. Later, arm work with weight was added while performing foot work, representing an additional benefit. We also performed foot work on the Cadillac, benefiting from weight bearing in a different angle, challenging hip extensors strength and stretch, knee extensors strength, hip adductor control and pelvic lumbar stabilization.

3. Abdominal work:

This is an area of the body where women in menopause lose tone and gain weight. The abdominal work was done on different equipment: reformer, chair and step barrel. Special emphasis was placed on the selection of the step barrel as abdominal work is performed where flexion of the torso comes from an extension range of motion. This has the benefit of being more functional for the client, as she would use the muscles that would help her to stand up straighter. The flexion of the torso from an extension range of motion is a great alternative to avoid the forward flexion range of motion that is contraindicated with clients experiencing osteoporosis.

4. Hip work:

This area tends to lose strength and stability. It is important to keep this area functional to help prevent issues with balance. Hip work was done on the reformer and cadillac, in order to mobilize, strengthen and stretch the hips muscles. Key attention must be given to maintain the pelvic lumbar stabilization throughout.

5. Spinal articulation:

Spinal articulation was only integrated after about 10 sessions. Around this time in the program, body awareness had increased to a sufficient level to safely attempt more complex exercises.

6.Stretching

It is of great importance for women in this stage to stretch in order to keep muscles flexible and reduce future pain and stiffness in the body. The client performed the stretching exercises on the reformer, step and ladder barrel.

7.Full body integration

Full body integration was introduced after ten sessions.

This block is important to enhance the client’s awareness of scapula, shoulder and trunk stabilization. The work was done in the reformer and cadillac. We focused on working the abdominals and back extensors simultaneously, promoting good posture of upper body. This is also an opportunity to look and understand hip and shoulder disassociation work.

8.Arm work

Arm work is essential for clients in menopause, as they lose fat deposit in the arms and the skin gets saggy especially in the triceps area. It is crucial to strengthen and build up muscle taking in consideration that as we age we have more difficulties to do any kind of over-head arm work exercises. The work was performed making use of multiple equipment and in different positions to add sufficient variety. The aim is to develop arm and shoulder strength, flexibility and control. Resistance can be increased as well as repetitions with light weights can be considered, but it is very important to do this slowly to prevent any potential injury. It is imperative for the client to pay special attention to core strength and stability, good posture and alignment. Considering that at this stage there is a tendency of kyphosis and sometimes the appearance of a dowagers hump, I tried to teach the client to look for the correct placement of the shoulders before performing the arm work block.

9.Additional leg work

We performed leg work standing upright rather than lying down. This enables the incorporation of balance, which is a challenge for clients in menopause. This also has the benefit of learning how to stay square with the pelvis. The focus is on strengthening hip extensors, hip adductors, knee extensors and keeping pelvic stabilization. In addition to weigh bearing, we also included cardio work. Attention was given to the gluteus maximus, area where in menopause women lose fat deposit and the skin muscle begins to drop.

10. Lateral flexion rotation

This block focused on abdominal control with emphasis on the obliques, spinal mobility and scapular stabilization. The sides of the trunk generally become weaker as the muscles lose some tone with the aging process.

11. Back extension

Working on back extension is imperative for clients in menopause. As we age, we have the tendency to lose good posture, weakening more and more the strength in our back extensors muscles. We focused on strengthening her scapular stabilizers, mid and lower trapezius, rhomboids and serratus anterior. We also worked on stretching the pectorals muscles of the chest and increase thoracic flexibility. I wanted my client to adopt improved posture in the studio as well as outside. Improving posture would lead to a better muscular balance, prevent future pain, and psychologically improved self confidence and awareness.

At the end of every session we finished with roll down, bringing the client to breath, to re-connect with her being, to cherish the time she dedicated to her wellness, inspiring a positive attitude towards herself, making her feel better with her body, mind and soul. This allows the client to experience how her body has loosened through the session and to get a sense of center and self achievement.

Block 1 Exercise Equipment Muscle Focus Special Comments

Warm up Roll down MAT Stretching the back of the body, through breathing create connection of mind and body. Learn range of motion of the pelvis, what is neutral pelvis, and disassociation with lower extremities. Working the spinal articulation and pelvic lumbar stabilization. Stabilizing upper torso, while performing spinal rotation, and strengthening the transverse and abdominal oblique muscles. Work upper body control, warm up the abdominals holding the pelvis in neutral position through spinal flexion. Challenging abdominals and working the oblique muscles

Pelvic tilt Abdominals and hamstrings Abdominals Abdominals

Pelvic curl

Spine twist

Chest lift

Chest Lift with rotation


Foot work Parallel heels REFORMER Hamstrings and quadriceps

At the beginning started on the reformer. After several sessions, the foot work was performed on the wunda chair, challenging trunk stabilization. When the client developed the awareness of the stabilization of the trunk, through co-contraction of abdominals and back extensors muscles, we added some weight for arm work, making the execution more difficult. After a few more sessions, we used the cadillac, where the weight bearing comes from above. Challenging the position of the pelvis in neutral throughout.

Parallel toes

V toes

Open heels

Open toes

Calf raises Ankle plantar flexion

Prances

Single leg heels

Single leg toes

Parallel heels CHAIR Hamstrings and quadriceps

Parallel toes

V toes

Open heels

Open toes

Calf raises

Single leg heels

Single leg toes

Parallel heels CADILLAC Hamstrings

Parallel toes

V toes

Open heels

Open toes

Calf raises Foot plantar flexors

Prances

Single leg heels

Single leg toes


Abdominal work

SHORT BOX SERIES: (fundamental intermediate)

REFORMER It is crucial to achieve pelvic lumbar stabilization while performing the abdominal work. The focus on the short box series is also abdominal strength. In Tilt and Twist emphasizing obliques control and stretch. At this stage of life when there is bone density loss, it is important to add to the abdominal block exercises where flexion comes from an extension. For this purpose we included chest lift, reach and overhead stretch on the step barrel. On the chair I chose exercises where the client needs to focus also on the scapular stabilization, stretching lower back as abdominal control. The reverse pike standing adds back extensors control. Torso press sit was done using the swiss ball as an assistant. Another abdominal work, good for improving posture, cueing lifting the sternum up, and not the ribs, and keeping the head aligned with the spine.

Round back abdominals

Flat back abdominals back extensors

Tilt abdominals with oblique emphasis

Twist

Chest lift STEP BARREL

abdominals

reach

overhead stretch

standing pike

CHAIR

abdominals

reverse pike standing

torso press sit abdominals back extensors


Spinal articulation

Bottom lift REFORMER abdominals Once we completed ten sessions, and having developed body awareness and strength,we introduced spinal articulation work. These exercises were chosen to engage the hamstrings throughout the spinal articulation. We used also the tower prep, to add hamstring stretch as well. Cueing to keep the arm straight, by sensing arms pushing away from the upright poles, and maintaining the scapula stable.

Bottom lift with extension

hamstrings

Tower prep CADILLAC abdominals and hip extensors.


Hip work HIP WORK SERIES REFORMER Hip work is very important to work at this stage of life as we tend to loose the strength and stability. We need strong hips to prevent issues associated with balance. We started the work on the reformer. First trying to focus on pelvis stabilization throughout. Afterwards we incorporate hip work on the cadillac, where it requires more control and stabilization of the lumbar pelvic region. I chose both, the double and single leg series in order to strengthen hamstrings and improve hip dissociation while stabilizing the pelvis.

Frog adductors

Circles down harmstrings and hip adductors Circles up

Opening adductors

BASIC LEG SPRING SERIES

CADILLAC

Frog adductors

Circles down hamstrings

Circles up

Walking

Bycicle

SINGLE LEG SUPINE SERIES

CADILLAC

frog hamstrings

Circles down hamstrings and adductors Circles up

Extension hamstrings

Bycicle


Stretching HAMSTRING STRETCH SERIES

REFORMER Stretching is very important at this stage to maintain flexibility, to reduce possible pain and stiffness in the body. During the program we added variety to stretching by using different equipment. Cueing (when using the reformer or the ladder barrel) a bias posterior tilt of the pelvis when performing the hip flexors stretch, and a bias anterior tilt of the pelvis during the hamstring stretch. It is also important to stretch the adductors and gluteals. After she performed correctly the standing lunge we progressed into the kneeling lunge stretch. Shoulder stretch lying side was selected to focus on the latissimus dorsi and the pectorals while the objective was to control and stretch the shoulder and thoracic. The client can also benefit by allowing the body to follow the movement of the arm and letting her enjoy the opening of the chest, and releasing tension and stress.

Standing lunge hip flexors and hamstrings

Shoulder stretch lying side

STEP BARREL

latissimus dorsi pectorals

gluteals

LADDER BARREL

gluteals

hamstrings

hamstrings

adductors

adductors

hip flexors hip flexors


Full Body Integration 1

Round back REFORMER abdominals After the first ten sessions, full body integration 1 block was incorporated. We started on the reformer with round and flat back,Then we continuous with up stretch 1, focusing on trunk and shoulder stabilization. I cued to keep the tailbone towards the ceiling, maintaining a pyramid shape with the body. After succeeding with up stretch 1 we moved on to up stretch 2, challenging more the trunk and scapula stabilization. At the beginning of up stretch 2, I stood in front of the reformer with my hands on her shoulder to help her maintain a consistent angle of the arms throughout, and to understand the pivoting happening on the hip joint. Focusing on hip and knee extensors control and strength. Side reach, on the cadillac, focused on the shoulder adductor stretch, oblique stretch and abdominal control. Started anchoring the pelvic with a posterior tilt. I cued the client to press her feet into the upright poles. Specially paying attention to the foot on the same side as the arm that releases from the push through bar, maintaining the pelvis stable.

Flat back abdominals back

Up stretch 1 extensors

Up stretch 2

side reach

CADILLAC abdominals with obliques focus


Arm work Shrugs WUNDA CHAIR mid and lower trapezius

Arm work is crucial at this stage, to achieve trunk and scapular stabilization. We started work on shrugs to teach the client how to use the lower trapezius muscle that depress the scapula. Then continuing with the triceps press sit, keeping the trunk and scapular stabilization. In the cadillac we started with shoulder adduction single and double arm, to teach the client how to actively engage adductors prior to the movement. I cued to maintain slight external rotation of the shoulder, minimizing the use of the biceps. After gaining the awareness of the scapular and trunk stabilization, we progressed to a standing arms work at the cadillac. This is a good way to train the body to be more functional and stable in everyday life. It requires more trunk stabilization.

Triceps triceps

Shoulder adduction double arm

CADILLAC latissimus dorsi

Shoulder adduction single arm

ARMS STANDING SERIES

CADILLAC

Chest expansion latissimus dorsi

Hug a tree

Circles up pectoralis major

Circles down

Punches triceps

Biceps biceps


Additional legs

Leg press standing CHAIR hamstrings This is the best block to work on standing balance. Considering balance to be crucial from this stage of life and up. We started on the wunda chair with leg press standing. Looking for hip and knee extensors control. I cued to avoid leaning back, insisting in keeping the weight back as if up against the wall. When the client gained the balance I challenged her by giving her some weight to add arm work simultaneously. We progressed with forward lunge assisting at the beginning with the handles, making easier to understand the idea of the body traveling directly upwards rather than forward. In this exercise the balance is challenged to the maximum. It is hard work for the core, back extensors, abdominals, hip abductors helping keeping the hip joint in place and the pelvis leveled. Once the client felt confidence on the execution I removed the handles. Also we added backward step down focusing on the stability on the standing leg and the pelvis. It is important to keep the heel of the back leg stable and the foot in plantar flex. On the reformer, the standing leg skating is also a good exercise focusing on pelvic lumbar stabilization, knee extensors and hip adductor strength. I cued the client to start with a bias posterior tilt of the pelvis to avoid going into an anterior tilt throughout. Other important element to add is cardio work with the jumping series, considering that at this stage of life it is crucial to incorporate cardio in the routine.

Forward lunge hamstrings

Backward step down

gluteals quadriceps hamstrings

Single leg skating REFORMER gluteals medium

JUMPING SERIES REFORMER

Parallel position quadriceps and foot plantar flexors

V position quadriceps and hip adductors

Single leg parallel quadriceps and foot plantar flexors

Leg changes

Exercise Equipment Muscle Focus Special Comments

Warm down Roll down Emphasizing in keeping broad shoulders. Finish with mindful breathing to help client be calmer for the rest of the day.


Lateral flexion and rotation

Side stretch WUNDA CHAIR

lateral flexor stretch

Great for activating deep stabilizer muscles in the back and stretching through the side of the trunk. Cueing keeping elbow up towards the ceiling and lifting when performing the side stretch. The mermaid is a very nice spinal mobility, as well as scapular stabilization, exercise.

abdominal strength with obliques emphasis

Mermaid REFORMER abdominals with obliques emphasis

deltoids

latissimus dorsi


Back extension

Basic back extension

WUNDA CHAIR

back extensors Swan basic on the wunda chair, focused on scapular stabilization, back extensors strength as well as abdominal control. Adding the back extension single arm challenged the pelvic lumbar stabilization and back extensors. I cued to reach arm away to the end of the room to avoid lateral movement of the trunk. I also checked that the opposite hip didn't lift from the chair.

Back extension single arm

pelvic lumbar stabilization back extensors

Breaststroke prep REFORMER back extensors On the reformer the breaststroke prep, is a nice exercise to keep maintaining the back extensor engagement throughout. We added the variation lifting the trunk to increase the extension of the upper spine. We progressed during the last sessions with breaststroke, challenging more the back extensors strength, as an important muscle group for her posture and particularly for menopause.

Breaststroke

5. Conclusion After completing 15 sessions with the client, she seemed to develop good concentration and strong control throughout the program. Session by session she demonstrated great progress in understanding the importance of pelvic lumbar stabilization as well as scapular stabilization, and what happened when she didn’t stabilize them. Her awareness enabled her to perform the exercises with precision and control. This Pilates’ principles helped her to regain confidence in performing the exercises. They also had a psychological impact on her, as she started feeling she could also stabilize her mind and move freely with her soul. She appeared very happy during the last sessions, expressing her joy specially when working on the jumping series. She became more aware of her ability to continuously work on keeping strong her body, mind and soul. Menopause is a stage of life, when women become deeply concerned about aging. They feel the best of life is now behind them, as their body starts demonstrating unpleasant changes and their emotions seem to run out of control. Many of these changes impact how women feel about themselves, their ability to perform regular activities, and bring scary thoughts and emotions about becoming old. Menopause occurs generally at a time when women are also experiencing less demands from their families and daily life. This opens up the possibility of a new beginning, in which they are able to focus on themselves, pursue their passions and live life at its fullest.

The client found in Pilates, a space to focus completely on herself. The Pilates program became her time to disconnect from daily concerns, and engage with her most intimate self. Experiencing her stronger and more balanced body, enabled a stronger control of her mind and brought joy to her soul. Having recovered her ability to live an active life, she realized she had the time and energy to pursue new passions and started giving a new meaning to this phase of her life.

Menopause = all about Me

6. Bibliography 1. Definition of Menopause: http://www.medicinenet.com/medterms-medical-

dictionary/article.htm

2. What is Estrogen by Rachael Rettner: www.livescience.com/38324-what-is-estrogen.html

3. Physical changes in the female body, Dr. Hiroaki Ota: https://www.otsuka.co.jp/en/health_illness/menopause/chenge.html

4. What is Estrogen?, http://www.femhealth.net/natural-hormones/high-estrogen-levels.htm

5. Menopause at a glance, www.healthsquare.com; http://www.drtimdelivers.com/EEasy122605/EmadeEasy.shtml

6. Perimenopausal depression, Current Psychiatry, http://www.currentpsychiatry.com/the-publication/past-issue-single-view/perimenopausal-depression-covering-mood-and-vasomotor-symptoms/292324f0a8a7bf31cf155275a6475aa1.html

7. Pilates for Menopause, by Carolyne Anthony

Documents

Pilates to enable a joyful menopause · 8.Arm work Arm work is essential for clients in menopause, as they lose fat deposit in the arms and the skin gets saggy especially in the triceps