So consider this:
The force of 3 to 6 times a person’s body weight is exerted across the knee while walking. Not a problem if you’re a lithe dancer at 110 pounds. But for a person who weighs 200 pounds, the force on his knees while merely walking is 600 lbs. When squatting, running, etc., the force can get to 1,200 to 2,000 lbs. Experience that year after year and you can imagine the wear and tear on the joints, the pain and even eventually, the arthritis.
Your obese client already feels stress on the joints during the act of simply standing that you may never experience in your lifetime of strenuous exercise. In addition to what are the obvious places of joint stress and pain – ankles, knees – there is also a prevalence of hand osteoarthritis in people who are overweight.
Bringing our attention to the center, or core of the body, we need to be aware of the potential spinal problems. The weight of excessive adipose tissue (or fat) can cause compression on the spine, leading to both back pain and disc issues. Think about when you’ve worn an over packed backpack. It drags your posture down, causing lumbar compression and kyphosis. Know how that feels? Now triple or quadruple that weight and you’ll feel what it is to be clinically obese.
Our obese clients need some special procedures to get around these issues. Here are four ways to make working in a session easier for your client:
1. Give the client plenty of time to get up and down. Overweight students have difficulty squatting to stand or sit, and that includes getting on and off the reformer. Give your client plenty of time and adjustments as necessary to get comfortable. There’s no rush. You need to be aware of your client’s safety and your safety as well. You could both fall if you hurry to get him down. If your reformer is on ground-level and you intend to work with this population, I encourage you to invest in legs to get it up off the floor. Obviously a higher up, physical therapy type of reformer is the most ideal. I don’t have those in my studio so I offer myself as a prop to help them get on and off the machine. Stand close to your client and lend a hand or a shoulder for her to press into for assistance. Gondolas work well too.
2. When working on the reformer, keep the headrest up and perhaps even use a pillow as well. You want to avoid having the client feeling as if he or she is suffocating, which is a common complaint. If you’re a woman who has had a child, it’s the same feeling as being 9 months pregnant and trying to lie down. Another option is to put a solid Spine Corrector on the reformer and have the client sit and work from there in a more upright position.
3. Tell him where to put his arms and legs. An obese client isn’t going to be able to put his arms down long by the sides of the body because his body takes up the carriage and may even spill over. At this point, have the client hold his hands across his lower abdominals. This keeps the chest open and avoids stress on the shoulders. Another option is to allow him to hold the strap pegs by the headrest. If you do so, monitor how low his elbows go. You don’t want them dangling below the carriage. Keep them in line with the shoulders or slightly higher.
4. Work on the Cadillac and the Chair for a good portion of the session. The Cadillac is easier for your client to get on and the mat feels more supportive to him or her than a moving carriage. The Chair allows the client to sit up tall and not to feel compressed by the width of the carriage. The sense of choking is eliminated and the client is stabilized.
As we are getting in touch with how to work with the obese client and to understand how it may feel to be clinically overweight, what are some of your thoughts or concerns? Let’s make this an open forum for sharing. If we want to get our clients healthy and happy, we have to have the knowledge to do. So share!
Kerrie Ann
Kerrie,
Very valid information, especially the information about having the client take their time getting on/off the apparatus. I have also found, do a fluid series of movements with the client in the same position so they do not have to continue getting up and down. Be aware of how long this client is on their back as the weight will be compressing their spine.
We have Gratz equipment in our studio and have found putting the client in second gear works much better for them. With the Balance Body equipment you do have the option to lower the footbar position. With the Gratz equipment we have also put the jump board in front of the shoulder rest, on a slight angle and then rest a pillow on top of the jump board. The client can then be slightly elevated to do work.
When working with the obese client, as with all, be aware of their foot placement when doing standing work. Equal pressure on all 10 toes and the ball of the foot. Sixty percent of the body weight should be on the front of the foot with slight pressure on the heel.
These are just a few things I have found. The main thing is to make them feel good about the movements they are completing!
Excellent, excellent additions. Thank you! I do the same elevation with both my overweight clients and my prenatals. Great point.
What I like the best is your reinforcement of “making them feel good about the movements they are completing”. This far outweighs any physical modification was can come up with. Have a great day!
Kerrie Ann