Pilates for Recurrent Bursitis of the Hip Joint

Transcription

1 Pilates for Recurrent Bursitis of the Hip Joint Krystal E Damare October 6, 2017 South Pasadena 2016

2 Abstract Eventually we all start to age. On the outside wrinkles appear, our hair starts to turn grey, our teeth are not quite as beautifully white as they were 10 years ago. Our backs start to hurt, joint range of motion becomes smaller, we gradually lose flexibility. Pilates can t help your wrinkles or thinning hair, but it certainly can help keep those joints and muscles stay active. 81 years old Maria is a wonderful example of how Pilates was able to give an older adult a new lease on life by greatly reducing the recurrence of Hip Bursitis and in essence improved her ability to get around in as painfree a manner as possible. 2

3 Table of Contents 4) Anatomy Class 6). Maria, a Case Study 7) The Program Assessment 8). The Program Exercises and Summary 10). Conclusion 11) Bibliography 3

4 Anatomy Class - The Hip Joint The Hip joint is a strong ball-and-socket joint that connects the lower limb to the pelvis. The hip joint is second only to the shoulder in the variety of movements it allows. What is a Bursa and Bursitis? A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. When a bursa becomes inflamed, the condition is known as "bursitis." Bursitis is the most common reason for hip pain. What is Bursitis of the hip and how does it occur? Inside the hip joint there are two main fluid sacs called Bursa (bursae plural). The Trochanteric bursa lies over the prominent bone on the side of your hip (femur). The Ischial Bursa (often called Ischial-Gluteal) lies between the ischial tuberosity (the lower part of the V-shaped bone that helps form the pelvis) and the tendon that attaches the hamstring muscle to the bone 4

5 Inflammation of either can be associated with stiffness and pain around the hip joint. Bursitis of the Trochanteric bursa can cause tenderness on the outside of the hip and make it painful while sleeping at night on the affected hip, painful to sit with legs crossed, increased pain when walking. Bursitis of the Ischial Bursa can be referred to as a literal pain in the butt as it occurs in the buttock area, can radiate down the leg and can be confused with sciatica (compression of the sciatic nerve within the piriformis muscle). How does Bursitis occur? Activities that cause over-use of the hip joint. repetitive actions like climbing up and down stairs, constantly getting up and down from a kneeling position. 5

6 Maria s Story/Case Study Maria, 81 years old, came to the studio to observe her daughter in a Group Pilates class. I was waiting on a client and we struck up a conversation. She had been diagnosed years before with hip bursitis (specifically trochanteric and ischial). It had been suggested to her by her Family Physician that she give Pilates a try, but she was rather reticent to accept it as a choice, so we chatted about the great benefits that she might take from it. In the early 1980 s she emigrated here from Mexico with her husband and 5 children, and spent a considerable number of years working in the fields bent over picking fruits and vegetables during the summer months and at the end of the day attending to her family s needs. Attention to fitness programs or healthy diets were not anything that fell inside their lifestyle at that time. Infrequent bouts of hip pain had become more frequent over the years and her activity level was greatly reduced by the time I met her. Maria was well aware that all of her joints were moving less easily and that she had fallen on occasion due to lack of ability to move her right leg quickly enough. Her hips felt unsafe and not right. She stated that a large part of the reason she was inactive was fear of the hip pain and falling. If she was active the pain would come back. She had resolved herself into a life of inactivity. It was exciting to see her realize that maybe, just maybe, Pilates could help her. 6

7 Program - Assessment of Alignment and Posture Maria s assessment began with us taking a brief walk around the studio together first, and then I had her walk a short distance away from me and back to observe her gait, alignment, and balance. [There were marked deviations in hip alignment ] Secondly, I had Maria stand up straight for me so I could assess her plumb line from the side and the front and back. [Right hip was sitting forward and below the line of the left hip] Lastly, I had Maria perform two roll-downs under my guidance with the express instruction that she was not to go out of her comfort zone. I observed her from all angles to gauge spinal flexibility, again alignment of several joints, and balance. [Upon reaching to her lowest point (which was remarkable for her age)..maria s right hip joint sat a good ½ inch lower than her left when viewing her from behind] Program Specifics Maria would benefit best from a gentle full-body balancing program that will bring her joints, muscles, posture, and alignment back to being as functional as possible with an appropriate level of flexibility, range of joint motion and strengthening for everyday purposes. Focus will be placed on carefully assessing the ability of her hips to work in correct alignment without aggravating them into a state of bursitis. 7

8 The Program Warm Up (Cadillac) <Roll-Downs Roll-Down-Bar Two short blue springs x 5 - To warm up and gradually increase spinal flexibity (focus on lower back) - To warm up and gradually increase the correct activation of abdominal muscles - My hand is placed behind her head to assist in case of neck tension occuring <Pelvic Curl Cadillac Mat x 3 (To articulate the spine, control hamstrings and provide Pelvic lumbar Stabilization, Care is taken to make sure the shoulder blades remain on the mat and that not too much pressure is placed on the cervical spine) <Spine Twist Supine Cadillac Mat x 3 each side (To encourage good spinal rotation, Pelvic Lumbar Stabilization, and Oblique abdominal control, Care if taken to make sure the shoulders remain relaxed and on the mat, and that the knees do not drop to the side outside of functional range) <Chest Lift -Cadillac Mat x 5 (To encourage abdominal strength and pelvic stability, keeping head aligned with spine carefully <Chest Lift with Rotation Cadillac Mat x 2 (to encourage rotation through the waist and maintain trunk flexion at a consistent height) 8

9 Footwork Reformer Two red springs x 5 reps <Heels Parallel, Toes Parallel, V position Toes, Heel Wide, Toes Wide <Single leg Heel, Single leg toes <Calf Raises, Prances, Prehensile. *Comfort level was assessed and monitored carefully with regard to hip joints Abdominals Reformer 1 red spring x 5 <Hundred Prep - (Maria had no problems with the co-ordination or the lifting of the head and chest) <Leg Lifts/Leg Changes all springs on to prevent movement of carriage/bar down Hipwork Cadillac Two long yellow springs x 5 reps each exercise <Single Leg Supine > Frog, Circles (Down/IUp), Hip Extension, Bicycle Care was taken to ensure good alignment and secure placement of hips on mat and to check that body did not drift from center of mat during exercise. Spinal Articulation <Spine Stretch (from Mat work) Cadillac Mat Stretch Reformer 1 blue spring - <Standing lunge Full Body Integration (MODIFIED from Mat work) Front Support (staying on knees) 9

10 Arm Work Reformer Supine Series 1 blue & 1 yellow spring <Extension, Adduction, Circles (Down/Up) Triceps Legwork Cadillac Mat - Gluteals Side Lying Series (no weight) <Side leg lift, forward and lift, Forward with Drops Lateral Flexion (from mat series) - <Side lifts Back Extension (from mat series) - <Back extension Cool Down <Rest Position, 2 roll-downs Maria was able to perform roll downs to a slightly better extend at the end of the session than at the beginning. This program was selected for the fact that it s fundamental properties were perfect for an aging client who needed a gentle program that could improve her condition over time. Springs or resistance were carefully selected to match her strength level with range of motion and flexibility taken into account without overwhelming or causing her to feel unstable, in fact she felt completely safe. The number of repetitions per exercise were decided upon to keep her completely inside her comfort zone without overusing any particular part of the body or causing any compensations, which she was carefully observed for. The result was all-over positive. The only change we made was from the reformer to the Cadillac for the hip work as she felt it was more supportive and took away lower back stress (the springs on the Cadillac were placed higher than they are on the reformer in relation to the mat/carriage itself, and we were also able to utilize the single leg supine series which made her far more comfortable and she felt more in control. 10

11 Conclusion When Maria started this program she had complaints of lessened abilities with range of motion, flexibility, and strength and a fear of returning hip pain. She had fallen a few times and greatly decreased her level of ability. It seemed that she had almost already written herself off due to her age. She was rather skeptical about Pilates but also at the same time was rather hopeful for what it might possibly do for her. After the first session she seemed extremely relieved and happy that she felt so very good, not worked-out or stiff no Jell-o legs, but instead was stretched out and motivated. Over the next few months Maria s progress was amazing partially due to her great genetics. Her gait was changing slowly and her new hip alignment felt more normal to her. She felt more confident and stronger overall. Best of all the pain from the hip bursitis was greatly reduced which excited her the most. All in all, Maria s Pilates experience was wonderfully positive, and her only regret was that she hadn t started doing it earlier. 11

12 Bibliography Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Abrahams, Dr. Peter. How the Body Works, Metro Books, NY Shiel Jr., MD, FACP, FACR, William C Hip Bursitis. Medicinenet, WebMD.March 1992.Web.Oct Miller, John, Trochanteric Bursitis Physioworks., Probity Web Marketing Sept, Web. October Robb-Nicholson M.D, Celeste What can I do about Ishchial Bursitis? Harvard Health Publishing, Harvard University. March Web. Oct Klemm, David Hip Groin Pain Treatment Total Motion PT. Dynamic Neuromuscular Rehabilitation Sept Web. Oct Magazine Buchman, Dana. A Special Education. Good Housekeeping Mar. 2006:

13 13