Pilates after Hernia Repair


Pilates after hernia repair offers a crucial piece of the exercise puzzle - pelvic floor and deep abdominal support!

Lately I have received several requests for exercise suggestions to help either repair small existing inguinal hernias, or assist in maintaining a hernia repair after surgery.

First of all, what is a hernia?

According to the NIH,

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia.

Basically, a hernia is an area where the intestines start to protrude through a weak area in the abdominal wall. Hernias are named for location (inguinal - groin, umbilical - belly button, hiatal - upper abdomen, femoral - upper thigh).

Hernias are caused by straining while abdominal pressure is increased - it can happen on the toilet, opening a window, or even lifting weights and/or doing abdominal exercises incorrectly.

Yes, you read that correctly. Poorly executed exercise can cause hernias and make existing ones worse.

However, correctly done exercise can help heal a hernia, especially after repair.

Exercise recommendations for pilates after hernia repair are similar to those for diastasis recti.

Once you have been cleared by your physician to exercise, it is important to avoid straining while increasing abdominal pressure. This requires careful monitoring of breathing patterns while moving and exercising.

At the beginning you should avoid most traditional abdominal exercises, such as crunches. You should also avoid overhead presses.

Focus on exercises that help engage your pelvic floor muscles, diaphragm, and deep abdominals.

Breathing correctly is the first challenge.

Listen to the first breathing exercise in my back pain video. This is the basis for moving correctly in any exercise.

5 Pilates Tips to Improve your Workout


Here are 5 Pilates tips that will improve your workout.

It's almost the end of January, and we are still seeing a steady stream of new clients coming into Real Pilates. Since I see so many newbies taking classes and privates, I thought I would give everybody five easy ways to improve your Pilates workout.

1. Don't press your lower back down constantly.

I know, you hear the words "scoop your belly" or "navel to spine" and it seems like you should be flattening your lower back all of the time.

Not true!

Your spine has a natural curve, and the lumbar vertebrae are built to curve slightly forward, towards your navel. So when we Pilates teachers say "pull you navel to your spine," we mean for you to keep that natural curve and just pull your abs closer to your spine - not flatten your curves!

2. Breathe consciously and often.

Most people I know tend hold their breath when exercising. This actually makes things harder instead of easier, and can put you more at risk for injury. Your ribs, which comprise a full half of your spine, move along with your breath. Your abdominal muscles help move the diaphragm and ribs to take full breaths, and I view breathing as a primary, basic abdominal exercise.

Since Pilates helps with spine mobility and abdominal strength, the breathing part is crucially important to the system as a whole.

If the prescribed breathing pattern doesn't work for you, ignore it and just breathe.

3. Keep it simple.

Most good Pilates teachers will offer several versions of an exercise, each a little more complex than the last. If the basic exercise is ridiculously hard, don't move on until the basic version feels do-able. Doing too much too soon can cause injury.

4. Work your back.

If you went by how people tend to characterize Pilates, you would think it is all abs and no back work.

Not so!

Joseph Pilates knew that all of the muscles in the body need strength. A weak back is just as bad as a weak front, and puts you at risk for injury.

5. Work your butt.

I see so many folks who have extremely weak gluteal muscles (butt muscles). Our glutes help to extend our hips (so important for proper gait in walking), support our legs, and keep our lower backs stable.

Use them! If your hamstrings always cramp when you bridge, for example, I guarantee that you are using your legs too much and not your glutes.

Keep these tips in mind during your next Pilates class, and you will have a more efficient and effective workout.

Beginner Core Exercises - Safe, Simple, Effective


Beginner Core Exercises should be simple, single plane movements that are safe, simple, and effective.

Unfortunately, that is not always what you will find in much of our online and print media in the era of insane and extreme exercise and fitness.

You might already know, if you are a regular reader of this blog or know me from elsewhere, that as a Pilates and Fitness trainer I specialize in working with people in pain. Most of my clients have lower back pain due to disc herniations, spinal fusions, severe scolioisis, and stenosis. And many have been hurt by other trainers.

Were these fitness and pilates trainers bad or unqualified? Absolutely not!

Did these trainers feel the need to keep upping the ante by making things always more intense and complex? Why, yes!

Surprisingly, other than a few modifications, my approach to all of my clients is similar. I look to stabilize the torso first, only working on small bits of flexibility as needed to strengthen the stabilizers. Once I see the stability happening, which means the stabilizing muscles are working, I then work a bit more with mobility as needed and tolerated.

This is how Joseph Pilates presented his system of exercises, so I am not going outside of classical Pilates here. And this is how I approach all exercises, even TRX and kettlebell training.

So I decided to do a general overview of what was out there for beginner core exercises, starting with a basic Google search.

And generally I found complex exercises that require a good spotter, or great exercises presented in more advanced forms, instead of the most simple and safe.

Why? Because trainers feel the push towards more extreme workouts. Clients are back into beating ourselves up in the gym, or at the barre or bootcamp, or even at home with our insane dvds.

Beginner exercises should be simple, but extremely intense and effective, so a person can quickly progress to more fun and exciting complex and intense movements.

Here is what I give many of my clients for Basic Core Exercises. All of these are easy to do at home and all are present somewhere in Pilates.


Note that these exercises start very simply and close to the ground, but when you do them correctly you shake and sweat and have a pretty intense experience.

You start always with short levers - knees bent and elbows bent and work on maintaining torso stability and getting all of your core muscles to work together to keep your parts steady. When that is easy, progress to longer levers, and even to fewer levers, but maintain the same stability.

Here is the explanation of a plank that I read this morning. Note there is no mention of modifications or variations, or is there any mention of the role of the abdominal muscles here. And if you fire your glutes without also using your abs, this will most likely hurt your back instead of helping it:

Push-up plank: A plank is an isometric core exercise that involves maintaining a strict, straight position for an extended period of time. I like to see my clients maintain a solid 30-second plank for three sets both front and side. This shows good core endurance and that the person is able to handle more advanced exercises.

How to do it: Plant the hands directly under the shoulders (slightly wider than shoulder-width apart) like you’re about to do a push-up. Ground the toes into the floor and squeeze the glutes to stabilize the bottom half of the body. Neutralize the neck and spine by looking at the floor about a foot in front of the hands. The head should be in line with the back. Hold the position for 20 seconds to start out.

As fitness and Pilates trainers, we need to be very careful with what we put out there for free public consumption - we need to focus on beginner core exercises that are safe, simple, and effective.