March 20, 2019

Fixing My Rib Flare

By Nikki Naab-Levy

As Pilates teachers, there are areas of the body that we are very aware of – in ourselves as well as in our clients. One of these of areas seems to be the ribs, or more specifically the rib flare where the lower front ribs lift up, increasing the appearance of a lumbar curve. When I was a newer teacher, my rib flare was prominent. Over the years, it’s become less noticeable as my spinal mobility and movement patterns have improved.

I share this to say that I have a nuanced understanding of rib flares and how to address them, particularly in my own body. I also have no pain or injuries. The only time my rib flare presents a “problem” is when a well-intentioned, but perhaps misinformed, teacher tries to “fix” it by forcing me into excessive thoracic flexion to get my ribs to look “right,” which for me triggers a headache.

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I recently experienced this when I took a private while traveling. The moment I started footwork, the teacher became fixated on getting back of my ribs and bra line to press into the carriage.

When I was unable to do this to her liking, she propped my head as high as the reformer would allow. When she began reaching for extra pillows, I politely informed her that having my head propped at that height was uncomfortable for my neck. Since I understood what she was trying to do, I told her that if she wanted my ribs to settle, we could either mobilize my spine or simply let it be and either way, by the end of the session my ribs would look far less flared. I also informed her that large amounts of thoracic flexion often trigger headaches for me.

Her response was, “I’ll make your ribs go down.” For the next hour, she proceeded to give me a session that was almost exclusively thoracic flexion exercises. At the end of the session, my ribs were down, but my body felt terrible and I had a headache.

I began to think that if I felt uncomfortable advocating for myself in this setting, then other clients might have had similar experiences. This prompted me to share my story on social media to start a discussion around the topic. Dozens of teachers commented that they had also felt berated because of the position of their ribs, shoulders, or pelvis and consequently they were afraid to take privates from teachers they didn’t know.

A small percentage of teachers missed what I was trying to say. Some offered suggestions on how I could correct my rib flare. One teacher went so far as to tell me that she had consulted a physical therapist about my “misalignment” and he had informed her that possible causes included “stenosis, a birth defect, dysfunctional breathing patterns, and weak abdominals.”

While I believe these teachers meant well, this experience and the comment above illustrates what happens if we prioritize “fixing” what we perceive to be misalignment over a client’s feedback and experience.

I’m not suggesting that we teach with a complete disregard for biomechanics or avoid offering corrections during a session. However, not only is it ineffective to try to change something in a single session by forcing a specific area of the body into an uncomfortable position but telling a client that a spinal condition or weakness is the cause of their pain is disempowering, creates fear, and presents a professional liability issue by going outside of the teacher’s scope of practice.

Clients often come to Pilates because they want to improve their fitness or return to regular activity after pain or an injury. When they walk through the door, there is a good chance that they already have some insecurity or fear.

If they have a fitness goal and aren’t in pain, it’s quite possible that they’re already sensitive to their posture and what they look like. They might feel embarrassed or ashamed about their current level of strength or athletic ability. They’ve never been on the equipment before. Everything is new. With this in mind, it would be easy to overwhelm someone with information or make them feel shame around their alignment, even though postural deviations are normal and not necessarily a problem.

Also, because our clients don’t know anatomical terms, they could interpret phrases like “weak psoas” or “poor gluteus medius activation” as a sign that something is wrong with them or that they are going to hurt themselves if they do an exercise incorrectly, when in reality these are just muscles that can be targeted through movement and the odds of tissue damage are low, particularly in the absence of pathology.

If a client does have pain, these statements can be even more demoralizing. A client might start to believe that if they don’t hold their body in a specific position or completely change their posture that they will be in pain forever. Given that posture has been proven to be a poor indicator of pain and that belief systems can support a positive outcome with pain management, not only it this untrue, but it can also keep someone in pain longer.

Finally, as Pilates teachers, it is out of our scope of practice to diagnose or treat our clients medically. We don’t have the training, licensure, knowledge, or tools to be able to tell if someone has a clinical condition and it is not our job to fix people. Suggesting to someone you think they have a condition isn’t just irresponsible. It might also be illegal (depending on where you live) and could result in litigation.

I don’t say this to criticize the industry. I recognize that this desire to fix alignment comes from a good place. However, if we find ourselves triggered by the position of a rib cage or a breath pattern, I think it’s worth asking why we feel so strongly about it and consider if it’s something that requires a high level of attention in a single session or moment. I also wonder if there is a more constructive way to share our information with clients while staying within our scope of practice.

As Pilates teachers, it’s a gift that we don’t have to focus exclusively on what’s wrong. This creates a beautiful space for us to help our clients to realize how much they are capable of. It’s far more empowering for someone to realize that they can get stronger and do more than to have them fixate on a perceived weakness. Additionally, referring a client out to the appropriate medical professional allows a client to get the treatment they need and can help us know which exercises are appropriate and safest for the client when they see us in the studio.

The most powerful thing we can do for a client is be present in the moment, listen to what they’re saying and guide them in a way that addresses both their physical and emotional needs.

square headshotNikki Naab-Levy is a Pilates teacher and massage therapist for people who aren’t zen, hate green juice, and are allergic to words like self-love (but kinda need it). She has over a decade of experience helping people build strength, improve mobility, and overcome injury.

Nikki holds a B.S. in Exercise Science and a B.S. in Journalism from Ohio University and is a Master Trainer for the Balanced Body Bodhi Suspension System. Her fitness wisdom has been featured in Greatist, Girls Gone Strong, The Balanced Body blog, and Men’s Fitness.

When she’s not teaching a sneaky hard Pilates class, you can find her hiking in the Pacific Northwest with her husband Kc, freelance fitness writing, and chain-drinking Americanos. For practical fitness advice + workouts that don’t hurt, visit her website NaabLevy.com or check out her podcast Moving Well on iTunes or Stitcher.