There is an excellent Linkedin Group for Pilates folks (Pilates for Physical Therapy and Rehabilitation ) and recently there has been a very interesting discussion. As I can’t just link to it, I copied the most relevant parts – much appreciation goes to the people who contributed:
Jeff Sims, LMT Therapist & Teacher asked the group members about Knee inflammation
“A new client complained of knee swelling and pain after one Pilates session. She described nothing in her history that might explain this, but I’m not sure she’s as forthcoming as I’d like. She performed the footwork series with 1 & 1/2 springs and maintained good form. She said she felt ok during the session, but later said it was the footwork that flared up her knees.
I’ll be seeing her next week and wonder what questions I should be asking. I’m interested in other ideas too. Thanks.”
Among many others, Cathy Watson the Owner of Cathy Watson Physiotherapy responded as follows. I highlioghted the most relevant part below:
“Hi Jeff. My thoughts are…typically, swelling without injury indicates an underlying condition…most likely a bit of wear and tear on the cartilage. If your client has had no symptoms thus far, there must be something else going on. I know you are already checking these things, but I will add them here as well:
when the ball is b/w the knees, make sure that the knees are still staying in line with the hips and feet. You know how when you place a ball b/w someone’s knees and they squeeze with their knees, rather than their adductor muscles? This may place their knees inside their feet, which would emphasize the valgus stress.
Try a theraband around their thighs, just above their knees, to emphasize their external rotators. If your client is tending towards a valgus stress, this may help them think about activating their outer hip muscles so their knees don’t lean in towards each other
Possibly, stay away from high half toe or movements where their forefoot is on the foot bar. If they tend towards hyperextension at their knees, (which many valgus stressed people do), then this may place their knees lower than their feet, thereby impacting a greater force through their knees. Especially since weight bearing through the forefoot is much less stable.
And definitely watch for hyperextension at their knee overall.
Main point is…the foot work is not the actual problem…their posture is. So, once again, Pilates is the perfect place for them to work on this. “