Pilates Anatomy

Chapter 2

Spine, Core, and Body Alignment

Body alignment can be described as the relative positioning of body segments, such as placement of the head relative to the shoulders. Static alignment is this relative positioning when the body is stationary. The relative positioning that occurs during movement is dynamic alignment. Both static and dynamic alignment are important in Pilates. Pilates should improve awareness of body alignment as well as your ability to achieve the desired body alignment associated with a given movement or position.

The Skeleton

To understand and improve alignment, we need to look deep inside the body at the structural building blocks—the 206 bones of the human skeleton—that help determine alignment. The skeleton has two major divisions: the axial skeleton and the appendicular skeleton. As seen in figure 2.1 on page 10, the axial skeleton (in yellow) is made up of the skull, vertebral column (spine), ribs, and sternum (breastbone). As its name suggests, when standing, the axial skeleton forms the central upright axis of the body to which the limbs are attached.

The appendicular skeleton consists of the bones that make up the limbs, or appendages. The appendicular skeleton has two subdivisions: the paired upper extremities and the paired lower extremities. Each of the two upper extremities (shown in green in figure 2.1) contains one clavicle (collarbone); one scapula (shoulder blade); one humerus (upper arm bone); one radius and one ulna (the forearm bones); and eight carpals, five metacarpals, and 14 phalanges (the bones of the hand). Each of the two lower extremities (shown in blue in figure 2.1) contains one os coxae (hip bone); one femur (thigh bone); one tibia (shinbone) and one fibula (the smaller bone in the lower leg); and seven tarsals, five metatarsals, and 14 phalanges (the bones of the foot). In the adult, one hip bone, technically termed theos coxae or coxal bone, is made up of three fused bones: the ilium, ischium, and pubis.

Figure 2.1 Bones of the skeleton (front view). The axial skeleton is in yellow. The two subdivisions of the appendicular skeleton are shown; the upper extremities are in green, and the lower extremities are in blue.

Figure 2.1 Bones of the skeleton (front view). The axial skeleton is in yellow. The two subdivisions of the appendicular skeleton are shown; the upper extremities are in green, and the lower extremities are in blue.

The Essential Spine

The spine provides the primary movements of the axial skeleton. And the movement, stability, and alignment of the spine are an essential focus in Pilates.

Elemental Vertebrae

The spine, or vertebral column, is made up of 33 bones called vertebrae that are stacked one upon the next to form a long columnlike structure. As shown in figure 2.2 on page 11, the vertebrae get larger in size from top to bottom as they progress from the neck to the pelvis. The vertebrae are arranged in five regions. The first three regions are depicted in color in figure 2.2 for emphasis, as these three regions contain the 24 vertebrae that are responsible for the primary movements of the spine.

Figure 2.2  Regions and curves of the spine (view of right side of vertebral column).

Figure 2.2 Regions and curves of the spine (view of right side of vertebral column).

• Cervical (green). The top seven vertebrae that span from below the head to the base of the neck are the cervical vertebrae. The smallest and lightest vertebrae, they are essential for movements of the head and neck.

• Thoracic (blue). The next 12 vertebrae are the thoracic vertebrae. They span from just below the neck to the last rib and gradually increase in size from top to bottom. They are unique in that they articulate with the ribs. The thoracic vertebrae are key for movements of the thorax, including the upper back.

• Lumbar (yellow). The next five vertebrae are the lumbar vertebrae. They span from just below the last rib to the pelvic girdle. These vertebrae are stronger and more massive than those above and are essential for their weight-bearing function. The lumbar vertebrae are important for movements of the lower back.

• Sacrum. The next five vertebrae are called the sacral vertebrae. Rather than act independently, they are fused in adults to form the triangular-shaped sacrum. Each side of the sacrum joins with one hip bone, providing important stability for the pelvis. Because these vertebrae are fused, the primary movements of the sacrum occur relative to the last lumbar vertebrae. This joint between the last lumbar vertebra and the sacrum is called the lumbosacral joint. Movements at this joint have a profound influence on alignment of the lower back and pelvis.

• Coccyx. The last four (or sometimes three or five) vertebrae are called the coccygeal vertebrae. They are fused to form a small triangle that is considered the vestigial tailbone. Hence, these vertebrae are often collectively referred to as the tailbone, although their technical name is the coccyx.

As can be seen in figure 2.2, the spine is not a straight rod. Instead, each of these regions has a distinct curve when viewed from the side. The cervical and lumbar regions are curved such that they are concave to the back, while the remaining regions are curved such that they are concave to the front. Ideally, these curvatures are each of a normal magnitude and are balanced relative to one another. These curves play an important role in both enhancing movements of the spine and shock absorption.

Joints Between Vertebrae

The lumbar, thoracic, and all but the top two cervical vertebrae are joined to the vertebrae above and below by a series of joints that greatly influence the ranges of motion that are possible between consecutive vertebrae. As shown in figure 2.3, the front rounded portion of each vertebra (the vertebral body) is joined to adjacent vertebrae by an intervertebral disc, forming a cartilaginous joint. This intervertebral disc has a strong outer ring of fibrous tissue called the annulus fibrosus (shown in gray) and an inner gelatinous central mass, the nucleus pulposus (shown in purple). The nucleus pulposus has a high water content, and the discs can be likened to little water cushions between the vertebrae that are vital for shock absorption and protection of the spine.

Figure 2.3 Joints of the spine. Facet joints and intervertebral discs, with a detail of an intervertebral disc.

Figure 2.3 Joints of the spine. Facet joints and intervertebral discs, with a detail of an intervertebral disc.

The back portions of these vertebrae are also connected by little paired joints called facet joints that allow small gliding movements. The shape and facing of the projections of the vertebrae (the articular processes) that come together to form these facet joints influence the movement allowed in this region of the spine. For example, the facing of the facet joints enhances rotation in the thoracic region but limits rotation in the lumbar region.

The motion of the vertebral column is also influenced by the presence of many strong bands of fibrous tissue that span between the vertebrae. These ligaments help control how far a vertebra can move in a given direction, provide important stability for the spine, and help prevent forward or backward bulging of the intervertebral discs.

Many factors such as strength imbalances, flexibility imbalances, postural habits, and injuries result in most people having areas in the spine in which movement is restricted, movement is excessive, or movement is asymmetrical. One of the goals of Pilates is to help fully utilize the potential range in each segment of the spine in a symmetrical manner.

Movements of the Spine

The large movements of the spine utilized in Pilates are illustrated in figure 2.4. Spinal flexion refers to a forward bending of the spine such as what occurs when rolling the spine down to touch the toes or when curling the upper trunk forward and up into a sit-up; extension describes a straightening of the spine from a flexed position or movement backward beyond straight (figure 2.4a). The backward movement beyond straight can also be termed spinal hyperextension. Bending the spine sideways to the right is called right lateral flexion, while bending it back up toward a straight position or to the opposite side is termed left lateral flexion (figure 2.4b). Rotating the head or upper trunk so that the face or chest faces to the right is called right rotation, while rotating the head or upper trunk back to center or toward the other side is termed left rotation (figure 2.4c).

Figure 2.4 Movements of the spine:  (a)  flexion and extension;  (b)  right lateral flexion and left lateral flexion;  (c)  right rotation and left rotation.

Figure 2.4 Movements of the spine: (a) flexion and extension; (b) right lateral flexion and left lateral flexion; (c) right rotation and left rotation.

Primary Muscles of the Spine

Many muscles of the spine produce movement or affect stability. Two of the most vital muscle groups are the abdominals and spinal extensors. The iliopsoas and quadratus lumborum also are key in certain circumstances.

Abdominals

The abdominals have long been appreciated for their potential to help create a flatter abdomen, enhance movement technique, improve certain postural problems, and reduce the risk for certain types of back injuries. There are four paired abdominal muscles: rectus abdominis, external oblique, internal oblique, and transversus abdominis. All of the abdominals attach into a tendinous band that runs vertically down the center of the abdomen (linea alba), but the location and direction of their muscle fibers are quite different. As seen in figure 2.5a, the rectus abdominis runs straight up and down in the central portion of the abdomen. In contrast, the external oblique runs diagonally downward toward the center, with its muscle fibers located to the side of the rectus abdominis. The internal oblique is deep to the external oblique, and its upper fibers run upward toward the center, with its muscle fibers also lateral to the rectus abdominis.

When both sides of these three abdominals contract simultaneously, they are all capable of producing spinal flexion, with the rectus abdominis being particularly powerful. When one side of these three abdominals contracts, they are all capable of producing lateral flexion to the same side, with the obliques being particularly effective. Contraction of one side of the obliques can also produce rotation, with the external oblique producing rotation to the opposite side and the internal oblique producing rotation to the same side. When you perform a curl-up type of exercise such as Chest Lift (page 54), both sides of all three of these abdominals work to produce the desired flexion of the spine. However, when rotating to the left, as in Chest Lift With Rotation (page 64), only the left external and right internal obliques can produce the desired rotation, while both the right and left rectus abdominis muscles primarily act to maintain the spine lifted off the mat in flexion.

The fourth abdominal muscle, the transversus abdominis (transverse abdominal muscle) is generally the deepest abdominal muscle. Its fibers run in an approximately horizontal direction across the abdomen as seen in figure 2.5b. Hence, it is not capable of producing spinal flexion, although it may assist with rotation. Its primary function is considered postural, and its contraction results in pulling the abdominal wall inward and compressing the abdominal contents similar to a corset. The transversus abdominis has been shown to play an important role in protecting the spine, automatically contracting to help stabilize the healthy spine and pelvis just before movements of the limbs. It can also aid with respiration and is recruited with forced expiration. In Pilates, therefore, an exhalation is sometimes used to encourage its activation. There is a strong emphasis on the use of the transversus abdominis in many current approaches to teaching Pilates.

Figure 2.5 Abdominals:  (a)  front view of external oblique and rectus abdominis on left side of body and rectus abdominis and internal oblique on right;  (b)  side view of trunk showing transversus abdominis.

Figure 2.5 Abdominals: (a) front view of external oblique and rectus abdominis on left side of body and rectus abdominis and internal oblique on right; (b) side view of trunk showing transversus abdominis.

Spinal Extensors

The paired spinal extensors are located on the back of the trunk, and they share the common action of extending the spine, or back. These vital muscles that at one time were neglected in favor of emphasizing abdominal strength have been shown to be key for optimal movement performance; prevention of certain back injuries, osteoporosis, and certain postural problems; and successful return to activity after back injury. The spinal extensors can be divided into three groups: the erector spinae, semispinalis, and deep posterior spinal group. As seen in figure 2.6, the erector spinae, the most powerful of the spinal extensors, is made up of three columns: the spinalis, longissimus, and iliocostalis. Deep to the erector spinae, the semispinalis is present only from the thoracic spine upward. Strengthening this muscle group can help prevent the common tendency for a slumped upper back posture. The deep posterior spinal group—interspinales, intertransversales, rotatores, and multifidus—is parallel in function to the transversus abdominis. Its primary role is stabilization of the spine and small movements of one vertebra relative to an adjacent vertebra (segmental movement). One of the members of this group, the multifidus (lumbar portion seen in figure 2.6), has been shown to be particularly vital for stabilization and rehabilitation of the spine. The multifidus spans more vertebrae and has the potential to produce more force than the other components of this deep group because of its attachments. Therefore, use of this muscle is often emphasized.

In terms of action, contraction of both sides of these three muscle groups (erector spinae, semispinalis, and deep posterior spinal group) produces spinal extension, whereas contraction of one side (except for the interspinales) can produce lateral flexion to the same side. Contraction of one side of the erector spinae (except for the spinalis) can also produce rotation to the same side, while contraction of one side of the semispinalis and some of the deep posterior spinal group (the multifidus and rotatores) can produce rotation to the opposite side. When you perform an exercise such as Back Extension Prone (page 66), both sides of the erector spinae, semispinalis, and deep posterior spinal group can produce the desired extension of the spine, with the erector spinae being the most powerful. However, when rotating to the right, such as in Swimming (page 184), two columns of the right erector spinae, the left semispinalis, the left multifidus, and the left rotatores primarily work to produce the desired spinal rotation while maintaining a lifted spine off the mat in extension.

Figure 2.6 Spinal extensors and the quadratus lumborum (back view of vertebral column). The three columns (spinalis, longissimus, and iliocostalis) of the erector spinae are shown on the left side. The semispinalis, multifidus (a key member of the deep posterior spinal group), and quadratus lumborum are shown on the right side of the spine.

Figure 2.6 Spinal extensors and the quadratus lumborum (back view of vertebral column). The three columns (spinalis, longissimus, and iliocostalis) of the erector spinae are shown on the left side. The semispinalis, multifidus (a key member of the deep posterior spinal group), and quadratus lumborum are shown on the right side of the spine.

Quadratus Lumborum and Iliopsoas

The quadratus lumborum and iliopsoas also have important actions relative to the spine that come into play with Pilates mat work. As shown in figure 2.6, the quadratus lumborum attaches from the pelvis to the sides of the lumbar spine and the lowest rib. When one side contracts, the quadratus lumborum can produce spinal lateral flexion to the same side.

The iliopsoas (figure 2.7a) is a powerful muscle that is primarily known for its ability to lift the leg high to the front (hip flexion), which will be discussed in the next chapter. As seen in figure 2.7b, its attachments onto the spine also allow the iliopsoas to serve a vital role in helping to maintain the desired normal curvature of the lumbar spine and assist with lateral flexion of the lumbar spine.

Use of Spinal Muscles in Pilates

Identifying the muscles actually used in a given Pilates mat exercise is often complicated by various factors. One important consideration is the relationship of the body to gravity throughout a given exercise. In addition, many Pilates movements utilize a simultaneous contraction of multiple spinal muscles in order to achieve the desired form and integration of the Pilates principles.

Figure 2.7 Iliopsoas muscle  (a)  primarily made up of the psoas major and iliacus (front view);   (b)  helping to maintain the lumbar curve (side view).

Figure 2.7 Iliopsoas muscle (a) primarily made up of the psoas major and iliacus (front view); (b) helping to maintain the lumbar curve (side view).

Influence of Gravity on Spinal Muscle Use

The position of the body relative to gravity greatly influences which muscles will work in a given mat exercise. When you are lying on your back and facing the ceiling (supine position), spinal flexion occurs against gravity and so provides a greater challenge for the abdominals. Therefore, many Pilates mat exercises that aim to improve abdominal strength and endurance incorporate a supine position, such as some of the exercises in chapter 5. To emphasize improving the muscular strength and endurance of the obliques, rotation can be added to spinal flexion performed from a supine position or lateral flexion performed from a side-lying position where it is effectively opposed by gravity, such as some exercises in chapter 8. Lateral flexion can also be produced by the quadratus lumborum and spinal extensors. Subtle changes in the alignment of the legs, pelvis, and spine influence the relative contributions of these muscles during exercises involving lateral flexion. From a prone position (lying on your belly, face toward the mat), spinal extension occurs against gravity and so provides a greater challenge for the spinal extensors. Many Pilates mat exercises that aim to improve muscular strength and endurance of the spinal extensors incorporate a prone position, such as some of the exercises in chapter 9.

Cocontraction of Spinal Muscles

Pilates often requires a skilled contraction of different spinal muscle groups at the same time, a process called cocontraction. Back Extension Prone (page 66) provides an example of cocontraction. Even though the spinal extensors are the muscles being focused on for strength, a cocontraction of the abdominals is used to limit the magnitude of hyperextension that occurs in the lower back and help protect the lower lumbar spine, which is very vulnerable to injury.

Some of the more complex mat exercises involve a changing of the body’s position relative to gravity in different phases of the movement, necessitating a modification in how the spinal muscles work. An example is Jackknife (page 123), in which the abdominals are predominantly used to flex the spine for the rollover phase, but cocontraction of the spinal extensors becomes important in the phase when the legs and trunk reach up toward the ceiling. Cocontraction is widely used in Pilates both to help with the achievement of optimal technique and to reduce risk of injury for the back.

Discovering Your Powerhouse

The powerhouse, or core, can be described as the area from the bottom of the rib cage to a line across the hip joints in the front and to the base of the buttocks in the back. Joseph Pilates placed great emphasis on the powerhouse, considering it a physical center of the body from which all Pilates movements should proceed. Many Pilates exercises are designed to strengthen the powerhouse, and there is a desire to keep the powerhouse working consistently throughout a given exercise. If the powerhouse is being used appropriately, the limbs should be able to move in a more coordinated and connected manner.

Some Pilates practitioners and many people in disciplines such as dance, fitness, and rehabilitation also refer to this area as the core and the desired maintenance of appropriate positioning and activation during movement as core stability. Core stability can be thought of as the ability to keep the pelvis and spine in the desired position while moving the limbs or the whole body through space without undesired distortions or compensations. Someone who is not maintaining desired control of this area in a given movement and who arches the lower back or moves the pelvis excessively is often said to have a weak core or demonstrate poor core stability or poor core control.

In Pilates terminology, the powerhouse consists of the abdomen, lower back, and pelvis. The abdominals and the lower spinal extensors are considered particularly key to the concept of the powerhouse and have already been discussed earlier in this chapter. In addition, the concept of the powerhouse includes the pelvis and, in general, the primary muscles that influence the movement and stability of the pelvis.

Each hip bone (os coxae) is connected firmly in the back to one side of the sacrum at the paired sacroiliac joints. The hip bones are also connected to each other in the front via a joint called the pubic symphysis. These strong connections allow the hip bones along with the interposed sacrum and coccyx to act as a unit, referred to as the pelvic girdle. As described earlier in the chapter, each hip bone is actually made up of three bones—the ilium, ischium, and pubis. Each of these bones has landmarks commonly used for identifying body alignment.

Bony Landmarks of the Pelvis and Hip

Bones have distinct markings such as indentations, openings, lines, and protrusions that are collectively termed bony landmarks. The selected bony landmarks described here and shown in figure 2.8 are helpful in identifying core alignment and stability.

• Iliac crest. The ilium is the large upper winglike portion of the hip bone. If you move your hands down from your waist, you will feel a large ridge of bone. This is the upper border of the ilium. This convex border is called the iliac crest.

• Anterior superior iliac spines (ASIS). If you slide your hands to the front of the iliac crests and then slightly down, you will feel a bony prominence on each side of the front of the pelvis. These paired prominences are called the anterior superior iliac spines (ASIS).

• Pubic symphysis (PS). The pubis forms the lower and front portion of each hip bone. The pubis of each hip bone join at the front to form the pubic symphysis, connected by a disc of cartilage. You can see the pubic symphysis by standing with your side to a mirror. The pubic symphysis is the portion of the lower pelvis that is the most forward. It is abbreviated as PS in figure 2.8.

• Ischial tuberosity. The ischium is a very strong bone in the lower and back portion of each hip bone. The lowest portion of each ischium has a roughened prominence, the forward portion on which we sit, termed the ischial tuberosity, or sit bone. You can palpate these tuberosities easily while sitting on the floor. Lean forward and place your fingertips under the bottom of the pelvis from behind. Slowly begin to rock your weight back to sit upright. The tuberosities will press down against your fingers.

Figure 2.8 Bony landmarks and standing pelvic alignment (side view):  (a)  neutral pelvic alignment;  (b)  anterior pelvic tilt;  (c)  posterior pelvic tilt.

Figure 2.8 Bony landmarks and standing pelvic alignment (side view): (a) neutral pelvic alignment; (b) anterior pelvic tilt; (c) posterior pelvic tilt.

• Greater trochanter. The hip joint is formed between the hollowed socket of the pelvis (acetabulum) and the rounded top (head) of the femur. A large projection toward the top of the femur faces outward. This projection is called the greater trochanter. When you are standing, the tip of the greater trochanter is at about the same level as the center of the head of the femur as it sits in the hip joint. Although not a part of the pelvis, this landmark is included because a line between the right and left greater trochanters can be used to mark the lower border of the powerhouse. You can palpate the greater trochanter by placing your thumb on the side of the crest of the ilium and reaching down the side of the thigh with the middle finger. When you internally and externally rotate the leg, you should feel the greater trochanter move beneath the middle finger.

Movement and Alignment of the Pelvis

Learning to identify a neutral pelvic position, an anterior pelvic tilt, and a posterior pelvic tilt and to achieve the positions desired in a given Pilates exercise are important goals of Pilates. Because the pelvis moves primarily as a unit, the large movements of the pelvis mostly occur at the lumbosacral joint, the junction of the lower back with the pelvis. Stand upright with your side to a mirror to observe the first set of movements of the pelvis and related changes in the lumbar spine. Place one index finger on each ASIS to aid in seeing the desired relationships.

When in a neutral pelvic alignment, each ASIS (the top projections of the front of the pelvis) is aligned vertically with the pubic symphysis (the front of the lower pelvis). If a piece of poster board were held vertically from the pubic symphysis, both the right and left ASIS would touch this poster board (figure 2.8a). In this neutral position of the pelvis, the lumbar spine is also generally in a neutral position, exhibiting its natural curve, not a diminished or exaggerated curve.

In contrast, if you rotate the top of the pelvis forward, each ASIS will be in front of the pubic symphysis; this is logically termed an anterior pelvic tilt (figure 2.8b). This anterior movement of the pelvis will tend to increase the arch of the lumbar spine (extension or hyperextension). Check to see if you can see a change in your lower back curvature.

Conversely, if you rotate the top of the pelvis backward, each ASIS will be behind the pubic symphysis. This is a posterior pelvic tilt (figure 2.8c). With a posterior pelvic tilt, the curve of the lower back is decreased, flattened, or even reversed to round in the other direction, depending on the mobility of your spine.

Although these are the most emphasized aspects of pelvic movement, the pelvis can also move in other planes. The pelvis can tilt from side to side. When the right ASIS is lower than the left ASIS, this is called a right lateral tilt of the pelvis. Conversely, when the left ASIS is lower than the right ASIS, this is a left lateral tilt. This is observed more easily from a front view, such as facing a mirror. Lastly, the pelvis can rotate. When the right ASIS is in front of the left ASIS, this is left pelvic rotation. When the left ASIS is in front of the right ASIS, this is right pelvic rotation.

Although classically these movements of the pelvis are described in a standing position, they apply to many other positions used in Pilates, such as lying on the back, lying facedown, sitting, kneeling, or being supported on the hands and feet. In Pilates starting positions or exercises requiring a neutral pelvis, ideally the ASIS would be aligned with each other so they are level versus laterally tilted and square instead of rotated, as well as being in the same plane as the pubic symphysis.

Pelvic Muscles of the Powerhouse

Many of the muscles of the spine attach to the pelvis as well as the spine or rib cage. Although the customary actions of these muscles relative to the spine have already been described, there are times when these muscles act to move the pelvis in isolation or in conjunction with the spine. So when the rectus abdominis and obliques contract, they are capable of creating a posterior tilt of the pelvis as well as spinal flexion. The spinal extensors are capable of creating an anterior tilt of the pelvis as well as spinal extension. The iliopsoas is capable of creating an anterior tilt of the pelvis as well as extension of the lumbar spine. And the quadratus lumborum can produce a lateral tilt of the pelvis as well as lateral flexion of the spine. One of the benefits of the Pilates method is that it incorporates exercises that use the multiple potential actions of these important core muscles. For example, Chest Lift (page 54) uses the abdominals to flex the spine, whereas Pelvic Curl (page 52) emphasizes the use of the abdominals to create a posterior pelvic tilt.

In many instances, the potential actions of these pelvic muscles are used to prevent an undesired action and create core stability rather than actual visible movement. For example, when the iliopsoas contracts rigorously to support the weight of the legs in Hundred (page 78), the potential action of the abdominals to create a posterior tilt is used to prevent the undesired anterior tilt associated with the iliopsoas so that the pelvis can remain stable and protect the lower back. Another example is when the quadratus lumborum works in a postural manner to help determine the distance between the top of the pelvis and the rib cage, a function used frequently in Pilates to keep the pelvis level.

Many other muscles that attach to the pelvis are known more for their actions of moving the legs at the hip joint than moving the pelvis. However, two muscle groups that are commonly included in a discussion of the powerhouse, or core, are the gluteus maximus and pelvic floor muscles.

The gluteus maximus is a powerful muscle that is pulled into play with movements such as jumping, cycling, stair climbing, and uphill running. In these activities, the muscle works as an extensor of the hip (to be described in chapter 3), but it can also function in a postural role to create a posterior pelvic tilt and help maintain core stability. The original Pilates work emphasized gripping this muscle and encouraged squeezing the buttocks together as if to pinch a dime between them. This approach may have been adopted because of the common tendency to lose tone in these muscles with aging. As they age, people often give up the powerful activities that effectively challenge the gluteus maximus. While still acknowledging the importance of strengthening this muscle, many current schools of Pilates put less emphasis on continuously gripping the gluteus maximus throughout a given Pilates exercise in favor of strategies of stabilization that are more functional in regard to everyday activities. Examples of alternative strategies include emphasizing a less forceful or continuous contraction of the gluteus maximus as well as combining its use with other core muscles such as the abdominals.

The pelvic floor muscles, consisting of the levator ani and coccygeus as shown in figure 2.9, form the funnel-shaped floor of the pelvic cavity. This muscular sling stretches between the coccyx and the front of the pelvis as well as between the lateral walls of the pelvis. The pelvic floor muscles provide support for the terminal part of the rectum, the prostate, and the urethra in males and the rectum, the vagina, and the urethra in females. Balanced strength and activation of the pelvic floor muscles is considered by some to be another important element of core stability. Simultaneous contraction of the diaphragm and pelvic floor muscles will help maintain the abdominal contents within the abdominopelvic cavity, while the transversus abdominis functions to enhance stabilization of the spine. Research indicates a close association between the pelvic floor muscles and transversus abdominis and that contraction of the pelvic floor muscles can be used to facilitate contraction of the transversus abdominis, and vice versa. Adequate strength of the pelvic floor muscles may also be helpful in preventing some types of urinary incontinence. Almost one-quarter of adult women in the United States are affected by pelvic floor disorders, and many studies focus on women (Kincade et al. 2007). However, pelvic floor exercises for men before prostate surgery may aid with urinary continence after surgery.

Although use of the pelvic floor muscles was not specifically emphasized in the original work of Joseph Pilates, some current schools of Pilates have integrated targeting the pelvic floor muscles into their approach. One of the recommended protocols in the medical community (Kincade et al. 2005) is to perform a 10-second contraction while gently exhaling with the mouth open, followed by 10 seconds of relaxation, for 15 repetitions, three times per day. For women, beginning by tightening the pelvic floor muscles as if to prevent passing gas, then bringing the tightening movement forward to the muscles around the vagina, and lastly thinking of drawing the vaginal contraction upward toward the small of the back can be helpful for desired activation of the pelvic floor muscles. In Pilates mat work, the pelvic floor is often less formally addressed by encouraging both men and women to pull the pelvic floor muscles inward and upward while activating the transversus abdominis before and during the execution of many exercises. Optimal pelvic floor activation and function is still an area of controversy.

Figure 2.9 View of pelvic floor from above showing the three parts of the levator ani—the pubococcygeus, puborectalis, and iliococcygeus—and the coccygeus muscles.

Figure 2.9 View of pelvic floor from above showing the three parts of the levator ani—the pubococcygeus, puborectalis, and iliococcygeus—and the coccygeus muscles.

Full-Body Alignment Basics

Pelvic alignment has been discussed already, and a similar naming of positions and analysis of muscles that affect alignment of a given region could be done for most segments of the body. In this section, we will focus on selected areas that are particularly key in Pilates. Optimal positioning of these 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. Realize that alignment problems can have many causes, and although some common suggestions for improvement are provided, it is vital to check with your physician to see if these recommendations are appropriate for you. This will help to rule out causes other than strength and flexibility imbalances or suboptimal patterns of activating the associated muscles.

Standing Alignment

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.

Practically, this concept can be reflected by viewing the body from the side and noting the positioning of surface landmarks relative to a plumb line, a suspended cord with a weight attached to the bottom that provides an absolute vertical line. Other vertical lines such as a vertical seam in a mirror can also serve this function. Stand with your side to the plumb line or vertical line so that the lower end of the line falls just in front of your ankle. With ideal standing postural alignment, the following external landmarks would be located right along this vertical line (as seen in figure 2.10a):

• 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

• The area just in front of the ankle

Although not always the case, optimal positioning of these landmarks ideally represents a situation where the following underlying alignment goals also are met:

• Feet neutral, not rolled in (pronated) or out (supinated)

• Knees straight but not straightened so far they bow backward (knee hyperextension)

• Pelvis neutral, not anteriorly or posteriorly tilted

• Spine with normal curve, not decreased or increased

• Scapulae neutral and shoulders open, not rolled forward

• Head above shoulders, not jutting forward

Figure 2.10 Ideal standing alignment and common deviations (side view):  (a)  ideal standing alignment with plumb line;  (b)  cervical lordosis and kyphosis;  (c)  lumbar lordosis.

Figure 2.10 Ideal standing alignment and common deviations (side view): (a) ideal standing alignment with plumb line; (b) cervical lordosis and kyphosis; (c) lumbar lordosis.

Common Spinal Alignment Deviations

One common source of alignment problems is an exaggeration of the curvature in a given region of the spine. Exaggeration of the cervical curve (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 (figure 2.10b). An increased curve in the thoracic region, termed kyphosis, is particularly common with aging. Increasing strength and the use of the upper spinal extensors often can improve this condition, at least in its earlier stages. Lumbar lordosis or lumbar hyperlordosis refers to an increased curve in the lower back region, commonly accompanied by an anterior pelvic tilt (figure 2.10c). 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.

When addressing these common spinal alignment deviations, it is important to realize that the goal is to not overcorrect and remove the normal curves of the spine. Such an action would create another spinal problem in which the lumbar and sometimes other curvatures actually are below normal in terms of magnitude. This condition is termed flat back posture and is theorized to interfere with optimal functioning of the spine.

Scapular Movements and Alignment Deviations

The shoulder girdle is composed of one clavicle and one scapula. Unlike the pelvic girdle, which is firmly attached to the spine via the sacroiliac joints, the scapula slides on the rib cage, with only muscles connecting it to the spine. The only true bony connection of the shoulder girdle to the axial skeleton is the sternoclavicular joint, the small joint between the clavicle and the sternum. Because of these limited connections, movements of the shoulder girdle are very dependent on muscles, and muscle imbalances can easily lead to alignment problems. Movements of the shoulder girdle can be simplified by referring to the movements of the scapula, which are shown in figure 2.11 on page 24.

Scapular elevation involves lifting the scapula up toward your ear; scapular depression means bringing it down toward your waist (figure 2.11a). In scapular abduction, the scapula is moved farther away from the spine, while in scapular adduction it is brought closer toward the spine (figure 2.11b). In upward rotation, the scapula is rotated so the upper outer portion moves upward; downward rotation involves the opposite motion (figure 2.11c).

Figure 2.11 Movements of the scapulae  (back view of trunk):  (a)  elevation and depression;  (b)  abduction and adduction;  (c)  upward rotation and downward rotation.

Figure 2.11 Movements of the scapulae (back view of trunk): (a) elevation and depression; (b) abduction and adduction; (c) upward rotation and downward rotation.

Figure 2.12 Use of the scapular depressors (serratus anterior and lower trapezius) to prevent excessive elevation of each scapula as the arms are raised overhead.

Figure 2.12 Use of the scapular depressors (serratus anterior and lower trapezius) to prevent excessive elevation of each scapula as the arms are raised overhead.

When the arm moves, ideally the scapula moves in a coordinated manner that allows the upper humerus (head) to maintain proper positioning in the shoulder socket (glenoid fossa) located on the scapula. One of the most common alignment problems in this region 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 (shown in figure 2.12 on page 24).

As with the pelvis, 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. An example of the former is rolled shoulders. In this posture, the shoulders round forward and the scapulae separate excessively. Often this can be helped by developing greater strength and use of the scapular adductors, including the trapezius. The latter function of stability is operative in many Pilates exercises in which the body weight is supported by the arms. For example, when lifting the pelvis off the mat from a sitting position (Back Support, page 138), gravity tends to make the scapulae elevate markedly. Forceful contraction of the scapular depressors, including the serratus anterior and lower trapezius, is necessary to keep the scapulae in their desired neutral position, protect the shoulders from injury, and allow the shoulder muscles to perform their desired function.

Putting Alignment Into Action in Pilates Mat Work

Many of the Pilates exercises in this book are designed to strengthen muscles that are important for alignment and core stability. However, strength alone will not necessarily create the desired results. It also is important to learn to feel correct alignment and core stability, to hone skills for quickly achieving this alignment, and to practice utilizing this alignment in the exercises in this book as well as during other appropriate activities in your life. Research suggests that with repetitive activation of the desired muscles in the appropriate manner, over time your body will automatically start utilizing these more optimal strategies.

Many common cues are used with Pilates to try to achieve the desired static or dynamic alignment in a given exercise. These cues, or directives, offer practical ways to help you apply many of the principles discussed in chapter 1 and in this chapter. Some cues used with the exercises in this book are described in this section. Others are described in the chapter introductions or with the specific exercises in chapters 4 through 9. In the original Pilates approach, many of these cues were exaggerated. However, the desire to create strategies that are more similar to those needed in functional movements has led various current approaches to apply some of these cues in a modified or less rigorous manner. This functional emphasis also led to the development of additional cues to encourage a neutral position of the pelvis or spine in appropriate exercises.

• Draw the navel or abdominal wall to the spine, or scoop. These cues are designed to counter the common error of having the abdominal wall bulge outward when the abdominals are activated and to encourage a flattening or pulling inward of the abdomen. With the first cue you can imagine that a string is attached to the inside of the navel, with the string tightening to pull the navel toward the front of your spine. Drawing the abdominal wall inward toward the spine can be likened to tightening a corset such that the circumference of your waist feels smaller. It can also be thought of as scooping or hollowing the abdominal area inward. If you have difficulty finding this muscular control, place the palm of one hand on your lower abdomen, and press the wall outward into your hand to feel the undesired position; then try to draw the abdominal wall inward so your hand lowers. Think of the hand pressing flat toward the spine or the hand scooping the abdomen, as if making a hollow in the sand at the beach. The cue of drawing the abdominal wall inward has been shown to be effective in recruiting the deep transversus abdominis as well as achieving the aesthetic goal of a flatter abdomen.

• Bring the spine to the mat. When lying on your back, firmly draw the abdominal wall inward to bring the lumbar spine closer toward or in touch with the mat, depending on your natural curve and flexibility. The change in the contact of the spine with the mat can be used to help maintain and monitor core stability. For example, when the legs are held off the mat in exercises such as Hundred (page 78), inadequate abdominal stabilization would cause an anterior tilt of the pelvis and arching of the lower back, lifting the lower back off the mat and potentially injuring the lower spine. So in exercises like this, the cue is often given to keep the legs at a height (the closer to vertical, the easier the exercise) at which the lower spine can remain close to or in touch with the mat, with the pelvis totally stationary. This directive involves an intentional decrease in the natural lumbar curve and, generally, a slight posterior tilt of the pelvis to help prevent lumbar hyperextension.

• Pull up with the abdominals. Pulling the lower attachment of the abdominals (rectus abdominis and obliques) upward can produce a posterior pelvic tilt. Often this cue is used to encourage creation of a posterior pelvic tilt and flexion of the lumbar spine in exercises that require this full rounding, such as Rolling Back (page 100). The cue is also used to prevent or limit an anterior pelvic tilt in exercises in which the limbs are moving or the back is arching, such as Double Kick (page 181).

• Keep the rib cage down and back. When trying to stabilize the trunk, a common mistake is to contract the spinal extensors so the rib cage juts forward (rib-leading). The upper attachment of the abdominals onto the rib cage can pull the front of the rib cage slightly down and back to prevent this undesired rib-leading and hold the rib cage in its desired neutral alignment in many exercises. In other exercises involving spinal flexion, pulling the front of the lower rib cage down and back can aid in getting the desired maximum spinal flexion to help with achieving a full C curve.

• Make a C curve. A common error when flexing the spine is to flex only the neck and the upper thoracic spine while leaving the rest of the spine flat or hyperextended. Another frequent problem is to have most of the curve occur in the thoracic spine, a region of the spine that is naturally concave to the front but is already excessively rounded (kyphosis) in static alignment in many people. Instead, the intent of this cue is to include flexion of the lumbar spine—a region naturally concave to the back and often tight, making flexion in this area more challenging. This will aid with distributing the forward curvature as much as possible throughout the spine while pulling in the abdominal wall so the head, spine, and pelvis form a C shape that is concave to the front.

• Lengthen your neck. A common alignment problem is an excessive arch in the neck so that the chin projects forward in static alignment (forward head posture) or during movement. Thinking of lengthening or stretching the back of the neck can help counter this tendency. For example, when lying on your back, bring your chin slightly down and back while rotating your head slightly forward so that the contact of the back of the head with the mat moves down toward the base of the skull. Anatomically, this involves using the neck flexors while focusing on relaxing often excessively tight neck extensors.

• Bring your chin to your chest. The cue to lengthen the neck is also linked with the cue to bring the chin to the chest. In original Pilates work, the cue to flex the neck so that the chin comes toward the sternum while the back of the neck lengthens was often exaggerated in many exercises involving spinal flexion. Bringing the head closer to the chest can help with the desired emphasis on greater use of the abdominals while producing less stress on some of the neck muscles in many supine abdominal exercises. However, many current approaches encourage a moderate use of this cue so that the head is in line with an arc created by the thoracic spine (a small fist or lemon could fit between the chin and chest).

• Move one vertebra at a time, or use a smooth sequential movement of each vertebra. A common error is to have a large chunk of the spine move as a solid unit, often causing jerky movements or making a portion of the spine appear flat rather than arched or curved. In contrast, the desire is precise consecutive movement of one vertebra relative to the next vertebra, aimed at achieving full movement in each segment of the spine that is involved in the exercise. For example, during the up phase of Roll-Up (page 73), the vertebrae should lift one at a time off the mat from top to bottom and lower sequentially in the reverse order on the down phase.

• Keep a neutral pelvis and lumbar spine. Most of the previous cues encourage flexion of the spine, often accompanied by a posterior pelvic tilt. However, some current approaches hold that too much emphasis on flexion may not be desirable. They encourage training multiple core muscles to cocontract to maintain the natural curves of the spine, believing this will aid in creating a stable spine in many everyday movements that do not incorporate spinal flexion. Practically, if neutral positioning is the goal, a coordinated contraction of the abdominals and spinal extensors is often required to allow the natural lumbar curvature to remain and the ASIS and pubic symphysis to be in a neutral relationship. For example, when lying on your back, think about drawing in the abdominal wall gently while reaching the sit bones away from the rib cage to encourage this cocontraction and limit the tendency to posteriorly tilt the pelvis or flatten the lumbar spine. In some exercises, cocontraction of the hip flexors and abdominals is another strategy for achieving or maintaining a neutral pelvis. Some approaches to Pilates also encourage maintaining a neutral pelvis in some exercises that involve flexion of the upper spine, such as Chest Lift (page 54). This can be helpful for learning more isolated control and awareness of the neutral pelvis. However, exercises that involve marked flexion of the lumbar spine, such as Roll-Up (page 73) naturally tend to be accompanied by a posterior pelvic tilt, and trying to maintain a neutral pelvis can place excess stress on the lower back.

• Sit tall. A common alignment error in sitting is to let the spine collapse downward, with the lumbar spine going into flexion and the pelvis posteriorly tilting. Think of lifting the upper back and the area of the head just behind the ears toward the ceiling, with the weight of the trunk right over the sit bones. Anatomically, slight use of the upper back extensors balanced with the abdominals can produce the desired lift in the thoracic spine without rib-leading. Another desired strategy, similar to that described in the last section, is to think of pulling the lower region of the abdominals slightly in and up to foster use of the transversus abdominis while simultaneously lifting the center of the back of the pelvis upward to encourage use of the multifidus. This cocontraction provides deep segmental support to the lower spine and encourages the maintenance of some of the natural lumbar curve. Activation of the iliopsoas can also be used to help maintain some of the natural lumbar curve as well as keep the upper trunk from falling back. Shifting the pelvis forward (hip flexion) while thinking of lifting the inside of the pelvis upward may help promote iliopsoas activation.

• Maintain a flat back. The term flat back refers to a position in which the trunk is approximately straight when viewed from the side; the side of the shoulder, rib cage, and pelvis are in line. This term can be used to describe the trunk in various positions including kneeling, being supported on the hands and feet, or sitting. The term is not literal—the spine still maintains its natural curvatures, but there is a feeling of being elongated as just described with sitting tall. Achievement of this flat back position involves a skillful simultaneous contraction of the abdominals and spinal extensors.

• Keep the scapulae down to neutral. This cue can be used to prevent the common alignment error of having the shoulders lift up toward the ears as the arms move. Anatomically, think of using the scapular depressors to pull the scapulae slightly downward before lifting the arms to encourage use of these muscles as the arms move. However, the goal is not to hold the scapulae excessively downward or in place but rather to help establish a neutral position of the scapulae as they naturally rotate upward. This is achieved with a balance of use between the upper trapezius, which elevates the scapulae, and the lower trapezius, which depresses the scapulae, as shown in figure 2.12 (page 24). You can also focus on keeping distance between the shoulders and the ears by using a less forceful contraction of the upper trapezius to prevent excessive undesired elevation of the scapulae with overhead movement of the arms.

• Stretch or reach your arms and legs. The cue of reaching the limbs outward is used to achieve the desired long line and dynamic of many Pilates exercises. Anatomically the joints of the limbs are in a straight line rather than bent or hyperextended. When the body is straight with arms overhead and legs elongated, such as the beginning position of Roll-Up (page 73), imagine someone gently pulling on your fingertips while someone else gently pulls on your toes in the opposite direction as you maintain strong core stability.