by Christine Romani-Ruby PT, D.Ed., MPT, ATC, NPCT
The Pilates Roll Up is a beneficial and challenging whole body exercise. It is especially challenging for clients who stand in the hyperlordotic posture with short hip flexors and lumbar extensors (often known as lower crossed syndrome). Certain phases of the roll up exercise can also be challenging for those with shortened latissimus dorsi muscles because of their extension pull on the spine and the need to flex the shoulders to complete the exercise.
Knowing the many challenges of the roll up exercise due to postural constraints, you can guess that there are potential risks in performing this exercise incorrectly. It is important that the roll up is performed slowly with control and breath to ensure the engagement of the external oblique muscles to protect the spine from the sheering force of the hip flexors. The roll up motion requires abdominal contraction for the first 30 degrees and then the last 70 degrees is performed entirely by the hip flexor muscles. If the abdominal muscles do not hold the spine in flexion, the hip flexor pull will extend parts of the lumbar spine causing a sheering effect on the vertebrae which would lead to cumulative trauma injuries to the intervertebral disc. You can tell if your client is holding the 30 degrees of lumbar flexion by monitoring the ASIS (anterior iliac spine) as they roll up. If the ASIS pop upward into an anterior tilt as the client rolls up, then they are performing the exercise incorrectly. The ASIS should remain in the same position or even better drop slightly into the mat as the pelvis posteriorly tilts from the contraction of the external oblique.
If your client demonstrates a lack of ability to keep the ASIS in the same position or dropped into the mat, then you should only allow them to perform the rolling down motion on the mat. They can come up by rolling onto their side. This will allow them to build the proper movement pattern over time by using the eccentric contraction to build strength. Another option would be to use the leg springs and roll down bar on the trapeze table to assist on the upward roll.
Traditionally, the modification for someone unable to perform the roll up in the past has been to bend the knees and pull slightly with the arms while rolling up. Unfortunately this is a poor modification as it takes away the ability for the hip flexor to perform its duty of pulling the body up for the last 70 degrees of motion and it takes the hamstring out of play for the necessary posterior pelvic tilt. I would suggest that you replace this modification with either the roll down only version or with abduction of the hips. For the abduction of the hips version, you will have your client use the hip abductors to stabilize the pelvis artificially while they are learning. To do this modification, you can stand at the foot of your client with your ankles on the outside of their ankles. When the client is feeling challenge either on the way up or down, they should abduct their hips into your legs isometrically. This will stabilize the pelvis and protect the spine and they will come right up. It will also protect the spine from sheering while they improve their strength and movement pattern. To practice at home, clients could abduct into the legs of a chair.
Cueing the roll up effectively requires understanding the muscles and movement involved in the roll up. Here is a summary. Begin lying down. As the arms raise watch for rib cage arms which would show shortness of the latissimus dorsi. The pelvis and rib cage should stay neutral and the elbows should remain straight. If the chin rises a pillow should be used. Liming the raise of the arms to where this neutral is maintained. Before rolling up the client should perform a posterior pelvic tilt using their external oblique and hamstrings as they exhale. Cue reaching the sitting bones to the heels and avoid using the gluteals. If posterior tilting is difficult try opening the legs wider in external rotation. From their they need to keep reaching long through the top of the head to avoid collapsing the spine. Think of rolling up and over a fence. At the top keep the client from elevating the shoulder girdle to reach for their toes. Reach with the spine. This is a spine lengthening exercise. To reverse the motion, exhale as the sitting bones again reach for the heels and slowly go down one vertebrae a time back to neutral. Many clients will experience what I call “speed bumps” where they have stiffness in their spine. Just be patient it will smooth out over time.
A special word about men. Men will almost always experience their legs lifting on the way up. This is due to their heavy upper body and their center of gravity and is not a problem. Never tie their legs down as it will encourage too much pull of the hip flexor which is dangerous.