Pilates to enable a joyful menopause

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 reconnect 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
Warm up
Roll down
MAT
Muscle Focus
Stretching the back of the body, through
breathing create connection of mind and
body.
Pelvic tilt
Learn range of motion of the pelvis, what is
neutral pelvis, and disassociation with lower
extremities.
Pelvic curl
Spine twist
Chest lift
Chest Lift with
rotation
Special Comments
Abdominals and
hamstrings
Abdominals
Abdominals
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
Block 2
Exercise
Equipment
Muscle Focus
Special Comments
Foot work
Parallel heels
REFORMER
Hamstrings and
quadriceps
At the beginning started on the reformer.
Parallel toes
After several sessions, the foot work was
performed on the wunda chair, challenging
trunk stabilization.
V toes
Open heels
Open toes
Calf raises
Ankle plantar
flexion
Prances
Single leg heels
Single leg toes
Parallel heels
CHAIR
Parallel toes
Hamstrings and
quadriceps
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
Prances
Single leg heels
Single leg toes
Foot plantar
flexors
When the client developed the awareness of
the stabilization of the trunk, through cocontraction 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.
Block 3
Exercise
Equipment
Abdominal
work
SHORT BOX
SERIES:
(fundamental
intermediate)
REFORMER
Muscle Focus
Round back
abdominals
Flat back
abdominals
back extensors
Tilt
Twist
Chest lift
STEP
BARREL
Special Comments
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
abdominals with
oblique emphasis comes from an extension. For this purpose
we included chest lift, reach and overhead
stretch on the step barrel.
abdominals
reach
overhead stretch
standing pike
CHAIR
abdominals
reverse pike
standing
torso press sit
abdominals
back extensors
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.
Block 4
Exercise
Equipment
Muscle Focus
Special Comments
Hip work
HIP WORK SERIES REFORMER
Frog
adductors
Circles down
harmstrings and
hip adductors
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.
Circles up
adductors
We started the work on the reformer. First
trying to focus on pelvis stabilization
throughout.
Frog
adductors
Afterwards we incorporate hip work on the
cadillac, where it requires more control and
stabilization of the lumbar pelvic region.
Circles down
hamstrings
Opening
BASIC LEG
SPRING SERIES
CADILLAC
Circles up
Walking
I chose both, the double and single leg series
in order to strengthen hamstrings and
improve hip dissociation while stabilizing the
pelvis.
Bycicle
SINGLE LEG
SUPINE SERIES
CADILLAC
frog
hamstrings
Circles down
hamstrings and
adductors
Circles up
Extension
hamstrings
Bycicle
Block 5
Exercise
Equipment
Muscle Focus
Special Comments
Spinal
articulation
Bottom lift
REFORMER
abdominals
Once we completed ten sessions, and having
developed body awareness and strength,we
introduced spinal articulation work.
Bottom lift with
extension
hamstrings
These exercises were chosen to engage the
hamstrings throughout the spinal articulation.
We used also the tower prep, to add
hamstring stretch as well.
Tower prep
CADILLAC
abdominals and
hip extensors.
Cueing to keep the arm straight, by sensing
arms pushing away from the upright poles,
and maintaining the scapula stable.
Block 6
Exercise
Equipment
Stretching
HAMSTRING
STRETCH SERIES
REFORMER
Standing lunge
Muscle Focus
hip flexors and
hamstrings
Shoulder stretch
lying side
STEP BARREL latissimus dorsi
pectorals
gluteals
LADDER
BARREL
hamstrings
adductors
hip flexors
gluteals
Special Comments
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.
hamstrings
adductors
hip flexors
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.
Block 7
Exercise
Equipment
Muscle Focus
Special Comments
Full Body
Integration 1
Round back
REFORMER
abdominals
After the first ten sessions, full body
integration 1 block was incorporated.
Flat back
abdominals
back
Up stretch 1
extensors
Up stretch 2
side reach
CADILLAC
abdominals with
obliques focus
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.
Block 8
Exercise
Equipment
Muscle Focus
Special Comments
Arm work
Shrugs
WUNDA CHAIR
mid and lower
trapezius
Arm work is crucial at this stage, to
achieve trunk and scapular stabilization.
Triceps
Shoulder adduction
double arm
triceps
CADILLAC
latissimus dorsi
Shoulder adduction
single arm
ARMS STANDING
SERIES
Chest expansion
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.
CADILLAC
latissimus dorsi
Hug a tree
Circles up
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.
pectoralis major
Circles down
Punches
triceps
Biceps
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.
Block 9
Exercise
Equipment
Muscle Focus
Special Comments
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.
Forward lunge
hamstrings
Backward step
down
gluteals
quadriceps
hamstrings
Single leg skating
REFORMER
JUMPING SERIES
REFORMER
Parallel position
V position
Single leg parallel
Leg changes
gluteals medium
quadriceps and
foot plantar flexors
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
quadriceps and hip
focusing on the stability on the standing
adductors
leg and the pelvis. It is important to
keep the heel of the back leg stable
and the foot in plantar flex.
quadriceps and
foot plantar flexors
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.
Block 10
Exercise
Equipment
Muscle Focus
Special Comments
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.
Mermaid
REFORMER
abdominal strength
with obliques
Cueing keeping elbow up towards the
emphasis
ceiling and lifting when performing the
side stretch.
abdominals with
obliques emphasis
The mermaid is a very nice spinal
mobility, as well as scapular
deltoids
stabilization, exercise.
latissimus dorsi
Block 11
Exercise
Equipment
Muscle Focus
Special Comments
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
Breaststroke prep
pelvic lumbar
stabilization
back extensors
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.
Equipment
Muscle Focus
Special Comments
Breaststroke
Exercise
Warm down
Roll down
Emphasizing in keeping broad
shoulders.
Finish with mindful breathing to help
client be calmer for the rest of the day.
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-medicaldictionary/article.htm
2. What is Estrogen by Rachael Rettner: www.livescience.com/38324-what-isestrogen.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-estrogenlevels.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-singleview/perimenopausal-depression-covering-mood-and-vasomotorsymptoms/292324f0a8a7bf31cf155275a6475aa1.html
7.
Pilates for Menopause, by Carolyne Anthony