Tall Kneeling - Why you should make it your business

By: James Gallegro PT DScPT MSPT CMPT CSCS



This will be my first post in a series with two goals:


1.    Expand the reader’s appreciation of how simple postures can optimize their workout

2.    Help the fitness professional avoid pitfalls in planning an exerciseprogram

The tall kneeling position can teach us a few things about ourselves and our clients. There is not an adult human among us in the western world who uses his or her body optimally, especially after the age of 6 or so. Why, do you ask? Mainly because we stop squatting and start sitting. Popular reporting abounds regarding the horrors of sitting, but I will take a different angle: yes, sitting is bad, but abandoning squatting is just as responsible for our postural woes.

Do we know squat?

I’m not referring here to squatting in the weight lifting sense, although stay tuned, we’ll get there! Instead I’m referring to functional squatting – as in people drinking tea in a public square in Tajikistan. A great mentor said about squatting – “it is the natural resting position of the human body.” Functional squatting utilizes the deep gluteus maximus and lower abdominals and loads through our heels and femurs – unlike sitting on our bottoms. Chronic under-activation of these key muscle groups leads to the dominance of their antagonist groups: the hip flexors and lumbar extensors. This creates a lumbo- pelvic postural imbalance with far reaching functionalimplications.


So back to tall kneeling and how it can serve to optimize our workout. In the tall kneeling position, pictured above, the focus is to “level” the pelvis, as if you were trying to get your belt line parallel to the floor. This allows us to connect to the deep glutes and lower abdominals while actively lengthening the hip flexors, quads and lumbar extensors. Many of us habitually lose this orientation of the belt line, with the pelvis tilted anteriorly as if the belt buckle were facing the floor. Optimal activation of the gluteus maximus, lower abdominals, transversus abdominis, and even the pelvic floor and lumbar stabilizers becomes difficult in that position.

Tall kneeling makes it easier to appreciate the lumbo- pelvic and hip position by largely limiting the influence of the knees and ankles. In tall kneeling, one can focus on the activation of the lower abdominals as they “pull up on the belt buckle,” and the deep glutes as they work against anterior hip tightness to encourage hip extension. Improving this positional awareness may

inform you or your client where there is muscle tightness and help flesh out a workout with the addition of quadriceps and lower back stretching if needed. Here’s a link out to my favorite method of quad/anterior hip stretching explained by Men’s Health: https://www.menshealth.com/fitness/a19524865/rear-foot-elevated-quad-stretch/.

The tall kneeling position can also help us to appreciate how well we can activate the glutes and lower abs, providing a caution light for progressing to more challenging movements like dead lifting, lunging and squatting. Failure to heed that caution light can result in failed loading in upright positions and can contribute to lower back and hip injury. Training the activation through tall kneeling can help with as a warm-up for carry over into more challenging positions.

Hopefully this simple discussion of tall kneeling can help you get more out of your workout, by incorporating better activation of these key muscle groups. In subsequent posts, we’ll discuss some simple ways to further evaluate and improve the activation of the gluteus maximus and lower abdominals for those who have difficulty there. If the activation is going well, the tall kneeling position can be progressed into a “kneeling bridge” exercise as well, to begin moving towards more functional upright standing exercises. In the meantime – happy exercising - and remember to always move thoughtfully!

About the Author:

James Gallegro PT DScPT MSPT CMPT CSCS is a physical therapist and fitness consultant who has worked with active populations ranging from Broadway performers and professional ballet dancers to high level athletes and exercise enthusiasts. He has a passion for helping develop fitness programs that incorporate improved postural integration for optimal performance.

Getting to the core of the issue

By Anna Hajosi, L.Ac and Sarah Walker, PT, DPT

We think it is worthwhile to raise awareness on how abdominal procedures, pregnancies, tummy tucks, hernia repairs, and Cesarean sections affect your core, posture, and health. The anecdote below illustrates the impact of core weakness and how to improve it.

Two years after undergoing an abdominal surgery, a long-term patient and friend who has completed 80 Marathons and 20 Ironman triathlons over the course of 15 years challenged me to complete an Ironman triathlon within a year. “How can you treat triathletes if you yourself haven’t raced yet?” he asked jokingly. (A full Ironman triathlon is a tough race. The course consist of a 2.4 mile swim, 112 mile bike and 26.2 mile run).

I have always been very active, but training for a race like this is incredibly challenging. “Let me start with a half one first!” (A half Ironman is a 1.2 mile swim, 56 mile bike and 13.1 mile run). I looked up the pool closest to me, got a swim coach and with his guidance, I was able to build up to the required 1.2 miles within a couple months. However, I noticed two things: one, that I finished my long swim sessions with a dull, nagging, aching pain in my lower back, that just wouldn’t go away. This worried me. How will I continue with a 56 mile bike ride and 13.1 mile run following the swim? Two, that my swim was rather slow, and I had a difficult time improving my speed.
I decided to revisit physical therapy - luckily I did not have to go far to find a great PT :-)

Following a thorough evaluation complete with scans and special tests, Sarah informed me that I was walking around with an arched lumbar spine (lower back) and an inhibited core. She explained that, despite my strenuous workouts, my deeper core muscles were weak and did not fire properly. I compensated for the weakness by using the wrong muscles, which compressed my spine. Sarah further said that while training had strengthened my arms and legs, I had failed to adequately connect the two. This loss of stability and proper transfer of load from lower body to upper body and vice versa created an increased amount of stress throughout my spine. This is why I was suffering from low back pain.  

After surgery and other abdominal procedures, it is hard for the brain to find and activate key muscles to maintain a neutral alignment due to trauma to the abdominal muscles and fascia. Surgery can also involve a loss of sensation at or around the scar, inflammation in the abdomen, and pain in the lower back. When the low back experiences pain, research has found that there is an inhibition to the the deep core muscles & lumbar spine stabilizers that support a neutral lumbar alignment. Since this inner cylinder of lumbar stabilizers are turned off, compensation patterns develop. In my case, my posture change resulted in shortened back muscles and hip flexors with an extended abdomen. This posture compressed my lumbar spine and created a sacroiliac dysfunction. Sarah initially worked to undo some of my compensations by improving my sacroiliac movement, decreasing some of the muscle tension, and improving the fascial mobility by using manual techniques to include joint mobilizations, muscle energy, and myofascial release. She then helped me to locate those “lost” muscles from my procedure. After I found those muscles, I was on to establish a neutral spinal alignment. Sarah reported that finding these local stabilizers and neutral alignment were the crucial foundation I needed to successfully progress for my triathlon.   

In addition to the exercises, I performed acupuncture on my core muscles’ motor points to assist my stability. A motor point is the entrance site of the motor nerve into the muscle. This is the exact point that connects the brain, the nervous system and muscles together. The brain signals the muscle to turn on through this system. By needling my own motor points, I was able to re-establish this connection that had been lost which allowed me to help find the muscles Sarah was asking me to retrain.  

I also needled my scar. Scar formation is a normal response following any injury or surgery; it is the way the body heals injured structures. Scar tissue may involve only the superficial skin, or it may involve the deeper tissues beneath it, including nerves and tendons. Scars can become overly sensitive and can limit motion and function. Needling my scar helped reduce sensitivity and loosen adhesions to deeper structures and allowed me to produce a scar that is smooth and moveable.

Eventually, my therapy progressed from isolated core work. We worked to connect my core to my arms and legs via dynamic upper and lower extremity movements that replicate swimming.  

With the help of the combination of therapies my lower back pain resolved within six weeks. I am now able to effectively engage my core and maintain spinal stability. I have better alignment, and as an added bonus, I’ve noticed positive improvements in my swim.

The takeaway:  

Following an abdominal procedure, pregnancy, tummy tuck, hernia repair or cesarean section your core muscles become weak and dormant. To combat this, we recommend a combination of physical therapy and acupuncture. Together we can help to reactivate, strengthen, and coordinate your core muscles. This will benefit your training, reduce future complications, and  thus improve your everyday life. Listen to your body and take care of it so you can live to your utmost potential always.  Take responsibility for your health.

Anna Hajosi, L.Ac & Sarah Walker PT, DPT

Note from our CEO


Dear All,
At Manhattan Physio Group, we strive for excellence and to provide you with an ultimate experience.  We are extremely meticulous about whom we bring on-board. Whether it is a physical therapist, a GYROTONIC® trainer, or our affiliated acupuncturists, massage therapists, nutritionist, meditation or yoga instructor, we make sure to have the best professionals available to you.  We choose professionals who are talented, passionate, curious and interested in addressing all of your needs.  It is our commitment to you and to our industry to help you live stronger, healthier lives.  We have invested a substantial amount of time and value into our new facility and we are thrilled to bring you a place of harmony and healing.  Our new facility allows for our cohesive team to work with you in collaboration.  All of our professionals are committed to working together, learning from each other and constantly continuing their studies within their respective disciplines.  Our interest is to provide you with a comprehensive wellness center that can address all of your needs.
Our main focus is you, our loyal patients and clients. You have made all of this happen and you are the driving force for us to continue to expand, to innovate, and to bring top-notch professionals into the MPG world.  Thank you for inspiring us to grow and for your confidence in us.  We will continue to always push for excellence in the fields of physical therapy, holistic health, and fitness.
I encourage you to take advantage of our newly integrated meditation class with the very seasoned and talented Jessica Dixon Majka.  Meditation is a great way to start or end your day.   
We would love to see you.  Please come check out our improved facility, if you haven’t done so already, and experience different services and treatments on the same day, all under one roof.     
To your health and wellness,
Adolfo Mendez-Nouel


by Michelle Rodriguez, MPT, OCS, CMPT

In 2004, I sustained a lower back injury.  I wasn’t able to walk or bend or work for 2 weeks.  I tried to treat myself.  I went to see the best doctors, acupuncturists, massage therapists and colleagues, but nothing really worked long term.  I discovered that nothing was truly wrong with me except that my body was out of balance; I had areas of incredible tightness and areas of weakness.  All I needed to do was unwind and reconnect while regaining balance and strength.  This revelation brought me to  GYROTONIC® .  I had done it 20 years prior as a professional ballet dancer.  I wish I knew then what I know now.  My approach to the movement was as a young aspiring ballerina, not as an experienced and skilled physical therapist.  When I came back to GYROTONIC® I was so blown away by how brilliant the movement system was for the body and mind that I became a certified instructor.  I felt like I needed to incorporate the principles and movement into my practice as a physical therapist.  I would be doing a disservice to my patients if I did not.

Three things GYROTONIC® has taught me…


Breathing is crucial for the support of all systems and the reduction of inflammation by decreasing cortisol levels and stimulating your vagus nerve.  I had to retrain my diaphragm (primary breathing muscle) to work properly with the rest of my inner core cylinder muscles (ie. transversus abdominus, mulitfidi, and pelvic floor) to support and decompress my spine.  How these muscles were working together was essentially “out of sync” and in order for you to have good posture that is well supported they need to work together.  Without this level of organization in your body, it is impossible to build true strength and be injury free.

By focusing on my breath and connecting my inner cylinder of muscles, I found myself in a very focused and mindful state.  I couldn’t do anything else or think about anything else or I would lose all the connections.  I was truly reprogramming my body.  I began to look at GYROTONIC® as “meditative movement”.  I was not only connecting my body, but my mind and my spirit as I searched within to reorganize myself.


Having been a professional dancer and recreational athlete I was very much of the mind set, “no pain no gain”.  I pushed my body to its extreme.  I thrived on this.  I felt like I wasn’t working hard enough if my muscles weren’t burning or trembling.  The way I had always approached working out or being in shape led me to an imbalanced state.  With my GYROTONIC® practice I started to learn to let go of all of that. Instead, I knew I needed to work smarter and more efficiently.  I started being able to connect to my body, listen to it, understand it better, and give it what it needed.  GYROTONIC® feels good, well at least it should.  I still worked very hard in GYROTONIC® but I learned to do so with more of a softness and a mindful breath that I later discovered led to greater suppleness, strength and vitality.  I was able to achieve better physical results with this approach then I had ever before.  My spine felt longer and decompressed, I actually “grew” 1 inch, my core was stronger than ever, my body was well aligned and strong.  It made me feel like I was all “set up” to go do whatever I wanted to do.  Freedom! Confidence!  I was able to achieve all of this by doing something that was good for me, GYROTONIC®! 


Through my own practice of GYROTONIC®, I developed a new vocabulary of imagery cues to offer to my patients.  By making connections within my own body, I have been able to better describe to patients how to make connections within their own bodies.  It has inspired me to be able to communicate clearly, precisely, and creatively with patients to help them achieve the necessary organization to reprogram their motor control.

The design of the GYROTONIC® equipment and movement allows me to achieve rehabilitation results more efficiently because it facilitates a decompression of the joints.  This is important because when there is more space in your joints there is less pain, greater range of motion and an inherent stability that allow for better muscle recruitment.  My interest as a physical therapist is not only to rehabilitate someone’s injury, but also to correct movement patterns that led to the injury.  At Manhattan Physio Group we look for the root cause of the injury and work with our patients on this level of detail and specificity.  True recovery from an injury means to us that it does not continue to reoccur.  We have been able to achieve this by having patients on a regular GYROTONIC® program.

I encourage all of my patients to do GYROTONIC® on a weekly basis.  It has something to offer for everyone.  One of the early signs of aging of the spine is stiffness, a loss of rotation and side bending.  Given the 3-dimensional nature of GYROTONIC®, it allows for the spine to arch, curl, side bend, and rotate and hence deter the aging process of the spine.  Also, given the age of technology that we live in, many people spend more hours than ever sitting in front of a computer.  We have heard for a while now how “sitting is the new smoking” and I’m sure you’ve heard that if you “don’t use it, you lose it”.  So, if you’re sitting for most of the day and your workouts don’t incorporate balanced, full body movements in all directions, you are most likely very stiff in certain areas and perhaps overworking other areas.  All of this would lead to imbalances and misalignment that can then lead to injury or insidious degeneration. 

Use GYROTONIC® as your cross-training for life, for sport, for dance.  It will help rehabilitate your injury faster.  It will help you avoid injury.  It will serve as your body’s anti-aging tool.  At Manhattan Physio Group our approach is unique; customized and collaborative.  Your GYROTONIC® sessions are guided by and under the direct supervision of a physical therapist to focus on your individual needs.         

I look forward to seeing you all soon at our incredibly amazing new space on the 3rd floor of City Center.   


With love and good health,

Michelle Rodriguez






Treating a Ganglion Cyst with Acupuncture by Anna Hajosi

What are ganglion cysts? 

Ganglion cysts are masses or lumps commonly found in the hands, most frequently developing on the back of the wrist. In most cases, the cysts are not cancerous and are relatively harmless, but if they interfere with function, or have an unacceptable appearance, there are several treatment options available. 

It is not known what triggers their formation. They are most common in younger people between the ages of 15 and 40 years, and women are more likely to be affected than men. These cysts are also common among gymnasts, who repeatedly apply stress to the wrist.

These fluid-filled cysts can quickly appear, disappear, and change size. Most ganglions form a visible lump. Smaller ones can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms, a cyst can put pressure on the nerves passing through the joint, causing pain, tingling, and muscle weakness. Large cysts, even if they are not painful, can be aesthetically unpleasant. 

Conventional Western Treatments: 

Ganglion cysts often do not require invasive treatment, but can be treated non surgically or surgically to ease discomfort. Presently, observation, immobilization, aspiration are all available in addition to surgical excision for treatment.

Can acupuncture help with Ganglion cysts?

In Chinese Medicine, ganglion cysts are linked to stagnation. From this perspective, any accumulation and thickening of fluids in the body points is either due to a local obstruction in the flow of energy, 'Qi' in Chinese Medicine, or to a systemic problem manifesting itself as a number of problems across the body and mind. A skilled practitioner can quickly make this determination and treat accordingly. The greater majority of cases we come across are local problems, often caused by either postural reasons - work stations, frequent use of the joint in a skilled operation or muscular tensions constricting the flow of fluids and blood. Treatment can help to reduce the tension and improve flow as well as help disperse the thickened fluids and reduce the size of the lump. 

Recent Success Case 

A 28-year-old female patient complaining of a ganglion cyst on the back of the right wrist came in for acupuncture to alleviate the resulting discomfort. As an office worker, her primary concerns involved pain and interference with function as well about unpleasant appearance.

Upon palpation, a hard, soft tissue nodule was found on the back of the wrist. It was painful with pressure but the patient could continue to move her wrist. Initially measuring 1cm by 1 cm, the patient wished to reduce the size of the cyst. 

After I treated the patient for three sessions over a week and a half with high frequency electroacupuncture, the patient reported that the ganglion cyst was no longer present.

Before and After



Ganglion cysts are the most common soft-tissue tumors found within the hand and wrist region. The origin of ganglion cysts are highly theorized, and include pre-existing intra-articular joint pathology, joint stress leading to degeneration, and joint stress stimulating mucin secretion. 

Following subsequent research, electroacupuncture may serve as a valuable and safe alternative for ganglion cyst treatment.


Learn more at http://www.annahajosi.com