by Eva Stabenow
How to help your clients with arthritis thrive through the power of Pilates
Pilates, I think we can all agree, is a great, low-impact workout that’s beneficial to just about everyone. It not only lengthens, strengthens and mobilizes the body, but also improves joint alignment and engages the mind – all qualities that make it a perfect fit for people with arthritis. Because even though people with arthritis often avoid movement due to pain, they actually need to move in order to stay mobile, build strength, reduce symptoms and enjoy a better quality of life all around.
Knowing how to teach these clients is useful even for Pilates instructors who don’t specialize in working with people who have chronic conditions – after all, 1 in 4 US adults have arthritis. Sooner or later, one of them is bound to make their way into your studio.
“Motion is lotion”
People with arthritis often experience stiffness and pain after sitting or lying down for long stretches of time. Warmth in combination with gentle, low-impact movement helps relieve these symptoms in the short term. But movement is also important for long-term health: It increases blood flow, helps keep cartilage healthy and triggers the release of synovial fluid, which helps lubricate the joints. (I like to think of it as the body’s own WD-40.) This helps people with arthritis stay mobile, reduce pain, build strength and increase function as well as confidence.
In general, the recommendation is for people with arthritis to put their joints through their full (available) range of motion every day to improve mobility and slow the degeneration of cartilage. But don’t just take it from me: The Arthritis Foundation not only refers to exercise as the best medicine for osteoarthritis – but also (along with weight loss) as the only thing that may stop it from getting worse. And in rheumatoid arthritis, exercise is the one thing that can help prevent disability.
RA, OA – what’s the difference?
When we talk about arthritis, we are actually talking about a number of different conditions that affect the joints of the body. Primarily, these can be categorized into osteoarthritis (OA) and inflammatory forms of arthritis including lupus, gout and psoriatic arthritis. The most common form of inflammatory arthritis is rheumatoid arthritis (RA).
OA is often called “bone-on-bone” arthritis – a pretty good description for a degenerative condition that results from mechanical wear and tear on the joints. It most often impacts weight-bearing joints (hips, knees and spine) as well as the hands. Symptoms include stiffness, especially after waking up or after sitting still, pain during or after movement, tenderness, impaired flexibility, joint swelling as well as a grating sensation or even bone spurs in the affected joints. Men and women are about equally affected, and risk factors include age, joint injury, poor alignment and excess weight.
RA, on the other hand, is an inflammatory autoimmune condition that often develops between age 30 and 60, especially in women. Here, the immune system mistakenly attacks the synovium and causes inflammation and damage that can lead to joint deformity. It mostly affects the hands, wrists, elbows, shoulders, knees, ankles and wrists. Symptoms include stiffness, pain and swelling in the joints and fatigue. For Pilates teachers, maybe the single most important thing to remember about RA and other types of inflammatory arthritis is that overexercising can be one of the triggers that may cause a “flare” – a painful exacerbation of symptoms that can go along with flu-like symptoms and fever and last several days.
Your first client with arthritis walks through the door – what do you do?
First things first: As with any other medical condition, check that they are cleared for exercise and ask about anything they were told not to do. Find out what type of arthritis they have, and which joints are affected. Above all, respect their pain! If a client with arthritis has pain with exercise, do not instruct them to push through it.
1. Slow and steady wins the race
People with arthritis often feel stiff and achy in the morning, when they are cold and before movement – especially if they are older or have been sedentary. Gentle movement environment helps loosen things up, so a longer, slower warm-up – and often, a gentler and sometimes shorter session – is a good idea.
2. Don’t strain the joints
You’ll want to limit the amount of weight and stress you put on joints – especially the arthritic ones. For instance, if your client has knee osteoarthritis, you will want to avoid deep knee bends with a heavy weight. In reformer footwork, for instance, you could reduce spring tension, bring the footbar further out or ask the client not to bring the carriage all the way in.
3. Easy on the hands
Weight-bearing on the hands can be extremely painful for those with arthritis, so you may need to modify exercises that involve planking or being on all fours such as long stretch, knee series and push-ups. While clients with severe arthritis may not be able to do these exercises at all, in others, it may be sufficient to pad the heel of the hand with rolled-up towels etc.
In addition, clients whose hands are affected by arthritis may have difficulty gripping the rolldown bar, the push-through bar and props. As a rule, larger, softer and more textured objects are easier to grip. Look around your studio: Can you pad or wrap the bar? (I like to wrap mine with a theraband.) Add padding? Use a larger ball? If you use hand weights, consider using weighted balls instead and teach clients to hold props with a light grip.
4. Don’t risk their neck
Arthritis often affects the spine, and it’s very common for people who have arthritis to experience neck pain. Exercises like the rollover that load the neck are contraindicated, as are other extreme neck movements. Some clients may also find it difficult to hold their head up during the hundred and similar exercises. To work around this, simply let them keep their head down or use a small pillow for their head.
5. A different body every time
People living with arthritis often report that their body feels different every day. This means that what worked during your last session may not be appropriate at every session. Check in with your client at the beginning of the session to find out how they are feeling that day and how the previous session impacted them.
6. Opt for private sessions where possible
Not only is every client with arthritis different, but they may feel very different on any given day, depending on the type of arthritis, the weather, or triggers like stress, fatigue or overdoing something as simple as cleaning the house. So, ideally, you want to work in a one-on-one setting with arthritis clients, at least at the beginning. This will allow you to safely guide them through the basics, teach modifications and obtain feedback.
Putting it all together
Hopefully, with all this information at your fingertips, you’ll feel well-equipped to help your next – or first – client with arthritis thrive with the power of personalized Pilates. In a nutshell, remember to start slow, progress gradually, place extra emphasis on alignment, avoid extremes of intensity, duration or flexion, and above all, listen to your client and don’t forget to have fun!
About the Author
Eva Stabenow, MA, MPH, NCPT first fell in love with Pilates when it helped her find lasting relief from chronic shoulder pain caused by long hours at her desk and has never looked back.
Today, she is a Polestar-trained Pilates instructor who seeks to empower others to achieve a better quality of life through individualized Pilates at her Nashville studio, Sunroom Pilates. Eva specializes in helping people with chronic conditions as well as peri- and postmenopausal clients regain confidence in their bodies and (re)discover the joy of movement. Read more at www.sunroompilates.com.
In addition to teaching Pilates, she is a medical writer with a focus on crafting engaging, evidence-based patient education content. Naturally, she is happiest when she has the chance to combine her two professional passions by writing about Pilates and the healing power – and joy! – of movement. If you’d like to know more about this aspect of her work or want to talk to her about a writing or editing project, please reach out to Eva here.