The Anatomy of Pilates

Understanding how the body works

Pilates seeks to produce a fit, sleek and well-toned body. To understand the Pilates method and gain maximum benefit from it, a basic knowledge of the key areas of anatomy can be very helpful. Most importance to us are the basic structure of the body, that is our bones and joints, the muscles, which help define our shape as well as powering all movement in the body, and the cardiovascular and respiratory systems, which get energy to our muscles and are vital for our overall fitness.


BONES

Skeleton Skeleton  

The basic shape and structure of our bodies is formed by our bones, making up our skeleton.
As a foetus our bones start out as cartilage which turns into bone (a process called ossification). Bone growth finally finishes when we are about 20 (this is why care should be take with exercise prior to this age).
Flat bones, for example the skull, and sesamoid bones, such as the knee cap, are the exception to this, flat bones coming from membranous tissue and sesamoid bones from a tendon-type tissue.
Throughout life our bones are constantly replacing themselves through the action of two types of cells: osteoclasts which break bones down and osteoblasts which make new bone to replace them.
The osteoblasts are a key part of the repair process after a bone break.
For bones to remain strong, and to reduce the risk of osteoporosis, a good diet and appropriate exercise are very important.
An adult human has 206 bones.

 

THE SCAPULA

The scapula is an inverted triangle known as the shoulder blade, the bone has three hollows, these make a hollow on the front of the scapula and two either side of the spine of the scapula; the spine follows a line across the blade to the top angle towards the shoulder, the two hollows at the back of the scapula are above and below the spine of the shoulder blade, the top hollow being smaller than the bottom hollow. The scapula has a lip on the outer surface the indentations allowing the muscles to attach to the bone. The spine of the scapula is to the rear of the shoulder blade.

These bones give the impression of just floating in the middle of the back, and yes, we have two, one either side of the spine, far from just performing an aesthetic role, they perform an interesting role in bringing control to the arms, shoulder and spine and require 18 muscles to hold them in place. If you follow the spine of the scapula it forms a processor that joins up with the clavicle, below this processor it forms a small cup that connects to the humerus corner at the top of the arm forming the shoulder joint.
The shoulder blade often shows the signs of a problem before any other part of the body.
 How many times have you been told or you have told some youngster to stand up straight or even sit up?
 What happens as the lower back tightens up the shoulders take up the tension, which can be caused by any one of the muscles that hold the scapula in place to tighten up, not unlike that of a guy ropes on a tent, and so disrupting the movements of the whole body during our daily routine.

 So when working with you I often work with the shoulder first as this will help to reduce any tension around the shoulders and thoracic area of the body and so improve the mobility of the upper body and so help a productive session when dealing with other areas that might be under stress.

For instance, if the lower back is under tension often the neck and shoulders roll forwards to take up some of the irritation and tighten up the muscles supports the spine. I often find it unproductive to try to loosen the lower back when the shoulders are causing a problem and therefore the shoulders are unable to allow the back to relax.

Fractures - form 3 main types
    * Closed Fractures - where the broken bone does not puncture the skin.
    * Open Fractures - where the broken bone does  puncture the skin
    * Complicated Fractures - which can be  open or  closed and will involve injury to other parts of the body

To Recognise these injuries, look for:
    * Pain at the site of the injury.
    * Swelling, discomfort and bruising.
    * Signs of the bone showing through the skin (Open Fractures).
    * Irregularity and abnormal appearance.
    * Lack of movement and power.
    * And SHOCK.

Your Treatment
    * Check for danger, to yourself and to the casualty and any bystanders.
    * Assess the situation and look for an indication of what has happened.
    * Immobilise the injury without moving it too much and so preventing further injury.
    * Support the injured area leave in the casualty in the position found unless they can be moved.
    * And treat for shock - see below.
    * Calm / Reassure and call 999/112 for help and monitor.

Bones of the foot.
The foot is made up of 26 bones, two in the rear foot five in the middle and 19 make up the forefoot on the toes.
The rear of the foot consists of the talus and the calcaneous. The Tallis is the uppermost bone of the food which connects the foot to the ankle by forming a joint with the tibia and fiba bones of the lower leg. The calcaneous sits underneath the talus and forms the heel bone as we passed forwards from the heel to the centre of the foot we come to the cuboid  and the navicula bone. I'm coming forwards from those two bands we come to the three remaining balance known as the cuneiform and are known as the medial intermediate and lateral and I situated in front of the navicula, All five of these bands are collectively known as the tarsals and these form the arch of the foot. The forefoot is made up of five metatarsals, The metatarsals are numbered 1 to 5 starting with the big toe is one and we have 14 phalanges, each of the toes has three phalanges with an exception of the big toe which is known as the height hallux which has only two phalanges.
The ankle releases the way to the body on the planter arch of the foot; here, the stability is mainly kept to the constant involvement of the gastrocnemius and Soleus muscles.
The foot having lost its prehensile function, has become both a three point support mechanism, and the device from movement that works like Alleva, increasing the propulsive strength of the leg: when moving, the fault of the planter arches flattens and lives up again, distributing the weight on the entire internal arch of the foot. Despite all these skeletal muscular mechanisms, there are still some problems with the equilibrium. In order to avoid falling, there are some sophisticated sensory systems which constantly control the posture and relationship between the body and the three dimensional environment. Is elaborate system transforms them into a set of signals which continuously adjusts the muscles to control posture. This can be seen when walking in wet sand, when we place the foot in the sand with first-place the heel into the sand giving is our largest indentation and so roll the foot through to the ball of the foot and then onto the big toe , this movement would indicate a healthy foot fall, but sometimes due to injury or to a natural dispensation we will for either to the lateral all the medial side of the foot, but the most desirable is always a neutral footfall with the heel, ball of the foot and big toe are controlled in one continuous process.

 ligaments of the foot.

The Ligaments that support the large bone of the foot.
the Tibionavacula part of the medial ligament extends from the medial malleolus to the navicular bone.The devision extends from medial malleolus to the neck of the talus.The medial or deltoid ligament is a compound ligament that consist of four parts that connects the medial Malleolus of the Tibia to the tarsal bones; 1 Anterior Tibiotalar 2 Tibiocalcaneal,3 Tibionavicular, 4 posterior tibiotalar ligamnets.

The Flexor retinaculum is also know as the internal annular ligament. it is a strong band of fibers that extend from the malleolus of the tibiato the calcaneus. It encloses the tendons of the flexor muscles as well as the posterior tibial vessels and the tibial nerve.

The dorsal talonavicula ligament connects the dorsal neck of the  talus to the dorsal surface of the navicular bone.

The dorsal tarsal ligaments join the tarsal bones together, specifically, the dorsal cuneonavicula ligaments connected the dorsal surface of the navicular with the cuneiform bones. The dorsal intercuneiform ligaments are small ligaments are small ligaments which connct the cuneiform bones of the dorsal foot.The cuboideonavicular ligament connects the dorsal surface of the lateral cuneiform to the cuboid bones.

The Dorsal metatarsal ligamnets have bends which connect the dorsal aspect of the base of the metatarsals.The dorsal Tarsometatarsal ligaments connect the tasals to the metatarsals.
 

Muscles of the foot
Extensor digitorum brevis of the foot
Origin
Superolateral surface of the calcanus.
Insertion
the base of the midle phalages and the dorsal aponeuroses of the 1st too 4th digits
Action
Extension of the metatasophalangeal and interphalangeal joints of the related digits.

Adductor Hullucis tranverse head
origin
Heads of the 3rd to the 5th metatarsal bones.
Insertion
Base of the lateral side of the proximal  of the hallux.
Action
Flexion of the metatasophalangeal joint adduction of the hullux, Its supports the longitudinal and transverse arches of the foot

Flexor Hellucis Brevis
Origin
Cuboid bone: the lateral cuneiform; the medial side of the first metatarsal bone; the planter calcaneocuboid ligament
Insertion
Medial belly; the medial side if the proximal phalanx of the 1st digit; Lateral belly: the lateral side of the proximal phalanx of the 1st digit
Action:
Flexion of the metatarsophalangeal joint of the 1st digit.

First lumbrical of the foot
origin;
Tendons of the flexor digitorum longus.
Insertion:
Dorsal aponeurosis  and the medial side of the extensor expansion of the 2nd digit.
Action:
Flexion of the metatarsophalangeal joint and extension of the proximal and distal interphalangeal joints of the 2nd digit.

Second lumbrical of the foot.
origin:
Tendons of the flexor digitorum longus.
Insertion:
Dorsal aponeurosis and the medial side of the expansion of the 3rd digit
Action:
Flexion of the metatarsophalangeal joint and extension of the proximal and distal interphalangeal joints of the 3rd digit.

Third Lumbrical of the foot:
Origin:
Tendons of the flexor digitorum longus.
Insertion:
Dorsal aponeurosis and the medial side of the extensor expansion of the 4th digit.
Action;
Flexion of the metatarsophalangeal  joint and extension of the proximal and distal interphalangeal  joints of the 4th digit.

Fourth Lumbrical of the foot:
Origin
tendons of the flexor digitorum longus.
Insertion
Dorsal aponeurosis and medial side of the extensor expansion of the 5th digit.
Action
Flexion of the metatarsophalangeal joint and extension of the proximal and distal interphalangeal joint of the 5th digit.

Extensor hallucis brevis.
Origin:
Superolateral surface of the calcaneus.
Insertion:
Dorsum of the base of the proximal phalanx and dorsal aponeurosis of the Hallux.
Action:
Extensor of the metatarsophalangeal joint of the hallux.

Flexor Hallucis brevis.
Origin:
cuboib bone : lateral cuneiform: the medial side of the first metatarsal bone: the planter calcaneocuboid Ligament.
Insertion.
Medial belly: the medial side of the proximal phalanx of the 1st digit:
Action;
Flexion of the metatarsophalangeal joint of the 1st digit.

Quadratus plantae:
origin:
Anterior calcaneus and the long planter ligament.
Insertion;
Tendon of the flexor digitorum longus,
Action
Assist the flexor digitorum longus in the flexor of the toes.

Abductor digiti minimi of the foot:
Origin
Medial and lateral sides of the calcaneal tuberosity; the planter aponeurosis.
Insertion
Base of the lateral proximal phalanx of the 5th digit.
Action
Abduction of the 5th digit and flexion of the metatarsophalangeal joint.

Flexor digitorum brevis of the foot;
Origin:
Calcaneal tuberosity and planter aponeurosis.
Insertion:
Base of the medial phalangels of the 2nd  to 5th digits
Action:
Flexion of the metatarsophalangeal and interphalangeal joints of the 2nd to 5th digits

Abductor Hallucis.
Origin.
Medial side of the calcaneal tuberosity.
Insertion.
Base of the medial proximal phalanx of the hullux.
Action.
Flexion and abduction of the hullux; supports the longitudinal arch.



JOINTS

Skeleton  
Although our skeleton is made up of rigid matter, that is the bones, we have flexibility due to joints, most of which allow free movement.
There are three types of joints:
Movable-also called synovial. These include hinge, ball-and-socket and pivot joints and are used in most of the Pilates movements.
Fixed-two bones connected together by fibrous collagen which allows almost no movement; for example the bones of the skull.
Joints with a little movement-these are typically joints between the vertebra making up the spine. They are formed where the ends of two adjoining bones are covered by slippery hyaline cartilage and are then connected by a tough fibrocartilage which allows a very little movement. Pilates is excellent at exercising and aligning these joints in a safe and controlled manner.
A combination of muscles, ligaments and fibrous tissue holds the joints together, powers their movement, brings them back into alignment, and stabilises and protects them.
The human frame has more than 200 joints.

THE SPINE

Skeleton  
The Spine is made up of 33 bones which are divided into three sectiion when talked about, these section are the Cervical, the Thoracic and the Lumbar spine (below the Lumbar spine is a bone called the Sacrum which although it appears on pictures of the spine is actual part of the pelvis ). There are 7 bones in the Cervical spine, 12 in the Thoracic spine and 5 in the Lumbar spine area.

The bones of the spine are called vertebrae. 24 of the Vertebrae are true or movable and each has a cartladge disc between them which prevents the bones from rubbing together. 9 are false or fixed Vertebrae and are fused together (except the Coccyx which moves against the Sacrum) and have no movement.

The Vertebrea all have a space to allow the spinal cord to pass through them and bony processes which extend out from them to allow muscle attachments points. Opening between the Vertebrea allow nerves to extend out from the spinal cord to various parts of the body.

A healthy spine has three natural curves; the Cervical spine which makes up the neck curves slightly inwards; The Thoracic spine or mid back which curves outwards and the Lumber spine or lower back which curves inwards.


MUSCLES

Skeleton
Skeleton
 
The muscles of the body make up to 40% of the body weight and their shape and structure define the shape of the body-provided they are not obscured by too much fat! The Pilates system aims to produce long lean muscles rather than bulky ones, and also trains them to hold the body in a naturally elegant and aligned manner.
Muscles are made up of a series of bundles of small muscle fibres, these bundles forming long fibres known as fascicles.

The Core - the flexible cyclinder formed by the Transversus Abdominis (the deep abdominal muscle)

TRANSVERSUS ABDOMINUS
The Transversus abdomimus is the inner most abdominal muscle that connects the spine at the back and wraps around the trunk to meet its counterpart in the front. It forms a large attachment to the lower 6 ribs and the top of the entire pelvis. When the Transversus abdominus contracts it causes a slight narrowing of the waist and drawing in of the lower abdominal muscles, something like Scarlet O'Haras corset. Its function is to stiffen the spine and stabilise the pelvis prior to movements of the arms and legs.

The Pelvic floor consists of a funnel of muscles that connect the pubis at the front to the tailbone (coccyx) and “sits” bone (ischial tuberosites) at the back. There are three main muscles that make up the pelvic floor - pupococcygeus, lliococcygeus and lschiococcygeus.
Your urethra, vagina and the anus pass through these muscles and are effected by their function.

All together the pelvic floor supports your bladder and uterus as well as provides support to the large bone between your hip bones, the sacrum. This muscle must be balanced in front (beneath the pubis) and the back (at the sacrum) as well as with the multifidus (behind the sacrum) for the core to be stabilised properly.

Recruitment of the pelvic floor and Imagery
The pelvic floor structure is considered the diaphragm of the pelvis and may be compared to the bottom lid of a cylinder. The thoracic diaphragm may be considered the top of the lid of a cylinder. The rib cage then, represents the cylinder itself. For optimal function, the two diaphragms  (the bottom and top lid) would float directly above/below one another (imagine a chinese lantern ). This alignment is a postural event, and will strongly influence function and performance in breathing, stability and movement.

The function of the pelvic floor structures is that of support and control of the internal organs and is functionally active with the movement of the respiratory diaphragm in terms of support of the pelvic organs. Upon inhalations as the diaphragm lowers, the pelvic floor widens and provides eccentric control to accommodate the organs displaced by descending diaphragm. On exhalation the concentric contraction assists in the return of the organs. The pelvic floor is also synergist, however antagonist with the hip musculature and is a true synergist with the transverse abdominis.

So this is the correct way of putting the action down for the pelvic floor, but a little long. So I have a shorter version for you that you might find  helps and give you our reasons for breathing control in pilates. As you breath in your rib cage expands at the same time your spine starts to move and  the curve in the lumber section increases. At the same time the pelvis changes its position to act as a counter balance, as you breath out so the rib cage changes allowing the spine to change. This is all controlled by the the muscles that form the cylinder the top is the cylinder is the diaphragm the side are the transverse abdominis and the pelvic floor. These muscles give us a balance to the lumber and support for internal organs        

The Multifidus (the deep  back muscles)
Multifidus is a very deep back muscle located right next to the bone in the midline of your spine and pelvis. It is contained within an envelope of fascia. This fascia tightens when the Multifidus contracts. This increases fasciae tension compresses the posterior pelvis and together with the transversus abdominuis completes the corset of the core.

The Multifidus belongs in the category of the Rectus Spinae Muscles with the difference that the deep fibre's are contributing to stability on a segmental level (vertebra by  vertebra). It finds its origin on the Sacrum on the level of the S2. These deep fibres are embedded within the toracolumbar fascia. The Multifidus completes the “corset “ of stability and although an antagonist to the  transverse abdominis, it is an import synagist.

Right. What does this mean?
Well, when the good Lord decided to put us together he had to find a way of keeping the  vertebra stable so when we rotated we had a range of muscles that reacted against this movement. Each muscle forms a weave from  vertebra to vertebra  so giving the spine extra support throughout the bodies movement and therefore becomes another section of the core muscles of the lumber; But it not only effects the section of the lumber it also move up the spine to give increased support  to other parts of the spine.


The body has three types of muscles:
Skeleton

Skeletal or striated - These muscles are attached to the skeleton and can be referred to as voluntary muscles as we control them. Under the microscope they look striated, appearing to be made up of light and dark strips or bands. They vary in size from the tiny muscles of the hands or feet to the large muscles of the buttocks and thighs. Although these muscles are under our conscious control many of the movements are done without conscious thought.
We have more than 600 skeletal muscles.
Smooth muscles - These muscles are found around the walls of the blood vessels and tubular organs such as stomach and gut. They are made up of spindle-like cells held together by connective tissue which contract and relax in a slow and rhythmically action to allow the contents to travel forwards. These muscles are not under our control (involuntary muscle).
Cardiac muscles - The cardiac muscles are only found in the heart wall. These muscles have a rhythmic action that pumps the blood around the body. Unlike any other muscles in the body they can contract without any nerve stimulation. Regular exercise makes the cardiac muscles more efficient, allowing a slower heart beat and a much fitter body overall. Muscles not only cause the body to move but also help to maintain both posture and good body position when stationary. Muscle tone - this term refers to a state of slight tension of the muscle fibres when not in use, which enables them to respond quickly to a stimulus.

Muscle fatigue - this occurs as a result of violent or unaccustomed exercise. As the glucose (the fuel used by the muscles) is used up during movement, lactic acid (the waste product of that action) is produced. A build up of this lactic acid in the muscles causes them to ache and possibly cramp. A fresh supply of oxygenated blood will help relieve some of the discomfort.

CARDIOVASCULAR AND RESPIRATORY SYSTEMS

Skeleton
Skeleton
 
If the body is to work efficiently, the muscles must be supplied with a good supply of fuel and oxygen and the resulting waste products must be removed effectively. Pilates helps in this process by encouraging deep and controlled breathing, and the exercise also helps build a stronger heart and circulation system.

Breathing

This is an essential and involuntary action that our bodies perform, although we can also regulate it ourselves. Breathing involves getting oxygen into the body and expelling carbon dioxide.
When we breath in, the chest cavity enlarges, the lungs expand and air is allowed down into the little branches of the lungs. During this action the diaphragm also flattens as it contracts and moves down into the abdominal cavity making the whole chest cavity longer from top to bottom.
When we breath out, the chest cavity decreases in size, the abdominal muscles pushing the abdominal organs against the underside of the diaphragm, causing it to become dome shaped and compacting the lungs causing air to be expelled.

SCIATIC NERVE

The issue many of you seem to have developed recently is with the sciatic nerve, this has caused you some discomfort or even a lot of pain travelling down the leg towards the foot.
 
So let's look at the nerve itself , the sciatic nerve is a large nerve that travels posterially (to the rear of the leg) it is the largest nerve in the body, as it travels down the back of the leg and just before the knee the nerve splits into two sections, one part will travel behind the knee and the second will start to wrap itself around  the top of the femur and then breaks down in to two sections; one travels down the front of the leg, the other travels on the outside of the calf and travels down to the foot and splits into smaller nerves serving the muscles on top of the foot. The nerve that travelled to the rear of the leg continues down the back of the leg to the foot and breaks down into a series of smaller nerves that controls the muscles of the foot. The nerves job is to control and maintain the movement of the muscles of the body.
 
The issues pertaining to sciatica vary depending upon the severity of the condition, so a minor incident would cause discomfort around the pelvis area, radiating down the leg a short way, and can move into the foot causing a great deal more pain and discomfort. Problems other than pain around the pelvis and leg is a possible change to the patients gait and so causing a problem with the lumber area of the back, also a reduced mobility in and around the foot which would aggravate the lower back even further, increasing the amount of discomfort with the sciatica.
 
What can we do? Well, one of the first things to do is to reduce the inflammation in the area of the pelvis. This can be done by taking an anti-inflammatory that your doctor or pharmacist might suggest, to prevent any further tension in the area.
For exercises I like to take any tension from the lower back by doing pelvic tilts and lifts, this helps to relax the lower back and encourage a better body position.
I like to add hamstring stretches and most importantly a piriformis stretch, this can be done by bringing the leg into a table top position and drawing the knee across to the opposite side of the body. So, lay on the floor on your back, bring the left knee into a table top position, take hold of the knee with the right hand and draw the knee across to the right side and hold for five breaths and release. If this is too much, leave alone and take some advice from your doctor, never force a stretch whilst in pain.
For the foot, a massage, or sometimes, I like to use a small ball and roll my foot over it to take any tension out of the foot.
 
Other effective ways of dealing with this are Massage or Acupuncture, both can have a great effect on the problem, but what you must not do is just leave it as it may well become a much greater problem and will require a lot more time to heal and settle down.

THE FOOT 

The human foot combines mechanical complexity and structural strength . The ankle serves as the foundation, shock absorber, and give us propulsion . The foot can sustain enormous pressure (if it is smooth walking where no additional forces are added except for the shift of the body weight). If the average persons weighs 150lbs and has an average surface area on one foot of 25 square inches, then each square would support 6lbs per square inch. The foot also provides flexibility and resilience .

The foot contains:
    * 26 bones (1/4 of the bones in the  human  body are in the foot )
    * 33 joints
    * More than 100 muscles tendons and ligaments  

These components work together to provide the body with support, balance, and mobility. A structural flaw or malfunction in any one part can result  in the development of problems elsewhere in the body. Problems in any other section of the body can also lead to the same in the feet .

You will often hear me say to clients in the class that the foot position is not correct and repeat that you should feel a triangle, from the ball of the foot to the heel and  feel your big toe through out the exercise. If you are able to keep the foot position you will be 90% sure of completing the exercise correctly.



TAKE CARE SECTION 

Pregnancy
In most cases women are encouraged to exercise at a mild to moderate level as long as the exercises are uncomplicated. However you should have permission from your doctor.

If you are already taking some form of exercise continue but please take care and advice from your doctor.   PREGNANCY IS NOT THE TIME TO TAKE UP A NEW EXERCISE  PROGRAM other then at a very  mild to moderate level, and should be monitored throughout for any changes and discomfort which can occur around 6 months.

Pregnancy does change your physiological response to exercise. Any exercise program will need to be modified to suit your needs at the time of the exercise class to allow the mother’s hormonal and body changes, to maintain maximum safety to both the mother and child.

The advantages of exercise during pregnancy
    * Reduces the increase in body weight during the pregnancy, this will help with the caring of the baby.
    * Babies are slightly smaller.
    * Just because a child is a little on the large side does not mean that it has any problems but will require medical staff to observe the infant more closely for complications.
    * Increased fitness may help the mother cope with labor better, but it may not help reduce the labor time.
    * Will help prevent gestational diabetes.
    * And will improve psychological well being. 

Risks of exercising to the mother during pregnancy
    * Musculoskeletal problems.
    * Low back pain (is common usually due to a combination of factors; change in the centre of gravity, increase in the lumbar lordosis.
    * And as the pregnancy develops a loosening of the ligaments related to the production of the hormone reloxin.
    * Hypotension .

The uterus compresses the major blood vessels resulting in reduced blood returning to the heart after prolonged standing, as can laying on the back.