Issue #342 – August 18, 2021
Hips don’t lie: Moving Through a Post-surgery Pilates Challenge with a Senior Client
by Ivan Zagorsky
When learning Pilates, you hear mentors go on about “precautions” and “modifications” for things like osteoporosis, spondylolisthesis, stenosis, and hip replacement. After teaching some generic group classes where clients have never even heard any of these scary words before, you tend to think you will never need that information. Until one day you do.
About four months ago, I started training an 87-year old client who had both of her hips replaced within a few years of each other. And while the surgeries were successful, both times she was given exactly zero physical rehab exercises to do afterwards. That seems to be a part of the overall approach with some Russian doctors, who try to limit people’s movement at any given opportunity. You hurt a pinkie finger? Better stay in bed and not move for two weeks!
In this situation, a lack of physical rehab means my client now has valgus knees and improper walking patterns, which led to her falling quite frequently. Not to mention separate issues involving shoulder flexion and rotation. Oh, and no experience with exercise besides some very basic Qigong moves she did a few years ago.
If that doesn’t sound like enough of a challenge yet, let’s add the fact that our training sessions are conducted only via Zoom due to COVID risks. She also cannot do any exercises on the mat, because it would be too difficult physically and mentally to get up from the floor afterwards. But as the great Ernest Rutherford once said: “we didn’t have the money, so we had to think”.
So we have a chair, a couch, a dowel and a few elastic bands as our starter kit. The client claims she doesn’t have osteoporosis, but no bone density test results to back it up. She already spends a lot of time in a flexion pattern, so more flexion exercises are out of the equation.
First, we do gentle seated exercises moving the spine in different directions. I’m demonstrating some very gentle side bending, twisting and extension moves. As we move towards standing hip abduction and other basic rehab leg work with light elastic bands, I’m also realizing my verbal cueing has to be stepped up several notches, because of her advanced age and difficulty picking up completely new concepts right away. Her body is discovering completely new neural pathways and I have to try and correct compensation patterns which have been ingrained over nearly nine decades. The main tool that I have is the power of my voice, no matter how much I want to reach through the screen to make a very simple tactile adjustment. We finish each class with her holding a dowel vertically behind her back and then getting her to hinge properly in order to order to get up from her chair and sit back down.
The first several sessions lasted only a half an hour, leaving her completely exhausted – physically, as well as mentally – from all the new information her brain was receiving.
To make our planned 60-minute workout go the distance, I add a proprioception warm-up which has her doing things like tapping her arms and rubbing her hands in anticipation of the upcoming class. A few breathing exercises also prepare her for what’s to come and allow her to maintain a good breath rhythm throughout the class. Our mid-class break consists of neuroplasticity exercises: moving her eyes in one direction while the head moves in the other, holding up different amounts of fingers on each hand and quickly switching, etc. Sometimes I can almost feel her neural connections lighting up and blinking like my Wi-Fi router. Other times, it takes several classes to get the proper signal through. And when I see her movement mechanics start to suffer from apparent fatigue, we go to some much needed relaxation time on her couch. Of course that entails some “leisurely” pre-Pilates, such as Bent Knee Openings, Femur and Arm Arcs etc. The couch appears to be hard enough to serve as a mat, and it’s not like we have any other choice.
As her legs get stronger through the twice-a-week sessions, she is able to move around without walkers and canes. That means it’s a great time to focus even more on shoulder flexion. Getting her to move from her shoulder joint without recruiting the whole body for assistance is a huge challenge. We are using a variety of exercises and every prop she can get her hands on, except for her pet cat (for now) to achieve that goal. Small and steady range of motion wins the race here, but progress is slow.
As someone who does not yet have decades of experience, these sessions always keep me on my toes observing patterns, finding better cues and making the classes more efficient. Not everything that I see is clear to me at this point, and besides always consulting fellow professionals and researching more, there is some careful trial and error involved as well.
Despite these challenges, the satisfaction from these classes is great! Her daughter is also a client of mine and hearing her say that her elderly mom is full of energy after our classes and is able to take walks without much help is very encouraging. Not to mention seeing the matriarch herself get genuinely excited as we begin the class and always talking about how much better she has felt over the past few months.
Ivan Zagorsky is a Moscow-based Pilates instructor. After spending 14 years in the media business (and surviving the physical and mental stress of it only thanks to Pilates), I realized that my calling in life is helping people avoid stress to live deeply inspiring energetic lives through healthy, functional movement – and became a Pilates instructor. I enjoy exploring both Classical and Contemporary work, and the different styles and methods which have evolved over the years. I currently run online and in-person classes in Russian and English for people all over the world – and add stress-reduction elements of meditation and other disciplines to enhance the students’ experience.