Picture the scene, you are at the start line, patiently waiting to run head first into the water along with 50 or more other people in your wave start or treading water desperately trying not to tire yourself out before you start the swim ahead.

Picture the scene, you are at the start line, patiently waiting to run head first into the water along with 50 or more other people in your wave start or treading water desperately trying not to tire yourself out before you start the swim ahead.

If you are lucky it is a wetsuit swim, the wetsuit giving you some welcomed buoyancy – unless of course you are a swimmer, one of those triathletes who swam before they could walk and just look so effortless as you flail your arms through the water to make it through the distance!

Personally, I was always grateful the swim was first, out of the way and then it was happy days on the bike!

It didn’t seem to matter what coaches told me about my freestyle technique, and I had a few coaches try to help (4 to be exact) – they all said similar things but none of them made enough sense to me and once i was face down, horizontal in the water I definitely had no idea!

What is it about being that way in water that totally threw my proprioception out of whack? As a Pilates trainer with pretty good body awareness and co-ordination, it was so frustrating to find myself unable to ‘keep my elbow high’, ‘press through the water’, ‘keep your fingers facing the bottom of the pool’ – I thought I was! The coaches saw otherwise.

And what about legs – what were they meant to do again? My triathlon coach (not swim coach) used the pull buoy in most of my training sessions – heaven on earth as far as I was concerned, now I can swim! As soon as my toy was taken away from me it was as if I had 2 separate body halves. Someone asked me to count once how many leg kicks I did per stroke – I tried to count for them, I tried – I failed. My body and mind became totally disconnected and I decided to ignore the request!

I was strong enough though to get myself through the swim of most races I did in the top three and I have Pilates to thank for that.

  I mainly used the Reformer to focus on my swim arms – as much as I could understand from what the coaches had said. I developed strong rotator cuff muscles, and kept myself open in the chest with GYROTONIC® method. My core strength helped to give me some lift in the water and not totally sink my legs. Planks on the Reformer definitely developed my streamlined torso so if I ever did manage to suss out the technique needed for swimming I had the internal stability and external strength for it! The Chair helped my spine stay subtle and rotate in a face down position, being able to move with control from one side to the other as if in the water. My leg kick wasn’t too bad on land – but again as soon as I hit the water and I had to coordinate I became dissociated from what my upper and lower body were doing! My legs were an issue as they are with most bikers and runners – they tended to drop in the water too much and create drag. With a strong core and glutes it helped to minimise the drag, but not as much as I needed to keep up with the lead girls.

Why did this not all come together in the water itself? Might be due to a near drowning when I was 9 leaving me a deep subconscious fear of relaxing as I swam – instead I tended to fight the water. So as calm and smooth and graceful as I might be on the Pilates equipment, it never held well enough together in the swim.

However, I never developed any swim injuries due to my total body stability and I used to swim 12km a week using hand paddles too – I developed strength to swim as opposed to form, not ideal but it worked better for me. Pilates and my knowledge of movement and the body and positioning kept me injury free.

I still swim – normally with a pull buoy and now I enjoy it more, very little focus on my 100m time, but I still have the coaches’ voices going round in my head in an attempt to help me become a swimmer.

Article written by Lisa Jones, Pilates Master Trainer and Triathlete

The more I cycled and the longer I stayed on the aero bars the tighter I found my back was getting– if I wasn’t careful I walked like a little old lady with a rounded upper back. The position is great for cycling, making us low and aerodynamic, but it’s not good for our posture or our internal organs, to be so squished up. Pilates gave my spine back its length – it unwound me, twisting me back into straightness and opening my body up again. This allowed me the flexibility to be on the aero bars for longer, by resetting my posture it was easier to be in that rounded position and lessened the strain on my shoulders and lower back and hips.

Pilates helped me to be a pain free cyclist, it taught me how to move, where to move from and when I started to feel niggles when I was cycling, I had the awareness in myself to change my pedaling action to not feel the niggle. The only pain I ever experienced was the pain of a race – or when I fell off!

“I’m a Pilates trainer” I thought, “surely I can balance!” It took me a few goes to understand how to get on them and stay on them – and stay on them for longer and longer without feeling tension in my back, hips and shoulders.

Whenever I was out cycling and especially on the bars, I started to think of the work I did in the Pilates studio – how my leg turned in its socket, how to set my shoulders to avoid neck tension and whether I did or didn’t need to use my core! Whenever I stood and accelerated, I realised how much I needed my core to hold me stable and provide power down to my feet.

Cycling – it looks easy; you sit on a saddle and you turn your legs around and the bike moves forward!

Try doing that for 180km if you are an IronMan triathlete or 100km for roadies (cyclists not triathletes…) – if your position on your bike isn’t quite right, and your biomechanics are slightly off, pretty soon you’ll experience some sort of discomfort, pain and possibly injury – not to mention saddle soreness!

Cycling from the outside looks like great exercise – and it is, but when you go to the extremes of the sport more ‘inside’ work is needed, enter Pilates.

Do you remember as a kid the first time you took the stabilisers off your bike? Your dad ran furiously next to you helping you balance for as long as possible and then YOU WERE ON YOUR OWN!!…The feeling was incredible, you could balance! As kids we have less fear – the excitement of being more grown up on the bike overtook all else. I remember when I got my first road bike as an adult, equipped with aero bars which I had never experienced before. Out I headed full of confidence – I went down onto the aerobars and promptly toppled off into the hedge – not a good start to my triathlon career!

When I then trained myself in the studio, I started adding in exercises and movements that tuned me in to how to move my hip joints and keep my pelvis still. When you are on the bike the last thing you want is your butt wiggling on or off the saddle – firstly it chaffs, secondly it is inefficient movement making you less streamlined and wasting energy and thirdly it leads to lower back tension/injury.

Pilates teaches you how to ‘disassociate’ the hip from the pelvis, how to let the leg move freely in its socket and how to transfer the power from your core in to the leg, the foot and thus the pedal. The more I focused in the studio, the more power I could generate on the bike and the more comfortable I was on my seat. Standing and climbing became easier as I learnt how to use the back of my legs to pull the pedal up while keeping my pedal horizontal – sparing me from tight calves (helpful in triathlons when you need your calves to run off the bike).

The more I cycled and the longer I stayed on the aero bars the tighter I found my back was getting– if I wasn’t careful I walked like a little old lady with a rounded upper back. The position is great for cycling, making us low and aerodynamic, but it’s not good for our posture or our internal organs, to be so squished up. Pilates gave my spine back its length – it unwound me, twisting me back into straightness and opening my body up again. This allowed me the flexibility to be on the aero bars for longer, by resetting my posture it was easier to be in that rounded position and lessened the strain on my shoulders and lower back and hips.

Pilates helped me to be a pain free cyclist, it taught me how to move, where to move from and when I started to feel niggles when I was cycling, I had the awareness in myself to change my pedaling action to not feel the niggle. The only pain I ever experienced was the pain of a race – or when I fell off!

Pilates Helps With:
• Core Stability: Keeping the pelvis still on the saddle whether sitting or standing.
• Hip/Glute Power: Transferring down the leg to pedal.
• Hamstring – Quad Balance: Important as we tend to pull up too much and overwork the front of the leg, using the back of the leg too (hamstring) means we keep the power through the whole pedal cycle.
• Flexible Ankles: The ability to keep the pedal flat throughout the pedal stroke requires flexibility in the foot and ankle, minimizing ‘ankling’ and keeping the power into the crank.
• Flexible Hips and Spine: To continue to provide power when on the aero bars and in a crunched in position.
• Flexible Upper Back: To alleviate shoulder tension wherever hands are on the bars (including on the drops).

Joseph Pilates said: “The health of our spine is directly proportionate to the age of our body. If your spine is inflexibly stiff at 30, you are old. If it is completely flexible at 60, you are young.”

What happens when we get old?
As we age, there are many changes to our bodies such as:

  • Degenerative conditions of the spine and joints
  • Spinal stiffness, Osteoarthritis, Osteoporosis
  • Knee pain and weakness
  • Weakening muscles
  • Loss of balance and proprioception
  • Slower metabolism

Regular exercise and physical activity could delay or reduce the risk of some diseases and disabilities that develop as people grow older.

In Pilates, we focus on strengthening the core- it’s designed to build core strength of the body through balancing, stretching and correct breathing techniques, which will help to protect the spine and reduce the risk of osteoporosis and back problems.

It’s also a safe exercise- it can be customised and modified for all types of body, fitness level, and any age groups.

There are many benefits to doing Pilates to help avoid the adverse effects of aging:

  • Improved posture
  • Increased balance and stability
  • Reduce chronic pain
  • Build bone density and strength.

It’s never too early to start strengthening your core.
Let’s stay active. Keep your body and spirit young.

Ways to Improve Your Posture

By understanding proper posture, you can learn about your own postural deviations and determine which corrective exercises will work best to improve your alignment. The easiest and most effective way to correct imbalances is to stretch the overactive, short muscles and to strengthen the underactive, weak muscles. With correct alignment and good posture, your muscles will work more efficiently. You can prevent pain and injury, look and feel better.

Pilates is a good form of exercise that can help with postural correction. You can get a postural assessment and work with your instructor to correct your muscle imbalances.

Posture can signal both the enduring characteristics of a person (character, temperament, etc.), and his or her current emotions and attitudes. So, if your health is not enough reason to improve your posture, then the way you look might be?!

The Physiotherapist from The Moving Body can assess your posture and check for imbalances. Contact us at The Moving Body if you feel that you need help with improving your posture or if your misaligned posture has already led to an injury.

All our Physiotherapists at The Moving Body are Pilates trained. Pilates is a good form of exercise that can help with postural correction. Our Pilates instructors can also do a postural assessment and work with you to correct your muscle imbalances. The physio’s and instructors work closely together and can refer you to each other in case they feel you are better off with the other discipline, to ensure the most optimal outcome for you!

Understanding Your Posture

Ideal Posture

Good posture, or ”neutral spine” is the proper alignment of the body. Deviations from neutral alignment are identified as excessive curvature or reduction in curvature. Ideal posture indicates proper alignment of the body’s segments such that the least amount of energy is required to maintain a desired position and a minimum amount of strain is placed upon the tissues of the body. It is ideal to maintain a neutral spine whether its sitting or standing!

A Common Postural Imbalance

Most postural deviations occur because the muscles that work to hold a joint in place are imbalanced – one muscle group will be too tight and the opposing muscle group is too weak. Muscles that are in a prolonged, or stretched position can’t function properly and lose strength. A muscle in a shortened position will decrease in length, since it is not being used causing muscle tightness.

For example, people with shoulders that hunch forward often have tight pectoral muscles that pull the shoulders forward and rotate them in towards the midline of the body. Pair tight pecs with weak back muscles and you have an imbalance that pulls the shoulder girdle away from its ideal position. When imbalances like these occur, for a prolonged period of time, overactive muscles compensate for underactive muscles, which causes tension, fatigue, discomfort and injuries.

The above described posture – the forward head posture is one of the most common postures these days. This posture leads to a typical imbalance of the upper postural muscles, described by Czech Physician Vladimir Janda as the upper cross syndrome.

This posture starts a domino effect; the head shifts forward, the centre of gravity shifts forward, the upper body shifts backward, and to compensate that, the pelvis tilts forward. The entire spine responds to the change of the head position. The load on the cervical spine increases from 5.4 kg to 19 kg!

Who should get a post-natal physiotherapy assessment? And when?

A postnatal assessment is recommended for all women following delivery. It can be carried out as early as six weeks after delivery to many, many years later. The time after giving birth can be hectic, and it is important to take the time to look after your own welfare and body as well as your baby’s.

After giving birth, a number of musculoskeletal imbalances can occur in a women’s body. These imbalances can cause pain and poor movement control which may lead to further physical problems in the future. They may not always be easily recognized in the beginning and so it is important to be assessed. A trained women’s health physiotherapist can assist in the diagnosis and treatment of post partum musculoskeletal and pelvic floor disorders.

Post Natal Physiotherapy assessment: What is Involved?

A one hour assessment with a specialist physiotherapist in which we carry out:

  • A tummy assessment to check for a ‘gap’ or diastasis rectus.
  • A pelvic floor examination (internal and external).
  • An assessment of any other physical problems experienced since pregnancy.
  • Prescription of a personalized post natal rehab program which incorporates the patient’s lifestyle and goals.
  • Education and advice regarding return to exercise.

What to look for in a post natal assessment?

  • Posture: New aches and pains in the neck, back and pelvis are extremely common post-natally. From feeding to lifting and bouncing your new baby, the body is often forced into awkward positions. Assessment of musculoskeletal range and strength can help us help you understand your symptoms and give you exercises to reduce your discomfort.
  • Pelvic floor assessment: Regardless of c-section or vaginal delivery, a post natal pelvic floor assessment is important post partum. Over 30% of women experience urinary incontinence in the months following delivery. An internal assessment of your pelvic floor contraction carried out by your specialized women’s health physiotherapist, will give you a greater understanding of how to best activate your pelvic floor. Furthermore, it can help us guide you on the best way to improve the strength of your pelvic floor.
  • Tummy assessment: A gap or a separation between the abdominal wall muscles is known as a diastasis recti abdominus (DRA). It occurs during pregnancy, when the abdominal muscles are stretched to accommodate your growing bump. A large DRA has been related to core instability and pelvic floor dysfunction. During your post natal assessment, we will assess your diastasis and advise you on how best to manage it. We can also assess your c-section scar and provide scar tissue release as required.
  • Breathing: Your bump during pregnancy impacts the diaphragmatic movement. Our diaphragm has an impact on the pelvic floor strength and control, and can affect your ability to return to exercise. Therefore, we assess your breathing pattern to optimally co-operate with your pelvic floor.
  • Wrist pain: De quervain’s syndrome (mothers thumb). Tendons of the wrist rubbing off surrounding structures causing inflammation, onset due to repetitive nature of motherhood in lifting and adjusting. Your women’s health physiotherapist can provide treatment to reduce the discomfort and exercises to increase the strength of the wrist to prevent worsening of the pain.
  • Breast feeding dysfunction: Mastitis is a condition where the milk ducts in the breast can become swollen and painful. It commonly affects women who are breast feeding. Treatment for this consists of a course of gentle massage and ultrasound therapy to help reduce the inflammation, and allow for a smoother breast feeding experience.

The Moving Body offers post- natal assessments by a trained physiotherapist.

Email us us to book your appointment now!

Written By Mary Wrixon, Physiotherapist

In the second part of a series of three articles, we will talk about how the concept of ”Preventive Physiotherapy” can be used to possibly prevent a slipped disc.

Slipped disc is the colloquial term for a herniated disc, or prolapsed disc. These can be traumatic in nature (due to accidents), or due to general wear and tear.

Intervertebral discs are found between the bones (vertebrae) of the spines. They function as shock absorbers, and maintain the space between vertebrae. It is important to maintain this intervertebral disc space in order to prevent compression of the nerves present here. Excessive pressure applied on any part of the disc will cause its gel—like contentsto ooze out. This gel may in turn apply pressure on the nerve root, resulting in pain along the course of this nerve.

There are two factors affecting the size of this space (and therefore, the amount of pressure on nerve roots):1. The health of the intervertebral disc
2. The balanced activation of the muscles supporting the spine

The concept of “Preventive Physiotherapy” will preserve the health of the disc by ensuring optimal activation of spinal stabilisers. Analysis of muscle strength, posture and lifestyle, can be used to identify the following:
1. Weaknesses in the muscular system supporting the spine
2. Incorrect movement patterns (which may place excessive force on the disc)
3. The cause of these weaknesses and incorrect movement patterns

Early intervention, in the form of specific exercises targeting the weak muscles and functional training, may prevent excessive force being placed on the disc. It is thus possible to prevent non-traumatic slipped discs.

Consult one of our Physiotherapists to maintain the health of your intervertebral discs.

Article written by Aparna Shah, Physiotherapist

Diastasis Recti is a fairly common condition during pregnancy and post-partum. Also known as abs separation, there is a widening of the gap between the left and right rectus abdominis muscle, at the mid line fascia.

Diastasis Recti reduces the functional strength of the abdominal wall and can aggravate lower back pain and cause pelvic instability.

Risk factors:

  • Separation in a previous pregnancy can significantly increase the probability and severity of the condition in subsequent pregnancies.
  • Women with multiple pregnancies and multiple birth pregnancy.
  • Petite women.

A simple self-test for Diastasis Recti:

  • Lie on your back with your knees bent, and the soles of your feet on the floor.
  • Roll your upper body off the floor into a “crunch”.
  • Check for a gap/separation at your mid line.

Things to avoid when you have this condition:

  • Avoid any movement or exercise that places strain on the mid line, like full sit-ups,crunches, oblique curls, reverse
  • curls, and full roll-ups and planks.
  • Avoid heavy lifting.
  • Abstain from backbends and other spinal flexion movements.

If you think you suffer from diastasis recti, please contact us at info@themovingbody.com.sg so we can work with you on a treatment plan.

Non-specific lower back pain can be troublesome and is more prevalent than you think. It effects over 80% of the adult Singaporean population at some time in their lives (Sing Health) and up to 60% of people in their adult life worldwide (WHO). It is one of the leading problems resulting in unemployment and disability when chronic. However there are a few changes that can be made to our lifestyle to relieve some of the causes of back pain.

1. Knowing when to Seek Help
Knowing the severity of your symptoms can help to identity the kind of health professional to engage as a first point of contact. In the acute stage (24-72 hours) pain can be intense, especially if the cause was due to trauma or a disc related injury. Seeking the advice of a medical professional is essential if you experience all or some of the following symptoms:

  • Pain that can keep you up at night
  • Severe pain which limits your daily functions
  • A loss of bladder and or bowel control
  • A significant reduction of strength/ power in the legs or back
  • Severe numbness

Please consult a doctor as these are often suggestive of a more serious underlying problem.

For back pain of a less serious nature, there is light at the end of the tunnel! Here at the Moving Body our experienced Pilates instructors and or Pilates trained Physiotherapists are at hand to help relieve that pain! But here are a few other changes that you could make for a healthy and happy back.

2. Posture
How many times have you found yourself slumped at your desk or sofa, or standing more on one leg than the other? Adverse postures can have a significant effect on your joints. Incorrect sitting or standing postures can contribute towards compression of the lower back. Over a period of time a poor posture can result in secondary muscle changes such as lengthening of the gluteal muscles and shortening/lengthening of the lower back muscles. Simple changes such as a chair that allows for support of the natural curve of your spine can help to reduce additional stress in the lower back. Alternatively using a lumbar role or towel can make a world of a difference to giving your back the support that it needs.

3. Core Control
Although the jury is not conclusive on the literature surrounding the science behind lower back pain and core stability, it is still a very important component of back strength. The core is made up for 4 key muscles, which align the spine and form a corset and hammock like structure that supports the spine and torso. These stabilizing muscles lie deep to the bigger muscles or the prime movers, to keep the spine stable and reduce excessive or potentially damaging movement. Not sure where your core muscles lie or how to activate them? Pilates is a great way to gain awareness and build up your core strength, and for those with a longer history of back pain a physiotherapist can help to work with you to regain function.

4. Muscle Balance
Short and tight muscles can be a source of pain. We all know what it feels like to have developed areas of tension, which may be rather uncomfortable to release via massage. The muscles in the lower back can be prone to tightness, especially the muscles on either side of the lower back called the quadratus lumborum and the parapinals , which are common sites for trigger points and referred pain patterns. Stretching or manual release can help to relieve this tension.

5. Keep it Moving!
Pain can be the start of a downward spiral for inactivity, which in turn can be a source of pain, so it is important to break this cycle. If you are having any of the more serious symptoms above then gentle exercises should be prescribed and monitored by a healthcare professional, as it is still important to strengthen the surrounding areas. If you imagine the muscles in the back of your body as a chain, and one part of the chain has a problem it is likely to affect the other muscles in the chain; this is why conditioning is important to maintain overall health. Exercises such as swimming or walking through water can be extremely beneficial as the water will give resistance to movement, strengthen several large muscle groups whilst weight bearing is reduced by up to 60%. Keeping active is also a great way to keep your weight controlled another factor that will increase the stress on the joints!

Article written by Rebecca Taylor, Physiotherapist

Congratulations! You’re pregnant! It’s nine months of excitement; but also involves some planning and lot of research. The last three months can also involve physical restrictions. Symphysis Pubis Dysfunction (SPD) is a real complication of pregnancy that arises from increasing size and weight.

The pelvis is made up of three bones – the two iliac bones and the sacrum. The sacrum is connected to the iliac bones through the sacro-iliac joints (found along the posterior aspect of the pelvis). The two iliac bones are connected to each other in the front through the symphysis pubis. Minimal movement occurs at these joints. Their function is to provide a stable platform for the movements of the arms and the legs.

A hormone called relaxin is released in the pregnant body during the second trimester. This hormone loosens up the ligaments of the pelvis, allowing the baby to pass through without any difficulties or complications.

As the ligament of the symphysis pubis loosens, the body increasingly relies on the muscles of the pelvic floor, hips, and the overlying fascia, to maintain the alignment of the pelvis. The inability to do so may result in pain and instability in the pelvis; and is termed symphysis pubis dysfunction (SPD). Although not very common, experts believe that more than 2% of all pregnant women will experience the symptoms of this dysfunction. SPD often goes undiagnosed and unmanaged, possibly because the symptoms are considered “normal” during pregnancy.

Signs and symptoms:

  • 1. Back and/or hip pain
  • 2. Pain in the pubic area, accompanied with a grinding or clicking sensation
  • 3. Pain and/or tenderness along the inside of the thighs
  • 4. Pain that increases during weight transfer (walking/running/going up or down stairs), when stepping side-ways, turning in bed
  • 5. Pain that is worse at night and possibly stops you from sleeping. Getting up to go to the toilet in the middle of the night can be especially painful
  • 6. Weakness in the legs; inability to support oneself in a seated or standing position

These symptoms can be quite distressing in the prenatal period. Symptoms persisting into the postnatal period could affect the new mother’s ability to look after a newborn, as well as her self-confidence. Early diagnosis is key.

A women’s health physiotherapist will be able to provide ergonomic advice (movements to avoid), supports (trochanteric or SIJ belts) and exercises critical for the effective management of SPD. Make an appointment with the Physio department if you experience any of the symptoms listed above; or if you want exercises to keep your pelvis supported through your pregnancy.

Article written by Aparna Shah, Physiotherapist

You go for a run and halfway you feel a slight pain in your knee. The next morning it feels a bit stiff, but not too painful. The next day you go out for a run again, but even before halfway you feel your knee again. You head home, disappointed and decide to rest for a week. The following week the knee feels fine and you start your run hopeful. You realise at the halfway point that your pain in the knee isn’t gone. It is still there. You start to wonder ‘should I see a physiotherapist? Or maybe a sports physio?’

With an acute (sports-)injury, like a sprained ankle, it is clear you can’t continue with running. But with a dormant injury it is more difficult.

Inflammation and how to overcome it

If you have signs of inflammation, like pain, redness, swelling, an increase in temperature and/or decreased function, it is wise to stop your sport activities. In the first 48 hours, the RICE principles should be applied; Rest, Ice, Compression, Elevation. In the next 10 days (the phase that follows the inflammation phase is the proliferation phase and this phase lasts approximately 10 days) you try to use your extremity as normal as possible for daily life activities. After this period the signs of inflammation should have completely disappeared. The next phase of the healing will start, the early remodeling phase (10 till 21 days). You can try to build up sports activities again, starting with low impact. In the late remodeling phase, which starts after 3 to 6 weeks and can last up to a year! It is important to restart to use the extremity is the desired function. Since in this phase the connective tissue will build up its strength depending on the load you place upon it.

Find the root cause of your injury

It is important to know the cause of your sports injury (knee injury) to find the solution. How about your running shoes? Are they old and worn out? Did you build up the run in a smart way? Or did you not run for 6 months and just restarted your old pace and distance without building it up? In a normal situation our body should be able to heal itself because of the earlier described phases of wound healing. But maybe something is obstructing the healing process, causing repetitive strain on the injured tissues and therefore preventing it from healing. Maybe you have tight, or weak muscles? Or a misalignment? These are issues your sports therapist can help you with.
The physiotherapists from The Moving Body will do a full assessment and after which give you advice on the best treatment. Depending on the cause of the injury and the severity of the symptoms you have, the physio might have to see you again for several sessions. A sports physio will always give you a clear explanation and a time frame when you should be able to return to sports. Because, in the end, that’s what it’s is all about… When can I resume my sports again?!