Fitness Trends for 2016

As the New Year approaches we tend to look back and review the past year and also plan ahead to the next one.
2015 saw The Studio develop extra-small classes, enabling clients to enjoy individual tuition within a group format. This makes it affordable, effective and sociable.
I undertook further training to enhance my skills as a fitness professional and soft tissue therapist. My specialist training with an experienced osteopath this year was in the diagnosis, treatment and prevention of knee pain. A really useful area in which to have more knowledge. My soft tissue work training was in recognising and releasing the tightness which causes poor posture and gives back pain along with some new techniques to offer sport massage without pain.

So, what underlying trends can we expect to see in 2016? (ref ACSM)
1. Wearable Technology
Trackers, heart rate monitors etc… all helping increase activity levels by constant monitoring.
2. Body Weight Workouts
Taking fitness back to basics by using body weight instead of machines and free weights.
3. HIIT
High Intensity Interval Training used with many forms of fitness to improve performance and shorten the time spent exercising.
4. Strength Training
Both in the gym and in classes for general fitness as well as improved bone density.
5. Fitness Professionals with better training
Improved training leads to better results and more choice for the public in looking to improve their fitness.
6. Personal Training
Including group PT - extra small group exercise classes, perfect for affordable individual tuition
7. Functional Fitness
Fitness which helps activities of everyday life, essential for keeping active for longer.
8. Fitness for Older Adults
Older adults have specific requirements which are now recognised and will be better catered for.
9. Exercise for weight loss
Dieting alone cannot achieve sustainable weight loss and this trend backs the theory that exercise is an essential part of weight loss.
10. Yoga
Yoga has many forms and often includes ‘wellness’ which features lower down the list of fitness trends. I see these combined to offer an exercise based way to cope with the stress of today’s busy lifestyles.

Why can't I control my weight?

It’s the magic question to which we all wish we had an answer!

New research from a study conducted at the University of Sheffield has addressed the problem of using a single classification of people who have a weight problem. They are suggesting that this restricts the effectiveness of treatment options. They propose a number of classifications each of which will require a different approach.

Below I have taken their classifications, adapted them to reflect the demographic I see in my work as a physical therapist and then suggest solutions:

1. Young healthy females displaying the most positive health characteristics.
   These are typically called yo-yo dieters, they are interested in health and fitness and follow the latest trends in exercise and popular diets. They are able to lose weight quite quickly but maintaining the weight loss over a long period is harder. They join the gym or a fitness class at the beginning of the year but find it hard to keep attending once ‘life’ gets in the way. It’s not their main priority in a busy life so is easily dropped.
   
   For these people, I would recommend a monthly session with a motivational trainer or nutritionist/exercise professional, booked and paid up well ahead. This will keep interest and motivation levels high by suggesting new exercises, new techniques, and help and encouragement in developing healthy eating habits with recipes and nutritional advice.
   
2. Males who are unable to control their weight despite having high levels of physical exercise.
   Lifestyle factors are likely to include high levels of food and alcohol consumption. This group can cover a huge age range from mid-30s to retirement. They may be gym members enjoying a weights based training programme on a regular basis, they may get exercise from dog walking or be golfers. The excess weight comes from the excessive intake of food and/or alcohol and the lack of enough cardiovascular exercise.
   
   I would recommend completing a food diary to capture exactly what is consumed over a month long period. Alongside this find a nutritionist/personal trainer to review the amount and type of exercise. They can then ensure there is enough cardio work to encourage fat burning rather than developing further muscle mass. A tracker to follow activity and monitor heart rate will check actual activity levels. Looking at portion control, meal content and reducing alcohol intake will ensure the best chance of success.
   
3. Middle aged females interested in exercise and weight management, although suffering from anxiety, insomnia, depression and fatigue maybe also with low self-esteem.
   This is another big group, many of whom are somewhere along the menopausal curve. Along with the symptoms listed above, weight gain is common as hormones fluctuate. Previously successful weight and exercise regimes no longer work.
   
   Support during this time is essential, recognizing that many others feel the same way. Exercise classes with a social element offer enjoyable exercise which is more likely to be continued as the people in the class become as important as the exercise content. Community venues or small private centres, rather than big leisure complexes, are more likely to offer this type of class. Look for pilates, yoga and general exercise to music with instructors specializing in this age group.
   
4. The affluent healthy elderly, many of whom have high blood pressure.
   Age was not specified so I’ll assume that they mean 65+ although that’s hardly old these days. I think this group is struggling with their weight as a result of changes in life style and in their body as it ages. Food choices have developed enormously during this group’s lifetime and their affluence can lead to indulgent choices with foods high in fat and sugar. This group of people are at risk, if they do not address their weight issues they will soon find themselves in the next category, ie with chronic health conditions.
   
   This group needs exercise which takes account of their age and high blood pressure as well as a carefully structured eating plan. They also need encouragement and support in keeping to the life style changes required. Exercise combined with a social element is a good solution in this case. Also look for an instructor specializing and qualified in exercise for older adults.
   
5. The physically sick but happy elderly with chronic health conditions such as arthritis, diabetes and high blood pressure but low levels of anxiety.
   This group of people are probably in a vicious circle, the chronic health condition has limited their ability to exercise and this has resulted in weight gain, which in turn adds more chronic health issues.
   
   It is very difficult for these people to keep doing exercise since they have to endure levels of pain to stay active. Unfortunately, without undertaking some exercise, the situation will get worse faster. Basic mobility exercises will get this group into better health, together with dietary advice to cut calories and look at foods which ease the inflammation of arthritis. Small classes designed for people with painful conditions can be helpful, providing support and encouragement from a position of empathy and understanding. Look for an instructor with a GP referral qualification, and ask for a one to one session first.
   
6. The elderly deprived who do not have healthy behaviours and have the highest BMI readings.
   These people are likely to have been overweight with unhealthy diets for their whole life. Exercise will not have featured in their lifestyle, and they may have no desire to change. Any cost of treatment is probably an issue, limiting their choices.
   
   This group are the hardest to help. Approaching GP surgeries to see what they offer is the best way forward. For example they might hold exercise sessions funded by the NHS, they should at least offer dietary advice.

Are you still doing sit ups in the hope of achieving a strong core?

Sit ups are often performed as a core muscle exercise. However research continually shows that they are not effective at building core strength. Old habits die hard and in the fitness industry sit ups, crunches, roll ups, roll downs etc… have been around for as long as people have been exercising. But, this doesn’t mean that they are good or effective!

Core muscles are those which hold your body together, giving it strength by binding around your trunk. They support your spine and strengthening them can significantly reduce back pain. I would include in core muscles those around the shoulder girdle. They have a big impact on posture which, if poor, can cause the shoulders to slump forward and eventually result in pain. Recent research has also added new muscles as essential for core stability, known as gluteals. This complex muscle group lies across your butt and holds your pelvis stable.

So back to sit ups, what happens to your body during the exercise?

Your shoulders round into a position very similar to that seen in the office chair slump, the slouched driving position or the collapse on the sofa rounding. In other words, good posture across the shoulder girdle is completely lost. When this was first performed I don’t suppose we were living a life of sitting and slouching so possibly the postural issues we see today were not as prevalent.

Your spine is curled forward. For some this may feel good and indeed be beneficial but for many the compressional force on the intervertebral discs will aggravate previous injuries such as herniations (slipped disc) or prolapsed discs. Measuring this compressional force is something we’ve only been able to do in recent years, and it is huge when performing a sit up. When I first taught these exercises the fitness industry was oblivious to these potential dangers.

Once you get almost half way up, your hip flexors become the main workers to stabilise and complete the movement, to bring you up to sitting. These are also shortened by a sedentary lifestyle and if not specifically stretched they pull the pelvis out of alignment causing back pain.

This brings us onto the new core muscles, the gluteals. Generally weak (despite years of tums and bums classes!) and difficult to activate, yet essential for good posture and a strong core. In those who perform lots of crunches the hip flexors, hamstrings and rectus femoris (thighs) tend to be strong but these muscles work in a vertical plane. In these people the gluteals are likely not to work at all, yet they provide all the essential diagonal support for the pelvis.

If you are looking for a strong core, the exercises you need are those which use the gluteals and the stabilizing abdominals, not the sit up muscles.

If you’re tempted to go for a ‘6 pack’, remember that it can only be achieved by over developing the muscles so they push out through the fascia, which is there to hold them together. For a female to develop a 6 pack, as well as the muscle development she also needs a BMI well below that recommended for good health.

For effective exercise advice look for an instructor with a good understanding of spinal load during exercise, preferably with a specific low back qualification and an interest in functional fitness and posture.

Pain is not as simple as you might think!

Almost everyone will have felt pain at some time in their life. Here at the studio we see a lot of people suffering from pain, mainly associated with movement or a persistent ache. We can usually help to alleviate this either by reducing it or by offering techniques to manage it. What you may not realise is that there may not be a physical reason for the pain.

To get a better insight into what is going on when you hurt, we need to understand how you feel pain.

The ability to feel pain is very important to our wellbeing. It stops us doing things that are damaging to our bodies, and makes us rest to allow our bodies to recover from injury. So you really should not ignore pain, or simply "work through it".
Firstly you should make sure that there is not physical damage causing the pain.

The expected mechanism of pain starts with some physical damage which causes receptors within the nervous system to fire. This action creates minute electrical currents which are passed from nerve cell to nerve cell up to the pain perception center in the brain. It is here that these signals are actually converted into what we know as pain. All along this pathway it is possible for your body to mistakenly trigger, sometimes from a sort of nerve memory. Hence, for example, the site of an old injury can often be painful even though there is no damage or reason for that pain.

The brain itself is quite capable of "making up" pain. If you injure your ankle your brain will avoid movements that cause pain in the damaged area. This is good. However once the damage is repaired, the brain continues to avoid movements that were painful. The fear of pain can cause actual pain. The brain has to be retrained to understand that the pain is no longer there by specific repeated movement patterns.

Often in avoiding pain the body will stress another area and cause a pain there. It doesn't always make the right decisions as to the best way of helping your body.
We see this type of issue often at the studio. A client may have had a small injury to a back muscle lifting something heavy out of a car (shopping or a child are frequent culprits here). The body's defense mechanism leaps into action and activates a range of alternate muscle actions to protect the damaged area. Unfortunately this will usually cause a misalignment, or imbalance in the body, often resulting in the stressing of and possible damage to a whole set of different muscles ranging from shoulders to knees and ankles.

Clients come to us with a problem in their knee. However, when we have taken a holistic review of their gait and completed a range of movement tests we can see that the problem is not in fact in the knee at all, rather it is a bodily imbalance brought about by a completely different issue.

So, if you have pain, my advice is:
Firstly, check with your GP to rule out a structural or other cause which needs medical treatment.
Then, come to The Studio for a half hour one to one consultation so we can assess the best ongoing solution.
Alternately, or in addition, if you have access to a physio ask them for muscle testing and exercises.

Frequently the solution from me (or a physio) will be regular exercise combined with soft tissue treatment and exercises to include in your existing fitness regime or to do at home.

Don't put up with pain, call us, we may well be able to help.

Back Pain Solutions - The latest research

As a practitioner in the field of back pain and a member of ‘Backcare’ the UK’s national back pain association I receive regular updates on current research and recommendations.  The most recent publication contained several interesting articles which I will summarise and share with you.

Orthopaedic surgeons speak out about what they see as the alarming trend in dangerous and unjustified back surgeries.

To quote George Ampat a consultant orthopaedic surgeon based at Royal Liverpool University Hospital ‘Unfortunately, there is a false belief that surgery or new technology can fix back pain.  This is far from the truth.’  He says that out of 100 patients who see a health professional for back pain 97/98% will get better without surgery through exercise and over the counter medication.

There are many products on the market for the condition known as sciatica, most of which you will see advertised for a while before they disappear – usually because they don’t work.  Sciatica is usually caused by a collapse of the spinal discs pushing the intervertebral cushion out, a bit like squeezing jam out of a doughnut.  Fortunately, with time and stability work this will usually ease within a few weeks.  One research study in the US looked at the results of surgery and showed a benefit for up to 8 years after surgery.  In the same study, those who did not have surgery also continued to improve over the same period.  Another study looked at the return to work ratio of those having surgery v those not having surgery.  The result?  26% of those having surgery returned to work v 67% of those who didn’t.  In addition, there was a 40% increase in the use of painkillers in those who had surgery.

Exercise myth busted - Don't delay, be active:
Nick Sinfield, a chartered physiotherapist says that a common effect of pain is that you become fearful of movement or believe that a certain movement will damage something.  In fact you should be moving and doing physical activities that move the spine normally.  Moving with a rigidly protected back will prevent your recovery not help it.  By not bending and moving correctly strain is placed on already sensitive soft tissues.

In my opinion if your back is sensitive, painful or stiff you should choose your exercises carefully.  Pick those which will reduce stiffness with gentle controlled movement and minimum spinal load on the spinal structure.  This type of exercise will improve the function of the spine, enabling it to cope better with everyday life. The ligaments and muscles which support your back require strengthening and rest will only weaken these leading to more back pain.

Remember the proven benefits of exercise:

Increases blood flow to all muscles which helps the healing process

Reduced muscle spasm, especially with biomechanic based anti-spasm techniques

Increase in your confidence in your body’s ability to move

Reduction in anxiety which helps with soft tissue relaxation.

Improved body awareness enabling you to listen to your body better in the future therefore reducing the likelihood of a recurrence.


Surgeons Speak out - Surgery can't fix all:
David Hanscom an orthopaedic surgeon specialising in complex spinal surgery says that although there is no connection between disc degeneration and pain there are hundreds of thousands of spinal fusion operations being performed for back pain every year based on MRI scans showing disc degeneration.
He says that in the over 60's, disc degeneration is present in 100% of people - most of whom do not suffer from chronic back pain.  This is normal.  Disc degeneration is not a disease, it is a normal part of aging, like grey hair.  Add to this the research that looks at back surgery patients after 2yrs with only a third showing improvement and you can see that it is easy to end up in what he calls the 'failed back surgery syndrome' with crippling pain for ever.

So, why do so many people see surgery as the best solution?

Well, there seems to be a number of factors having an effect.  Firstly, the health industry is increasingly commercialized with huge sums of money to be made from drug development and spinal devices. So it’s no wonder that these are promoted.

Add to this the fact that exercise in the UK is still almost entirely unregulated so usually excluded from being prescribed on the NHS.

Also, the training required to be effective as a back specialist forms something of a barrier to many exercise professionals.  As a result only a small number of us are fully aware of all the techniques and therefore the best way to help people with back pain.

Finally, people will always tend to select the solution that requires them to do the least work.  Often the choice will look like a life time of exercise against an operation and a period of recovery followed by a pain free existence.  Unfortunately this view is being called into question more and more.

My opinion?

This situation is a great shame because exercise is a cost effective, less invasive and therefore risky, solution.  However the fix for all this is not easy and probably would involve some form of regulation for those exercise professionals who would like to provide the service for the NHS.  Also doctors and surgeons need to be aware of the success rates of the exercise alternative, and also be directing patients down this course.
You can see from this why I feel so strongly that exercise options should be thoroughly tried before progressing to surgery. 

If you have any questions on this just give me a call

Pelvic Floor Dysfunction - More common than you might think

 HAVE A LOOK AT THE NEW PELVIC FLOOR WORK - IT
AFFECTS MORE PEOPLE THAN YOU MIGHT THINK

Pelvic Floor Dysfunction: What is it, why do you have it and how can you correct it?

To start with, new research in 2014 shows that 80% of women will have Pelvic Floor Dysfunction (PFD) at some point in their life and 30% will have stress incontinence.  Men are also affected by PFD, frequently as a result of prostrate problems, although this is talked about much less.

What is Pelvic Floor Dysfunction?
A dysfunctional muscle is one which will not contract nor release so it tends to be both tight and weak, and consequently, unable to function correctly.
The pelvic floor is the muscle group which forms the 'under carriage' of your trunk.  It supports your internal organs, includes the "bathroom" muscles and adds support to the sacro-iliac joint. So it is essential that it functions correctly.  If it is dysfunctional it will be tight, short and weak instead of being flexible, long and strong.

Symptoms of PFD may include:
Abdominal separation following pregnancy
Stress incontinence
Pelvic discomfort
Back and Sacro-Iliac joint pain

The contributors to PFD include:
Pregnancy
Crunches and sit ups
Poor posture
Wearing high heels
Sitting for too long 

What is the solution?
New research has identified that the pelvic floor will not work effectively in isolation, it will function up to 75% better through a specific mix of muscle group activation rather than with the traditional 'kegels' exercises (controlled lifting of the pelvic floor in isolation).
In addition, all exercises should be performed with the pelvis in a neutral position, not in the pelvic tilt position.
The specific mix of muscle group activation is to work the Glute (butt) muscles in conjunction with inner, and outer, thigh muscles.  This is the key combination for optimum pelvic floor engagement and improved support to the pelvis.

The best exercises are:
Squats with correct alignment to strengthen yet lengthen the pelvic floor
Shoulder bridge with a small ball between your knees
Curtsey or split squats
Clam type exercise using fast and slow twitch pelvic floor activation
Check with an exercise professional to ensure that your technique is correct as this is essential to gain any PF benefit.  The big benefit of this new approach is that by working this specific group of muscles, correctly, the pelvic floor will activate automatically.

Exercises to avoid
Any exercise with a pelvic tilt as this shortens the pelvic floor muscle, encouraging dysfunction.
Crunches or sit ups, which increase the downward pressure on the pelvic floor.
High impact exercise.
Pilates exercises such as 'the 100'

Would you like to know more?
Just contact Anne by phone or email to discuss your needs. The correct exercises and techniques are taught in 'I Move Freely' Pilates Classes at The Studio

Risk v Benefit - Keeping your exercise programme safe

Risk v Benefit – Keeping your exercise programme safe

 

There is much in the popular press about the benefits of exercise for both physical and mental health.  Many people are encouraged to take up exercise by their doctor or physiotherapist.  On the other hand, there are many articles about the risk of injury from exercise.  For example one study showed that over 60% of runners will pick up an injury in any one year, and another stated that 35% of women exercising on a regular basis will have a musculoskeletal injury.  

 

As a fitness professional and physical therapist I use a variety of techniques to ensure that my clients gain the benefit and do not suffer any injury:

 

I encourage clients to work at their own level, not keeping up or competing with each other.

I keep a close eye on the posture of each client as they exercise.  If there is a postural fault when a client walks in, they will probably keep that faulty position as they exercise.  This will be a habit that I am keen to discourage and correct with exercise.

When I spot a common postural imbalance within a group I will add exercises to help them correct it.  This could be drawing back rounded shoulders, lengthening the neck or stretching tight hamstrings to encourage better pelvic alignment.

At the beginning of each session I check how everyone is feeling and how long standing injuries are progressing.  I will include the best exercises to help each person’s condition.  This could be reducing range of movement to encourage stabilization of a lax joint, work to strengthen a weak joint or stretches to help muscles tightened up by other sports such as running or cycling.

 

Using these methods I aim to help everyone to exercise and gain a benefit whilst not risking an injury.  Remember that your feedback is essential to ensuring a safe effective exercise programme so don’t keep quiet about any pain or discomfort as there is usually a way to manage it, and it is often a good indicator to the types of exercise you need.

Yoga:- Religion? Life Style? Extreme Exercise, Relaxing Exercise? Just what is Yoga?

Yoga:- Religion? Life Style? Extreme Exercise, Relaxing Exercise?  Just what is Yoga?

In fact it can be any of these things, and more besides.  For an understanding of Yoga it is necessary to look at the history and development of this ancient art.

 

Before we start I must point out that I am not a Hindu, neither do I teach nor practice any of the “true” forms of Yoga. I am not an expert in this field, but am offering a simplified insight into the many meanings of the statement “I do Yoga.” and what might be involved in a “Yoga session”.

 

In the beginning.

We can start with the Vedas.  These are the four collections forming the earliest body of Indian scripture, which codified the ideas and practices of Vedic religion and laid down the basis of classical Hinduism. They were probably composed between 1500 and 700 BC, and contain hymns, philosophy, and guidance on ritual.

 

It is the Vedas that are the common link between Hinduism and Yoga and which form their very foundations. Yoga is in fact one of the 6 main branches of Hindu philosophy.

The word Yoga means Union – some say union with God, others union with self. This union can be perceived through a variety of methods including, but not limited to, control of the mind and senses, meditation and caring for the body through asanas, pranayam, cleansings, and detachment from worldly objects. Yoga directs us towards a righteous path of living; it is the remover of our identification with our physical body; and the aid to achieving moksha (liberation) in this lifetime.

 

So Yoga is religious and part of Hinduism?

Yes, but not necessarily!  Even from quite early in the development of Yoga and Hinduism it seems to me that Yoga could and did stand separately from Hinduism, as well as being an intrinsic part of it.  Yoga was originally a way of life but over time, it seems, a variety of elements from the whole have been extracted, each with specific benefits, and each called Yoga.  Confusing isn’t it.

 

And now?

There are many forms of Yoga, some are named (e.g.  Hatha, Vinyasa, Kundalini, Ashtanga, Bikram, Iyengar, Anusara, Restorative, Jivamukti, to name but a few) whilst others are just Yoga.  Each focuses on a set of targets or beliefs drawn from the Yogic teachings.

 

What does this mean for me?

When you attend a Yoga class you might find you spend your time relaxing and meditating.  Or, you could find yourself attempting to achieve extreme positions.  The class might be constructed to be accessible for any age or ability, or the session could expect a high level of fitness, stamina, strength and flexibility.

There is no doubt that there can be huge benefits to be gained by the practice of Yoga … however it is also clear that Yoga can also be physically detrimental.

When you consider the history of yoga you can see that it was not invented as a remedy for back pain or other injury. If this is your aim you need to seek form of exercise with a more physiological remedial basis.

 

How can I know what I am letting myself in for?

I would strongly advise that you contact the person running the sessions and ask them specifically what the aims of the class are, what their qualifications are, and make sure that their answers match up to your own targets and expectations.  In any case be extremely wary of any class that expects you to “push past the pain”.  Pain is the body’s protection mechanism and you should only be working through pain in closely controlled circumstances with specific goals.

I have arthritis, should I exercise?

Some Facts about arthritis:

• About 70% of people over the age of 65 will have some level of arthritis and 1 in 5 of the whole population.  This equates to around 10 million people in the UK.
• A number of people will have no symptoms and be oblivious to the fact that they have arthritis, but most people with it will suffer some symptoms, such as pain and stiffness, on a daily basis.
• The most common type of arthritis is Osteoarthritis, followed by Rheumatoid (especially in women) and Gout (especially in men).
• There are actually over 100 different diseases that can cause the problems characterised as arthritis.
• There is no cure for arthritis.

 
What is arthritis?
Arthritis affects the joints of the body.  At least two bones meet to form a joint, but some joints have three and wrists and ankles have more. Each joint in the body is constructed in a slightly different way.  Most of the main joints have cartilage covering the bone ends and the whole joint is enclosed in a sort of bag called the joint capsule.  This bag holds synovial fluid which effectively lubricates the joint.
Arthritis develops when the cartilage has become worn, torn, or has been removed, often due to trauma.
The synovial fluid within the joint capsule becomes thicker or ‘stickier’ as we age and as a result doesn’t coat the cartilage as well.  This results in increased wear to the cartilage and the bone ends which become roughened.  The joint can no longer slide smoothly and pain results.  This is typical in osteoarthritis of the knees, shoulders and hips.
With Rheumatoid arthritis joints become swollen as the body attacks its own tissues.  There are many other forms of arthritis, such as spondylitis which is when inflammation around the spine causes pain.

What causes arthritis?
Arthritis has a variety of causes, most of which are not fully understood.  For example:

• Trauma to a joint earlier in life frequently makes arthritis more likely.  A car accident, sporting injury, trip or fall can all cause damage to a joint, weakening it and making it susceptible to arthritis, sometimes not manifested until later life.
• Cartilage has a poor blood supply which means that when damaged by twisting or tearing is doesn’t heal very well.  As a result, it was common for cartilage to be removed following trauma, although nowadays this is less frequently performed and exercise is used to manage the situation.
• Carrying excess weight puts more strain on the joints increasing the amount of wear and tear.
• There is a clear genetic link which can increase the risk factor for Rheumatoid arthritis which can be activated by trauma.

 
Exercising with arthritis.
Arthritis causes joints to be stiff, painful and to have a reduced range of movement.  Exercise can improve these symptoms but it needs to take account of the arthritis. I work to create an environment and exercises within which the joints can be moved freely and without pain and you feel able to exercise within you own capabilities.  In addition, exercise can encourage good posture, which is essential in keeping the spine straight and reducing the risk of kyphosis – rounding of the neck shoulders as well as potentially slowing the progress of degeneration.
 
Key points to remember:

• Loosening joints, using movement which is pain free, is essential to encourage and keep the maximum mobility.  For example, in ball and socket joints, simply rotating the limb within the joint capsule can have a beneficial effect, by encouraging the synovial fluid to coat the whole joint and become less ‘sticky’.
• Specific muscle strengthening work to support the damaged joints will help reduce pain on a daily basis.  This is especially beneficial for the hips, shoulders, knees and spine.
• Do not push through the pain, look for a different way to loosen or strengthen the painful area.
• Avoid overstretching and putting joints into positions out of their normal range.  For example, knees are a hinge joint, designed to bend in a forward and backward motion with limited rotational range.  Sitting with legs crossed will stress the joint and in time can cause wear and then damage.
• Note which activities cause pain and look to find other ways of doing them.  Exercise can be designed to help you strengthen your body enabling you to do regular activities with less pain.

Finally:
Arthritis can be debilitating and has no cure, but exercise is one of the recommended treatments - don’t let arthritis be a reason to stop exercising.

 

Exercise - Benfits more than just your body!

When you think about ‘exercise’ you probably think about the benefit to your muscles and cardio vascular system, that it may hurt, you may ache afterwards but you’ll feel better for it and you’ll spend time with a group of likeminded people at your class or in the gym.  The first few statements relate to the physical benefits, but the latter are the extra benefits you may not have considered as being so important.

NHS Choices has this to say about exercise and mental wellbeing:

“It has long been known that regular exercise is good for our physical health. It can reduce the risk of cancer, heart disease and strokes. In recent years, studies have shown that regular physical activity also has benefits for our mental health. Exercise can help people with depression and prevent them becoming depressed in the first place. Dr Alan Cohen, a GP with a special interest in mental health, says that when people get depressed or anxious, they often feel they're not in control of their lives. "Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events," he says.”
see : http://www.nhs.uk/conditions/stress-anxiety-depression/pages/exercise-for-depression.aspx for the full detail.

So, if you are feeling down, generally tired, depressed or lonely, why not try a regular exercise class?

If you’re not used to exercising particularly in a class, you may think of a number of reasons why exercise is not for you.  Often, these reasons are based on misunderstanding or misinformation.  I have listed a few common feelings here along with an explanation of what actually seems to happen.

I have never been sporty, so I don’t do physical activity.
In fact many of our class members are not sporty in the slightest, and they still find the classes are easy to do.

I always feel tired so class will simply exhaust me further.
Many exercises or movement in classes can be made easier or harder by the way you do them.  Simply do as much or as little as you feel you can.

Exercise has to hurt to be beneficial, I don’t want that.
The more recent thinking by exercise professionals is that “no pain, no gain” is not, in fact, true.  In reality we have seen plenty of people who have improved their fitness and personal wellbeing, through exercise, and have not felt any pain in the process.

When I get there everyone will know everyone else, consequently I will be left out and feel awkward.
Whilst some classes can be a bit insular, in our experience most class are actually very inclusive.  New people are joining all the time and are very soon embraced by the class camaraderie.  As an alternative why not take a friend with you?

I have tried yoga/pilates/circuits/whatever and I found it painful/just didn’t like it.
Actually, pretty well every class is different in one way or another.  The content is usually created by the person giving the class so there are as many different forms of pilates, yoga, circuits, boot camps, meditation, etc. as there are teachers.  It is worth trying a number of different classes until you find the ones that suit you.  Almost always there is at least one out there.

I have never done any exercise, there are so many different classes I don’t know where to start.
In this case, go for pilates or yoga.  Look for a class where the instructor tailors content to fit peoples’ ability. Talk to the instructor, or other class members to find out about other classes in your area that may suit you.  Then just go along and give it a go.  It is normally easy to have a trial at any class and move on until you find one you like. But it is always worth taking to the instructor about any aspect that you didn’t like because it may be that it could be change to suit you.

The fact of the matter is that almost everyone can benefit from joining a class.

If you continue to be inactive you are more likely to suffer from low mood, depression, tension, stress, anxiety and worry.

By taking more exercise you will feel better about yourself, be less depressed, less anxious, have improved sleep and better concentration, not only this, but you will improve your physically capabilities.  All great reasons to be more active, particularly the older you get.

Looking at the technical side of why we benefit mentally from being more active there is a combination of reasons, some of which are not fully understood.  The simplest factor is that exercise stimulates the release of mood enhancing chemicals, dopamine and serotonin. On top of that the social aspect of common goals and camaraderie have a positive effect, as does the realisation of achievement.  Also your support network can be extended, we have found that classes are very good at support and often bring together common experiences and solutions to life’s difficulties.

The key to gaining a benefit is in finding an exercise programme which suits you.

It needs to be enjoyable and an escape from the pressure of ever day life.

It may not be hard work and you should feel able to rest during the class when you feel that you’ve done enough.

There may be a strong social element with interaction with others in the group.  The companionship you feel from your fellow class mates can be as important as the actual exercise.

Choose a form of exercise that you can keep up on a regular basis.

Thai Boxing - Personal Training with a difference

Make a difference to yourself today.

Are you in the Warwick area and looking for a different way to get and stay in shape?

Personal training will not only help you achieve your goals but is also a great alternative to a regular gym work out and run on the treadmill!

Singkhao Muay Thai Instructor Macauley Coyle is a competitive Muay Thai Fighter and athlete.

The training he will provide is varied and is planned to suit your individual needs and goals, whether you want to work on technique, become healthier, lose weight, improve your fitness or just learn something new.

So whatever you are aiming for, Macauley can help you reach your goals and achieve them faster than you would on your own.

Personal training sessions vary from person to person, areas that you may cover in a session include padwork, technical work, cardio and plyometrics. All equipment is provided and all you need to bring is lose fitting clothing, suitable for working out in. Nutritional advice is also available on request.

Why do you need strong 'glutes'?

When new people join a class or come to me with back pain they are usually completely unaware of their glute muscles.  The glutes are quite likely to be weak and tight, which sounds like an odd combination.

Strengthening the muscle and stretching it so it can function correctly is an essential part of keeping your body working effectively and without pain.

• Keeping correct alignment
  Strong glutes can protect you from injury and reduce the impact of arthritic pain by providing support to the spine and pelvis.  They also give correct alignment throughout the body helping to protect the knees from uneven wear, keep the feet lined up reducing problems with the achilles and plantar fascia.

• Support when walking or running or weight training
  The glute muscles stabilise your pelvis while you run or walk. They help with hip extension and forward propulsion. If they fail to engage correctly the work falls to the hip flexors which are less able and become tight quickly.  This puts stress onto the lumbar spine giving back pain.  Strong glutes help give correct positioning when weight training, especially during squats, so your knees are protected.  They also help with protecting your back when bending to pick up items from the floor or gardening.

• Injury prevention
  If your glutes are not strong, your entire lower body alignment may become out of balance causing injuries such as achilles tendinitis, shin splints, knee pain and leading to tight ITB which runners are particularly susceptible to.  When the glutes are not strong enough to do their job, other muscles not as well designed for the job take over.  While in everyday life it is usually the back which suffers, in those who train at a higher level the muscle imbalance is more pronounced leading to increased risk of injury.

• Strength
  The glutes are one of the largest muscle groups in the body.  If trained it can produce an enormous amount of power. By strengthening this muscle you will be able to move with less stress on your skeletal structure.  This is of enormous benefit as bones become less strong with age and affected by degenerative conditions.

• Reduction in back pain
  To simplify the effect strong glutes have on back pain visualise your spine.  It runs from the back of your head to your pelvis (hip bones).  Your pelvis sits like a t junction at the bottom of your spine.  Below this are your glutes, providing support to everything above it – hips and spine.  Once you move they are powering from behind you enabling you to move easily with less effort.  The other muscle groups, abdominals, quads and hip flexors are at the front of your body and while they are essential for movement and stability they are not nearly so well placed to provide power as the glutes.

So, to keep active and move with ease - get your glutes working!

How important is balance to your overall health and well being?

Many clients I see have very poor balance skills when they first attend The Studio.  This usually improves hugely within a few weeks.  I am frequently asked why it is that our balance is so bad, and, why it is important to improve it.

Firstly, why is our balance poor?
Balance is a motor skill which we acquire in childhood.  It requires the use of large muscles groups and although this skill remains with us throughout our lives it deteriorates with age.  At any stage of your life it is possible to improve your balance skills with training.
The ageing process causes muscle weakness which will affect the body's ability to recover from a trip on an uneven surface.  With age often comes inner ear misbalance causing dizziness or blood pressure issues which can cause light-headedness.  Also failing eyesight means you may mis-judge uneven surfaces, or distances from objects.  All of these situations can easily lead to falls.

How big a problem is this?
It is estimated that 30% of the over 65's fall every year, and more than half of the over 75's living in nursing homes or care facilities are unable to live independently because of falling.
Women suffer from bone thinning (osteoporosis) and this increases the risk of hip fractures if they suffer a fall.  Almost 50% of hip fractures are seen in people who had no mobility problems prior to their fall, however only 50% recovered to their previous level of mobility (NICE 2012)

How does this affect you?

1. Every time you walk you put all of your weight on your front foot as you lift the back foot up to swing it through.  If you step on an uneven surface, ice or simply misjudge the height of a kerb you will need to be able to balance on one leg for that little bit longer than usual to avoid falling. This is particularly true when walking down steps.
2. When you reach up to a high shelf you probably balance on one leg to gain extra height.
3. When you get out on the car you will place one foot down and put your weight through that leg as you push up to standing.  The added twist provides more challenge to the balance and it is easy to strain your back if your muscle structure doesn't support you too.

Things to remember

• Balance can be improved with practise both in a controlled environment such as with an exercise therapist and at home.
• Improved core strength gives better balance.
• A fall can signal the end of independent living, changing your life completely.
• Improve your balance and you'll improve your overall health and wellbeing.

Take action
If you are not currently attending The Studio, call me to arrange an appointment where I can assess your balance and help you to improve it.

Physical Therapists and Practitioners: which one is right for me?

There are a whole host of people out there offering a service to improve your physical being. Some have virtually no training, others have trained for years. Some provide a diagnosis, others just relieve stress. Some are very different, Pilates vs Indian head massage, while others are confusingly similar, osteopathy vs physiotherapy vs chiropractic. Some provide regular exercise, others are more remedial. So which one is right for you?

To look at it another way, for what should I go to each person? Or, what can I expect from each visit? Unfortunately, and possibly surprisingly there is not a straight forward answer to this (except possibly for GPs). Mainly because each therapy is practiced by an individual and your experience will vary greatly, even within a single discipline, depending on that individual’s experience, capabilities and beliefs. The best thing to do is book a consultation session so the practitioner can explain what services they offer, what you can expect to experience with them and a recommendation as to what would be best for you. Alternatively talk to someone who has been to a session and get a recommendation.

To help you choose which is right for you we can identify some basic information about each therapy.

1 Medically qualified and registered practitioners.

• GP – For diagnosis and medical knowledge. Your GP is the first place to go for any diagnosis. If your GP cannot complete a diagnosis he will be able to send you to someone who can.
  • Physiotherapy – For injury rehabilitation with medical knowledge. A physiotherapist will work generally on a specific site on your body. They may use manipulation techniques and suggest exercise programmes.
  • Chiropractic – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. They use manipulation and movements beyond your normal range. They tend to do this quickly, many people will recognise this as “clicking”.
  • Osteopathy – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of healing based on the manipulation of bones or other parts of the body. This is a more holistic approach than chiropractic, but they also use movements beyond your normal range. They tend to do this slowly, manipulating and stretching the muscles and tendons.
  

Bear in mind that, with the exception of GPs, you might have a very similar treatment from any of the above therapies and differentiation can be quite difficult. They all undertake many years of training in their own discipline and are required to be registered to practice.

2. Exercise Methods:

• Yoga – An ancient teaching from India. It is as much a way of life as an exercise class. There are many types. Some will include extreme positions and movements to improve strength and flexibility. Some include meditation, breathing, and relaxation techniques. Some will use flowing movements through a range of positions to achieve strength and flexibility. Try to talk to your yoga teacher prior to attending a class to establish whether the class will suit you. Generally you can expect a Yoga class to be physically challenging and involve a lot of stretches, balances and quiet reflection.
  • Pilates – Invented in the early 20th century by Joseph Pilates. This concentrates on the development of the “core” musculature. Again there are a number of variations from the pure, following exactly the original moves and approach, to fitness based and hot Pilates. Generally you can expect a Pilates session to be full of small slow movements coupled with balance. The focus is on correct technique to ensure the engagement of the important “core” muscles of the body.
  • Gym Training – A range of strength and cardio-vascular training equipment can be found in most gyms. Trained staff are on hand to explain the use of the equipment, and you would expect to have a personal programme to follow developed by one of the trainers. The staff are usually fitness experts but may not necessarily have any more specific training or expertise. Generally you can expect to be left to follow your own programme at your own pace in your own way.
  • Exercise classes – There are a large range of general exercise classes from circuit training to spin, from British Military Fitness (BMF) to Zumba. They are normally quite large classes (8 to 30 and more) and can be very social. There is usually a large cardio element to these classes, some also include strength work. You can expect to work hard, work up a sweat, and gain stamina.
  • Personal training – Otherwise known as one-to-one or consultancy. This category covers a wide range of services from specific sport training, through weight loss and life coaching, to back care and post-operative exercise. Some personal trainers are also qualified in massage techniques and a one-to-one session can help enormously to get the best out of classes such as yoga and Pilates. You can expect personal and tailored interaction but make sure you understand the qualifications of your trainer and that they match your goals. These one-to-one sessions are usually invaluable in helping people to meet their goals by selecting the best therapies and explaining the important techniques.
  

Once again it is a good idea to discover what qualifications and experience your trainer has, for any of these exercise therapies. Do remember that an inexperienced therapist can be just right for you, and an experienced, well qualified therapist may not suit your requirements. That situation is rare, it would be more normal for you to get a fuller, more effective and more enjoyable class from a more qualified and experienced instructor. In other words, to some extent, you will need to “suck it and see”. Just because you went to a Pilates class and it made your back hurt, that doesn’t mean that all Pilates classes would make your back hurt.

3. Massage Therapy (soft tissue therapies).

• Sports Massage – Despite its name this is not just for fit and active people. It is a deep massaging technique that focuses on areas of tight or knotted muscles and aims to release them by manipulation and the use of pressure. It can be quite painful, and often the massaged areas can be worse for a couple of days. Generally there is noticeable improvement after that. Having said that, very often it is not painful, and the improvement can be immediate. It is unlikely to be a relaxing experience although some people do find it so. Look for a sports massage if you have muscles that are knotted. Deep massage can encourage a healthy circulation before strenuous activity and a sports massage therapist can also provide post exercise or event massage.
  • Myofascial Release – Your whole body is covered with the fascia. It is under the skin, but over the muscles. If you look at a joint of meat the fascia is the white fibrous covering. In the best circumstances the fascia is taut yet flexible. In most people it has areas where it is attached to muscles, or damaged, or affected by scar tissue and so on. It can be like having a large rubber band holding your body out of alignment. As a result you may have pain in a shoulder that is cause by tight fascia running down your leg. A Myofascial massage is different from any other soft tissue therapy and feels gentle. The aim is to free the fascia to allow the body to align itself correctly. Look for a fascial release massage to ease those aches and pains, or to correct a postural anomaly.
  • Manual Lymphatic Drainage – Generally known as MLD. The body’s lymph system is just as important as the blood system, although not many people realise just how essential it is. Without lymph your blood would not get oxygen from the lungs, and your muscles would not get the oxygen from the blood. Not only that, but the body’s immune system would not work at all properly. It is lymph that is normally responsible for swelling at injury sites. Lymph is circulated around the body, but it doesn’t have pipes and a pump like blood, it relies on muscle movement and gravity to get around. There are specific sites around the body that process lymph, called lymph nodes. It is here that the lymph is processed to allow it to fulfil its many functions. The movement of lymph around the body can be adversely affected by inactivity, injury, illness and pressure. You should consider MLD if you have swelling, such as post joint replacement surgery, joint pain, or sinusitis. Since the lymph system is in the skin MLD is extremely gentle, but its effects can be immediate and dramatic.
  • Swedish Massage – Probably the best known massage. There are a wide range of generic massage techniques, such as this, that have general positive effects, but are not targeted like the techniques covered so far. They range from light to deep massages, some involve slapping and or drumming actions, others are done with the feet. Swedish massage will stimulate the circulation and be both enjoyable and very relaxing.
  • Hot Stone Massage – The use of pre-heated stones helps in many ways to increase the effect of massage. Hot stone massages are extremely relaxing. The heat from the stones encourages circulation and the muscles to relax. Using a hot stone to massage with has the effect of a deep massage without the need for so much pressure. Try one of these if you are stressed, or if you have any particularly stiff or knotted muscles.
  • Indian Head Massage – Although it is called a head massage you will normally get a head, face, neck and shoulder massage. It is said to stimulate hair growth, but it is definitely a most relaxing massage. It can be done with the client in a sitting position, and fully clothed, so it is ideal for an office environment, or anywhere away from a massage couch. When I have given these types of massage it is quite normal for my client to fall asleep, such is the relaxing effect of the technique. It is very good at reliving the tension in the shoulders that results from sitting at a desk working a computer. Try one of these if you are stressed, have a stiff neck, have a head ache or just fancy a good old pampering.
  

Which massage may suit you is very difficult to identify, a particular massage for one person can be brilliant, the same massage for another person can be debilitating. Have a conversation with your chosen therapist about your own preferences and any medical conditions you may have. If you have a bad reaction after a massage it is worth letting the therapist know and going back for another try. Most qualified soft tissue therapists will have a range of techniques at their command and will be able to take an alternative approach to avoid any bad reactions.

4 Other specialist areas

• Postural Assessment
  • Therapists with a postural assessment qualification will be able to identify any postural issues that may be causing pain, or imbalance. They will have a thorough knowledge of the musculature that is essential to correct stance. This is applicable to both exercise and massage therapists.
  Bio-Mechanics
  This area is a whole profession in its own right. Usually employed to gain the maximum performance from athletes and sports people, it has an application for everyone. A therapist with bio-mechanics training will be able to help anyone to a better understanding of their body and, generally, to identify an alternative approach to solving issues such as back pain, knee pain and the correction of running or walking style (gait).
  GP Referral
  This qualification enables exercise therapists to understand and make allowances for chronic conditions presented to GPs which would benefit from exercise. A therapist with this knowledge can support not just GPs, but any of the medical therapists (osteopaths, chiropractors and physiotherapists). Often this support can be in the form of specific exercise plans, but may also be particular massage techniques.
  Back Pain
  The causes of back pain are myriad. Sometimes there is a medically identifiable issue (e.g. herniated disc), but often there is no specific reason for the pain. Where this is the case therapists with specific training in dealing with back pain are able to help with targeted exercise plans, manipulations and massage.
  

In short, look at the qualifications of your chosen therapist and make sure that they meet your requirements.
Remember that you can get a good result from a newly qualified therapist, but if you have a recurrent problem to solve, look for qualifications, experience and evidence of on-going training, as research continues to improve the way we treat physical conditions.

Pilates, Yoga and back pain.

What is the difference between Pilates and Yoga, and why would you choose to take up one or the other?
Frequently either are recommended by physio’s or doctors for back pain and can be very beneficial under the right circumstances. Unfortunately both carry inherent risks, particularly for people with back issues, and Yoga tends to be less useful than Pilates in these circumstances.

Yoga
Yoga was developed in India hundreds of years ago to address a whole range of human issues, from the physical to the psychological. It would normally include a significant spiritual aspect as well as extreme body positioning, providing a 'whole body' (holistic) teaching and healing.
More recently popular Bikram and Ashtanga developments of this teaching include a dynamic approach, which can be difficult for less able (normal) people to handle.
Many Yoga teachings, including the Bikram and Ashtanga methods, aim to stretch the body as far as possible and to target the maximum range of movement through each joint. While this may be considered beneficial for a person with no history of joint pain or injury, it is not recommended from a bio-mechanical view. One reputable source recommended that only the under 25’s should be allowed into this type of yoga class.
I feel it is not developed from a physiology base, and not all positions nor movements would be recommended by up to date research into human physiology.
There are Yoga classes that focus on the spiritual elements and relaxation. These can be perfect if you are looking for stress relief or a meditation like class. The spiritual element actually enables some people to really connect their mind and body and gain a tangible benefit from this.

Pilates
Pilates is an exercise method developed by Joseph Pilates, an injured gymnast and body builder, in the 1920's. It was developed from exercises from all the programmes available at the time along with some innovation from Joseph P. This included Yoga and several fundamental Pilates exercises clearly come from this discipline. Joseph understood the need for “core strength” and this is the focus for most Pilates forms.
Whilst there are still trainers that teach “pure” Pilates (as Joseph would have done), other professionals have modified and developed the exercises ever since. There is no copyright on the word 'Pilates' so the content of classes can vary hugely.

Back Pain
Many of the Yoga movements are medically contra-indicated for the back (i.e. the risk of making matters worse, by doing the exercise, is greater than the likely benefit). Some of the Pilates movements are also contra-indicated for the back (mostly derived from Yoga movements).
For an example of a Yoga inspired Pilates exercise which can cause back pain we can take a bio-mechanical look at the ‘roll down’.
Yoga and Pilates both use the ‘roll down’, a movement from sitting to lying where the back curls round to allow vertebra by vertebra to reach the floor. The intention being to strengthen the abdominal muscles.
But what actually happens to your body when doing this?
The intervertebral disc space is opened which can aggravate or even cause bulging (herniation/slipped disc). A little like squeezing a jam donut until the jam pops out.
In fact not only the abdominal muscles but also the hip flexors, hold the body as it rolls down.
The shoulders curl forward shortening the pectoral muscle group and the mid trapezius lengthens.
For many people these muscles are either already tight (pectorals) or already long (mid trapezius) from daily repetitive movements such as computer work or driving. The hip flexors are frequently tight just from sitting down for too long.
It turns out that this exercise provides no real benefit but potentially compounds the postural issues that everyday life gives most of us. Worse still it can aggravate back pain and intervertebral disc issues, rather than helping.

My training as a back pain specialist made me question the validity of some of these exercises, particularly when clients have back problems (slipped or bulging vertebral discs, degeneration of facet joints or osteoporosis). My bio-mechanic training has encouraged me to question each exercise that I teach. What is the benefit? What is the risk? Why am I teaching it to this particular group? Is there a better way to gain the desired result? There should always be a clear answer to all these questions.
I have been teaching Pilates and Yoga, in various forms, for more than 20 years. Over the last 10 years I have developed “I move freely” Pilates as an exercise form that carries most of the Pilates benefits with few of the risks.
I Move Freely Pilates takes the principles of Pilates but integrates Bio Mechanic coaching techniques to offer an up to date way of keeping mobile, strong and with the optimum amount of flexibility. Mobility work is essential to keep the whole body moving easily.  I feel that mobility and balance are key skills that deteriorate with age but which with work can be improved reducing the risk of stiff joints and falls in old age.
The strengthening work uses the body's ability to statically contract or 'engage' a muscle as well as using controlled lengthening and contracting of specific muscle groups. It works on the muscles of the abdomen, buttocks (glutes) and back, many of which you can't see (most people don’t even know they have them), but which should perform functional roles of support throughout daily life.
  It is this functional supporting role that reduces back and other joint pain. Each exercise involves a very precise movement and often it is impossible for anyone else to 'see' how hard a person is working as the work is in 'engaging' a specific muscle.  This often leads people to do the exercises at a level below that of which they are capable and so they don't achieve the full benefit but feel they are 'stretching out' rather than 'working'.
Performed correctly Pilates can achieve great core stability and it is as useful to elite sportsmen and women as it is to the general public. 
This link (from my Norfolk Studio) explains more about stretching v working a muscle:
http://thestudionorfolk.wordpress.com/2013/08/12/are-you-stretching-or-working-your-muscles/

To Conclude
Most Yoga teachers have spent time in India studying and practicing so they are expert in their knowledge. Most Pilates instructors have studied the teachings of Joseph Pilates and have an in depth knowledge of the exercises and breathing techniques he espoused. However this does not make any of them experts in back pain management. They are unlikely to have had the training to working with particular conditions, such as arthritis, or liaising with physio’s as to the correct exercise programme for someone with a recently herniated (slipped) disc. For this you need a back pain specialist.
All forms of Pilates and Yoga can offer some people real benefits. To choose which would suit you best give some thought to what you hope to achieve and how your body will respond to the challenges of each class. Do try several before deciding which suits you and don’t be put off if your back aches after one class, try another – they are all different.
I also strongly recommend taking at least one consultation with a back pain trained exercise professional, since it is essential to know some basic information about how to perform Pilates exercises that is not usually covered in the class situation.