How a young instructor found safe techniques to challenge herself and her clients
By Rebekah Rotstein

People who first meet me find it odd that as a Pilates instructor I actually don’t do Pilates mat for my own body. In fact, ever since my osteoporosis diagnosis two years ago at the unusually young age of 28, the annual PMA conference is the only time I participate in a traditional mat class. Flexion, lateral flexion (side bending) and rotation of the spine are contraindicated for people with osteoporosis and osteopenia (the precursor to osteoporosis, which should be treated in the same manner from a movement perspective). Unfortunately, this rules out three-quarters of the Pilates mat exercises.

So I’m often asked with disbelief how it is that I can actually work my abs. I too had doubts during my initial shock at the diagnosis, questioning what these limitations would mean for my ability to move and work out the way I had since my days as a ballet dancer. But I soon realized that even for an advanced client like myself, spinal articulation and flexion is only one aspect of an abdominal regimen and of Pilates in particular. Remember that we have four sets of abdominal muscles, and Pilates targets most specifically the innermost layer, the transversus abdominus, to contract throughout exercises and frequently in tandem with isometric contraction of the internal and external obliques. This means that abs are working regardless of whether the spine bends. And we can also still work the superficial layer – the rectus abdominus – by moving the spine from extension to neutral against gravity.

Indeed, I’ve found that it is possible for me—and my clients—to still get a great workout, even at more advanced levels. Pilates educators Sheri Betz and Elizabeth Larkham have both presented mat workout options for osteoporosis that utilize lever loads and varying bases of support to challenge the core. For instance, working with foam rollers and rotational disks on the mat provide numerous ways to alter the difficulty level. And many existing Pilates exercises can be modified to keep the entire spine in a neutral position (try Teaser with a flat back and propped with hands from behind remove the spinal articulation.)

Furthermore, the Pilates machines offer a whole host of possibilities for a full-body workout without bending the spine. Classical exercises that I like to teach include Chest Expansion, Long Stretch and Trapeze Pullups (for advanced clients). And I also use these creative variations on traditional exercises:

One-Legged Elephant: Extend one leg and keep a flat back while bringing the Reformer carriage home with the standing foot

Single Arm Hug-a-Tree seated on rotational disk: To keep the disk from spinning, a client must use her abs

Hamstring III/Pull Up (Hamstring Stretch II) on the High Chair with flat back and single leg: Slowly swing leg in the air to the side as you push the pedal down or as the pedal rises

Reverse Roll Down: Lie with legs bent, extend the back beyond the end of the trap table, and “roll” down and up from extension to neutral. Use one hand behind head if needed to support head or for a greater challenge.

We also need to remember the statistic that 55% of people over age 50 are at risk for osteoporosis; therefore, our own community of Pilates instructors will personally need to address this issue more over the coming decades. Many of us accustomed to doing Rollover and Short Spine will need to find alternative methods in our own workouts. 

As an instructor with osteoporosis, I think it’s important to inform our clients of the recommended limitations to their movement to avoid fracture and maintain safety without allowing them to feel limited or excluded. Teach and remind them of the multitude of possibilities available to them in a workout.

Osteoporosis Resources:
National Osteoporosis Foundation (www.nof.org)
Foundation for Osteoporosis Research and Education (www.fore.org)
Sara Meeks Seminars on Osteoporosis for Health Professionals (www.sarameekspt.com)
Sherri Betz on Pilates and Osteoporosis (therapilates.com/osteonews.html)

Rebekah Rotstein is the founder of Incorporating Movement, through which she offers workshops on osteoporosis. She is also an expert instructor at the Kane School of Core Integration in New York City.