Pilates Through Anxiety

Pilates Through Anxiety Evelynn Korszyk August 29, 2017 Los Angeles 2016

Abstract Page Anxiety disorders are the most common mental illness in the United Stated, affecting 40 million adults (18.1% of the population) ages 18 and older. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety (even though less than 40% of those suffering actually receive treatment). Anxiety disorders develop from a complex set of risk factors: - Genetics - Brain chemistry - Personality - Life events (traumatic experiences and/or consistent stress) - Medical conditions and certain medications Symptoms of anxiety can include, but are not limited to: - Feeling nervous, restless or tense - Having a sense of impending danger, panic or doom - Breathing rapidly (hyperventilation) and/or increased heart rate - Sweating - Trembling - Feeling weak, fatigued, tired or sleepy - Trouble concentrating or thinking about anything other than the present worry - Trouble sleeping or over-sleeping - Gastrointestinal problems - Difficulty controlling worry - Urge to avoid things and people that used to bring you joy Anxiety can easily be described as a disorder that deeply affects the mind, body and spirit. Because of its developmental factors and symptoms, anxiety needs to be treated from a perspective that develops all those areas. Contrology [Pilates] develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind, and elevates the spirit. Joseph H. Pilates 2

Table of Contents Abstract Page Page 2 Table of Contents Page 3 Anatomical Description Page 4 Case Study and BASI Conditioning Program Page 6 Conclusion Page 15 Bibliography Page 16 3

Anatomical Description 2002 Time Magazine (Jan 10, 2002) 4

The amygdala is a small structure located deep inside the brain, and is believed to be the center of communication between incoming information to the brain and how they are interpreted. This is the part of the body the alerts the rest of the brain that there is a threat, and it will trigger a fear or anxiety response in the body. The amygdala also stores memories that are directly linked to our emotions, whether fear, happiness, love or anger. Another part of the brain is the hippocampus. This is the part of the brain that interprets threatening events and stores them into memories. Its role is to replay these memories and attempt to prevent the threat from happening again. The feeling of anxiety is the body s stress response. An anxious body never turns off the fight or flight responses in the brain, and the person will live with the emotional and physical effects of anxiety, even when there is no reason or cause for them. When the fight or flight response is triggered, the body s system is flooded with norepinephrine and cortisol. Too much of these hormones are extremely harmful to the body and can lead to the shutdown of vital organs and death. The image carefully shows and explains the different aspects of the brain and their functions, and the path the brain takes when a threat is presented. Note the gun in front of the eye the brain sees a threat and it either turns on the fight or flight response or it does not. When it comes to anxiety, brain cannot tell the difference between being attacked by a bear or being so overly stressed at work that it causes anxiety. Both are considered and triggered as life-threatening events in the brain. 5

Case Study and BASI Conditioning Program Tina is a 29-year-old woman who began experiencing signs of anxiety two years ago. After suffering with the symptoms for five months, she finally decided to see a doctor and was officially diagnosed with General Anxiety Disorder. She was recommended to a psychiatrist for further evaluation, medication, and routine check-ups. The psychiatrist confirmed the primary physician s diagnosis and prescribed 20mg Lexapro per day, 0.5mg Xanex to be used as necessary, 5,000mg Vitamin B12 daily, 5,000mg Vitamin D daily, 400mg Magnesium Glycinate daily, and Probiotics daily. She was also referred to a therapist to talk about her triggers of anxiety and depression, revisit the past to learn from it, and how to equip herself to avoid anxiety in the future. Knowing Tina s aggressive and extremely stressful career as a wedding and event planner and designer, the therapist recommended that she go on a strict daily routine with everything from her work hours, diet, exercise and sleep patterns to alleviate the stress and therefore alleviate the anxiety. Tina had decided she wanted to try Pilates. She had never done it before, but the idea of going somewhere where she thought she could lightly workout and not think about work, life or her problems sounded appealing. She committed to 12 private Pilates sessions. She had no physical goals like losing weight, toning or strengthening. Her only goals listed were to be able to alleviate her stress and remove herself from her crazy world throughout the duration of the session. After 12 sessions, not only has she alleviated her stress and anxiety, she began her life-long practice of Pilates and saw numerous positive changes to her life body, mind and spirit. 6

Weeks 1-4 I start Tina with a Postural Analysis starting with the feet and moving all the way up to the head. The number one goal in Pilates is for proper alignment mind, body and spirit. Teaching Tina how to stand with her feet directly underneath the knees at hip distance apart, bringing her pelvis into neutral, keeping the ribs aligned, avoiding rolled shoulders, and keeping the head in line, attempting to create the perfect plumb line. Tina did not roll her feet in or out, nor had them turned in or turned out. She had a very anteriorly tiled pelvis, and beginning kyphosis in the spine due to the immobility of the vertebrae, rolled shoulders and forward neck. I knew that as an instructor, to analyze where a client is from the very beginning would guide me in the session and know what exercises to do to help the body in front of me. After the Posture Analysis, I wanted to focus specifically on lateral breathing, as breath has so much to do with stress and anxiety. After teaching Tina how to breathe profoundly and breathing through the ribs, she said as though it felt as she had been breathing for the first time. From there, Tina went into her first three Roll-Downs, which I also used to assess her. Breath was very important here, as it allowed her neck and head to fully lower down, and allowing the arms to release in front of her. I cued her about her posture the entire time, and she felt very relived and stretched just after the rolldowns. We continue the session with fundamental exercises on the Reformer, progressing through the Block System. For the following three weeks, I very slowly increased the level of difficulty through spring tension and exercises. I learned that Tina had extremely tight pectoral muscles, lower back and hamstrings. She also had limited range of movement in the shoulders. We focused on stretching, lengthening and extending. 7

Weeks 1-4: Highlighted Exercises through the Block System Warm Up - Mat Fundamental Warm-Up: Pelvic Curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation - Reasoning: Teaching Tina the pelvic curl in the supine position, beginning with the pelvic tilt and articulating the spine all the way to the shoulder girdle. Breath was very important in all the warm-up exercises to begin preparing the body for the session. Foot Work - Reformer: Fundamental Foot Work Series (removing Prehensile) - Reasoning: Extension of the legs was profound for Tina. Learning what muscles the body was using, and primarily learning to relax the back extensors while the legs were moving. We focused on the stability of the pelvis in neutral, as well as keeping the stability in the feet throughout the exercises. Abdominal Work - Reformer: Hundred Prep (increasing spring tension slightly in Week 3) - Reasoning: Strengthening the core muscles and learning to release the lower back extensors. We focused on drawing into the deeper abdominal muscles and activating the transverse abdominals. Hip Work - Reformer: Frog, Circles (down, up), Openings - Reasoning: Control of the muscles, strengthening the adductors, lengthening the leg muscles as they reach throughout the exercises. We emphasized on the lumbar stability and neutral pelvis. Stretches - Reformer: Standing Lunge - Reasoning: Stretching was something that Tina hadn t done in years. She could not get to full extension in the hamstring, but through the weeks she progressively loosened up and lengthened. Arm Work - Reformer: Arms Supine Series: Extension, Adduction, Circles (up, down), Triceps - Reasoning: Starting with one blue spring and progressing to one red spring through the weeks, working and stretching the arm muscles, avoiding the engagement of the trapezius muscles. We focused on deep breathing through each movement to increase the mind and body awareness. Lateral Flexion/Rotation - Reformer: Mermaid - Reasoning: Focusing on engaging the oblique muscles and drawing the lifted hip downwards, Tina was able to really open up her sides and feel an incredible stretch. Back Extension - Reformer: Pulling Straps 1 and Pulling Straps 2 - Reasoning: Trying to avoid continued use of the trapezius muscles, attempting to lengthen the arms as they pull back. Back extension was a challenge for Tina in the beginning, but as she learned to activate the correct muscles and proper alignment throughout the weeks, she got increasingly better at these exercises. 8

Weeks 5-8 After the first four weeks, Tina started to feel more confident and connected to her body. She said that she had felt muscles that she had never felt before, and that paying attention to her posture was becoming a common thing throughout her day. Although her body was still tight, I was really happy with the progress we had made. I wanted her to feel the mind body connection in herself, because it will allow her to be aware of her natural tendencies to tighten up, have bad posture, and hold all her stress in her shoulders and neck, all which lead to her anxiety. Even though I had introduced her to most of the fundamental exercises on the Reformer, most were not quite perfected yet. In order to not throw too much at her, I wanted to stick with fundamental exercises throughout her session, but implement some intermediate exercises to challenge her core and include some mat exercises to stimulate the mind. One thing Tina did say after the first few weeks was that she loved coming to Pilates for the mental benefits for that one hour, she was incapable of thinking about anything else (the stresses of her life, her work, etc.), because she was so focused on my verbal cues and trying to feel it in her body. And for that one hour, she felt like she was mentally free. As I learned from my anatomical study of anxiety, releasing the fight or flight response allows the body to relax. So keeping that in mind, I wanted to introduce her to mat exercises that would compliment the work we had started on the Reformer. I didn t want to stimulate and overwhelm her too much, so I still stayed away from the Cadillac and Wunda Chair, because the overstimulation might cause an adverse affect and trigger anxiety. 9

Weeks 5-8: Highlighted Exercises through the Block System Warm Up - Mat Fundamental Warm-Up: Pelvic Curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation - Reasoning: Fine tuning the movements and focusing on engaging the correct muscles. Articulation in the lower back during the Pelvic Curl has improved, but still needs work. We focused on engaging the hamstrings during the exercises an area she is very weak in. Foot Work - Reformer: Fundamental Foot Work Series (removing Prehensile) - Reasoning: Focusing on initiating the movement from the hamstrings, versus just relying on the power of the quads. We focused on the stability of the pelvis in neutral, as well as keeping the stability in the feet throughout the exercises. Abdominal Work - Mat: Hundred - Reasoning: Breath. Breath. Breath. Pairing the movement with the correct breath was a challenge in the beginning. Having learned how to breathe correctly, Tina was able to realize how her breath actually changed her movement, compared to when she would try holding her breath during this exercise. Hip Work - Reformer: Frog, Circles (down, up), Openings - Reasoning: Adding a quarter more weight for these weeks, we focused on the control of the muscles, strengthening the adductors, and lengthening the leg muscles as they reach throughout the exercises. We continued to work on the lumbar stability and neutral pelvis. Spinal Articulation - Reformer: Bottom Lift (adding with Extensions in week 7) - Reasoning: Learning how to do this exercise in the Warm-Up from the very first session was the perfect setup to now bring the feet onto the foot bar for more hamstring challenge. Keeping the heels still was difficult in the beginning. We focused on properly engaging the leg muscles and not flaring the ribs when in the up position. Stretches - Reformer: Kneeling Lunge - Reasoning: Stepping up from the standing lunge, Tina was able to stretch the hip flexors well, but still could not get full extension in the hamstrings. She stayed where she felt the stretch and kept breathing throughout the exercise. Full Body Integration F/I - Reformer: Upstretch 1, (Upstretch 2 in week 7) and Elephant - Reasoning: Progressing through the Block System, Tina s core was ready for the challenge. The setup took a little while in the beginning, and properly engaging the abdominals without moving the upper body (except in Upstretch 2) was a challenge in the beginning. Arm Work - Reformer: Arms Kneeling Series: Chest Expansion, Circles (up, down), Triceps, Biceps - Reasoning: Starting with one blue spring and progressing to one red spring through the weeks, working and stretching the arm muscles, avoiding the engagement of the trapezius muscles. We focused on deep breathing through each movement to increase the mind and body awareness. 10

Leg Work - Reformer: Single Leg Skating - Reasoning: Knowing how to engage her leg muscles and stabilize through her core, I felt as though Tina was ready for the challenge of Leg Work. We focused on maintaining a neutral pelvis throughout the exercise, as well as keeping the body perfect still and only focus on moving the moving leg. Lateral Flexion/Rotation - Reformer: Mermaid - Reasoning: Focusing on engaging the oblique muscles and drawing the lifted hip downwards, Tina was able to really open up her sides and feel an incredible stretch. Back Extension - Reformer: Breaststroke Prep - Reasoning: Having little movement in the thoracic spine as a result of the forward shoulders and bad posture, back extension is something I did very carefully with her. We started with just the arm movement the first two weeks, and then progressed to the variation of lifting her trunk as her arms straightened in week 7. 11

Weeks 9-12 Tina has established the fundamental movements of Pilates and is ready to move onto other apparatuses and increase the challenge of the exercises. Her flexibility in her hamstrings has dramatically improved, and she is more focused on her posture than ever. Consistently opening up the chest and clavicle, while avoiding rolled shoulders, has allowed her to breathe more profoundly and take deeper breaths. The breathing in and of itself has reduced her anxiety tremendously. Her mind, body and spirit awareness and connection was close to non-existent prior to Pilates. In the first 8 weeks, she has become so much more aware of her body and has learned to activate muscles on command, rather than the body just functioning on the body s path of least resistance and remaining in her bad posture. Standing taller and straighter has improved her confidence, and in turn has reduced her anxiety in that way as well. With that in mind, I decided to introduce her to the Cadillac, which requires correct muscle recruitment almost immediately in order to do the exercises correctly. We kept the exercises fundamental on the Cadillac for the first couple of weeks, and then moved onto more intermediate exercises in Week 11. The exercises increased her strength and control, while remaining connected to her breath and mind. In Week 12, I introduced her to the Wunda Chair, my favorite piece of equipment and in my opinion, one of the hardest. Still keeping her decreasing anxiety in mind, I don t want to overwhelm Tina with too much too quickly, so I only added a couple exercises on the Wunda Chair to keep things fresh and evolving. 12

Weeks 9-12: Highlighted Exercises through the Block System Warm Up - Mat Intermediate Warm-Up: Roll Up, Spine Twist Supine, Double Leg Stretch, Single Leg Stretch, Criss Cross - Reasoning: Introducing Tina to the Intermediate Warm-Up was a challenge for her right away. Focusing on the articulation of the spine and increasing her core strength throughout the exercise. Stabilizing the pelvis throughout each movement. Foot Work - Cadillac: Foot Work Series - Reasoning: Stabilizing the core and pelvis throughout the movement was key. Tina s hamstrings are very tight, so this series was a deep stretch and challenge for her. Abdominal Work - Cadillac: Roll Up with RUB, Mini Roll-Ups, Mini Roll-Ups Oblique, Roll-Up Top Loaded - Reasoning: Having established proper primal articulation and strengthening the core during the first 8 weeks, Tina was ready for the intermediate abdominal exercises on the Cadillac. We focused on co-contracting abdominals and back extensors to stabilize her trunk, while keeping her legs and feet engaged and weighted. Hip Work - Cadillac: Frog, Circles (down, up), Walking, Bicycles - Reasoning: A set up from the Reformer Hip Work Series, having each foot on its own spring was a challenge for Tina. Pelvic stabilization was what we really focused on while moving the legs correctly. Spinal Articulation - Reformer: Short Spine - Reasoning: A major challenge for her tight hamstrings, this was an incredible stretch for Tina s lower back extensors and increasing the articulation in the lumbar spine. Stretches - Reformer: Kneeling Lunge - Reasoning: Continued to work on getting full extension in the hamstrings. She stayed where she felt the stretch and kept breathing throughout the exercise. Full Body Integration F/I - Reformer: Upstretch 1, Upstretch 2, Upstretch 3 - Reasoning: After having done Upstretch 1 and 2 for a couple weeks, we increased the challenge by adding Upstretch 3. Using both her abdominals and back extensors, she was able to move from the Front Support Position to the Upstretch Position with ease at the end. Arm Work - Reformer: Arms Kneeling Series: Chest Expansion, Circles (up, down), Triceps, Biceps - Reasoning: Worked on stretching and strengthening the arm muscles, while avoiding the engagement of the trapezius muscles. Full Body Integration A/M - Reformer: Balance Control Front and Balance Control Back Prep - Reasoning: Core needs to be strong and developed in order to do the exercises well. We worked on shoulder extensor strength and scapular stabilization to avoid sinking into the shoulders, which is easy for Tina to do. 13

Leg Work - Reformer: Side Split - Reasoning: Continued work on her hip abductor strength, while keeping the pelvis and spine in neutral throughout the movement. Lateral Flexion/Rotation - Reformer: Side Over on Box - Reasoning: A major exercise for the obliques, the challenge for Tina was to keep her body in between two panes of glass. The natural tendency was to lean forward in the upper body in order to use more of the abdominal strength to move. Back Extension - Wunda Chair: Swan on Floor - Reasoning: Tina loved the shoulder stretch at the Set-Up position. It further opened up her chest and stretched her pectoralis muscles, which are tight. Instead of focusing on height of the back extension, we focused on length lengthening through the crown of the head and through the feet. The stretch was incredible for her, and the perfect way to end our sessions. 14

Conclusion The progress I have witness in Tina through Pilates has been absolutely incredible. I am so glad I was able to take her through the beginning of her Pilates journey, and see first-hand how her anxiety has decreased the past three months, her posture has improved, her character has brightened, and she is overall happier. I witnessed first-hand what Joseph Pilates meant when he said that his method was a mind, body and spirit connection, a lifestyle learning things that are to be applied to your daily life. The principles of Pilates that were discussed and ingrained in Tina from the very first session seeped into her daily life, and she was not only able to see a difference in her body physically through the toning and development of muscles, but she felt the difference Pilates made in her life internally, especially mentally. The BASI Block System was the perfect method to introduce her to the work, as well as progress her throughout the weeks. I realized that there is a reason the blocks are in a certain order, as it allowed Tina to warm-up properly, engage the proper muscles throughout the more challenging exercises, and finish off with an exercise that opened up her chest and allowed her to breathe more profoundly. Tina is committed to making Pilates a part of her life for the rest of her life, and continuing on a path to being anxiety-free. [Pilates] is a lifelong journey of learning and practice that deepen understanding of movement and offer a path to physical and mental well-being. Rael Isacowitz 15

Bibliography "The Anatomy of Anxiety." Time Magazine. 10 Jan. 2002. Web. 24 August 2017. Anxiety Symptoms. Mayo Clinic. Web. 26 August 2017. "Facts and Statistics." Anxiety and Depression Association of America, ADAA. Web. 26 August 2017. Isacowitz, Rael. Pilates. Champaign, IL: Human Kinetics, 2006. Print. Isacowitz, Rael, and Karen S. Clippinger. Pilates Anatomy. Champaign, IL: Human Kinetics, 2011. Print. Pilates, Joseph. Pilates' Return to Life Through Contrology. (1945-2011) Presentation Dynamics. Print. 16