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Keeping Pilates Safe
Karen Kemmis, PT, DPT, MS posted:
If you have low bone density or osteoporosis, you can still make Pilates a part of your regular exercise program. However, you should avoid or modify certain movements to prevent too much stress on your spine, ribs and hips. It's important to work with an instructor who is knowledgeable about osteoporosis to develop a program that is safe and appropriate for your individual needs. Here are some tips:

Avoid Flexion of the Spine

Many movements in Pilates involve flexion or bending, which causes the back to round into a C-curve. Forward flexion brings the head and shoulders closer to the abdomen. People with osteoporosis or low bone density should avoid or modify movements with flexion. The most common Pilates exercise that involves forward flexion is called "the hundred." The position of the head, neck and back are not safe if you have low bone density or osteoporosis. Other exercises that involve flexion or bending include ab prep and scissors. You can modify these movements by keeping your head down. This will actually make these exercises more challenging. You should not feel pain in your lower back. Only do what you are comfortable with.

If you have low bone density or osteoporosis, you should avoid Pilates movements that involve flexion of the spine and cannot be modified. Some of the exercises to avoid include: roll up, rolling like a ball, seal, criss cross, teaser, roll over, shoulder stand, saw, spine stretch, jackknife, bicycle, boomerang, double leg stretch, single leg stretch, open leg rocker, crab, corkscrew and neck pull.

Choose Extension Exercises

People with osteoporosis or low bone density should focus on extension exercises. These include exercises that involve backward bending. Some examples are: breast stroke prep, one leg kick, breast stroke, double leg kick, swan and swimming. You can put a pillow under your lowest ribs to protect them when lying face down.

Be Careful With Exercises That Involve Side Bending and Twisting

A little side bending and twisting is fine, but you should not push yourself to a point of strain. Keep these movements small. When bending and twisting, it is important to keep your spine as straight as possible. To do this, imagine you are standing against a wall with your head, middle back and buttocks touching the wall. You should only have a slight curve inward in your lower back. When doing movements with bending and twisting, your instructor can help you make sure your form is correct.
An_223961 responded:
do you have any advise for using the pilates machine? I don't do the exercises on the floor but use the machine.
Karen Kemmis, PT, DPT, MS replied to An_223961's response:
Fortunately, the same principles apply whether you do Pilates exercises on the machines or as floor exercises. If you have low bone density or osteoporosis, it is important to avoid flexion, or rounding, of the spine. People who use machines can adjust the springs to either apply more assistance or resistance. This gives the opportunity to do some exercises that may not be possible as mat exercises. Adding a spring-assist to a typical spine flexion exercise may allow the exercise to be done with the spine left in a neutral, or natural, position without spine flexion. The same precautions of avoiding forced side bending and twisting apply to machines as well.

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