Influence of stabilising exercises on neck headaches. and habitual ankle dislocations. Maciej Krzyślak June 2015 Zielona Góra

Transcription

1 Influence of stabilising exercises on neck headaches and habitual ankle dislocations Maciej Krzyślak June 2015 Zielona Góra

2 Abstract Posture deviation and abnormal patterns of movement can result not only in back pain and joint injuries, but also problems rarely associated with motion organs e.g. headaches. Sedentary lifestyles, working at the computer and stress causes reactions in our body which limit the pleasure in our lives. Learning how to stabilise and control our body, awareness of how to care for it and how to change our attitude becomes crucial in ensuring that our body rewards us with vitality and health. In my research paper I present my work with a client who suffered from chronic headaches for three years. These headaches prevented him from functioning normally and sleeping. He went to many specialists, but no one was able to help him. He had to take painkillers the whole time. At the first session it also turned out that he often sprained his right ankle. My thesis briefly describes the fatigue posture, causes of discomfort in the cervical spine and ankle injuries. Also, I describe actions that we have taken to improve the client s posture and balance the body, which have led to the disappearance of headaches and a significant reduction in the number of ankle sprains. 2

3 Table of contents Anatomy of the fatigue posture, cervical spine and ankle joint...4 Introduction...6 Case study...6 Conditioning programme...9 Conclusion...11 Bibliography

4 Anatomy of the fatigue posture, cervical spine and ankle joint Fatigue posture is characterised by the pelvis pushed forward relative to the plumb line and thoracic spine. It is a passive posture that takes very little energy to maintain. The pelvis is in retroversion and head extended forward. Hamstrings are tight. O'Sullivan found that at this position the contraction of the internal oblique abdominal muscles, the superficial part of the multifidus, and thoracic spinal part of the extensor muscles is reduced. Pushing the head forward displaces the balance of the upper spine and considerable muscle disorder of the head and neck. This inevitably leads not only to functional changes, but also, in the long term, to structural changes in cervical vertebrae. The consequences of these changes might be, for example, persistent headaches, blurred vision, breathing difficulties and emotional problems. Pic. 1 Fatigue posture, from Study Guide: Comprehensive Course R. Isacowitz The seating position may lead to: - Bending of the lower and hyperextension of the upper part of the cervical spine, - Lowering of the thoracic cage and upper ribs, - Flexion of the lumbar spine, - posterior pelvic tilt, what causes a shift of weight to the rear part of the sciatic bones or even the sacrum. Pic. 2 Incorrect posture at the computer, from Anatomy Trains - Th.W. Myers 4

5 Ankle sprains are injuries to ligaments. The most common sprain involves one or more of the lateral ligaments and is characterised by pain and swelling on the lateral ankle. A classic mechanism of injury is plantar flexion and inversion, such as when stepping down off the curb or landing from a jump. Ankle instability may come from: Pic. 3 Peroneus - Prior ankle muscles, joint fom damage, Anatomy Trains. - - Weakening of: muscles, ligaments and a joint capsule stabilising the joint, - Impairment of neuromuscular control and proprioception, - Postural disorders. 5

6 Introduction Attachment to cars and laptops causes more and more people to suffer from ailments arising from bad posture. They treat themselves by taking painkillers. The pain passes, but there is no awareness that without changing their habits they will return, leading eventually to more serious ailments and injuries. At the same time, sporty lifestyles have become more popular: running, tennis, cycling etc.. It is supposed to ensure a good figure, increase levels of fitness. It is for your health. Is it though? When after years spent at a desk we start to run, our body is not ready for such a challenge. This may aggravate muscle imbalance and lead to serious injuries. There is no awareness in society of what our body actually needs. What should we do to guarantee that our bodies serve us as long as possible? The client, whose case is the subject of my paper, is a typical example of a modern young man: a man who has spent many hours at the computer in a careless position. Until finally his body refused to obey him. The client was devastated and discouraged when he came to me. Developing his own company required great commitment, but he had no energy. Headaches, reduced vision, trouble sleeping. "The world is behind the glass " - he told me at the first meeting. He had tried everything: visiting specialists and psychotherapists, physical activity. Nothing changed. Just a few sessions with a rehabilitation doctor in our center reduced headaches. The client was told to start specific exercises in order to restore the proper posture and correct patterns of movement. Case study My paper is based on the case of a 36 - year- old client who spends a lot of time working at the computer. He is married and has a baby. He likes spending his free time actively: running, cycling, snowboarding or playing with his child. When he came to our centre his main problems were severe headaches that periodically prevented him from working and sleeping. He went to many specialists, but these visits did not produce any positive effects. He even 6

7 went to a dental clinic because of the suspicion that his pain was caused by problems with his jaw and teeth. The client s problems were typical for his profession: head extended forward, excessive pelvis retroversion, sunken chest, protruding shoulder blades. Despite his slender frame, he had a pot belly. With externally rotated legs he had a waddling gait. He also suffered from habitual right ankle sprains which happened even 2-3 times a week, e.g. when getting out of a car, going downstairs or playing with his child. He had to give up running. In his childhood he had an injury to his right knee. During the first session I discovered that he had weak abdominal muscles, especially in the lower part, and also very weak hip adductors, middle gluteus and flexors. Hip flexion was limited to 45 degrees. While tilting forward in the standing position he could touch his knees with the tips of his fingers. He had weak back extensors, especially in the upper part. The instability of his body particularly drew my attention: limb movement caused numerous minor movements of the torso, raising the shoulders and tension around the neck. He was no longer able to keep upright while standing on the toes of both of his feet. Medical examinations had not shown somatic changes, therefore I decided that the reason for his discomfort could have been his incorrect posture and poor body control. The client decided to have 3 or 4 individual sessions per week. Unfortunately, his frequent business trips meant cancellation of some sessions. That is why he was additionally given a simple set of exercises to do by himself: abdominal strengthening, back extensor muscle and hamstrings and chest stretching exercises. In addition, we agreed that he needed to change his attitude at work: - Sit on sit bones with a straight spine and retracted neck - until then he worked in a reclining position. The client has even bought a special chair with an unstable seat requiring the maintenance of a straight posture, - Shoulders to be lowered, forearms placed on the table, which is why the laptop must be on his desk (not on his knees ) at the proper height, - Every 1-2 hours, a break from work to straighten up and do simple exercises. 7

8 Objectives: 1. Correct positioning and stabilisation of the pelvic girdle to improve posture and stabilise the ankle: - Strengthening of abdominals and middle gluteus, with particular attention to the transversus abdominis and multifidus, - Stretching and strengthening hamstrings and strengthening gluteus maximus, - Strengthening the hip adductors and flexors, especially iliopsoas, which helps to stabilize the lower spine, - Learning leg axial flexion and extension, - Strengthening the peroneal muscles to stabilise the ankle joint. 2. Strengthening back extensor and stabilisation of the shoulder girdle for the correct position of head and neck. 3. Integration and stabilisation of the whole body - correct positioning of the body parts to each other and their coordination during daily activities. 4. Improving body awareness and understanding of its functioning, of how abnormal movement patterns and faulty posture may contribute to the emergence of ailments and injuries in the future. Time frame January to June

9 Conditioning programme BASI BLOCK FUNDAMENTALS FUNDAMENTALS + INTERMEDIATE 1-10 weeks weeks 21 weeks onwards WARM UP Roll up and down Roll up and down Roll up and down, Roll Pelvic curl Pelvic curl up, Spine twist supine, Spine twist supine Spine twist supine Double leg stretch, Chest lift Chest lift with rotation, legs lift Chest lift, Chest lift with rotation, leg circles Single leg stretch, Criss cross FOOT WORK Reformer Reformer Cadillac ABDOMINAL WORK Reformer : Hundred Reformer - Short Box Cadillac Warm up Prep, Hundred Series series HIP WORK Reformer Reformer Cadillac - Supine leg Supine Leg Series: Supine Leg Series: series: Frog, Circles Frog, Down circles, Frog, Down circles, Up (down, up), Walking, Up Circles, Openings Circles, Openings Bicycle SPINAL Cat stretch Reformer: Bottom lift Reformer: Bottom lift ARTICULATION Wunda Chair: Pelvic curl with extension, short spine STRETCHES Reformer: Reformer: Standing lunge, Reformer: Standing Standing lunge Pole series lunge, Pole series FULL BODY N/A Reformer Elephant, Reformer - Elephant, INTEGRATION (F/I) scooter Upstretch1 ARM WORK Reformer Arms Reformer Arms sitting Cadillac Arm standing supine series: Chest series: Chest expansion, series: Chest expansion, expansion, Biceps, Rhomboids Hug a tree, Circles (up, 9

10 ARM WORK Reformer Arms Reformer Arms sitting Cadillac Arm standing supine series: Chest series: Chest expansion, series: Chest expansion, expansion, Biceps, Rhomboids Hug a tree, Circles (up, Adductors, Up Circles, Hug a tree, Salute down), Down circles, Triceps Punches, Biceps FULL BODY INTEGRATION A/M) N/A N/A N/A LEG WORK Mat - Side lying leg Mat - Gluteal kneeling Mat Adductor Squeeze series: Side leg lift series: Hip extension with Magic circle, Forward and lift bent knee, Hip adduction Reformer Single Leg Forward and drops bent knee, Hip extension Skating straight leg LATERAL Mat Side lifts Wunda Chair Side Reformer Side Over on FLEXION/ROTATION Stretch Box, Marmaid BACK EXTENSION Mat Back extension Reformer Breaststroke Reformer Breastroke, Reasoning for conditioning programme Footwork correct placement of feet and strengthening shin muscles especially peroneus muscles to enhance control in ankle joint. Using hip adductors to maintain legs in line throughout the foot work (ankle, knee and hip joint). Keeping pelvis and trunk in a neutral position to learn body control and awareness while legs are working to avoid ankle sprains in everyday movement and activity. Abdominal work strengthening abdominals to strengthen the core. Short box series for teaching coordination of abdominals and back extensors to learn how to maintain correct posture of the trunk. Hip work mobilising hip joints, strengthening hip adductors and stretching hamstrings whilst maintaining pelvic lumbar stability. In this case, the focus was on engaging lower back extensors. Spinal articulation Mobilising the spine and increasing awareness of utilising back extensor control working segmentally articulating through the spine. Opening the chest and using abdominals especially transverse abs as it is important to change fatigue posture. 10

11 Stretches increasing range of motion through hip joints, especially by lengthening the hamstrings. Activation of abdominals and back extensors for balance in the pelvic area is crucial. FBI Obtaining pelvic stabilisation by proper recruitment of abdominals and back extensors and independent movement of hip joints from lumbar flexion. Increasing the length of hamstrings. It will help the client maintain a proper position in sitting at a computer or in a car and during running as well. Arm work Building a base for stabilisation in the shoulder area to avoid lifting shoulders to ears and rounding upper back. Maintaining straight alignment of the neck during arm movement. Chest opening. Changing position from supine to standing, will progressively challenge the core stabilisers of the spine. Leg work Strengthening the gluteus to obtain correct alignment and stabilisation for the pelvis. It is crucial in reducing the danger of ankle joint injuries. Lateral flexion/rotation Obtaining better recruitment obliques and trunk control in lateral flexion. It is important to maintain the neck in line with the spine. Back extension Developing strength in the back extensors to assist in maintaining a head and neck in line with the spine to obtain upright posture. Conclusion After just a few classes a client told me with joy and surprise that he was sleeping better and had fewer headaches and vision problems. That engaged him in even greater commitment, also to practice at home. He changed his workspace, he bought a chair that enforces a proper sitting position. Also, during daily activities he paid attention to proper posture. After a few months his family and friends found that he seemed taller. With great satisfaction, the client noticed improvement in his muscles. There were very rarely problems with the ankle. These changes also influenced his state of mind. Engaged in the development of his company, he began planning its expansion into new markets. He improved his relationships with his loved ones. It brought me great joy when the client's wife came to me to thank me for bringing her husband back to life. Without his commitment nothing would have changed. I think that an important element of 11

12 our work is mutual trust and the belief that together we can achieve the objectives set. The role of the instructor is to support the client in going through the subsequent steps. Surprisingly, when working with this client, I discovered how much our body affects our psyche, relationships with people, and thus having a happy and good life. Pilates with its holistic approach to body movement is great for people of all ages. And a wonderful tool for the instructor. 12

13 Bibliography Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Myers, Thomas W. Anatomy Trains. Myofascial Meridians for Manual and Movement Therapists. 2 nd dition. Warszawa, Isacowitz, Rael, Karen Clippinger. Pilates anatomy, Isacowitz, Rael. Pilates, 2006 Myers, Thomas W. Ciało3. Diane Lee. Obręcz biodrowa, Warszawa, 2001 Carolyn Richardson, Paul W. Hodges, Julie Hides. Kinezyterapia w stabilizacji kompleksu lędźwiowo- miedniczego, Wrocław,