Pilates for Clients with Myofascial Pain

Transcription

1 Pilates for Clients with Myofascial Pain Jerusha (Ellie) Weaver June 3, 2015 FAP and CAP Herndon, Virginia

2 Abstract The subject, who will for now on be called Alice, suffered a severe bought of depression that housed itself in the form of Myofascial Pain and Fibromyalgia. Both cause severe pain and limited mobility in the area of the body that it manifests itself. For Alice, that was her upper and mid back on the right side and her right shoulder. After three years of primarily lying down with limited movement, Alice was able to switch her prescription medication, perform intensive physical therapy and start a regiment of Pilates that she continues to do today. After extensive daily work in Pilates along with psychotherapy and prescription medications, Alice is well on her way on the path to full recovery. Weaver, 2

3 Table of Contents Anatomical Description... 4 Case Study... 5 Pilates Program Conclusion Bibliography..10 Weaver, 3

4 Anatomical Description: Place of Myofascial Pain and Areas of Strength Training Alice feels pain in the tissue of her upper thoracic spine region, primarily on the right side. She also experiences pain in her right shoulder in the deep tissues underneath and surrounding the scapula. There is no indication that the pain is muscle pain but rather nerve pain, more of a burning sensation. Movement of a certain nature, primarily lifting objects in front of her, causes the pain to flare up. Overall, the subject has weakness and atrophied muscles throughout her entire body, but especially in her postural muscles. Weaver, 4

5 Case Study A brief background on the subject, Alice is 56 years old. She gave birth to six children in a time span of seven years. Although she was physically active before having children, Alice gave up taking care of her body and her health after having children so she could put all of her focus on their upbringing. When her children became adults, Alice started exercising again but by this point she had not been exercising regularly for 20 years and was between pounds overweight. Alice also has incredible flexibility and hypermobility in all of her joints despite the lack of movement in those years and her recent bought of Myofascial pain. Alice has a history of mental illness in the form of depression. Usually she experiences her depression in the physical sense following traumatic life experiences. The first time Alice noticed this was in 1992 after three major life events happened one after another. Alice housed this stress in the form of severe back pain that put her in the hospital. She lost 25 pounds in less than two months and stopped eating regularly. She was prescribed Fluvoxamine, an antidepressant, and had successful results. The doctor informed her she would have to be on this particular medication or some form of antidepressants for the rest of her life. Alice experienced another bought of severe depression at the age of 52. A series of major life events, some of them traumatic, happened in a short time span. Alice also took several falls that sprained both her ankles and nearly broke her hip. All of these factors combined caused a second bought of severe depression that took the former of severe Myofascial pain. Myofascial pain is a complex syndrome that is widely discussed among doctors and psychologist. In a nutshell it is the body s innate response of fight or flight when dealing with stressors. When someone goes through something traumatic or feels they have to suppress their reaction to something, they are initiating the flight or fight response in their body but are not Weaver, 5

6 acting on the response. Eventually, this response captures itself in the muscles spindles that make up our muscles and these spindles stop relaxing over time, therefore causing inflammation or what some doctors call Myofascial pain. To treat Myofascial pain, the patient usually needs to seek a combination of several therapies, including psychotherapy chiropractic or osteopathic treatments and fascia release or massage therapy. This is a brief description of Myofascial pain and more can be discovered about this condition in the reading material listed in the bibliography. Before she was diagnosed, Alice was bed ridden for two years due to the severe pain. Because of her inability to communicate her symptoms due to the pain and her confusion from depression, Alice was continuously misdiagnosed by doctors. She received MRI s of her low back, mid back, upper back, X-rays of her shoulder, neck, and hip, and nerve testing in her legs and arms by a slew of doctors. Nothing was found that could explain her pain. It wasn t until a doctor noticed the antidepressant she was on was most probably not functioning properly did Alice finally get a diagnosis and a new medication, Cymbalta, or duloxetine. In recent years, research on Duloxetine has shown to be highly effective in pain management and categorized as an analgesic drug. Doctors will prescribe this medication to patients who have unexplained pain, especially to those with nerve pain. It acts as a pain blocker in less words. Soon after she started on this medication, Alice saw results within the week. She was able to sit for longer than five minutes and was able to endure walking up to ten minutes. Over the course of a month she was able to walk up to one hour but was very fatigued and in intense pain by the end. This is where she was when she sought out Pilates. Weaver, 6

7 Pilates Regiment and Adjustments Alice already went through intensive physical therapy and once her certain number of visits was up, she was told to continue with Pilates. Besides the obvious atrophy in her muscles that needed strengthening Alice also needed a lot of stretching. She had me come to her home to work with her because she could not drive and usually did not have assistance at home during the week to get her to a studio. So I primarily used mat exercises with assistance of therabands and balls. We met twice, sometimes three times a week. Assessing Alice, I noticed immediately her weak posture and fragile state. She showed mild kyphosis due to atrophy and weakness. She complained of pain inhibiting her from standing up straight. I started very slowly with a regiment of gentle neck rolls while standing or sitting and a roll down from a seated position on a chair. This way she was able to catch herself if it was too painful too soon (we were both in agreement that these session wouldn t be pleasant in the beginning as we tried to figure out what worked and what didn t work). We did some shoulder stretching and resting positions with little rotation and with little lateral stretching. For starters in strength training, we did standing footwork with arms resting on a surface (in this case her grand piano). That way she was able to balance and not worry about pain in her arms, primarily her Weaver, 7

8 right shoulder. That was all we did in our first five sessions until I felt she was stretched enough to do a basic mat warm-up with assistance. At this point, we were able to do full roll downs. Her mid and lower back were still very tight but Alice was able to perform the footwork block (mainly standing footwork), the abdominal block (chest lifts, leg lifts, leg changes, and hundred prep) and very slowly with few reps in the spinal articulation block (pelvic curl). The only hip work exercise she could tolerate was leg circles with the theraband. Her hip flexors were incredibly tight when we started and would click and inflame when she did leg circles without the band. We continued building in the stretch block, adding more stretches each week as she could tolerate them. Arm work was only range of motion exercises with no weights. She was not able to support any of her weight in plank positions and she could only move her arms while lying prone. Lateral lifting to the front and to the side was not an option in the beginning. Alice was not able to do anything with trunk rotation outside the minimal stretching so lateral flexion/rotation was not a part of our routine. Back extension was left to only minimal movements such as lifting the shoulders back in a prone position. We built on our sessions in this fashion. We very slowly incorporated chest lift with rotation after seeing was able to spine twist supine with little to no pain and after her abdominals were strong enough to support her in a lifted position. After five months of diligence Alice was able to perform spine twist (after weeks of spine twist supine), roll ups with the assistance of the resist-a-band, and supine arms with one pound weights. Weaver, 8

9 Currently, eight months after I started with her, Alice is able to do all fundamental mat work with ease, arm work seated and standing with 2-5 pound weights (except not lateral lifting with palms down which she is still only able to do with no weights). She is able to hold planks and do modified push-ups along with very basic back extensions. She is even able to extend her arms and do a slow motion swimming. Alice is also walking an hour every day and has joined a gym to receive one on one attention with a personal trainer in the warmed pool. Conclusion Thanks to Pilates and all of her hard work, Alice has the ability to do tasks and chores at home that she, for a long time, could not do. She can wash, dry, hang, and fold laundry. She is able to cut up vegetables and meat to cook meals. And more recently, Alice has started driving again. All of these tasks were impossible for Alice for three and a half years. To this day she still practices Pilates on a daily basis and works with me one to two times per week. Weaver, 9

10 Bibliography: Brown, Jacques P., and Luc J. Boulay. "Clinical Experience with Duloxetine in the Management of Chronic Musculoskeletal Pain. A Focus on Osteoarthritis of the Knee." Therapeutic Advances in Musculoskeletal Disease. SAGE Publications, n.d. Web. 03 June Ferguson, Lucy Whyte., and Robert Gerwin. Clinical Mastery in the Treatment of Myofascial Pain. Philadelphia: Lippincott Williams & Wilkins, Print. Ingraham, Paul, and Tim Taylor, MD. "Trigger Points and Myofascial Pain." PainSciencecom RSS. PainScience.com, n.d. Web. 03 June Kolber, Petra. "A Workout for Unwinding." Health.com. Health Media Ventures, Inc., 04 Mar Web. 03 June Leitner, Pamela J., PT, DPLeitT, OCS. "Does the Name Quasimodo Ring a Bell?" Leitner Physical Therapy RSS. Leitner Physical Therapy, 23 Oct Web. 03 June Weaver, 10