Pilates to Relieve Knee Pain

 

When I practice Pilates 3+ days per week, my knees do not hurt. With less frequent Pilates practice, my right knee reminds me of all the wear and tear that’s shown in both the X-rays and MRI. Over the course of the past decade or so, this pattern has remained true, and I have come to rely upon Pilates as one of the three tools I use to manage what orthopedists consider a worn-out joint.

When many people think of Pilates, they tend to mention “core strength” or how Pilates helps loosen up stiff joints. While a strong core and supple spine are definitely among the benefits arising from a Pilates practice, I have come to believe that the Pilates secret sauce is how it benefits postural alignment.

The first step in improving alignment is to
connect lower-ribs with the abdomen.

In an era of staring at handheld screens, sitting in cars and working at computers, most of us developed a head-forward habitus. Perhaps you’ve experienced the tight neck and shoulders that often accompany head-forward posture? In the 21st century, head-forward posture is virtually ubiquitous. To their credit, many people catch themselves with their head forward, and then lift their chest in the hopes of improving their posture. While placing the head more in-line with the vertical axis is a positive, postural step, most people’s attempts to do so are more one step forward and three steps backward!

In the accompanying diagram, you can see the Head-Forward Posture on the left. This is the postural default for the majority of people. In the middle is the Split-Diaphragm Posture that most people consider “good posture.” Notice how the lower-ribs jut forward? This seemingly innocuous misalignment of the ribs puts a great deal of stress on the lower-back, sacrum, hips, and in particular, the knees. In Pilates, the first order of business is to reconnect the lower-ribs with the abdomen, and from that foundation, methodically work from proximal to distal in aligning and mobilizing.

When my body segments are aligned, as in the Optimal Posture seen in the right of the accompanying diagram, my knees do not hurt at all. Thrice weekly Pilates reinforces and strengthens the habit of Optimal Posture. With less frequent reminders, the postural artifacts of Head-Forward Posture or Split-Diaphragm posture emerge, and my knee pain lets me know that it’s time to practice Pilates.

In my long history in working with the body, I’ve not found a system that methodically works with posture with the same keen insight as Pilates. In teaching and practicing Yoga for 30+ years, I found that the common instruction to “lift the chest” seemed to reinforce the Split-Diaphragm Posture. It was only once I began learning how to breathe while practicing exercises such as the 100, Roll-Up and The Stomach Series, that I finally enjoyed posture that connected upper-body with lower-body in a harmonious relationship with gravity. (And enjoyed pain-free knees!)