Pilates instructor

Movement Is Always in Season: The Practice Of Being Present

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By Nichole Zuckerman — Pilates Educator, Teacher Trainer & Director of Polestar Pilates USA

Opening: Movement Changes

You’re a runner. You run through the spring, set goals, watch your pace change, feel yourself getting stronger.

Then summer arrives, it’s hot… and running doesn’t feel the same – so you swim!

At first, maybe swimming is the alternative, but hen something happens. You start setting swimming goals. You notice your stroke. Your breath. The number of laps you can swim without stopping. You start looking forward to the pool.

And then fall comes. You lace up your running shoes again, and somehow, you’re 5% stronger than you were last fall.

Movement has seasons, and maybe our job isn’t to resist them. Maybe it’s to notice them. Unless you live in a place with completely steady weather, the reality is you will have to adapt your movement throughout the year. And even if your routine is inside a gym, shifting modalities and goals will help you become a more well rounded mover and experience new fun ways of moving.

Sometimes the Season Chooses You

Sometimes the change is environmental: Summer gets too hot to run. Winter moves you indoors.

Sometimes it’s an injury: You assess. You adapt. Maybe the miles disappear for a while and the Reformer becomes your practice.

Sometimes it’s pregnancy: Your speed changes. Your capacity changes. The quantity of movement may change.

But none of that has to diminish the quality of your movement.

You can still bring your breath, your attention, your curiosity, your positive mental outlook.

Your presence.

Quality Is Available in Every Season

We often measure movement by what we can count: Miles, Laps, Repetitions, Weight, Pace, Classes.

But there are qualities of movement that don’t disappear when the numbers change.

  • How present were you?
  • How well did you breathe?
  • Did you listen to your body?
  • Did you notice the people around you?
  • Did you enjoy being there?

These are things we can practice whether we’re running ten miles, walking around the neighborhood, swimming laps, taking a Pilates class, recovering from an injury, or moving through pregnancy.

Notice Where You Are

There’s another gift in allowing movement to have seasons: you start noticing them. The light reflecting across the ceiling of the indoor pool, the first leaves changing on your neighborhood walk, the feeling of coming into the Pilates studio when the heaters turn on for the first time in winter, the energy of a class at the end of the school year, when everyone is talking about summer and getting ready for vacations.

Movement becomes one of the ways we experience time.

Instead of constantly asking, What did I do? How far did I go? How hard did I work?

We can also ask: Was I there for it?

Bring Your Vibe to Your Tribe

Presence isn’t only something we practice for ourselves. Every pool, studio, trail, gym, class and neighborhood has a community around it. You get to contribute to that community. So, if you can… Be the person who gives the high five! Be the person who says good morning. Learn someone’s name. Encourage the person next to you. Thank your teacher. Thank the person at the front desk. Notice when someone hasn’t been there for a while.

Bring your vibe to your tribe, support the people around you, and hopefully allow yourself to be supported, too.

The Practice That Lasts All Year

Your movement will change. There will be seasons when you feel strong and fast. Seasons when you slow down. Seasons when you explore something completely new. Seasons when your body asks you to reconsider what movement means altogether.

The goal doesn’t have to be holding onto one version of yourself all year. The practice can be learning to show up fully for each version.

Bring the quality, the breath, your presence. Bring the “good morning”, the “thank you” and the high five.

Because those are always in season.

You can find Nichole on social @nicholemoves and on the Polestar Blog

Read more from Nichole: The Best Teachers Teach In The Moment

The New Era of Pilates Instruction: Movement Science, Clinical Thinking, and the Evolution of the Modern Practitioner

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How the Modern Pilates Instructor Is Expanding the Way We Understand Human Movement

The Pilates and Movement industry is changing. Not because the foundations of Pilates are disappearing, but because the people walking into our studios are changing, and the profession itself is evolving alongside them.

Pilates instructors today possess greater access to research, continuing education, interdisciplinary collaboration, and movement science than at any other point in the history of the profession. Pilates is increasingly becoming a trusted presence within healthcare, rehabilitation, performance training, and wellness settings around the world.

When I started out 40 years ago, Pilates was viewed primarily as a niche exercise method. Now it is regularly discussed in clinics, integrated into recovery programs, referenced by healthcare providers, and sought out by clients navigating increasingly complex physical and neurological experiences.

As the visibility and credibility of Pilates continue to grow, so does the opportunity, and responsibility, for movement professionals to deepen the way they observe, understand, communicate about, and influence human movement.

Today’s Pilates instructors are working with so many diverse bodies:

  • persistent pain
  • hypermobility
  • pelvic floor dysfunction
  • post-surgical recovery
  • nervous system dysregulation
  • fatigue syndromes
  • trauma histories
  • autoimmune conditions
  • complex movement behaviors
  • metabolic disorders
  • cancers/neoplasms

Clients are also arriving more informed, more medically aware, and often carrying language they have heard from physicians, physical therapists, psychologists, podcasts, social media, and healthcare systems.

And as movement professionals, we are being asked to evolve alongside them! This evolution is not about abandoning the art of teaching movement. It is about deepening our understanding of why movement changes, how pathology influences movement, and how movement itself can influence physiology, perception, behavior, and healing.

This is the essence of Pathokinesiology. As I often say: Pathology influences movement… and movement influences pathology.

The future of the movement profession is not built upon fear or over-medicalization. It is built upon observation, critical reasoning, communication, and the ability to create positive movement experiences that improve the lives of the people we serve.

Below are three examples of how the modern, pathokinesiology-informed Pilates instructor may begin seeing common client presentations through a broader and more integrated lens.

-Dr.Brent

1. Hypermobility

From “Flexible” to Understanding Stabilization, Fatigue, and Proprioception

What Clients Often Say:

“I’ve always been really flexible.”
“My joints feel unstable.”
“I’m exhausted all the time.”
“I can do strange things with my body.”
“I was told I might be hypermobile.”

For years, many Pilates instructors viewed hypermobility primarily through the lens of flexibility, but today, the conversation is evolving rapidly.

Through recent discussions in the Pilates community, including conversations with experts such as Dr. Marcia Perretto on Pilates Hour and Live Aligned , movement professionals are beginning to recognize that hypermobility is often far more complex than excessive range of motion alone.

A pathokinesiology-informed instructor may begin thinking about:

  • proprioception
  • force transfer
  • connective tissue behavior
  • fatigue patterns
  • autonomic nervous system involvement
  • stabilization strategies
  • movement variability

The question becomes less: “How flexible is this client?”

And more: “How efficiently is this person creating stability?”

What the Science Is Showing

My Live Aligned Episode “The Hypermobility Puzzle” discusses just this! ( Watch Here)

Proprioception may be altered: Research suggests many hypermobile individuals demonstrate altered joint position awareness and sensory feedback, meaning the nervous system may work harder to determine where the body is in space.

Stability is metabolically demanding: Many hypermobile clients expend tremendous muscular energy creating stabilization throughout the day, which may contribute to chronic fatigue patterns.

Hypermobility is often systemic: Conditions such as hypermobile Ehlers-Danlos Syndrome (hEDS) may involve cardiovascular, autonomic, gastrointestinal, and sensory system involvement, not simply joint laxity.

This changes the movement conversation dramatically, the modern movement professional increasingly understands: flexibility does not always equal resilience.

2. Pelvic Floor Dysfunction

From “Engage Your Core” to Understanding Pressure, Breath, and Coordination

What Clients Often Say:

“I leak when I sneeze.”
“My core feels disconnected.”
“I don’t know how to activate my pelvic floor.”
“I’ve had back pain since pregnancy.”
“I feel pressure in my pelvis.”

Traditionally, many movement conversations around the pelvic floor centered around strengthening, but modern movement science is revealing something much deeper:
the pelvic floor does not function in isolation.

It functions as part of an integrated pressure-management and stabilization system involving:

  • the diaphragm
  • abdominal wall
  • spine
  • rib cage
  • breath mechanics
  • posture
  • and autonomic regulation

In many ways, the modern Pilates instructor is shifting from cueing isolated muscular contraction toward facilitating coordinated movement strategies.

The question is no longer simply: “Can this client activate their core?”

But rather: “How is this person managing pressure, breath, coordination, and load throughout the system?”

What the Science Is Showing

The diaphragm and pelvic floor work together: Research increasingly supports the relationship between respiration and pelvic floor mechanics. Breath strategy directly influences pressure regulation throughout the trunk.

More tension is not always better: Some clients with pelvic floor dysfunction may not demonstrate weakness at all but rather excessive resting tone, poor coordination, breath-holding strategies, or inefficient pressure management.

Stress physiology influences pelvic floor behavior: The autonomic nervous system influences muscle tone, guarding patterns, respiratory behavior, and pelvic floor function.

This is why movement professionals are increasingly studying:

  • respiration
  • nervous system regulation
  • variability
  • and movement efficiency

Not merely muscular activation, because sometimes the solution is not “more contraction”, sometimes the solution is “better coordination.”

3. Chronic Pain

From “Tight Muscles” to Understanding the Protective Nervous System

What Clients Often Say

“My shoulders are always tight.”
“I’ve tried everything.”
“My MRI looked terrible.”
“I’m afraid to move.”
“I feel fragile.”
“My pain keeps moving around.”

Perhaps no area of movement science has evolved more dramatically in recent years than our understanding of pain. In our conversations on Live Aligned with pain science experts such as Dr. Adriaan Louw, one concept continually emerges: Pain is often protective and the body is not simply a mechanical machine.

Human movement is influenced by:

  • perception
  • stress
  • threat assessment
  • previous experiences
  • sleep
  • inflammation
  • emotion
  • behavior
  • and nervous system sensitization

A pathokinesiology-informed Pilates instructor begins understanding that persistent pain is often not explained entirely by tissue damage alone.

The question becomes: “What is the nervous system trying to protect?”

What the Science Is Showing

Pain and tissue damage are not always strongly correlated: Research repeatedly demonstrates that imaging findings do not consistently predict pain severity or movement capacity.

The nervous system adapts: Persistent pain may involve sensitization, where the nervous system becomes increasingly efficient at producing protective responses.

Fear changes movement behavior: Anticipation, fear, and perceived threat can alter breathing patterns, muscle guarding, balance strategies, motor coordination, and movement variability. This understanding profoundly changes movement prescription. As movement professionals, we are no longer simply stretching tissues – we are influencing human experience.

And as I often teach: Distribution of movement equals distribution of force. When movement becomes more adaptable, efficient, and variable, the body often becomes more resilient as well.

The Future of the Movement Profession

The Pilates instructor of the future may not look entirely different from the Pilates instructor of the past, but the lens through which they observe movement is evolving.

The modern movement professional increasingly understands:

  • biomechanics and neuroscience
  • movement and physiology
  • stabilization and variability
  • anatomy and perception
  • pathology and human behavior

This does not mean Pilates instructors must become physicians, it means they are becoming more sophisticated observers of human movement.

More skilled communicators. More collaborative professionals. More capable of creating positive movement experiences that change the lives of the people they serve. This is the evolution of the profession, and this is the work of Pathokinesiology.

For more information about Dr.Brent’s Pathokinesiology 2026 Fall Cohort click here.

The Rise of The Movement Practitioner

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This blog is written by Dr. Brent Anderson as part of an ongoing conversation at the intersection of movement science and clinical reasoning.

With the Summer Pathokinesiology Certification cohort opening for registration on May 1, alongside early bird tuition – this is your invitation to step into the work and join a global community advancing how we understand movement and pathology.

The Rise of The Movement Practitioner: Bridging Fitness & Healthcare

The next evolution of healthcare isn’t happening in hospitals, it’s happening in movement studios. A new kind of professional is emerging: one who understands both the science of pathology and the language of movement. Not just instructors. Not just clinicians – Movement practitioners.

Movement practitioners like Shelly Power, who I write about in my blog When Movement Speaks First, are already leading this shift, bridging the gap between what we see in the body and what’s often missed in traditional care. And they are quietly reshaping how we approach health, recovery, and performance.

Every day, people walk into movement spaces carrying far more than a desire to exercise. They bring pain, diagnoses, compensations, fears, and unanswered questions about their bodies. They are navigating chronic conditions, recovering from injuries, or simply trying to feel at home in their bodies again.

Whether we acknowledge it or not, we are making decisions that influence their outcomes.

The challenge is not a lack of care or intention – It’s a lack of framework. Most movement professionals are trained in exercises, but not in how pathology shapes movement, or how movement can influence pathology. So we rely on intuition, experience, and pattern recognition… without always having the language to support it.

But intuition is not guesswork, it’s recognition, and recognition can be trained. When we begin to understand how the body adapts to injury, stress, and disease, movement becomes something more than exercise. It becomes a form of assessment, a form of communication and a form of intervention.

This is where the role begins to shift from instructor to practitioner, and from delivering workouts to making decisions. You stop asking “What exercise should I teach?” and ask “What does this body need?” – This is the work. It requires more than repertoire, and it requires a deeper understanding of how pathology influences movement and how movement, in turn, can influence pathology.

This is the foundation of Pathokinesiology. The study of how pathology impacts movement, and how movement influences pathology. A framework designed to give movement professionals the clarity, confidence, and language to step into this role fully.

Across more than 20 countries, movement professionals are already stepping into this work. They are working with older adults, clients in chronic pain, post-rehabilitation populations, and individuals whose needs don’t fit neatly into a single category.

Not as replacements for healthcare, but as informed collaborators within it – because the future of health is not built on isolated disciplines, it’s built on integration, on communication and on a shared understanding of the human body in motion.

If you’ve ever felt the responsibility of guiding someone through pain,
If you’ve ever questioned whether you’re doing the right thing,
If you’ve ever sensed that there is more to understand beneath what you’re seeing,
I’ve been there, and…You’re right.

And you’re already closer than you think! Pathokinesiology is the next step, and I hope to see you inside!

-Dr.Brent

Learn More Here

Enrollment for the Pathokinesiology Certification Summer Cohort opens May 1, with early bird tuition available—the course begins July 1st.

Six Tips To Better Cue The Breath in Pilates

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By Polestar UK Mentor Kristin Loeer. If you are interested in learning more about Kristin’s approach to working with the breath in Pilates you may be interested in the upcoming workshop “The Movement of Breathing” which will be hosted by Polestar Pilates UK in November 2022.

I have never met a client who was not confused or insecure about the nature and function of their breathing. In fact, I have never met a client who, when asked about it, did not assume that they are “probably breathing badly”. People are exposed to plenty of breathing cues in Pilates and Yoga classes. Outside of the studio, there is also an abundance of breathing practices and breathing apps.

So why is there such confusion and lack of confidence about breathing? And secondly, I dare ask, do we, as movement professionals who cue breathing all the time, feel all that confident about it ourselves?”

After all, we may have learned that thoracic breathing is the way to go. Or we were told that deep diaphragmatic breathing is important. We may feel compelled to remind people to take deep breaths during movement because we see their tendency to hold their breath. Then again we may wonder about the exhale because if we do not breathe out we can not take in fresh air either. When we add Pilates to the equation and start talking about inhaling and exhaling in relation to movement we can easily overwhelm our clients, if not ourselves.

The Breath as Autonomic and Conscious Process

The reason why the subject of breathing causes never-ending confusion is that breathing is both a very finely tuned autonomic process, as well as under our conscious control. Hence it can be altered, but we may wonder whether it should be. This will always have a very complex impact on the rest of our being. 

Just like digestion or heart rate, breathing is orchestrated largely by our autonomic nervous system. The autonomic nervous system is influenced by our life experiences. It is constantly responding and adapting to external and internal changes. Its main concern at all times is homeostasis and survival.  

The Breath As A Tool

As mentioned, unlike heart rate and digestion, breathing is also under our conscious control. I can choose to lengthen my exhale or to hold my breath. I do not have the same control over my heartbeat or digestive processes. This makes breathing such a powerful tool. We can use it when we want to become calmer or more alert and of course, it gives us the opportunity to optimize movement through breath. 

I am a practitioner, who specializes in somatic trauma work. My belief is that it is important to remember that while we can alter our breathing and create powerful change through it, breathing is a carefully and deliberately orchestrated nervous system process. No matter how inefficient or dysregulated a client’s breathing pattern may seem, in my experience, it is never random. There is no such thing as “lazy breathing”, “wrong breathing” or “I forget to breathe”.

There is nothing the nervous system does without good reason or without its key concern being survival. 

This does not mean that we should not work with our breath. It means that we need to go about it gently and respectfully. We need to be aware that there is a reason for the client’s current breathing pattern, and that if we try to alter it, there may be pushback from the client’s nervous system. We can bring about positive change indeed if the nervous system recognizes that this change in breathing is helpful. On the other hand, if we are not careful we might promote a messy interference with the nervous system’s autonomic process, which does not serve the client well.

Here are my six top tips for how to work with the breath in both private Pilates sessions and group classes:

1. Observe The Breathing Pattern

Particularly in private sessions, we have the opportunity to observe our client’s breathing both in stillness and motion.

Let’s not be too hasty with our wish to help them use their breath better. Let’s be curious about what their body is naturally doing. Also, consider how breath might change automatically as we work with using other cues. It is very possible that your soothing voice or their awareness of their body’s movement against the ground settles their nervous system. This alone might regulate their breathing without you having to address it directly.

2. Make Breathing Cues Relevant To The Client.

As with movement, respond to what you are observing rather than using generic, popular cues.

Some people do indeed breathe shallowly. Others have already been told they do so and are now stuck in compensating patterns of excessive abdominal breathing. Many people inhale more than they exhale, however, there are also a fair few people who stretch their exhales and barely feel the need to inhale. The point is that no one person breathes the same and we need to be careful not to generalise and give people cues that are not useful to them.

3. In Group Classes: Offer Different Breathing Cues To Explore.

In group classes, it is much harder to observe and attend to individuals of course.

We need to be aware that not one breathing cue will work or be right for everyone. Let’s provide different options so that they can explore and be inspired by the cues that feel good to them. You might ask them to become aware of how much they breathe in compared to how much they breathe out. You might suggest they try out opposite options within an exercise to let them decide what feels right for them. Also, give people the option to ignore the breath-related cues altogether. They may simply not be in a place where they feel safe to explore their breathing patterns. 

4. Use Positive And Invitational Language

Whether you work with individuals or a group, when it comes to breathing I strongly recommend using invitational language.

Let’s remember that the nature of our breathing is closely linked with our sense of survival. It is important to put the client in charge of their breath. Encourage them to be present and curious with their breath. Reassure them that while they may want to try out making changes, their natural breathing is not wrong and they can return to it whenever they want.  

5. There Is No Failure. 

A client may simply not be able to access the shift in breathing we are encouraging them to find.

This may bring about a sense of failure in the client. Let’s remember that the nervous system always has the final say and if it does not deem a change safe it will not allow it. You can communicate this to the client by explaining how their body is “saying no” to this today and how over time it can change its mind”. Encourage the client to explore and “play with this again later.”  

6. Bring Awareness To The Impact

If the client’s breathing does change, allow them time to experience this without adding any further new information or cues.

It can take a few minutes to explore this and to become aware of the holistic impact this change has had. They may feel calmer, stronger, or experience more flow in the movement. This positive shift is really worth exploring! It has the potential to integrate and perhaps become the new normal. They may become emotional, anxious, or irritated and feel their movements ‘disintegrate’. It is important for the client to experience whether this shift is positive for them or not. They can revert back to their previous way of breathing if they need to. 

If you would like to learn more about my approach to working with the breath in Pilates you may be interested in my upcoming workshop “The Movement of Breathing” which I will be running for Polestar Pilates UK in November 2022. For more information please contact me @kristinloeer_movement .

Kristin Loeer

5 Ways Pilates Can Support Your Mental Health

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“If you can relate to overwhelm, anxiety, or perhaps being ‘tired and wired’, then read on for ways in which Pilates as a practice can help you, and support your positive mental health.”

Sarah Edwards is a Doctor of Education and Comprehensive Polestar Graduate of Polestar Pilates UK.

Pilates is often promoted as being great for ‘core strength’ or ‘reducing back pain’, both of which it certainly can do. (I know, as back pain was the main reason I took up Pilates in the first place). Through personal experience and in teaching clients in private and group settings, I now know that Pilates has consistently supported me in managing my own anxiety. The practice can be instrumental in supporting the positive mental health of others.

Prior to teaching with Polestar and while I attended my weekly Pilates class, I was working as a Teaching and learning director in higher education. I completed a Doctorate in Education, raised a family, and I also experienced a number of traumatic experiences regarding my children’s health. Not surprisingly, I was diagnosed with Generalised Anxiety Disorder. 

Thankfully, Pilates really brought me out of that very busy headspace and, at times, my overwhelm. My experiences led me to train with Polestar as a Comprehensive Practitioner. I also trained as a mental health first-aider and, safe to say, I haven’t looked back.

Joseph’s Mind-Body Method

Joseph Pilates advocated a mind-body practice much before his time. In many aspects of holistic health, the context of “typical daily life” has changed in drastic ways. Modern lifestyle habits including chronic sleep deprivation, poor nutrition, and even social media use and ‘doom scrolling’, have fuelled the anxiety epidemic. Mental Health disorders, including anxiety, have also increased as a result of the COVID-19 pandemic. While the context has changed, the practice of Pilates, for the main part, hasn’t.  

How can Pilates specifically help? If you can relate to overwhelm, anxiety, or perhaps being ‘tired and wired’ then read on for ways in which Pilates as a practice can help you, and support your positive mental health.

1. Regular Practice

Pilates as part of your regular schedule will interrupt your overthinking and helps ‘press pause’ on any overwhelm. In our digitized, and always “on call” culture, we need to step away from our devices, and literally and figuratively “switch off”.

2. Break The Cycle

In turn, positive movement experiences can help break the chronic stress cycle. Chronic stress affects the nervous system, and influences related anxiety disorders. Stress can also have profound physiological effects. The long-term stimulation of the fight-or-flight response leads to the constant production and secretion of hormones such as cortisol. Long-term excessive cortisol is associated with a variety of consequences, including diabetes and cardiovascular disease.

3. Connect With The Breath

Pilates focuses on breath (it’s the first Principle of Polestar Pilates). Focusing on the breath, and particularly an extended exhale can help access the parasympathetic nervous system. This sends signals to the brain that all is well. The parasympathetic nervous system is responsible for the “rest and digest” function of the body which is why you can likely hear your digestive system at work once you relax!

4. Practice Embodyment 

A skilled teacher will give you both internal and external cues that allow you to move in a mindful way. When you focus on the internal sense of your body (interoception) you cannot be thinking about your overwhelming to-do list. Teachers who have also embraced an element of psychological fitness training (such as with Polestar) can also help clients come out of their ‘thinking brain’ by stimulating the vagus nerve. This can support reducing stress, anxiety, and even depression.

5. Empowerment

The benefits in strength, posture, and mobility you gain from Pilates can help your self-confidence (we call this self-efficacy) and your self-esteem. Any positive movement experience will release endorphins, and hormones that will reduce pain and stress, and improve your mood.

Sarah Edwards @positivepilateswithsarah is a Doctor of Education (with specializations in Teaching and Learning), a Comprehensive Pilates Instructor with Polestar, and a Mental Health First Aider. She is particularly interested in promoting Pilates for mental health and runs one-to-one, and on-demand classes from her recently completed garden studio in England (gardening being another of her passion projects)!

References:

i Vora, E. (2022) The Anatomy of Anxiety. Harper Collins publishing.

ii Mental Health First Aid England, 2020.

iii The Parasympathetic Nervous System (2022) Brittanica Science. Available at : Sciencehttps://www.britannica.com/science/parasympathetic-nervous-system (accessed 8th August 2022).

iv The Counselling Directory. What is the vagus nerve? Available at http://www.counselling-directory.org.uk/member-articles Accessed 24th August 2022.

v As a Mental Health First Aider (1) I am trained to recognize when someone is struggling with an anxiety disorder, depression, or psychotic episode and to signpost them to appropriate help. It is not within my scope to diagnose these conditions.

Do You Really Understand Osteoarthritis?

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Gain insight into osteoarthritis and discover the benefits of Pilates for osteoarthritis prevention in this exclusive conversation with Polestar faculty Brent Anderson PT, PhD, OCS, NCPT, and Beth Kaplanek RN, BSN, NCPT. Watch the #PilatesHour Webinar “Working With Clients With Osteoarthritis” and take your understanding to the next level in our online course “Osteoarthritis of the Hip & Pilates”.

BA:  We’ve been talking about positive movement experiences since the first time we met. How do we create these positive movement experiences? Osteoarthritis (OA) of the lower extremities is the best topic to talk about regarding positive movement experiences. The research all points clearly to this!

BK: As you know, osteoarthritis is the most under-recognized chronic condition out there. The wear and tear are present in almost all individuals on some level, whether you are exemplifying symptoms or not. 

59.4 million Americans have some sort of arthritis and if we look at it globally it’s much bigger. If you take hip, knee, hand, and spine, we’re talking about the fourth largest global disability. 85% of this osteoarthritis is related to the hip and knee.  

There are many different types of arthritis. We are talking specifically about osteoarthritis which tends to be more about wear and tear. But there are definitely some systemic inflammatory conditions that can cause osteoarthritis besides just wear and tear. 

What is Osteoarthritis?

Osteoarthritis is a breaking down of the articular cartilage. Exposed subchondral bone, underneath the articular cartilage, is supposed to slide and glide and move beautifully. It’s also bathed in synovial fluid. The articular cartilage needs this nourishment to stay healthy.  

When you have irritated synovial fluid, in addition, to wear and tear, the breakdown of cartilage creates an inflammatory contusion. We want to work on the things we can do to create an anti-inflammatory environment. This creates the best environment possible to keep that nourishment going properly for the articular cartilage so we have less breakdown. We want to get to a place where we have a little homeostasis. This will hopefully delay and deter the breakdown of the articular cartilage.  

Osteoarthritis today is not only occurring in older people. There is a major increase of individuals between the age of 40 and 55. It is amazing how many more people are suffering from osteoarthritis these days. When it gets severe, it’s a total joint failure. One in two Americans and two in three obese people will likely get knee osteoarthritis. The knees seem to be the leading joint where osteoarthritis is found. 1 in 4 Americans, or about 25 percent of the population, will develop hip osteoarthritis, and it’s very costly. 

Not just costly for the amount of care you need, but costly to the individual. They lose work and time, and can’t make the money they need which also affects their well-being and quality of life. There’s a lot to it, and the pathogenesis of osteoarthritis can get very deep – the chemistry. What we can do is create a beautiful environment to deter or prevent further breakdown. Pilates is great for this!

BA: Something that comes to mind is the importance of students knowing the leading causes of excessive stress to the knee. Especially since the knee is the primary joint where osteoarthritis occurs. I often challenge them with this question:

Where is a place where you have decreased mobility leading to knee wear and tear? 

The answers are lack of ankle mobility, dorsiflexion, hip extension, and deceleration strength in the hip and pelvis. These are some of the leading causes of excessive stress through the knee leading to the loss of congruency. Because the knee is always load-bearing in humans, because we are bi-pedal animals, it takes a lot of the brunt of that wear and tear. If we work backward, how can we improve alignment, congruency, and distribution of force? These are the fundamental components of prevention.  

BK: Yes, lack of hip extension and dorsiflexion are the two biggies. We can also add a lack of thoracic extension and balance on the lateral line of the body to that list. These are the very things we can target in our Pilates programs.

Looking at a 2017 Study from the Journal of Orthopedic and Sports PT, we can see the highlighted reasons that are causing OA. We see that 25% of knee pain is related to obesity. We also see that high BMI has increased overall in males and females ages 15-49 which contributes to the increase in global osteoarthritis. The five major contributors to osteoarthritis are obesity, traumatic injury to the knee, femoral acetabular impingement (FAI), hip dysplasia, and sports injuries.

We see more young people playing sports and see a lot more ACL injuries early on, along with meniscal tears. Both of these can develop into knee osteoarthritis in a person’s lifetime.

The five major contributors to osteoarthritis are obesity, traumatic injury to the knee, femoral acetabular impingement (FAI), hip dysplasia, and sports injuries.

When we get into the hip we’re talking about femoral acetabulum impingement and hip dysplasia. These can have a 10-fold increase in progressing to end-stage hip osteoarthritis within 5-20 years. 

We also see osteoarthritis develop due to high-impact sports like wrestling, distance running, soccer, and weight lifting – these are definitely players as well. Of course, if you are not recovering, rehabbing correctly, maintaining the congruency in the joint, and doing all of the other anti-inflammatory things you need to do, that causes a progression as well. 

BA: A lot of our students answer running when we ask what the causes might be. I want to make it clear that although there is a stereotype out there that running is bad for the knees, humans are designed to run! I will say that jogging may not be as natural human locomotion as others, but walking, running, and sprinting are.

Jogging seems to put an abnormal amount of stress on the knee. Especially if you run with a heel strike, and more if you don’t have the ankle dorsiflexion that you are meant to have. If you visit countries where they still squat a lot, they do not have the same incidence of knee pathologies as elsewhere. These are areas where they are squatting to go to the bathroom, do work, socialize, and rest specifically with the heels down.

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