PILATES FOR A WEAK CORE

Transcription

1 PILATES FOR A WEAK CORE NICOLA PARRY 18 JAN 2019 BASI COMPREHENSIVE STUDENT LONDON, WIMBLEDON SEPT

2 ABSTRACT: In Pilates terminology, the CORE or powerhouse, can be described as the area from the bottom of the ribcage to the line across the hip joints in the front, and to the base of the buttocks in the back. They are the muscles that connect the upper and lower body. [1] These areas of the body are the ones that usually frame the posture of a person and they are vital for body mechanics, strength, endurance, balance, and all activities encountered during daily living. Joseph Pilates placed great emphasis on the powerhouse, considering it a physical centre of the body from which all Pilates movement should proceed. [2]. Julie came to me after being refered by her physiotherapist following a core scan that highlighted that she was unable to recruit her core muscles to stabilise her movement. As a result of this, she suffered from lower back pain and general instability. Coupled with this, Julie is also hypermobile which caused further imbalances and weakness in her body. Joseph Pilates said civilisation impairs physical fitness. Modern life doubled up over screens, bent over desks, stressing about deadlines takes a considerable toll on posture, and as a result the effect it has on our physical, spiritual and emotional wellbeing. Julie is a great example of this, as years spent working at a computer have further exacerbated her lordotic posture and muscle imbalances. I created a program for Julie that focused on recruitment and stabilisation of her muscles through each of the blocks. Initially Julie was extremely frustrated as she had little awareness and control of her muscles. As the weeks progressed, she was able to activate and more importantly control her movements - resulting in a stronger core, reduced back pain and most importantly a love for Pilates. As joseph Pilates said you will feel better in 10 sessions, look better in twenty sessions, and have a completely new body in thirty sessions. 2

3 TABLE OF CONTENTS ABSTRACT 2 ANATOMICAL REVIEW 4 CASE STUDY 9 INTRODUCTION PILATES EXERCISE PROGRAM CONCLUSION REFERENCES 14 3

4 ANATOMICAL DESCRIPTION OF THE CORE: The 4 core muscles that comprise the core/powerhouse in Pilates are: 1. The Transversus abdominis 2. Multifidus 3. Internal and external oblique s 4. Pelvic floor These muscles are at the centre of the bodies power, coordination and stability. FIGURE 1: shows the core stabilising muscles on the anterior side of the body. [3]* FIGURE 2: shows the core stabilising muscles from the side. [3] 4

5 THE TRANSVERSUS ABDOMINIS: Transversus abdominis (TVA) is the deepest of the abdominal muscles, lying internally to the internal obliques, and wrapping around the abdomen between the lower ribs and the top of the pelvis. See image below. [4] the pubic crest and the pectineal line [5] It is a thin sheet of muscle whose fibres run horizontally anteriorly. It arises as fleshy fibres from the deep surface of the lower six costal cartilages, the lumbar fascia, the anterior twothirds of the iliac crest and the lateral third of the inguinal ligament. It inserts into the xiphoid process, the linea alba and the symphysis pubis. The lowest tendinous fibres join similar fibres from the interior obliques to form the conjoint tendon which is fixed to Role: The TVA works like a corset. When it contracts, the waist narrows slightly and the lower abdomen flattens. The function of the transversus abdominis is to stabilize the lower back and pelvis before movement of the arms and/or legs occurs. This function is critical if wear and tear (degeneration) of the joints in your lumbar spine and pelvis is to be prevented. When healthy, this muscle anticipates motion, e.g. the TVA involuntarily contracts during lifting, stabilizing the spine and pelvis by creating a kind of corset or hoop of tension around the mid-section of the trunk. It is estimated that the contraction of the TVA and other core muscles reduces the vertical pressure on the inter-vertebral discs by as much as 40%. [6] THE MULTIFIDUS: The multifidus muscle is one of the smallest yet most powerful muscle that gives support to the spine. The multifidus is a series of muscles that are attached to the spinal column. The muscle consists of 5

6 a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. The multifidus is a very thin muscle. It spans three joint segments, and works to stabilize the joints at each segmental level. The stiffness and stability make each vertebra work more effectively, and reduces the degeneration of the joint structures caused by friction from normal physical activity. [7] It is important that the stabilizers of the lumbar spine function together with the transversus abdominis and the pelvic floor to stabilize the lower back and pelvis. [8] EXTERNAL OBLIQUES: The external abdominal oblique muscle is the largest and most superficial of the four muscles and lies on the sides and front of the abdomen. It is broad and thin with its muscular portion occupying the side and its fibrous tissue situated on the anterior wall of the abdomen. It arises from the external surface and inferior borders of the lower eight ribs. The fibres from the lowest ribs pass nearly vertically downwards and are inserted into the anterior half of the iliac crest; the middle and upper fibres, directed inferiorly and anteriorly, end in an aponeurosis at approximately the mid-clavicular line and insert into the xiphoid process, the linea alba, the pubic crest and the pubic tubercle. {5] Function: Both sides acting together, the external abdominal obliques flex the vertebral column by drawing the pubis towards the xiphoid process. Acting unilaterally, it results in ipsilateral (same side) flexion and contralateral (opposite side) rotation of the trunk. [9] 6

7 INTERNAL OBLIQUES: The internal abdominal oblique muscle is also a broad thin muscular sheet that lies deep to the external oblique muscle. It arises from the thoracolumbar fascia, the anterior two-thirds of the iliac crest and the lateral two-thirds of the inguinal ligament. The muscle fibres radiate superomedially and insert into the inferior borders of the lower three ribs and their costal cartilages, the xiphoid process, the linea alba and the symphysis pubis. Near their insertion the lowest tendinous fibres are joined with similar fibres from the transversus abdominis to form the conjoint tendon [10] Function Acting unilaterally, contraction of the internal oblique results in ipsilateral (same side) flexion and rotation of the trunk.[4] It acts with the external oblique muscle of the opposite side to achieve this torsional movement of the trunk. It also acts to compress the abdominal viscera, pushing them up into the diaphragm, resulting in a forced expiration. [10] THE PELVIC FLOOR: The pelvic floor is a funnel-shaped structure forming a large sling of muscles stretching across the floor of the pelvis. It attaches to the pubic bone in front, and spans backwards to attach to the coccyx behind. The pelvic floor can be thought of as our undercarriage. The anus, vagina and urethra are all located here. The pelvic floor muscles are the foundation for the core of the body. [11} The roles of the pelvic floor muscles are: Support of the abdominal and pelvic viscera (bladder, intestines, uterus etc.) through their tonic contraction. Resistance to increases in intra-pelvic/abdominal pressure during activities such as coughing or lifting heavy objects. Urinary and faecal continence. The muscle fibres have a sphincter action on the rectum and urethra. They relax to allow urination and defecation. [12] 7

8 Female Pelvic Floor Muscles [13] 8

9 CASE STUDY: NAME: JULIE ASH AGE: 42 LIMITATIONS: Core muscles not being recruited (core muscle scan). Coupled with this, Julie has hypermobility in her knees, and lumbar spine resulting in additional instability and weakness. SYMPTOMS: Lack of stability and strength Lower back pain Inability to feel abdominal connection and recruit the appropriate muscles. BACKGROUND: Julie was referred to me by her physiotherapist following a core scan which identified that she is unable to recruit the appropriate muscles to activate her abdominals. The core scan revealed that she was able to activate her oblique s however there were asymmetries which resulted in rotation of her pelvis and hips. Coupled with this she was unable to recruit her transversus abdominis as well as her pelvic floor. POSTURAL ASSESSMENT: Slight lordosis of the spine and hyperextension of the knees. Resulting in weak abdominals; hip flexors and glutes. Due to her hypermobility Julie is flexible in her lower back and hamstrings however the muscles are weak and not activating sufficiently to support and stabilise her movements. OBJECTIVE OF THE PROGRAM: Pelvic lumbar stability and control o Strengthen abdominals: focus on awareness and recruitment of the muscle group o Restore neutral pelvic alignment through strengthening the abdominals, hip flexors and the spinal extensors o Activate the multifidus through engagement of the transverse abdominis and pelvic floor. Increase pelvic floor connection through strengthening of the adductors. 9

10 Strengthen the hamstrings and glutes and stretch the quadriceps and hip flexors CONDITIONING PROGRAM: BASIC WARM UP: Roll down Pelvic curl Spine twist supine Chest lift Chest lift with rotation Additional: leg lifts, progressing to leg changes once Julie was able to isolate her abdominals and retain the connection to her TVA and oblique s. BLOCK APPARATUS EXERCISES FOOTWORK Reformer Parallel heels Parallel toes V toes Open v heels Open v toes Calf raises Prances Single leg heel Single leg toes I chose footwork on the reformer as it enabled me to focus on Julie s Pelvic lumbar stability. This was achieved by focusing on her abdominal connection whilst retaining neutral spine. Footwork allowed me to focus on working her hamstrings and quadriceps whilst preventing hyperextension. I achieved this by slowing down the footwork and ensuring Julie didn t hyperextend back into her knees but rather pulled up through her quadriceps and hamstrings. The progression for this footwork will be to move onto the Wunda chair which requires greater pelvic lumbar stabilisation through the activation of the core. ABDOMINALS Wunda chair Standing pike Standing pike reverse 10

11 As Julie is not able to feel her abdominals activating I chose abdominals on the Wunda chair which are focused around recruiting and maintaining the abdominal connection. HIP WORK Reformer series 1 Frog Circles down Circles up Openings The objective for choosing this series for Julie is focusing on strengthening her adductors and hamstrings. I find that Julie was able to better connect into her pelvic floor and abdominals when she activated her adductors. I focused on Julie keeping the movements slow and controlled and minimising her ranges of motion particularly with circles. Throughout the series I was focused on her pelvic lumbar stability through the connection of her transverse, oblique s and pelvic floor. Spinal Reformer Bottom lift articulation Bottom lift with extension This is a brilliant exercise for Julie as it works her abdominals and hamstrings. The focus was to get Julie to initiate the movement with her abdominals. Julie tends to lose her adductor connection so I utilised a ball between her thighs in the initial sessions to keep this awareness, helping Julie to activate with her hamstrings vs. her glutes. When progressing to extension the focus was on maintaining the abdominal and hamstring connection. The extension was kept small ensuring the correct pelvic alignment and to ensure recruitment of the hamstrings to draw the carriage back in. Stretches Reformer Standing lunge I chose standing lunge to stretch into Julie s hip flexor whilst working on stability of the supporting leg through correct alignment of the knee. For Julie and her hypermobility, ensuring the correct set-up is vital to her ability to successfully execute the exercises. FBI 1 Reformer Scooter I chose this exercise again as it focuses on trunk and shoulder stabilisation through the recruitment of her abdominals which are key areas for Julie. Also, as the movement is closed chain, short lever and on one leg it helps work on her stability and core strength. As the supporting leg is bent it makes her pull up through her quadriceps and hamstrings for stability vs locking her knees into hyperextension. FBI 1 Reformer Reverse knee stretch This is an intermediate exercise however is great at activating into the lower transverse abdominals and maintaining trunk stability. 11

12 ARM WORK Reformer Arms supine series Extension Adduction Up circles Down circles Triceps I chose the supine arm series as it requires pelvic lumbar stabilisation and abdominal control, whilst working stability and strength of the arms and shoulders. LEG WORK Wunda chair Leg press standing This is an extremely challenging exercise for Julie as it works her core stability and balance. As she has a slightly rotated pelvis this also highlights the asymmetries and she has to work her obliques and TVA even harder to avoid twisting with the movement. FBI Lateral flexion and rotation Spine corrector Side overs I chose the spine corrector to work Julie s obliques as it helps to give her feedback and we can control the movement. Back extension Spine corrector Swan basic Julie s spine is beautifully mobile so we focused on protecting her back by activating her abdominals. The objective of this exercise was to get greater range of motion in her thoracic spine before going into her lumbar spine CONCLUSION: Julie came to me a bit like a gangly colt. On the surface she moved beautifully however when looking closely you could see the muscle weaknesses that needed time to strengthen and activate correctly. Initially Julie found the session extremely frustrating as she wasn t able to turn on her abdominals when she needed them. Weekly private sessions were not enough to get the results we were after, so I gave Julie 5 exercises to do at home every day: Pelvic curl (abdominals and hamstrings) Spine twist supine (obliques) Chest lift (TVA and pelvic lumbar stability) Chest lift with rotation (obliques and pelvic lumbar stability) Leg lifts progressing to changes (TVA and obliques) 12

13 As the weeks have passed I ve seen Julie not only become physically stronger with reduction in lower back pain, but also feel more in control of her body. This has resulted in a positive impact to both her physical and emotional wellbeing. Joseph Pilates knew that the benefits of Pilates were far reaching and said; through the Pilates method of body conditioning this unique trinity of a balanced body, mind and spirit can ever be attained. Self-confidence follows. 13

14 REFERENCES: 1. BASI Comprehensive Study guide 2. Pilates Anatomy Rael Isacowitz and Karen Clippinger May Dr. Phil Page May 6, 2013 Performance Health Academy Research Updates, Thera-band elastic resistance 4. Aiden Turner Dec Embody Pilates < 5. Gray H. Grays Anatomy. 37th ed. Edinburgh: Churchill Livingstone, 1989 Wikipedia. Transversus Abdominis < < 6. < 7. Gray H. Grays Anatomy. 37th ed. Edinburgh: Churchill Livingstone, 1989 Wikipedia. < 8. Long-Term Lumbar Multifidus Muscle Atrophy Changes - Documented with Magnetic Resonance Imaging A Case Series LR. Mark Woodham, Andrew Woodham, Joseph G Skeate, and Michael Freeman. 9. Gray's anatomy for students. 3rd edition. Philadelphia: Churchill Livingstion Elsevier; p Drake RL, Vogyl AW, Mitchell AW. cite_note-gray Gray H. Grays Anatomy. 37th ed. Edinburgh: Churchill Livingstone, Wikipedia. Internal Abdominal Obliques < Body Arts and Science International Ashley Ritchie Pilates through pregnancy and beyond. 12. Sophie Fidoe January <