This month I’m writing about ‘Sam’, who’s a 38 yo second time C section mom with a 10 year history of significant bilateral SI Joint instability due to trauma. Pre-pregnancy, she was at a point where she could keep her symptoms controlled as long as she was good about doing her squats and lunges, but still couldn’t quite get her right glute to fire like her left. Single leg squats didn’t feel centred in her hip and there was a lot of hiking.

When I started working with Sam, we were focused on postpartum rehab and C section scar massage. But as you know, you can’t just work on one thing and ignore the rest. Sam has other findings as well, but I’m going to keep to her glute today.

It’s been a few months of getting her deep core back more functional, and I’ve been widening my scope to her hips and glutes. A closer look at her hips showed piriformis tension with decreased sacral nutation, and pelvic inlet external rotation. Femoral head was also slightly forward in the acetabulum from all that piriformis tension. We had done some releases in the past, but what really made a dent in her progress was adding Reformer Pilates for rehab exercises.

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Here’s a brief overview of what I did to help her find her right glute again:

1) Piriformis release with dry needling and IMS, manual soft tissue work along the sacral glute attachments.

2) Manual mobilisations to restore sacral nutation and femoral head positioning.

3) Reformer: Side lying single leg squats with manual mobilisations (MWMs) to facilitate pelvic inlet IR, femur centering, and sacral nutation in the early and late ranges of squatting.

Here’s an idea of what we did (this is not Sam). Some of you may recognise this photo from my Foundational course in the manual therapy module. 1 heavy and 1 medium spring to really help with activation.

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4) Chair: For those of you with a Pilates chair, I followed up with her doing Forward Step-up with 2 heavy low springs. If you don’t have a chair, this is just a facilitated large step-up with a big bias toward the hip extensors by starting with a forward trunk lean and more forward foot placement.

5) Homework was practicing single leg squats on an elevated surface (step stool or bottom stair) with the contralateral foot sliding forward on the floor. Cues were given to keep her stance hip/waist elongated and square, as well as ‘reaching’ her sit bones back in space while hinging.

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We’re still working on getting her to maintain her glute connection for longer periods after treatment, but it’s looking promising. Sam told me that this was the first time she’s felt her glutes in 7 years. Such a huge win and I’m excited to support her further in her recovery. This is exactly why I love using Reformer Pilates for Rehab.

If you have any success stories with your Reformer I’d love to hear them!

All the best,

Ellen