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NCHPAD - Building Healthy Inclusive Communities

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Sample Warm-Up for SCI with Emphasis on STOTT PILATES Five Basic Principles


Before starting any exercise program, get clearance from your physician. The following is a general warm-up for individuals with paralysis and may require modification based on individual abilities. To get the most out of Pilates, it is recommended you work with a qualified instructor to develop an individualized program. Having a solid understanding of the basic principles will increase your skill level and mindfulness and allow for increased control in performing Pilates exercises.

  1. Breathing:
    A primary component of Pilates is the mind-body connection and the use of breathing to relax and release neck tension while facilitating abdominal muscle contraction. Encouraging a full breath for improved oxygenation while focusing the mind on the muscles that should be activated can facilitate healing and improve body awareness.

    Breath control warm-up
    Starting position: Sit tall with upper back away from chair back, ears over shoulders, shoulders over hips, neutral spine, eyes and head level. Try to minimize the pressure through your arms. (This can also be done lying on your side or back with knees over a pillow or arc barrel.)

    Take a deep breath in through the nose, expanding your rib cage out and back, release blowing out through your mouth (you should hear the air as it passes through your mouth; if not, you are not exhaling with enough effort). As you exhale, engage your abdominal muscles, drawing your belly button towards your spine. Make sure your neck muscles stay relaxed. Repeat 3 to 5 times.



  2. Pelvic Placement:
    The ability to achieve good postural alignment in an upright position is directly related to pelvic stability. This involves a balance of abdominal, lower back, and pelvic floor musculature. A person with paralysis will require assistance and support for ideal alignment. Often, individuals with SCI have lost the 'connection,' but with training can often gain some awareness and improved balance and posture.


    A woman is lying on her back with hips and knees flexed over a pillow or arc barrel
    A woman is lying on her back with hips and knees flexed over a pillow or arc barrel
    Tilt and release

    Lying on your back with hips and knees flexed over a pillow or arc barrel, inhale to prepare. On the exhale, draw your lower ribcage and front of your pelvis closer together using your abdominals, creating a slight flexion (gentle lengthening) of your lower spine. Inhale and release back to neutral. Repeat 5 to 8 times.





  3. Rib Cage Placement
    The abdominal wall attaches to the lower ribs. The abdominal muscles must often be recruited to maintain the ribcage and, indirectly, the thoracic spine in good alignment.

    A man is on his back with knees and hips flexed over a pillow or arc barrel
    A man is on his back with knees and hips flexed over a pillow or arc barrel
    Arm Raises Start on your back with knees and hips flexed over a pillow or arc barrel. Inhale and reach both arms over your head as far as you can without the front of the ribcage lifting toward the ceiling. Exhale and return arms to your sides. If you are unable to perform this exercise, reverse the breathing pattern and exhale to tighten the abdominals as you lift the arms. This will assist in keeping the ribcage in place. Repeat 5 to 8 times.



  4. Scapular Movement and Stabilization
    Stabilizing the scapulae (shoulder blades) on the ribcage is very important. When this does not occur, there is a tendency to overwork the upper trapezius and other muscles around the neck and upper shoulders.

    A woman is lying on a mat readying herself to demonstrate scapular movements
    A woman is lying on a mat readying herself to demonstrate scapular movements
    Scapular movements

    To become more aware of your shoulder blades, move them up towards your ears and then relax the shoulders and gently draw your shoulder blades down and back in a V pattern. Next, bring your shoulders forward and then draw back and down. At no time should you be jamming or pinching the shoulder blades.

  5. Head and Cervical Placement:
    The cervical spine should hold its natural curve, with the ears in line with the shoulders when sitting in neutral. Many individuals with trunk weakness and paralysis tend to bring the chin forward and overuse the cervical muscles to help maintain balance. In most instances during Pilates exercise, the cervical spine should continue the line created by the thoracic spine.

    A woman is lying down readying herself to demonstrate head nods.
    A woman is lying down readying herself to demonstrate head nods.
    Head nods
    On your back, inhale and gently nod your head without lifting from the surface, gently lengthening the back of your upper cervical spine. Exhale and return to neutral. You may require a pad or towel under your head to avoid excessive tension of the neck muscles. Repeat 5 times.


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