Benefits of Pilates for Menopausal Women

By: Diane Valine

November 30, 2017

Course Year: Santa Barbara 2017

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Abstract:

Menopause can be a difficult time for women. There are many changes to the mind and

body that can be frustrating. Menopause can lead to irritability, weight gain, lethargy and

depression. Pilates is a great workout. In addition to feeling great and reducing stress,

Pilates makes people feel better about themselves. Pilates improves mood by providing

improved mental focus and body awareness, provides physical & social activity which helps

alleviated depression, and provides increased bone density from weight bearing exercise.

A post-menopausal woman is the client who has kyphosis with head forward posture is

seeking a Pilates exercise program as a goal to taking better care of herself. Pilates has

many benefits for all age groups, including menopausal women.

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Table of Contents

Abstract: 1

Table of Contents 2

Anatomical Description: Postural Types 3

Movements of the Scapulae: 4

Introduction 5

Conditioning Program 12 - 13

Results 13

Conclusion 14

Bibliography 15

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Anatomical Description: Postural Types

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Movements of the Scapulae (From Pilates Anatomy by Isacowitz and Clippinger):

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It is a secret known by some fifty-something women (and some men) who enjoy

working out with a supportive group: Pilates is a fantastic exercise program. Menopausal

women benefit from Pilates. Pilates is a great workout and in addition to feeling great and

reducing stress, it makes students feel better about themselves. Pilates teaches students

to recruit muscles that they may not be aware they possessed. Many menopausal women

have given up on exercise. Their chronic pain, insecurity about their bodies, and lethargy

are preventing them from starting an exercise program. Most have tried the gym, but

unless they are in peak physical condition, it can be intimidating. The aging American

population has become addicted to technological devices, sit for hours at a desk with little

physical exercise and eat poorly. This has contributed to aging adults being overweight

with poor posture and chronic neck, back and shoulder problems. With some focused

exercise, their chronic pain could be minimized. Joseph Pilates said: “Not only is health a

normal condition, but it is our duty to not only attain it but to maintain it.”i What most

people don’t understand is that Pilates classes are not usually held in a gym where less fit

people are judged. Pilates exercises are tailored to the individual based on their goals. For

menopausal women, improving posture, improving physical fitness, maintaining bone

health and positive mental attitude should be at the top of the list of goals.

There is much more to menopause than “raging hormones.” Research into the

physiological changes taking place in menopausal women reveals that in addition to

hormonal shift, our bodies and our nervous systems are changing. A woman’s thoughts,

her ability to focus, and the amount of fuel going to her intuitive centers in the temporal

lobes of her brain are being rewired. Menopausal women are no longer invisible and

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silent, but a force to be reckoned with – educated, vocal and sophisticated in their

knowledge of medical science, and determined to take control of their own health. For

most women, identity and self-esteem are generated by our associations and relationships.

Women often begin to direct more of their energies toward the world outside of home and

family, which may suddenly appear as a great, inviting, untapped resource for exploration,

creative expression, and self-esteem. A women’s life expectancy is 84 years old. She will

live 30-40 years past menopause and be vibrant, sharp and influential as well. A 1998

Gallup survey showed that half of American women between the ages of fifty and sixty-five

felt happiest and most fulfilled at this stage of life. Menopausal women who take care of

themselves can transform and improve their lives.

Vigorous regular exercise is an absolute necessity if you intend to live well beyond

midlife. For post-menopausal women, maintaining bone health with weight bearing

exercise and proper nutrition is also important. Vigorous exercise sends positive signals to

your entire body that increase your levels of human growth hormone. Exercise tells your

body to stay vigorous, vibrant, healthy and growing. Sitting on the couch and eating junk

food and drinking too much alcohol gives your body the opposite message: get old,

deteriorate and go into decline. Pilate’s mind/body fitness approach engages the mind,

the muscles, breathing and stretching all at once. Pilates like any discipline that use the

mind as fully as the body, ends up transforming both. ii Pilates improves mood by

providing improved mental focus and body awareness, provides physical & social activity

which helps alleviated depression, and provides increased bone density from weight

bearing exercise.

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The Pilates method of body conditioning is a unique system of stretching and

strengthening exercises developed over ninety years ago by Joseph H. Pilates. It

strengthens and tones muscles, improves posture, provides flexibility and balance, unites

body and mind and creates a more streamlined shape. Pilates was developed to create a

healthy body, a healthy mind and a healthy life. Exercise should be an important part of

our lives. The Pilates philosophy focuses on training the mind and body to work together

toward the goal of overall fitness. Pilates sought to reeducate us to work our bodies to

improve the efficiency of performing our daily tasks. The Pilates method can change the

way you relate to your own body and the way you carry it. Through visualization, physical

strengthening and stretching of the body, mental vigor and improved blood flow returns to

inactive brains cells. The renewed spirit of thought and movement is the first step toward

stress reduction, grace of movement, and a greater enjoyment of life.

Without properly caring for our bodies, it is impossible to feel good. Some stress

and fatigue come from poor posture, imbalances in the body and lack of correct breathing.

Pilates movements stretch the body as it strengthens. Rather than straining ourselves

with gym type exercises to strengthen our muscles, we should be enjoying the movements

themselves.

Using visual imagery to engage the mind is the fastest way to gain access to our

anatomical system. Using your mind’s eye to visualize a sensation also accesses muscles

you may not know existed. It is the mind’s creative ability that will control the actions of

your body. Pilates believed that proper movements should become as natural to a person

as they are to an animal. In most everything we do, we can and should utilize all our

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muscles. A goal of Pilates is to create a natural flow of movement and then gradually

increasing the energy which you use to perform the movement.

The first and biggest hurdle in exercise, especially for menopausal women, is

combating the mind’s self-deprecation. Reward the desire for change with positive

thoughts rather than dwelling on the deficiencies. Believing in your innate ability to

achieve is the key to changing your body. The physical and mental commitment you must

make to achieve your goal is the most important step in the process of change. The Pilates

method is an education in body awareness and is meant to provide you with the necessary

tools for taking care of yourself. Uniformly developed muscles are the key to good

posture, suppleness and natural grace. iii

Poor posture is hard on our bodies. Ideal alignment of the body is efficient. If the

musculature is out of alignment, it taxes the muscles. Good posture includes proper

alignment of the head. The scapula is the crucial link between back extension, shoulder

placement and head placement. Good posture always includes position of the head. In

the head forward position, all muscles are affected.iv Posture can be described in terms of

alignment of the joints and bony landmarks and may be understood in terms of muscle

balance and function. Good alignment translates into less stress on the spine and more

efficient muscle activity. When the spine is aligned with gravity, the body works in

harmony. The natural curves of the spine are important because they act as shock

absorbers for the body. Ideal alignment of the spine also facilitates normal and efficient

functioning of the inner organs of the body. v Lower back, neck and shoulder pain are

some of the most common health problems in adults today. With society having an

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increasingly older population and people living more sedentary lifestyles, back, neck, and

shoulder pain afflict many people. There are many contributing risk factors to back and

neck pain including age, obesity, physical activity (both too little and too much) poor

posture, psychological stress, trauma, and poor work ergonomics.vi

Optimal positioning of body segments often involves a relationship in which healthy

joint mechanics is encouraged and excessive use of muscles or excess stress to joints is

prevented. Strength and flexibility imbalances or suboptimal patterns of activating the

muscles should be avoided. Ideal standing alignment is a position in which the head, torso,

and pelvis are aligned above one another and above the feet so that very little muscle

activity is required to maintain their position. View the body from the side and note the

positioning of surface landmarks relative to a plumb line. External landmarks should be

located right along this vertical line: Earlobe, middle of the tip of the shoulder, middle of

the rib cage, Greater trochanter (projection on lateral femur), the area just in front of the

middle of the knee, and the area just in front of the ankle. This is ideal posture and few

people can meet this standard. Optimal positioning of these landmarks ideally represents

a situation where the following underlying alignment goals are met: feet neutral, knees

straight, pelvis neutral, spine with normal curve, scapulae neutral and shoulders open and

head above shoulders not jutting forward. One common source of alignment problems is

an exaggeration of the curvature in a region of the spine.

Exaggeration of the cervical cure (cervical lordosis) is often associated with the

alignment problem called forward head, in which the chin juts forward and the earlobe is

forward relative to the plumb line and shoulders. An increased curve in the thoracic

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region, termed kyphosis, is particularly common in aging. Increasing strength and the use

of the upper spinal extensors often can improve this condition. Lumbar lordosis or lumbar

hyperlordosis refers to an increased curve in the lower back region. This common postural

problem, which may increase the risk of lower back issues, often can be helped by

developing greater strength and use of the abdominals as well as adequate flexibility of the

lower spinal extensors and iliopsoas.

Another common alignment problem is shoulder instability or improper

recruitment of the correct muscles. Movements of the shoulder girdle are dependent on

muscles, and muscle imbalance can easily lead to alignment problems. The shoulder girdle

is composed of one clavicle and one scapula. The scapula slides on the ribcage, with only

muscles connecting it to the spine. When the arm moves, ideally the scapula moves in a

coordinated manner that allows the upper humerus to maintain proper positioning in the

shoulder socket (glenoid fossa) located on the scapula. One of the most common

alignment problems of the shoulder is related to raising the arm to the side or front. This

movement is accompanied naturally by a smooth upward rotation of the scapula, but

many people add undesired excessive elevation of the scapula. This tendency can be

countered by coordinated use of the muscles that depress the scapula, the serratus

anterior and lower trapezius. In many instances the function of the scapular muscles may

be related more to posture or prevention of an undesired scapular motion so that stability

is maintained than to producing visible movement. Repetitive activation of the desired

muscles in the appropriate manner over time your body will automatically start utilizing

these more optimal strategies. (Isacowitz & Clippenger, 2011)vii

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The Client:

A fifty-six-year-old post-menopausal woman, with kyphosis and with head forward

posture. Poor posture was contributed by slouching over desk for years, excess weight,

age, and large breasts. The postural deviations are both structural and learned. Large

heavy breasts caused self-consciousness which contributed to the poor posture. There

was also a horse riding injury to right shoulder in her late teens that contributed shoulder

instability. Improper recruitment of shoulder stabilizing muscles and over use of rotator

cuff caused mild pain and “clicking” during use. She exhibits excessive elevation of the

scapula during exercise. A fall injury several years ago resulted in sciatica, so intermittent

tightening of the lower back muscles also occurs. Her daughter leaving for college has

creating an empty-nest which has led to periodic depression. She has a goal of taking

better care of herself and been a mat Pilates student for 10 years.

Kyphosis involves an increased thoracic curve of the spine. Correction focuses on

strengthening the thoracic extensors and stretching the anterior shoulder muscles. The

emphasis of the program below is to strengthen the spinal extensors and more fully

develop the powerhouse to improve posture. Scapular stabilization to prevent excessive

elevation of the scapula is also a goal. Spinal Extensors are located on the back of the

trunk and they share the common action of extending the spine. These muscles have been

shown to be the key for optimal movement performance and prevention of certain back

injuries, osteoporosis and certain postural problems, as well as successful return to activity

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after back injury. Strengthening this muscle group can help prevent the common tendency

for a slumped upper back posture.

The powerhouse is structured around the hips, lower back and buttocks. Pilates

movements are instrumental in maintaining good posture and alignment. Working all the

muscles simultaneously and continuously switching movements is the most efficient way

to build stamina. Pilates was designed to work directly with the deepest muscles in the

body, creating a strong core without the pain associated with conventional exercises. The

client’s goals were used to develop the conditioning program below:

BLOCK Exercise Muscle Focus Objective

Warm-Up Foam Rolling Pelvic Curl Spine Twist Supine Chest Lift Chest Lift with rotation

Abdominals & Hamstrings Abdominals with oblique emphasis

Spinal Articulation Hamstring Control Pelvic Lumbar Stab. Abdominal strength

Foot Work Parallel Heels Parallel Toes V Position Toes Open V Heels Open V Toes Calf Raises Prances Single Leg Heel Single Leg Toes

Hamstrings and Quadriceps Ankle plantar flexors

Hip extensor strength Knee extensor strength Ankle plantar flexor st. Warm up Foot Stretch

Abdominal Work Abdominals legs in Straps

Abdominals Abdominal Strength Hip Flexor Strength Pelvic lumbar Stabilization

Hip Work

Frog Circles Openings

Hip Adductors Hamstrings

Hip Adductor Knee Extensor Control Pelvic lumbar stabilization

Spinal Articulation Bottom Lift Abdominals Spinal Articulation

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Bottom Lift with extension

Hamstrings Hip Extensor Control

Stretches (ladder barrel)

Shoulder Stretch 1 Shoulder Stretch 2

Shoulder Extensors Shoulder flexors

Shoulder Extensor Stretch Shoulder Flexor Stretch

Full Body Integration Up Stretch Series Abdominals Back Extensors

Trunk stabilization Shoulder stabilization Hamstring Stretch Shoulder Stretch

Arm Work Shoulder Push Shoulder Push - single arm Magic Circle: Arms Bent, Arms Straight Arms Overhead Single Arm Side Press Single Arm Bicep

Triceps Pectorals Shoulder adductors Biceps

Elbow extensor strength Trunk Stabilization Scapular Control Pectoral strength Shoulder adductor strength, bicep strength

Full Body Integration Balance Control Front

Abdominals Deltoids

Trunk Stabilization Scapular Stabilization Shoulder flexion Strength

Leg Work Hamstring Curl Hamstrings Knee Flexor strength Hip extensor strength

Lateral Flexion/Rotation

Side Over on Box Abdominals with oblique emphasis

Abdominal strength Trunk Stabilization

Back Extension Breaststroke Prep with straight arms

Back Extensors Back extensor strength Elbow extensor control

Results:

The use of the program above has improved the client’s posture. She is engaging

her lower trapezius and abdominal muscles when she walks and is feeling more confident

in this more engaged position. She is using her pectoral muscles to stabilize her scapula.

There is less pain in the previously injured shoulder, especially at night. The client is

finding it easier to throw a ball for her Labrador retriever. She is making progress engaging

powerhouse during Pilates exercises. She has a more positive outlook as she develops

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relationships and has more social interactions at Pilates classes and in the community.

Conclusion:

The life expectancy for menopausal women is 30 years or more past menopause.

By taking care of themselves with a Pilates program tailored to their goals, their lives could

benefit tremendously. These women have more time for activities outside the home,

often have disposable income and a curiosity about new things. They need to know that

they are not too old for this type of activity and they will be welcomed. Pilates will

improve their posture and physical appearance and make them feel better about

themselves. Pilates is great exercise program for all people, but menopausal women’s life

is improved by taking better care of themselves at a time when many changes in their lives

are occurring.

i Pilates, Joseph H., Your Health, Presentation Dynamics Inc., New York, NY, 1934. ii Northrup, Christiane, M.D., The Wisdom of Menopause, New York, NY: A Bantam Book, 2006. iii Siler, Brooke, The Pilates Body, Harmony Books, 2000. iv Isacowitz, Rael, MA, “Scapular Stabilization Mat with Small Props” Body Arts and Sciences International, 2009. v Isacowitz, Rael. Study Guide: Comprehensive Course, Costa Mesa, California: Body Arts and Sciences International, 2013. vi Striano, Philip, DC, Healthy Back Anatomy, Thunder Bay Press, San Diego, CA, 2011, p 7. vii Isacowitz, Rael and Clippinger, Karen, Pilates Anatomy, Human Kinetics, New York, NY, 2011.

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References: Isacowitz, Rael, MA, “Scapular Stabilization Mat with Small Props” Body Arts and Sciences

International, 2009. Isacowitz, Rael. Study Guide: Comprehensive Course, Costa Mesa, California: Body Arts

and Sciences International, 2013. Isacowitz, Rael and Clippinger, Karen, Pilates Anatomy, Human Kinetics, New York, NY,

2011. Kendall, F.P., McCreary, E.K., Provance, P.G., Rogers, M.M., Romani, W.A., “Muscles:

testing and function, with posture and pain. 5th ed., Baltimore, MD, Lippercott, Williams & Wilkins, 2005

Northrup, Christiane, M.D., The Wisdom of Menopause, New York, NY: A Bantam Book,

2006. Pilates, Joseph H., Your Health, Presentation Dynamics Inc., New York, NY, 1934. Siler, Brooke, The Pilates Body, Harmony Books, 2000. Striano, Philip, DC, Healthy Back Anatomy, Thunder Bay Press, San Diego, CA, 2011.