You were taught to organise the feet before you cue anything else. You probably were also taught that stability comes from the centre and moves outward. So we learned both but didn’t learn when we need to do which one.
These are actually two different things. Let’s dive in.
Read more: Where to start reading the body: Feet first or centre first?[Read more…] about Where to start reading the body: Feet first or centre first?Movement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
Nocebo is the opposite of placebo. It means – negative outcomes produced by negative expectations. Research (Darlow et al. 2013) shows that the language clinicians use about back pain directly affects beliefs, function, and disability independent of actual pathology. Pain neuroscience education combined with movement is the evidence-based approach. Words shape outcomes.
Across every blog post on Movement notes – discs, ligaments, joints, tissues – there’s one thread that keeps coming back.
[Read more…] about The influence of words that you hear about your body on your movement. (The nocebo effect)Movement Notes — Pilates on George — by Olya Kudryavtseva
Patellofemoral pain (PFP) is pain around or behind the kneecap, typically aggravated by squats, stairs, and prolonged sitting. Imaging usually shows nothing structural. The 2018 international consensus statement confirms hip and knee strengthening combined is more effective than knee-only programs. The knee is downstream but the work is upstream.
[Read more…] about Patellofemoral Pain: Can the knee pain be originated in the hip?Movement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
Diastasis recti is a separation of the rectus abdominis along the linea alba. It’s present in 60% of women at 6 weeks postpartum and around 33% at 12 months, meaning some persistence is normal. Recent research (Lee & Hodges) showed that linea alba function (its ability to generate tension) matters more than gap width. Crunches aren’t categorically forbidden. The entire system coordination is the goal.
[Read more…] about Diastasis Recti: It’s Not About Closing the GapMovement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
The sacroiliac joint moves only 1–4 mm and about 2 degrees in healthy adults – it’s built for stability, not mobility. The popular notion that the SI joint goes “out of place” isn’t supported by biomechanical research. SI pain is real, but it’s typically a force closure problem (muscular coordination), not a structural misalignment. Glute strength and pelvic floor coordination form the foundation of effective rehab.
Few topics generate more confusion in our field than the sacroiliac joint.
Clients arrive convinced theirs is “out”, “unstable”, “twisted”, or “locked”. Practitioners speak with confidence about putting it “back into place”. Whole certifications exist around correcting things that, based on the biomechanical evidence, don’t really happen the way we say they do.
Time for a more accurate model.
What Is the Sacroiliac Joint?
The sacroiliac joint (SIJ) connects the sacrum (the triangular bone at the base of the spine) to the ilium (the large pelvic bone) on each side. It’s a synovial joint anteriorly and a syndesmosis (a fibrous joint with strong ligaments) posteriorly.
It’s surrounded by some of the strongest ligaments in the body: the interosseous, dorsal sacroiliac, and sacrotuberous ligaments. The SI joint is built to transmit massive load between the spine and the lower limbs without giving way.
Can the SI Joint Go Out of Place?
Not really, in the way it’s commonly described. The most-cited biomechanical work on SIJ motion (Sturesson et al., Vleeming and colleagues) consistently shows minimal physiological range:
• Roughly 1–4 mm of translation
• Around 2 degrees of rotation
That motion decreases with age and is even smaller in men than women. The takeaway: the SIJ is built for stability, not mobility. The idea that it routinely shifts “out of place” and needs to be put back in is not supported by data.
Studies on SIJ palpation also show poor reliability. Practitioners can’t reliably agree on “position” of the SIJ, which makes “my SI is out” a hard claim to sustain.
Form Closure and Force Closure: The Useful Framework
Vleeming’s model of pelvic stability is one of the most useful frameworks we have:
Form closure – the passive stability that comes from joint shape, ligament tension, and articular surfaces. The SIJ has good form closure due to its ridged surfaces and dense ligaments.
Force closure – the active stability provided by muscles compressing the joint surfaces. The posterior oblique sling (latissimus dorsi crossing to opposite gluteus maximus via thoracolumbar fascia) and anterior oblique sling (external oblique to opposite adductor) are the main contributors.
Most SIJ-related pain isn’t a structural issue. It’s a force closure inefficiency – the muscular system isn’t compressing the joint adequately during load transfer.
Is SI Joint Pain Real?
Yes, very. Schwarzer et al. (1995) and Laslett (2008) demonstrated this with diagnostic injections. SIJ-mediated pain is estimated to account for 10–25% of chronic low back pain.
But “SIJ pain” doesn’t equal “SIJ instability” or “SIJ dysfunction.” It means the joint is the pain generator. Those are different things, and conflating them leads to the wrong intervention.
What Exercises Help SI Joint Pain?
Effective SIJ rehab focuses on building the muscular slings that compress the joint:
• Force closure work: bridging with band, contralateral arm-leg lifts, woodchop patterns, single-leg work that demands trunk control
• Glute max strength: the single biggest contributor to posterior force closure. Real glute work, not just clamshells, but loaded extension and bridging
• Pelvic floor coordination: the deep system contributes to pelvic compression. Breath integration, not gripping
• Reframing the language: if you believe your pelvis is fragile and out of alignment, that belief affects pain
Frequently Asked Questions
Can the SI joint really get stuck or locked?
The SI joint can be a source of pain, and movement around it can feel restricted or stiff. But the popular concept of it being “locked” or “out of place” in the way a finger joint dislocates isn’t supported by biomechanical evidence. The joint normally moves only millimetres.
What does SI joint pain feel like?
Typically a unilateral pain just below the lower back, around the dimple of the buttock, sometimes radiating into the groin or back of the thigh. It’s often aggravated by transitional movements (sit-to-stand, rolling in bed) and asymmetric loading (single-leg standing, stairs).
Are SI joint adjustments effective?
Adjustments may provide short-term relief through neuromuscular effects, but research doesn’t support the idea that they’re “realigning” the joint. Long-term resolution typically comes from strengthening the surrounding muscular system to provide better force closure.
Is Pilates good for SI joint pain?
Pilates is particularly well-suited because it builds the glute, deep abdominal, and pelvic floor coordination that creates force closure around the SI joint. Our Sydney CBD studio works with many clients managing SI joint pain through targeted strengthening.
Can pregnancy cause SI joint pain?
Yes, relaxin and other hormonal changes during pregnancy increase ligament laxity, which can reduce form closure at the SI joint. The body increases reliance on force closure, which is why pelvic girdle pain is common in pregnancy and why glute/core work helps.
The Bottom Line
Clients don’t need their SI joint adjusted, twisted, popped, or put back. They need force closure. They need glutes that fire when asked. They need a brain that trusts the joint to handle load.
That’s the work. And it looks a lot like Pilates.
References
Movement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
Femoroacetabular impingement (FAI) is a mechanical conflict between the femoral head and socket. Labral tears are common in pain-free people (69% in one study). The FASHIoN trial showed personalised hip therapy is a valid first-line treatment. Hip strength, particularly abductors and external rotators, is the foundation of conservative care. Pilates is well-suited to this work.
Hip pain in active adults often gets one of three labels: FAI, labral tear, or early osteoarthritis. They overlap clinically. They overlap on imaging. And they often can be present in one client at the same time.
The label matters less than the functional picture in front of you.
Here’s how to make sense of all three.
What Is FAI (Femoroacetabular Impingement)?
FAI describes a mechanical conflict between the femoral head/neck and the acetabular rim (the socket edge) during certain movements typically deep flexion combined with internal rotation.
Two morphological types are described:
• Cam morphology – an aspherical femoral head (the ball isn’t perfectly round). Common in young athletes who developed in sports loading the hip in flexion (football, hockey, dance).
• Pincer morphology – over-coverage of the acetabulum (the socket extends further over the ball than it should), pinching the labrum on flexion.
Mixed (cam + pincer) is the most common. But many people with these morphologies have no symptoms. Morphology + provocative loading + symptoms = FAI syndrome. Morphology alone isn’t enough.
What Is the Hip Labrum?
The acetabular labrum is a fibrocartilaginous ring (similar tissue to the meniscus of the knee) around the rim of the socket. It deepens the socket, contributes to a suction seal, and provides proprioceptive feedback.
Tears are extremely common on imaging Register et al. (2012) found labral abnormalities in 69% of pain-free volunteers. Symptomatic tears typically produce sharp anterior groin pain, clicking or catching with hip flexion and rotation, and sometimes a feeling of giving way.
But again: tear on the MRI doesn’t equal pain in the hip.
Early Hip Osteoarthritis
Hip OA involves loss of articular cartilage, but the picture is broader: subchondral bone changes, capsular thickening, muscle weakness around the joint, and altered pain processing. Early OA may show normal-looking cartilage on plain X-ray but altered MRI signal.
It’s not just “wear and tear” – that’s an outdated framing. It’s a whole-joint condition where the cartilage is one piece of a bigger story.
Do Hip Labral Tears Need Surgery?
Often not. The FASHIoN trial (Griffin et al. 2018, The Lancet) compared hip arthroscopy to personalised hip therapy for FAI syndrome. Surgery was modestly better at 12 months, but conservative care produced meaningful improvement for many patients and crucially, conservative care can be tried first without precluding surgery later.
For hip OA, exercise has strong evidence (Fransen et al. 2014, Cochrane). Strength training, particularly targeting hip abductors and external rotators, reduces pain and improves function.
What Exercises Help Hip Impingement and Labral Tears?
The evidence-based foundations:
• Hip abductor strength (gluteus medius and minimus), side-lying leg work, standing single-leg work, reformer side splits. Critical for offloading the hip joint during gait.
• External rotators (the deep six: piriformis, gemelli, obturators, quadratus femoris), clamshells with progression, reformer footwork variations.
• Avoid forced end-range flexion + IR in symptomatic FAI. Stay where the joint stays quiet.
• Build hip extension capacity. Many hip-pain clients live in flexion. Bridging variations, prone leg lifts, standing extension work all matter.
Frequently Asked Questions
What does FAI feel like?
Symptomatic FAI typically produces sharp groin pain or anterior hip pain with deep flexion movements (squatting, getting in and out of cars, sitting cross-legged). Pain may be reproduced with the FADIR test (flexion, adduction, internal rotation). Stiffness and reduced range of motion are common.
Can a hip labral tear heal on its own?
Labral tears generally don’t heal in the way a muscle does, because of poor blood supply. However, symptoms from a labral tear often improve significantly with appropriate strengthening and load management, meaning many people live well with the tear without surgery.
Is squatting bad for FAI?
Not necessarily, but how you squat matters. Forced end-range flexion combined with knees collapsing inward (which loads the hip in flexion + internal rotation) can provoke symptoms in cam-type FAI. Squat depth and form should be matched to symptoms.
Can Pilates help hip pain?
Yes, Pilates is particularly suited to hip pain because it allows targeted strengthening of the abductors, external rotators, and extensors in supported positions. Our Sydney CBD studio works with many clients managing FAI, labral tears, and early OA.
How long does FAI take to improve with exercise?
Many people see meaningful improvement within 8–12 weeks of consistent strengthening, with continued progress over 6–12 months. The FASHIoN trial showed conservative care produced significant benefits at 12 months.
The Bottom Line
Whether the label is FAI, a labral tear, or early OA the work is largely the same. Build strength around the joint. Avoid the positions that flare. Progress thoughtfully.
References
