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Flattening The Curve: Pilates in 2020

The Coronavirus, a pandemic responsible for infecting hundreds of thousands of people in more than 130 countries has changed our world. The death toll is devastating. Covid-19 has caused a new norm of working from home, Zoom meetings, social distancing, sheltering in place and the expression “flattening the curve.” It refers to the projected number of people who could contract this horrific virus. Obviously, we want to flatten this number. However, the expression is not new at all. Joseph Pilates was revolutionary in the fitness world.

His method, now more than a hundred years old, is taught all over the world. His exercises are used by physical therapists, personal trainers, and coaches. Some of these professionals may not even realize what they are teaching is based on one man’s invention. Yes, he was a genius and he used the expression “flattening the curve.” No Joe did not have a crystal ball. Even though he lived through the Spanish Influenza of 1918, he didn’t know that Covid-19 would decimate his beloved New York City and the world around it. In fact, during that devastation a hundred years ago, Pilates used his breathing system and his exercise method to help prevent people around him from contracting that terrible flu. But that is not what I want to talk about. The curve Joe Pilates was referring to, was the spine.

Today, just as the Coronavirus brought a new normal to our world, there are many people trying to change Mr. Pilates system of exercise stating that the flat-back position Joe taught was dangerous. They want you to work in what is referred to as a neutral position. However, neutral allows each person to exercise in the spinal position they come to the studio with. This means that nothing in the body changes. What Pilates wanted to do and did with all his clients was work toward a healthy long spine when lying supine. He had sound reason for doing so. There is, for example, strong correlations between a person with an upright healthy spine that has the natural curves God intended and a person who slouches. The person hunched over is reducing space in the body for the vital organs therefore impeding the proper function of the lungs, heart, kidney, and liver.

Joseph Pilates also wanted his students to have a stable core, which he called “The Powerhouse.” To achieve this, the person must have strong abdominals and be able to properly articulate the muscles surrounding the spine. This requires decreasing over-curvatures such as hyper-lordosis, hyper-kyphosis, and scoliosis which all impair daily function and eventually lead to severe pain. He worked on correcting, reconditioning and eventually maintaining the spine in a more functional placement not only when exercising but while completing daily movements. This is what he wanted to achieve when he discussed flattening the curve.

Joseph Pilates wrote and talked a lot about the spine. As we see how today things are changing around us, we must understand that when Mr. Pilates conceived his methodology, the world he lived in was quite different from our own. There were no computers and cell phones — phrasing was different too. We have to keep this in mind when we interpret his work. He knew the mechanics of the body and was not referring to people with normal curvature of the spine. He did not literally mean a flat spine and was referring to how we visually see someone standing. Is the head hanging forward? Are the shoulders rounded? Are the hips behind the pelvis? These and many other conditions are considered poor posture. In our modern world these postural imbalances are on the rise. Furthermore, positions such as arching of the lower back, hips in front of the pelvis or other spinal imbalances occur when there is little to no control of muscles. Holding the spine upright and elongated requires proper abdominal control.

Unfortunately, critics of Mr. Pilates’s original work are just uninformed. The spinal position Pilates talked about was not static or contracted as some people interpret it to be. When the student lies on the mat or carriage of the reformer the following should occur: 1.) The pelvis should be pulled away from the rib cage creating length; and 2.) There should be a gravitational energy that equally works the abdominal wall and the back muscles which activates the transverse abdominus and the obliques which attach to the thoracolumbar fascia creating what can be referred to as the body’s natural girdle. Consequently, this activates the abdominals and stabilizes the lumbar spine allowing for safer, more effective movement. These are the points that are instrumental in allowing someone practicing traditional Pilates to control their body. While exercising, the spine is capable of moving in all planes of motion which allows for flexion, extension, rotation, and side bending of the spinal column.

As the exercises begin to bring the head, neck and legs into play, the navel is brought in toward the spine to truly activate the deep abdominal muscles (transverse abdominus) as the body works in a “C” curve. This would not be possible if the lower spine were off the mat as it would be with people with hyper-lordosis. Further, the abdominals would not be able to fire, and the lumbar spine would be required to withstand too much compression. No strength would be gained, and pain would result. Working the way Pilates taught is deeper and allows the person practicing the method to fully trigger the whole Powerhouse and not just the rectus abdominus known as the “six pack abs,” which are popular to show off on Instagram but alone will not allow for proper movement patterns. Traditional Pilates teaches stabilization. This is crucial for people with Ehlers-Danlos Syndrome, people who struggle with proper balance, athletes, dancers, people with Parkinson’s disease, and well, frankly, everyone. So, what does the phrase “flat back” truly mean? It simply refers to the lengthening of the spinal column while exercising. This then helps us to bring our spine into a healthy upright position. We cannot have the strength to hold our spine upright while standing without abdominal strength.

A lot is changing in our world. We are surrounded by uncertainty. There is a lot we need to work together to change, but the Pilates method is tried and true. It does not need to be altered. It just needs to be understood. We need proper spinal health for overall well being in our bodies. Keep in mind healthy people are more likely to successfully combat disease. Aligning your spine by working on reducing poor postural habits is what Joseph Pilates was talking about because he understood the importance of stability, core strength and overall well being. So, let’s work together to “Flatten the Curve” during this Pandemic. Please stay home and join one of our virtual Pilates classes to strengthen your Powerhouse and stay well.

Ehlers-Danlos Syndrome and Pilates

It is fair to say that most of us want to have control of our body and not allow our bodies to control our movements, our actions, our ability to live life in the way we choose. Can you imagine picking up a package from your front step and having the discs in your back give out? How about swiveling around in your office chair when a co-worker calls out your name, what if that simple action caused you to end up with a sprained ankle? For some these scenarios may seem crazy. If you have Ehlers-Danlos Syndrome you understand exactly what I am talking about.

Joe Pilates said, “change happens through movement.” Yes, we all need to move. However, people with extremely hypermobile bodies must be so careful what movements they do and how they do it. If you have been hurt so many times while exercising you may want to stop exercising altogether. But movement is necessary, most specifically small, controlled strengthening exercises that help to bring you into balance and allow you to gain back the control to complete daily tasks and more without pain.

Therefore Ehlers-Danlos Syndrome (EDS) and Pilates work better together than any other system of exercise. Although many medical professionals add the method to the list of suggestions, they offer to EDS patients that include other low impact programs, there is a big difference. About twenty years ago I had a young woman come to me with EDS. She told me her doctor had recommended Yoga, Tai Chi or Pilates. She found me solely because my studio was closer in proximity than anything else. I didn’t really know what EDS was at the time but after doing some research I was so grateful that she had not first visited the yoga studio a mile down the road. I came to realize one downward facing dog and severe dislocation of her joints could have occurred not just in one but both wrists. She worked with me safely for more than ten years in my studio on Cape Cod.

Unlike yoga which is an ancient system that incorporates physical, mental and spiritual disciplines and Tai Chi, which is also an ancient practice, Pilates was a man. Joseph Hubertus Pilates was a revolutionary figure in the fitness industry. Mr. Pilates began to develop his system of exercise in 1912, which he himself called Contrology. The name says a lot. He created the original 34 mat exercises we still practice today and was one of the first to use outcome studies and photography to document the benefits of his method. His teachings included developing abdominal strength and control over one’s body. He later created apparatus such as the Reformer, Cadillac, Wunda Chair, Ladder Barrel and other lessor known pieces. Well over a hundred years later this system, now simply called Pilates, promotes core stability, increased balance, overall flexibility, postural awareness, correction of muscle imbalances and endurance. Joe himself worked with several hypermobile bodies in his New York City studio, specifically dancers and contortionists. Thankfully, due to the way he recorded his work, authentic Pilates instructors can see how he individualized the system to every one of his students. The benefits were game changing then, just as they still are today. You will not find this testimony from a group yoga or Tai Chi class.

Although these systems will help with centering, proprioception, lowering blood pressure, helping to combat sleep disorders and aiding one with anxiety, which can be beneficial for many people regardless of hypermobility, we must look at the downside. Increasing flexibility to the degree performed in both yoga and Tai Chi will wear down the flimsy tendons and ligaments in an EDS body. The connective tissue disorder from faulty collagen production requires a more specific regime because stretching may feel great at first, but it won’t for long. The poses held in a traditional yoga class may not dislocate your wrist, it could do worst. A 90-minute class could result in a hypermobile person experiencing such severe pain and discomfort that they become bed ridden for weeks.

With that said, there are lots of exercise clothes that come in ‘one size fits most’ but exercises need to be designed for the individual and fit the body perfectly. Pilates replaces poses with small micro movements that are performed to develop a strong powerhouse as Joe called the core of the body for each student. That doesn’t mean every Pilates student should do the same exercises. Our goal is to create a body in balance which as a result will help prevent injuries.

This is crucial for everyone with EDS regardless of what type. Achieving it means being mindful of who you are working on. As I worked with more clients dealing with Ehlers-Danlos Syndrome I realized they need to learn to exercise efficiently and effectively for their individual body’s needs. It is important that they learn how to stabilize and control their flexibility with movements designed for their unique requirements. Pilates corrects postural imbalances and helps to develop better body awareness more than any other method of exercise when presented correctly. This is important for everyone including those with and without EDS.

Unlike the one size fits all outfit, Pilates fits everybody if it is made to order. Before anyone begins a Pilates practice, it is important to first find a certified Pilates instructor who has worked with EDS patients or is at least willing to learn about it. Not everyone knows what EDS is and Pilates has become a generic term. This can be a dangerous combination. There is classical Pilates, the way Joe taught; there is also contemporary Pilates, cardio Pilates, Pilates on the ball, Pilates at the barre, Pilates with suspension systems and lots of Pilates in large groups. Most of it is a low-impact way to work out but that doesn’t mean that its safe. There are also different types of EDS. In the Pilates repertoire there are now more than five hundred exercises left to us by Mr. Pilates. Instructors certified in the system need to know which ones are best for each client and what modifications may need to be presented for that body.

I had another EDS client who would repeatedly try to coax me into stretching her after a session. It would have been a release for only a very short time and then she would have experienced severe pain. I would have to refuse. I also had to eliminate the pull pull from an exercise known as single straight leg stretch in the abdominal five series. Tree from the short box series was another exercise that needed to be removed all together, even though they were favorites of hers. What works for one person dealing with EDS may not be best for another person with the genetic disorder. For clients it’s important to have a dialogue with your instructor. For instructors it’s important to listen and evaluate each client throughout their sessions. They can still progress and can be challenged just like any student of the method.

The common denominator, the thing that does work for everyone is starting out with the principles that Joe taught and the basic exercises. A strong foundation is something everybody needs regardless of EDS or any mast cell activation disorder or connective disorder. The goal is always the same as well, to live the best quality of life that we all can and to maintain control of our bodies and our well being. Pilates is the best prescription.

COVID-19: What are You Thinking About?

Even in the best of times, many people tend towards negative thinking. In fact, I would venture to guess that the number of individuals who tend to be negative is so large that this is more of a norm than an unusual circumstance. Right now, with the world feeling so dangerous with COVID-19 and social distancing decreasing the number of outlets we have for stress relief it is so easy to allow our brain to spin itself in a never-ending loop of negativity.

So, if this resonates with you, I can assure you that you are not alone. The good news is that you can actually change those negative thoughts. It takes a little practice. It is much like going to the gym or starting a new diet. You have to work out your mind just as you would your body to see the results.

Getting back to that thought you were having when you started reading this. Was it a happy or stressful thought? If it was happy you might not need to keep reading. But if it was stressful here are some activities you can begin doing to change the habit of thinking negative thoughts:

1. Look at the stressful thought as if you are an observer. Get a little curious about the thought. Ask it some questions:

a. Is it prompting you to take action?

b. Is there something you need to do immediately or in the near future to address the thought?

c. Does the thought lack a need for action and is just interfering with your happiness?

If action is required that is great! You can make the phone call, submit the form, buy the toilet paper or whatever else it is that you need to do. But when no action is required, and you keep having the same negative thought it is time to move on to step #2.

2. Challenge and talk to the thought. This may sound silly at first but trust me it works. Imagine you are enjoying a Netflix show and your thoughts go to your fear of COVD-19. This thought popped in your head to try and protect you. You have two options. Most people opt for the first option, a fight or flight response. This causes you to release stress hormones that are not healthy. It tricks your body into thinking it is in a fight or flight situation when you are actually safe. I understand the world isn’t feeling so safe right now but in the moment that you are enjoying the show you are truly safe. What should you do instead? That brings me to option #2. You can thank the thought for reminding you that the world feels crazy right now and let it know that you want to finish enjoying this wonderful show. Again, this takes practice. That thought can be pretty powerful and initially it will keep coming back. But each time you can just reassure the thought that no action needs to be taken and let it know that you are going to continue to watch the show. You can even get tough and tell it to go away and let you enjoy the show. This is strengthening the muscle of your mind and retraining your subconscious mind. What you have is this very moment and if there is no action to be taken you deserve to enjoy it. Your health and happiness depend on it!

3. This one is my favorite. Think of something you love to think about. This might take a moment, but time is something most of us have plenty of right now. Did you come up with something? Perhaps it is a funny memory, vacation spot or favorite hobby? Or maybe it is a special friend, family member or pet? Now really picture whatever it is you are thinking about. Imagine there is a canvas hanging in front of you. Add all the details you can think of to this canvas that represent that happy thought. Use your favorite colors and feel free to add words if you would like. Now brighten up this picture in your mind. Add some fun happy music and stretch this picture out to be bigger by pulling at the corners. Ahh your picture is now complete. I am sure it is beautiful! Put a big smile on your face and take a deep breath in as you really stare at this picture.

How did that feel? When you experience joy even if it was only for a minute you release feel good hormones. As you experience the reward of feeling good you are again retraining your brain.

This may initially feel or sound like a lot work. But I can assure you that sending your body into a fight or flight response when you are actually safe takes a much bigger toll on your body and robs you of the happiness you deserve to experience.

Creating a new habit takes some practice but the reward is so big.

We at MCAD would like you to know we are here for you.

If you would like to learn more about these activities or set up a virtual coaching appointment, please contact Jaimy Blazynski at jaimy@jblazecoaching.com.

Stay home, stay healthy and work on the exercises above to help you keep calm.

Getting to the Root Cause of Mast Cell Activation Syndrome

Whether you have been newly diagnosed with mast cell activation syndrome (MCAS) or if you have been struggling for years, you likely have been provided the same basic treatment options. Most patients are first offered Histamine 1 blockers (H1 blocker) which are antihistamines including Claritin, Allegra, Zyrtec, Xyzal, Benadryl and Hydroxyzine. Typically, a histamine 2 blocker is then added which is usually Pepcid now that Zantac is off of the market. If these medications at appropriate doses are insufficient, mast cell stabilizers such as cromolyn sodium and ketotifen (really both a mast cell stabilizer and an H1 blocker) are used. If prostaglandin D2 levels are high, aspirin therapy may be recommended and for those with leukotriene and asthma symptoms, Montelukast or zafirlukast can be implemented. If symptoms are very severe, steroids such as prednisone are offered. Long term immunotherapies such as Dupixent and Xolair are also considered. Unfortunately, while this may help some patients tolerate the world a bit better, it rarely eliminates the symptoms altogether.

After working with mast cell patients for so many years, it has become extremely clear to me that to begin to really improve patient outcome in those with MCAS, you have to find and then address the root cause. This is where things become a bit trickier as there is no “one-size-fits-all” root cause. At one point, we thought Ehlers-Danlos Syndrome (EDS) was a root cause. Now we know it is part of the triad: MCAS, EDS and dysautonomia. However, it still isn’t really a root cause. There are three things that I have found do drive mast cells to misbehave. This includes familial hypertryptasemia, immunodeficiency and neurological autoimmunity.

Familial Hypertryptasemia

Related to a copy number variant (CNV—a fancy way of saying more than one copy of the gene) in the tryptase gene, familial hypertryptasemia also know has hereditary alpha tryptasemia is a genetic condition where there are multiple copies of the tryptase gene. Tryptase is released by the mast cell most commonly as a part of an anaphylactic response. It is also elevated in mastocytosis. In the case of this genetic condition, we find that patients present with symptoms including flushing, itching, swelling, hives, hypermobility/EDS, allergic reactions, food reactions, medication reactions, chemical sensitivities, IBS, dysmotility, acid reflux, dysautonomia, anxiety, depression and pain. No patient will have all of these symptoms, of course, but usually multiple symptoms will be present. The average tryptase level without this condition is typically between 3-5. Those with familial hypertryptasemia will have levels that are above 5 consistently. This can be well below an elevated tryptase level which is when levels increase above 11. Testing for the tryptase CNV is available at Gene by Gene.


Immunodeficiency is another common driver of mast cell activation. This is because immunoglobulins are the “smart” part of our immune system that has memory. When we are exposed to a virus or bacteria that our body has been exposed to either by a vaccine or illness, it sends out immunoglobulins even more quickly to fight the infection than when the body was first exposed. When the body’s ability to produce immunoglobulins becomes compromised, then other portions of the immune system must step up to the plate so to speak and take over. Mast cells are part of the innate immune system. They are present since birth and amongst other things guard the periphery of our body (anywhere we come into contact with the outside world) from antigens. When things are working properly, part of this responsibility is calling in immunoglobulins for back up when they cannot do the job themselves. As a result of immunodeficiency (even subclinical immunodeficiency), we can find that the mast cells go onto high alert and are more likely to degranulate at the slightest trigger. This can then cause mast cell activation.

Immunoglobulin deficiencies can either be primary or secondary. Primary immunoglobulin deficiency includes disorders such as common variable immunodeficiency (CVID) and are genetic in nature. They are typically treated with IVIG and often prophylactic antibiotics. Secondary immunodeficiencies are acquired and not genetic. They tend to result when there are either chronic infectious agents, autoimmunity and/or aggressive treatment with antibiotics (such as what is often prescribed for Lyme disease). Secondary immunodeficiencies sometimes require IVIG. When levels are not low enough to warrant medical intervention, use of over-the-counter colostrum or bovine albumin immunoglobulins can be helpful.

For some patients, immunodeficiency may not be immunoglobulin based and may be more related to a mannose binding lectin deficiency (MBL deficiency). MBL is part of our complement system. This system is designed to help kill off pathogens. It may be triggered through one of three mechanisms: immunoglobulins, MBL or innate immune cells including mast cells. For this reason, when MBL is low it can also trigger mast cell activation. MBL deficiency is also genetic and may be caused by a heterozygous (one allele is affected) or homozygous (both alleles are affected) mutation. This is a milder immunodeficiency and often goes undiagnosed. Those affected often have more severe and frequent respiratory and gastrointestinal infections.

Neurological Autoimmunity

There also appears to be a strong overlap between MCAS and neurological autoimmunity. So many mast cell patients present with dysautonomia/POTS types of symptoms including tachycardia (rapid heart rate), low or high blood pressure, dizziness, nausea, gastroparesis, fainting, light sensitivity, sound sensitivity, etc. Many also present with neuropathy (nerve pain). Often these issues can be related to small fiber, large fiber and/or autonomic neuropathy. This happens often in conjunction with not just MCAS but with those with Ehlers-Danlos Syndrome as well.

Many of these patients can have an autoimmune disease known as autoimmune small fiber polyneuropathy. It can cause a variety of symptoms including those listed above. Further, many of these patients have neurological reactions that are easily confused for MCAS reactions and often become incredibly limited in terms of food tolerances. This disease is related to autoantibodies to either ganglioside and/or sulfatide. Traditional treatment may include the medication gabapentin which is helpful with nerve pain. Some of the more forward-thinking neurologists are using neurological doses of IVIG and are having extraordinary effects.

How Do I Handle My Family’s Insensitive Comments About My Health?


My husband and I have a family event coming up and my 79-year-old father always makes snide, sarcastic comments about my food sensitivities. This triggers me to defend myself and often leads to an argument. It ends up being embarrassing and can really ruin the whole event for me. How can I get my dad to understand his comments are hurtful so he will stop?


This is a great question that I think many can relate to. You can’t change your dad. He is the only one that can change and likely at age 79 he is unwilling or uninterested in doing so. What you can change is your reaction to your dad. Below are a few steps that will help you get there:

1. Accept: The first step is to accept that your dad says insensitive things and is uninformed about your health issues. There are many people in the world that may not believe or understand your situation. This just means that they are not part of your support network when it comes to your health. I am sure (or at least hope) your dad has other redeeming qualities. Focus on those and let go of trying to get him to understand you. It is exhausting and stressful to try to convince someone to see things through your lens especially if they are resistant. That stress is not good for anyone, particularly someone trying to improve their health issues.

2. Practice and Prepare: Now that you have accepted how your dad behaves and are clear on what to expect you are ready to practice a new reaction. You mentioned your husband is joining you so perhaps he can help. I love the idea of role playing. Have your husband pretend to be your dad. It is best if he can exaggerate his voice to make you laugh. When he makes that sarcastic comment just smile and don’t respond. Pause for a moment and slow down your thinking. Look at what is happening. Your dad is being sarcastic, and you are not reacting. This is not suggesting that you think your dad is right. It is really saying that you no longer want to exhaust yourself and expend energy on this topic. You are accepting this is him and it is no longer your job to change him.

3. Implement: Welcome the party or upcoming family event. This means you can now implement your great new response that you have been practicing. The moment arrives when your dad says exactly what you predicted but now everything is different. You pause instead of reacting. Now anyone observing the conversation will simply see that your dad said something insensitive and you didn’t entertain him. You actually look like the relaxed, healthy person. There is no more polluting the party with an argument, no more bringing extra attention to your health and no more ruining the entire event for you.

4. Laughter: This is the most important step! In order to live your happiest, healthiest life you need to have laughter. Perhaps on the ride home you can share something your dad said and his reaction when you didn’t take the bait. Be sure to inject humor into the story which will make it even easier to not internalize everything he said. You can also focus on all the great conversations you had with other people at the event. In the past you may have spent hours rethinking one comment your dad made. What did this really do for you? It certainly didn’t add to your joy and happiness. It may take a little practice to focus on the happy parts of the day. But this practice is actually training your brain to think happier thoughts. The wonderful thing about positive thinking and laughter is that it provides so many health benefits to your entire body!