Correcting Lumbar Hyperlordosis through Pilates

Transcription

1 Correcting Lumbar Hyperlordosis through Pilates Shalyn Lettieri July 11, 2016 BASI CAP 2015 Herndon, VA

2 Abstract Joseph Pilates believed that the Pilates method Is designed to give you suppleness, natural grace the ability to perform arduous duties, to play strenuous games, to walk, to run or travel long distances without undue body fatigue or mental strain (Pilates 19). Good postural alignment plays a key role in the benefits of Pilates as it leads to less stress on the spine and more efficient muscular activity. On the contrary, faulty postural alignment can create unnecessary stress and strain throughout the entire body. The purpose of this paper is to focus primarily on one of the common types of faulty posture, hyperlordosis. This paper will define hyperlordosis, and demonstrate the benefits of a Pilates conditioning program, utilizing the BASI Block System, for a 38-year-old female suffering from lower back pain due to lumbar hyperlordosis. 2

3 Table of Contents Abstract 2 Table of Contents 3 Anatomical Overview of the Spine 4 Anatomical Overview of Hyperlordosis 5 Meet Nancy: A Case Study 8 Conditioning Program for Nancy 9 Conclusion 13 Bibliography 14 3

4 Anatomical Overview of the Spine The spine, or vertebral column, consists of 33 bones, or vertebrae, that are arranged into five regions that are responsible for the primary movements of the spine. Those five regions of the spine include the cervical (neck), thoracic (mid back), lumbar (low back), sacrum (connects the spine to the hips) and coccyx regions (fused bones that provide attachments for muscles and ligaments), shown in Figure 1. In adults, the sacral vertebrae are fused together to form the sacrum. The vertebrae of the spine interlock on top of one another and are connected by intervertebral discs, ligaments and muscles, resulting in a flexible curved structure. In a normal spine, there are four main curvatures present, as shown in Figure 1. This includes the cervical, thoracic, lumbar and sacral curvatures (Isacowitz and Clippinger 11-12). These curves play an important role in both enhancing movements of the spine and shock absorption (Isacowitz and Clippinger 11). Figure 1: Vertebral Column ( 2016). 4

5 Anatomical Overview of Hyperlordosis Abnormal curvatures of the spine can create increased stress on the body, which can, overtime, lead to muscle imbalances. Lumbar hyperlordosis refers to an exaggerated curvature of the lower back region (Figure 2) and is commonly accompanied by an anterior tilt of the pelvis (Figure 3). This common faulty posture may increase the risk of lower back issues, including lower back pain, and is often associated with weak abdominal muscles and hip extensors, tight hip flexors and tight lower back extensors (Figure 4). Hyperlordosis may be caused by many different behavioral movement patterns or by congenital disorders, and can be found in all body types. Often, correction of this posture focuses on strengthening the abdominals, as well as stretching the hip flexors and low back extensors (Isacowitz 44). Strong abdominals and back muscles are also a key component to achieving good alignment, stabilization and proper body mechanics. When the spine is aligned with gravity, the body works in harmony with the laws of nature (Isacowitz 41). It is important to strive for ideal alignment, as the natural curves of the spine act as a shock absorber, protecting the body from during impact, and facilitate with efficient functioning of the internal organs (Isacowitz 41-45). This can be achieved through a consistent and specific Pilates practice. 5

6 Figure 2: Curvature of a Normal Spine vs. Lordosis of the Spine ( 2016). Figure 3: Neutral Pelvis vs. Anterior Pelvic Tilt ( 2016). 6

7 Figure 4: Muscle Imbalances Associated with Lumbar Hyperlordosis ( 2015) 7

8 Meet Nancy: A Case Study Nancy is a 38 year-old-female who owns and operates a Coffee shop/wine bar five days a week. She does it all. She prepares the drinks, chats with her customers, bakes, cooks, cleans, and spends countless hours behind the scenes making sure everything runs smoothly at the shop. The long hours on her feet leave her feeling exhausted and achy, particularly in the lower back, by the end of her workday. Nancy is 5 7 tall with a slender build. She used to practice yoga regularly, but has been unable to attend yoga classes consistently due to her demanding work schedule. She sees a massage therapist twice a month to help ease some of the tension in her muscles, and states that her massage therapist tends to spend a great deal of time working on her hips, glutes and lower back. Nancy has no other complaints of pain, injuries or medical conditions. She is new to the Pilates method and excited to gain a better understanding of her own body mechanics. Her goals are to increase her mind-body awareness, flexibility, and to strengthen her core muscles, particularly her lower abdominals. She is also looking forward to just doing something good for my body! During an initial evaluation, Nancy performed the roll down exercise as well as the fundamental warm up exercises on the mat. Upon assessment, Nancy does, in fact, exhibit an exaggerated curve in the lumbar spine, which tends to increase as she becomes more fatigued. Her pelvis is generally in an anterior tilt position, causing her abdominals to protrude forward. There is also a slight increased curve noted in the thoracic spine and the head is slightly forward of the plumb line. While Nancy appears to be quite flexible in her extremities, shoulders, cervical and thoracic spine, she does exhibit a lack of mobility in the lower back. Prior to executing the pelvic curl, Nancy practiced flattening her lower back 8

9 into the mat as she tucked her pelvis into a posterior tilt. Once this movement was understood, she was able to transition into a pelvic curl. While performing abdominal exercises in a supine position, it was noted that Nancy does struggle with keeping her abdominals engaged, allowing her rib cage to flare, thus creating a greater arch in her back. After some practice and explanation, Nancy was able to focus on drawing in her abdominals, and found that the cues of pulling her navel to her spine and keeping her ribs knitted together helped her to keep her abdominal muscles engaged. Conditioning Program for Nancy A conditioning program, utilizing the BASI Block System, will be designed to address Nancy s needs and limitations, specifically, strengthening the abdominals and hip extensors, and stretching the hip flexors and lower back extensors. Another limitation to consider is Nancy s slight cervical lordosis, noted during her evaluation, so attention will also go toward strengthening the upper back extensors. As Nancy is new to Pilates, her program will begin at a fundamental level, allowing her to learn and adapt to the basic principles of Pilates as she gains strength and flexibility. The program will progress appropriately to keep her body challenged. Exercises performed in each block will be chosen based on the equipment that is available during that particular session. Due to Nancy s busy schedule, she is only able to meet in the studio one time a week. The program will be designed in such a way that Nancy will practice fundamental exercises for approximately the first ten sessions, progressing to intermediate exercises when ready, and later on, to advanced exercises when appropriate. Nancy will only advance from exercises when she can demonstrate understanding and good form consistently. While planning Nancy s program, it is important to remember that when addressing spinal 9

10 alignment deviations, the goal is to not overcorrect and remove the normal curves of the spine. Such an action would create another spinal problem in which the lumbar and sometimes other curvatures actually are below normal in terms of magnitude (Isacowitz and Clippinger 23). It is imperative to reassess Nancy s posture throughout the program to ensure optimal function of the spine, as well as progress. The desired outcomes of this program are for Nancy to achieve greater core strength, more mobility in the lower spine, to decrease her lower back pain by correcting the hyperlordosis of her lumbar spine, and to increase her mind-body awareness. The detailed conditioning program is shown below. Conditioning Program for Nancy BASI Block Sessions 1-10 Sessions Sessions 21 + Warm Up Foot Work -Roll down -Pelvic curl -Spine spine twist (feet on floor) -Chest lift, -Chest lift w/ rotation REFORMER/ -Parallel heels -Parallel toes -V Position toes -Open V heels -Open V toes -Prehensile -Calf raises -Prances -Single leg heels -Single leg toes -Roll down -Pelvic curl -Supine spine twist (legs in table top) -Chest lift -Chest lift w/ rotation -Leg lifts -Leg changes -Hundred REFORMER/ -Parallel heels -Parallel toes -V Position toes -Open V heels -Open V toes -Calf raises -Prances -Single leg heels -Single leg toes -Roll down -Roll up -Pelvic curl (advancing to shoulder bridge prep then to shoulder bridge when ready) -Supine spine twist -Double leg stretch -Single leg stretch -Criss cross -Front support -Back support REFORMER/CADILLAC/ WUNDA CHAIR: -Parallel heels -Parallel toes -V Position toes -Open V heels -Open V toes -Calf raises -Prances (not on chair) -Single leg heels -Single leg toes Abdominal Work -Hundred prep -Coordination -Tilt -Short box series (excluding round about and climb a tree) -Hundred -Short box series -Double leg (legs in straps) -Double leg w/ rotation (legs in straps) 10

11 Hip Work Spinal Articulation -Frog -Circles down/up -Openings -Spine stretch -Rolling like ball -Mini roll ups -Mini roll ups oblique -From -Circles down/up -Openings -Basic leg springs -Roll over -Seal puppy -Roll up top loaded -Roll up bottom loaded (when able) -Frog -Extended frog -Extended frog reverse -Circles down/up -Openings -Single leg supine series -Open leg rocker -Jackknife -Bottom lift -Monkey -Bottom lift w/ extension -Short spine -Tower prep -Long spine -Tower Stretches Full Body Integration (F/I) Arm Work -Standing lunge LADDER BARREL: -Hamstrings -Gluteals -Adductors -Hip Flexors -Shoulder stretch 1 &2 STEP BARREL: -Shoulder stretch lying side POLE: -Shoulder stretch -Overhead stretch -Side stretch -Scooter -Round back -Flat back -Up stretch 1 -Elephant -Arms supine series -Kneeling lunge -Side split LADDER BARREL: -Hamstrings -Gluteals -Adductors -Hip flexors -Shoulder stretch 1 & 2 STEP BARREL: -Shoulder stretch lying side -Reverse knee stretch -Up stretch 2 -Long stretch -Sitting forward -Side reach -Arms sitting series -Full lunge CADLLAC: -Shoulder stretch LADDER BARREL: -Hamstrings -Gluteals -Adductors -Hip flexors -Shoulder stretch 1 & 2 -Down stretch -Thigh stretch w/ RUB -Kneeling cat stretch -Arms kneeling series 11

12 Full Body Integration (A/M) Leg Work Lateral Flexion/Rotation MAGIC CIRCLE: -Arms bent -Arms straight -Arms overhead -Single arm side press -Single arm bicep -Arms standing series (excluding butterfly) CHAIR: -Shrugs -Triceps press sit -Arms standing series (including butterfly) CHAIR: -Frog back N/A N/A -Up stretch 3 -Sitting forward -Side reach -Saw MAGIC CIRCLE: -Sitting series -Supine series -Prone series -Adductor squeeze -Gluteals side lying series -Side lifts STEP BARREL: -Side lift -Spine twist supine LADDER BARREL: -Side over prep -Hamstring curl CHAIR: -Hamstring curl -Hip opener -Leg press standing -Gluteals kneeling series -Saw -Spine twist Chair: -Side stretch -Mermaid -Sitting back -Single leg skating CHAIR: (With the assistance of handlebars, if needed) -Forward lunge -Backward step down -Corkscrew -Side over on Box LADDER BARREL: -Side overs Back Extension -Back extension -Rest -Single leg kick -Cat stretch -Double leg kick -Swimming -Breaststroke prep CHAIR: -Basic swan STEP BARREL: -Swan prep -Pulling straps 1 -Prone 1 LADDER BARREL: -Swan prep -Pulling straps 2 -Breaststroke -Prone 2 CHAIR: -Back extension single arm Finish Roll down Roll down Roll down 12

13 Conclusion Hyperlordosis is a faulty posture in which the curve of the lumbar spine is exaggerated, creating an undesirable alignment of the spine. If uncorrected, this posture can lead to muscle imbalances, pain, inefficient body mechanics and even inadequate functioning of the internal organs. Hyperlordosis is often associated with weak abdominals and hip extensors, as well as tightness in the hip flexors and low back extensors. By implementing a Pilates program that focuses on strengthening the abdominals and hip extensor muscles, while stretching the hip flexors and low back extensors, hyperlordosis can be reduced, bringing balance back into the muscles and an ideal alignment of the spine within reach. Nancy, who presented with lower back pain and an obvious hyperlordosis of the lumbar spine, completed a ten-week Pilates exercise program, customized to address her specific needs and goals. The BASI Block System was utilized when planning out her sessions as Nancy progressed over time. Upon evaluation after completing her tenth session, the exaggerated curvature of Nancy s lumbar spine had slightly decreased while her pelvis appeared to be closer to a neutral position than it had been at the beginning of the program. The mobility in Nancy s lumbar spine has also improved. She was able to reestablish a mind-body awareness when moving, that she carried over into her body mechanics while at work, moving more efficiently and safely. Nancy was thrilled to report that her lower back pain had notably improved and that her belly does not pooch out as much as it used to. In fact, Nancy claimed that she felt taller, stronger and just fabulous. She is motivated to continue her Pilates conditioning program, striving for ideal alignment and a healthy spine. 13

14 Bibliography BASI. Study guide comprehensive course. Costa Mesa, CA; BASI. Reformer movement analysis workbook. Costa Mesa, CA; BASI. Mat movement analysis workbook. Costa Mesa, CA BASI. Cadillac movement analysis workbook. Costa Mesa, CA BASI. Wunda chair/ladder barrel movement analysis workbook. Costa Mesa, CA BASI. Auxiliary movement analysis workbook. Costa Mesa, CA Isacowitz R. Pilates. Champaign, IL. Human Kinetics; Isacowitz R, Clippinger K. Pilates Anatomy. Champaign, IL. Human Kinetics; Pilates JH. Return to life through contrology. Miami, FL. Pilates Method Alliance: Reprinted;