PUSH-as-Rx ®™ Wellness Exercise & Fitness

For individuals wanting to try Pilates for back pain and exercise, can learning how to find their neutral spine help improve flexibility and increase the range of motion in the joints?

Pilates Neutral Spine

Pilates is a functional exercise modality emphasizing core stability, which is fundamental to developing a balanced body. The exercises strengthen the muscles, improve flexibility, and increase the range of motion in the joints. (Kloubec J. 2011) It is considered a functional fitness method because its principles work to establish more graceful, efficient movements from everyday life, such as improving posture. Pilates has shown its effectiveness in that it is often used in physical therapy and rehabilitation settings. (Byrnes, K., Wu, P. J., and Whillier, S. 2018) However, knowing how to find the neutral spine is essential for performing various Pilates exercises correctly. (Barbosa, A. C. et al., 2018) This subtle adjustment during practice may help prevent injury and increase overall performance. A neutral spine is the natural position of the spine when all three curves:

• Cervical (neck)
• Thoracic (middle)
• Lumbar (lower)
• Are active and in healthy alignment.

This is the strongest position for the spine when standing or sitting, allowing the body to move more naturally.

Alignment

The following exercise can help find the neutral spine.

Basic Position

• Lie on the back with knees bent and feet flat on the floor.
• Ensure the legs are parallel to the hips, knees, heels, and toes.
• Let the arms rest at your sides.

Relax

• Relax the body, including the shoulders, neck, and jaw.
• Allow the back to melt into the floor.
• The rib cage will drop when the lower ribs are released to the floor.

Breathe Deep

• Inhale all the way into the body, allowing it to move into the back and sides of the rib cage and all the way to the pelvis.

Pelvic Tilt

• Exhale and use the abdominals to press the lower spine into the floor in a pelvic tuck. (Eickmeyer S. M. 2017)
• Inhale to release.
• Exhale and pull the lower spine off the floor, creating a pelvic tilt.
• Inhale to release.

Pilates exercises don't use excess energy or tension. Proper alignment and a neutral spine position can ensure that tension is released and excess energy is not exerted. (Byrnes, K., Wu, P. J., and Whillier, S. 2018) When performing the exercise, ensure that the shoulders, neck, and legs are relaxed and not involved in the movement.

When Exercising

Once a neutral spine is achieved, the goal is to maintain this spinal position during the exercises and when changing positions.

• Start by lifting the right leg and placing it back down without letting the hips move.
• Then, repeat the motion with the left leg.
• Engage the abdominal muscles to help stabilize the pelvis, keeping it from moving and maintaining a neutral spine.
• Repeat this process with each leg.
• Once each leg can be lifted easily, test with both legs.
• Exhale deeply and lift the legs while keeping the core and pelvis stable.
• Then, lower them back down.
• When performing this progression, there may be a want to release the abs and let the back arch.
• This will cause a tuck and tilt position away from the neutral spine position.
• If this progression is difficult, keep practicing until you can maintain a neutral spine.
• Once this basic progression feels easy, try additional progressions and positioning.

Visualization Tips

Most people have their spines in one of two positions: tucked or tilted. A neutral spine requires individuals to be in between, with the lower abdominals flat and the lower spine's natural curve slightly off the floor. The following visualization can help establish a neutral spine.

Balanced Pelvic Placement

• Imagine a cup of water sitting on the lower abdomen, a couple of inches below the belly button.
• Allow the abdominal muscles to drop toward the spine, flattening the belly.
• You don't want the water to spill, so the pelvis cannot be tipped forward or tucked under.

Body Scan Meditation

• Once the body is relaxed with a balanced alignment on the floor.
• Allow breathing to become deep and full and the abdominals to drop toward the floor.
• The natural neck and lower spine curves should be off the floor.
• Ensure the lower spine is not pressed into the floor, as this indicates a pelvic tilt.

If there is any discomfort or pain when working to increase endurance, seek advice from a healthcare professional. Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach to treating injuries and chronic pain syndromes. It offers personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Is Motion Key to Healing?

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Kloubec J. (2011). Pilates: how does it work and who needs it?. Muscles, ligaments and tendons journal, 1(2), 61–66.

Byrnes, K., Wu, P. J., & Whillier, S. (2018). Is Pilates an effective rehabilitation tool? A systematic review. Journal of bodywork and movement therapies, 22(1), 192–202. https://doi.org/10.1016/j.jbmt.2017.04.008

Barbosa, A. C., Vieira, E. R., Silva, A. F., Coelho, A. C., Martins, F. M., Fonseca, D. S., Barbosa, M. A., & Bordachar, D. (2018). Pilates experience vs. muscle activation during abdominal drawing-in maneuver. Journal of bodywork and movement therapies, 22(2), 467–470. https://doi.org/10.1016/j.jbmt.2017.05.002

Eickmeyer S. M. (2017). Anatomy and Physiology of the Pelvic Floor. Physical medicine and rehabilitation clinics of North America, 28(3), 455–460. https://doi.org/10.1016/j.pmr.2017.03.003

Working out on a treadmill is a great way to get cardiovascular exercise when unable to go outside or to change things up. However, it's not just about getting on the machine and walking or running. Like anything, proper form and posture are important in preventing injuries. This allows the individual to walk smoother and faster, burn more calories, and get the full benefits. Individuals with a medical condition that impacts posture or makes it difficult to walk on a treadmill should speak to a healthcare provider for recommendations to ensure they can work out without aggravating the condition or putting themselves at risk. There is an option of working with a physical or occupational therapist to address any concerns individuals may have about using a treadmill.

Treadmill Walking Exercise Errors

Safety

A common error is getting on a treadmill with the belt already running. This may seem unnecessary, but many accidents happen when individuals just jump on. To avoid injuries, it is recommended to follow these safety tips.

• Make sure the machine is off.
• Know where the emergency stop switch is.
• Stand next to the base/running deck.
• Clip the safety key to your body to stop the treadmill if you slip or stumble.
• Start the treadmill and set it to slow speed.
• Look at the speed and carefully get onto the moving tread.
• Gradually increase the speed once comfortably on board.

Wrong Shoes

A healthy step is to strike with the heel in front with the forward foot slightly off the surface. The foot then rolls from heel to toe; by the time the toe is on the ground, the individual is halfway into the next step, and the forward foot is now the rear foot and ready for the toes to push off to take the next step.

• This sequence is only possible with flexible shoes.
• Wearing stiff shoes may not allow for the roll-through.
• Stiff shoes force the foot to slap down.
• The body and walking stride become a flat-footed stomp.
• Take a few minutes during a walking session to think about what the feet are doing.
• Ensure they strike with the heel, roll through the step, and the rear foot provides an adequate push-off.
• If you cannot do this in your present shoes, then it's time to look at other flexible walking/running shoes.

Holding The Handrails

• The handrails provide stability, but natural walking posture or natural movement involves a healthy stride and arm motion.
• Constantly holding onto the handrails doesn't allow for this motion.
• Walking or running at a slower pace is recommended without using the handrails.
• Individuals will get a better workout at a slower pace than they would at a faster rate holding on to the rails.
• Individuals with a disability or balance issues may need the handrails and should consult a trainer or physical therapist for healthy workout recommendations.

Leaning Forward

Proper walking posture means the body is upright, not leaning forward or backward.

• Before stepping onto the treadmill, check and readjust your posture.
• Engage the abdominals and maintain a neutral spine.
• Give the shoulders a backward roll so they are not hunched up.
• Get on the treadmill and walk.
• Remind yourself to maintain this upright posture.
• When changing pace or incline, check your posture again.

Looking Down and Not Ahead

• A healthy walking posture means the head is up and the eyes forward.
• An unhealthy walking posture can lead to neck, shoulder, and low back pain.
• Improper posture doesn't allow the body to take full, complete breaths.
• It also reinforces unhealthy sitting postures.
• Check the shoulders and do a backward roll every few minutes to ensure they aren't hunching forward.

Overstriding

• Overstriding means the front heel hits the ground too far in front of the body.
• Many individuals do this to walk faster.
• An overstride can result in the foot slipping, which can cause a trip and/or a fall.
• A healthy walking stride means the front heel strikes close to the body while the back foot stays on the ground longer to provide a powerful push-off.
• This push-off provides more speed and power and works the muscles better to burn more calories.
• You may need to shorten the stride and take shorter steps when beginning.
• Then focus on feeling the back foot and getting a thorough push with each step.
• Focus on this for a few minutes each session until it becomes familiar and walking becomes faster and easier.

No Arm Movement

• If the handrails are not necessary, the arms should be moving during the workout.
• Proper arm motion allows the body to go faster and burn more calories.
• The swinging motion can help shoulder and neck problems developed from unhealthy postures.
• The legs only move as fast as the arms do.
• To speed up the legs, speed up the arms.

Going Too Fast

• Go only as fast as the body can go while maintaining proper walking posture and form.
• If overstriding, leaning forward, or hunching shoulders begin to present, slow down until a comfortable/maintainable speed that allows the body to walk correctly is found.
• If the workout doesn't feel like it's helping
• Individuals with a bad walking form at high speeds may consider adding running intervals.
• Running will create quick bursts of higher heart rate and change form.

Running Intervals

• Warm up at a slow speed for 3 to 5 minutes.
• Increase walking speed to a fast pace that can maintain proper walking form.
• Start a jog and increase the speed to match the jogging pace.
• Jog for 1 to 3 minutes.
• Return to the fast walking pace for 3 to 5 minutes.
• Jog for 1 to 3 minutes.
• Repeat until the end of the workout.
• Finish with 3 to 5 minutes at an easy walking pace to cool down.

Challenge Yourself

When the body has fully adapted to a workout, it's time to challenge the body to achieve greater fitness and stay motivated. This is where workout variation intensity, duration, frequency, and/or mode come into play.

Intensity

• Add intensity by increasing the incline or the speed.

Duration

• Increase the time spent on the treadmill.
• If spending 30 minutes for several weeks, increase to 45 minutes for at least one weekly session.
• After a couple of weeks, increase to 60 minutes.

Frequency

• Once the body is used to treadmill walking, try to incorporate a session every day or every other day.
• Walk at a brisk pace for 30 to 60 minutes, going for a total of 150 to 300 minutes per week.

Type of Exercise

• Try jogging or running.
• Alternate using the exercise bike, rowing machine, or stair climber.
• Add weight training, circuit training, or anything enjoyable that gets the body moving in different ways.

Set goals and get into the habit of using the treadmill regularly to reap all the benefits. Avoid common treadmill errors, stay safe, and make the most out of walking and running workouts.

Move Better, Live Better

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Centers for Disease Control and Prevention. Benefits of Physical Activity.

Donlin, Margo C et al. "Adaptive treadmill walking encourages persistent propulsion." Gait & Posture vol. 93 (2022): 246-251. doi:10.1016/j.gaitpost.2022.02.017

Donlin, Margo C et al. "User-driven treadmill walking promotes healthy step width after stroke." Gait & Posture vol. 86 (2021): 256-259. doi:10.1016/j.gaitpost.2021.03.031

Hashiba, M. "Transient change in standing posture after linear treadmill locomotion." The Japanese Journal of Physiology vol. 48,6 (1998): 499-504. doi:10.2170/jjphysiol.48.499

Liang, Junjie et al. "The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain, gait, and EMG: Case report." Medicine vol. 98,18 (2019): e15386. doi:10.1097/MD.0000000000015386

MacEwen, Brittany T et al. "A systematic review of standing and treadmill desks in the workplace." Preventive medicine vol. 70 (2015): 50-8. doi:10.1016/j.ypmed.2014.11.011