Pilates For Promoting Back Health
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1 Pilates For Promoting Back Health Relieving Low Back Pain Lisa Henry-Hamilton 1 January 2015 Sept 2014 Jan 2015 San Antonio, TX Lianne Gamble
2 Abstract The purpose of this paper and case study is to explore the benefits of a Pilates practice as it relates to back health. Back pain is the second most common neurological ailment in the United States only headaches are more common. And, after colds/flu, it s the second most common reason Americans see their doctors. At some point, almost all of us will have an episode of severe low back pain (LBP) that will adversely interfere with our quality of life. It s believed that LBP costs the US economy $50 to $100 billion annually. It s also the most common cause of job-related disability, accounting for more than 149 million lost workdays per year in the US. Every month in the US, more than 4 million people Google the term back pain looking for information on why they hurt and what they can do about it. Research shows a strong correlation of LBP to extended periods of sitting. This is cause for concern since the average 8-hour work day for many is spent at a desk sitting. In addition to proper sitting mechanics, an effective and consistent Pilates practice may be effective in protecting against LBP occurring. When sitting, the pelvis is the base of support for the spinal column and eliminates the supporting role of the legs. Individuals with chronic LBP show a decrease in activation of certain muscles, mainly the transverse abdominis (TA), internal obliques, pelvic floor muscles, multifidus, diaphragm, and deep erector spinae. These muscles comprise what is referred to as the core. Joseph Pilates called it the powerhouse, and Rael Isacowitz calls it the Internal Support System. The deep muscles of the core work as a protective belt to shield the spinal column from unwanted movement. 2
3 Table of Contents Title Page Abstract 2 Anatomical Description and Pictures 4 Introduction 7 Case Study/Conditioning Program 8 Conclusion 12 Bibliography 13 3
4 Pictures of Low Back Figure 1. Figure 2. Figure 3. 4
5 Figure 4. Figures 1 & 2. The lower back where most back pain occurs includes five vertebrae (referred to as L1- L5) in the lumbar region, which supports much of the weight of the upper body. They allow for movement and flexibility in the back and are integral to general mobility in that area. These five vertebrae are the largest of the spine and together form a reverse C curve in the lower back. With this larger circumference, the nerves are able to move more freely and thus back pain is more likely to occur. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Some common risk factors for developing LBP include: age, fitness level, pregnancy, weight gain, genetics, and occupational risk factors. Daily life prevention/relief of LBP may 5
6 occur by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly, maintaining a healthy weight, and proper sitting. Figures 3 & 4. To properly support the back, there needs to be enough strength in the abdominal and trunk muscles as well as the pelvic floor to create a protective belt. By strengthening the core muscles, the back is supported, thereby relieving the back pain. The abdominals are made up of the rectus abdonimis, external oblique, internal oblique, and transverse abdominis (TA). The TA muscles are the most important of the abdominal muscles regarding stabilization of the torso. The TA is the deepest of the abdominals wrapping around the spine and acting like a natural protective weight lifting belt to protect the spine from unwanted movement. Intra-abdominal pressure is the cocontraction of the TA and the obliques, which surround and compress the abdomen to protect the spine from pressure. When these muscles are weak, the spine is left vulnerable to stress which can lead to injury. The spinal extensors are located on the back of the trunk and include three muscle groups: erector spinae, semispinalis, and the deep posterior spinal group. The deep posterior spinal group includes the multifidis muscles which lie deep along the spinal column and are comparable to the TA in terms of stabilization. The multifidus and TA work together to co-contract providing support and stabilization to the trunk helping to provide relief and prevention of back pain. Actively working the pelvic floor muscles, can influence the position of the sacrum and can help relieve or prevent LBP. Three other important muscles that support the low back and spine: psoas major, quadratus lumborum, and lattissimus dorsi. 6
7 Introduction This research paper will focus on the issue of LBP. It will look at what it is, how/why it occurs, and anatomy. It will also discuss a case study and provide a Pilates conditioning program. Pilates has gained recognition in medical and fitness circles as a beneficial form of exercise to address an array of concerns to include LBP. An effective Pilates back care program pays careful attention to the muscles of the abdominals, back extensors and pelvic floor while also considering the body as a whole. The body is an interconnected chain and compensation or dysfunction in the lumbo pelvic hip complex will lead to dysfunction in other areas of the body. A complete program will provide special attention to varying ranges of motion, sufficient intensity, load, correct mechanics and muscle recruitment, as well as utilizing the core. 7
8 Case Study John is a 50 year old male who works in a job sitting at a desk for most of the time during a 40 hour work week. A couple of his hobbies involve sitting as well; playing video games and watching TV. His exercise includes walking a couple times a week and coaching softball 3-4 times a week. John has had low back pain off and on for 15 years. Pain relief medication is how he has dealt with this recurring issue. He s motivated to try Pilates to improve his body structure and quality of life. The following conditioning program is laid out into three sessions of 10, progressing on each previous program. The objective of the conditioning program is to take in the Pilates principles in order to establish realistic goals consisting of recruiting muscles correctly, developing core strength, building the appropriate muscle strength and stretching the tight muscles, improving flexibility, and building through the progression of exercises. John has poor posture from slouching/hunching and sitting a lot. He has weak abdominals, tight psoas, hip flexors, and hamstrings. General goals for John include: 1) balance in the body to reduce load on the lower back, 2) strengthening weak areas (core muscles, hip abductors, upper back stabilizers for example), 3) stretching tight areas (psoas, hamstrings, hip flexors for example), and 4) improving body awareness and postural correction. General exercises will include back extension to bring awareness to and help correct posture. We ll also work on flexibility and strength around the hip flexors and extensors and alignment of core while doing exercises with arms, legs and hips through full range of motion. 8
9 Sessions 1-10 Block/Equipment Exercise Purpose/Desired Results Warm-Up/Mat Footwork/Reformer Abdominal Work/Reformer Hip Work Roll Down Pelvic Curl Spine Twist Supine Chest Lift Chest Lift with Rotation Parallel Heels Parallel Toes V- position Toes Open V Heels Open V Toes Calf Raises Prances 100 Prep Coordination Supine Leg Series - Frog - Circles Down/Up - Openings None Assessment Tool SA, hamstring control, pelvic lumbar stability Ab Obliq, spinal rotation, pelvic lumbar stab Abdominal strength, pelvic stability Abdominal oblique strength, pelvic stability Hip/Knee extensor strength, hamstrings, quads Hip/Knee extensor strength, hamstrings, quads Hip/Knee extensor strength, hamstrings, quads Hip/Knee extensor strength, hamstrings, quads Hip/Knee extensor strength, hamstrings, quads Ankle plantar strength Ankle plantar strength Abdominal strength, shoulder extensor control Ab strength, shoulder extensor control Hip adductor strength, knee extensor control Hip adductor strength & extensor control Hip adductor stretch & strength Spinal Articulation (SA) Stretches/Reformer Standing Lunge Hip flexor & hamstring stretch Full Body Integration I None (FBI) Arm Work/Magic Circle Arms Series - Arms Bent Shoulder adductor strength, pectorals - Arms Straight Shoulder adductor strength, pectorals - Arms Overhead Shoulder flexor strength, deltoids - Single Side Press Shoulder adductor strength, scapula stability - Single Arm Bicep Elbow flexor strength, biceps, scapula stability FBI II None Leg Work/Magic Circle Supine Series - Knees Hip adductor strength, pelvic lumbar stability - Ankles Hip adductor strength, pelvic lumbar stability Lat Flex & Rot/Step Spine Twist Supine Spinal rotation, abdominal oblique control Barrel Side Lift Lateral flexor stretch, abdominal oblique control Bk Extension/Step Barrel Swan Prep Back extensor strength, trunk stability Gain familiarity with foundation of BASI Pilates. Most of the practice is on the mat with some Reformer and Step Barrel. Goals include: teaching awareness, movements, proper alignment and focusing on specific muscle groups. Always starting and ending with roll-up and a few extra stretches at the end. 9
10 Sessions Block/Equipment Exercise Purpose/Desired Results Warm-Up Same as Sessions 1-10 Same as Sessions 1-10 Footwork/Cadillac Parallel Heels Parallel Toes V- Position Toes Open V- Position Heels Open V Position Toes Calf Raises Prances Single Leg Heels Single Leg Toes Hip & knee extensor strength, hamstrings Hip & knee extensor strength, hamstrings Hip & knee extensor strength, hamstrings Hip & knee extensor strength, hamstrings Hip & knee extensor strength, hamstrings Foot plantar flexor strength, foot stabilizers Foot plantar flexor strength, foot stabilizers Hip & knee extensor strength, hamstrings Hip & knee extensor strength, hamstrings Abdominal Work/Cadillac Hip Work SA/Reformer Warm- Up Series - Roll- up with RUBar Mini roll- up Mini roll- up oblique Roll- up Top Loaded Supine Single Leg Series - Frog - Circles Down/Up - Hip Extension - Bicycle Bottom Lift Bottom Lift With Extensions Abdominal control, trunk stabilization Abdominal strength, pelvic lumbar stability Abdominal oblique strength, neutral pelvis Abdominal strength, shoulder stretch Hip/Knee extensor control, hamstrings Adductor & Hip extensor control, hamstrings Hip extensor strength, hamstrings Hip extensor control, hamstrings, coordination SA, abs, hamstrings, hip extensor control SA, abs, hamstrings, hip extensor control Stretches/Reformer Standing Lunge Hip flexor & hamstring stretch FBI I/Reformer Scooter Elephant Trunk/Shoulder stability, hip/knee extensor Trunk/Shoulder stability, ham/shoulder stretch Arm Work/Ped-A-Pul Arms Standing Series - Extension Shoulder extensor strength, latissimus dorsi - Adduction Shoulder adductor strength, latissimus dorsi - Circles Up/Down Shoulder extensor/adductor strength, lat dorsi - Triceps Elbow extensor strength, triceps FBI II None Leg Work/Leg Weights Gluteals Kneeling Series With Short Box - Hip Ext Bent Knee Hip extensor strength, pelvic lumbar stability - Hip Abduct Bent Knee Hip abductor strength, pelvic lumbar stability - Hip Ext Straight Leg Hip extensor strength, pelvic lumbar stability Lat & Rot/ Wunda Chair Side Stretch Side Kneeling Stretch Lateral flexor stretch, abdominal oblique Abdominal oblique stretch/control Back Extension/ WC Swan on Floor Ab control, scapular stability, back ext strength Start to bring more awareness to muscle areas. Trunk stabilization, co-contracting abdominals and back muscles. Strengthen shoulder extensors. Introduce more apparatus: Cadillac, Ped-a-Pul, leg weights, and Wunda Chair. Add on to first 10 sessions, yet still at a mostly fundamental level. It takes time to strengthen back and abdominals, and to stretch chronically tight hip flexors and hamstrings, for example. 10
11 Sessions Block/Equipment Exercise Purpose/Desired Results Warm-Up/Mat Footwork/Wunda Chair Abdominal Work/WC Hip Work/Reformer (Ref) Spinal Articulation/Ref Stretches/Reformer FBI I/Reformer Arm Work/Reformer Roll- Up Spine Twist Supine Double Leg Stretch Single Leg Stretch Criss/Cross Parallel Heels Parallel Toes V- Position Toes Open V- Position Heels Open V- Position Toes Calf Raises Standing Pike Cat Stretch Kneeling Extended Frog Extended Frog Reverse Short Spine Long Spine Kneeling Lunge Side Split Stomach Massage Series - Round Back - Flat Back - Reaching Arms Kneeling Series - Chest Expansion - Circles Up/Down - Triceps - Biceps Assessment Tool Spinal rotation/abdominal obliques Abdominal strength, trunk stabilization Abdominal strength, trunk stabilization Abdominal obliques, trunk stabilization Trunk stability, hip ext control, hams, quads Trunk stability, foot/ankle control, hams, quads Trunk stability, foot/ankle control, hams, quads Trunk stability, hip ext control, hams, quads Trunk stability, foot/ankle control, hams, quads Ankle plantar flexor strength/stretch Lower back stretch, abdominal control Abdominal control, back extensors Hip adductor stretch/strength Hip adductor stretch/strength SA, abdominals, hamstring stretch SA, abdominals, hamstrings, hip ext control Hip flexor & hamstring stretch Hip adductor stretch/strength Trunk stability, knee extensor strength, abs Trunk stability, knee extensor strength, bk ext Trunk stability, knee extensor strength, abs Shoulder/elbow extensor strength, lat dorsi Shoulder flexor strength, anterior deltoid, pecs Elbow extensor strength, triceps Elbow extensor strength, biceps FBI II/Reformer Down Stretch Trunk stability, shoulder ext control, abs Leg Work/Wunda Chair Lateral & Rot/Step Barrel Back Ext/Step Barrel Frog Front Backward Step Down Side Lift Corkscrew Swan Prep Swan Trunk stability, knee ext/hip external rotation Knee extensor strength, glutes, quads, hams Lateral flexor stretch, abdominal obliques Hip flexor control/stretch, abdominal obliques Trunk stability, back extensor strength Back extensor strength, hip extensor control Sessions Some intermediate exercises are added. John finds Pilates challenging, interesting, and motivating as he notices the progress/benefits he is making. This builds his confidence and continues with the program to a healthier and happier quality of life. 11
12 Conclusion Back pain is something that most people will experience at some point in their life. John has made very nice progress in starting and advancing his Pilates sessions and has noticed the benefits. He feels stronger and knows what muscles to use to co-contract to maintain proper alignment. He is restoring balance in body by strengthening weak areas and stretching tight areas with an emphasis on neutral spine while moving. He plans to continue taking 2-3 sessions weekly and to start small group apparatus classes. He wants to keep the good postural habits he has learned and is aware of continuing to take them out into his daily life both at work and elsewhere. Lastly, several strengthening and stretching mat exercises were written out for him to do as homework at his leisure. 12
13 Bibliography 1. Aaronson, Naomi, and Turo, Ann Marie, Pilates For Breast Cancer Survivors: A Guide to Recovery, Healing, and Wellness, Demos Health New York, Isacowitz, Rael, BASI Study Guide, Comprehensive Course. Costa Mesa, CA, Isacowitz, Rael, BASI Movement Analysis Workbooks: Mat, Reformer, Cadillac, Wunda Chair, Auxiliary, Costa Mesa, CA, Isacowitz, Rael, Pilates, 2 nd Edition, Human Kinetics, Isacowitz and Clippinger, Pilates Anatomy, Human Kinetics, Levin-Gervasi, Stephanie, The Back Pain Sourcebook, Lowell House, Los Angeles, CA, Stern, Jack, Ending Back Pain: 5 Powerful Steps, Weill Cornell Medical College, Vijay, Vad, and Hinzmann, Hilary, Back RX: A 15-Minute-a-Day Yoga - & Pilates-Based Program to End Low Back Pain. Gotham Books NY, Back Pain Sept Low Back Pain Fact Sheet Low Back Pain Nonspecific Lower Back Pain In Adults Lumbar Spine Anatomy and Pain by Davis, Eben, DC, Jan Pilates Exercise System To Promote Back Health by Glosten, Beth, MD, Mar
14 15. Figure 1: back pain image. 16. Figure 2: image. 17. Figure 3: image. 18. Figure 4: image. 14
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