Pilates for Increasing Thoracic Spinal Mobility for the Athletic Client!!!!!!!!!!!!!!!! Holly Erickson

Transcription

1 Pilates for Increasing Thoracic Spinal Mobility for the Athletic Client!!!!!!!!!!!!!!!! Holly Erickson November 2016 Gig Harbor, Wa 2015

2 Abstract!! Thoracic spinal mobility is one of the most crucial aspects of mobility of the human body and yet a lack of mobility of the thoracic spine is extremely common. Both inactivity and incorrect muscle recruitment during activity can lead to immobility. Immobility can lead to pathology.! The thoracic spine is designed to be mobile, yet it must be used and moved correctly to become and remain mobile. Pilates provides the means gain appropriate mobility of the spine. Pilates exercises provide full range of motion of the spine and a controlled and safe setting.! This paper looks specifically at a physically active sample client with reduced range of motion in the thoracic spine. Her lack of mobility is causing low back pain and tightness in her shoulders. 30 one hour Pilates sessions will be outlined using the BASI block system including both mat and apparatus work. 2

3 Table of Contents I. Anatomical Description of the Thoracic Spine... 4 II. The Role of Thoracic Spinal Mobility in Back and Shoulder Health...6 III. Case Study: Meet Julie...8 IV. Julie s Pilates Conditioning Program...11 V. Goals and Intentions of Conditioning Program...13 VI. Conclusion...15 VII. Bibliography

4 Anatomical Description The thoracic spine is made up of 12 vertebrae. It is the section of spinal column inferior to the cervical spine and superior to the lumbar spine. The ribs connect to the thoracic spine from spaces between its 12 vertebrae.! The thoracic spine is designed for mobility and is designed to move freely in all planes of motion. 4

5 ! The muscles that affect the mobility of the thoracic spine are the muscles of the spine and trunk.! Thoracic spinal movements in the Sagittal plane include flexion and extension. The muscles involved with flexion include rectus abdominis, external obliques, and internal obliques. The major muscle contributors of thoracic extension are the spinal extensors. These include erector spinae (spinalis, longissimus, and Iliocostalis), as well as, deep posterior extensors ( multifidus and semispinalis).! 5

6 ! Lateral flexion is the movement of the thoracic spine in the coronal plane. External oblique, internal oblique, quadratus lumborum, erector spinae muscles, and deep posterior extensors are responsible for side bending or lateral flexion.! In the Transverse plane, rotation of the spine occurs. Rotational muscles include external oblique, internal oblique, erector spinae, deep posterior group. Internal obliques and erector spinae rotate the thoracic spine to the same side, while the external obliques and deep posterior group contra-laterally rotate the spine to the opposite side. The Role of Thoracic Spinal Mobility in Back and Shoulder Health! We all know that sitting at a desk for hours hunched over a computer with poor posture will lead to stiffness in the back. Many don t realize that poor posture and incorrect muscle recruitment during physical activity can also lead to stiffness and immobility in the back, particularly in the thoracic spine.! Many athletic folks train only in the Sagittal plane. They walk, run, hike, cycle, and swim moving in a forward only plane of motion. Just like sitting with poor posture leads to immobility in the thoracic spine, poor posture while running, walking and cycling and improper form while swimming will eventually lead to the same immobility. Couple this with not moving the spine in the coronal and transverse planes, and you have restriction of movement.! These restrictions eventually lead to compensations. Let s say the athletic individual decides to cross train with yoga or Pilates, activities which require the spine to 6

7 flex, extend, bend to the side and rotate. Often times this athletic person is a bit competitive and attempts to imitate the degrees of flexion, extension and rotation others in the class are doing regardless of a lack of thoracic mobility. Here is where the compensation may happen. The thoracic spine is meant to be highly mobile and has the greatest range of rotation within the spine. When you take an immobile part of the spine beyond it s range of motion, another segment of the spine must take over in order to find the range of motion. Most likely this will involve the lumbar spine.! Compensations lead to Injuries. Rarely does the individual with reduced thoracic mobility actually feel pain in the area of T1-T-12, but rather in the segments of the spine that must compensate. The lumbar spine is designed to stabilize and bear weight. When we ask it to extend and rotate beyond its capabilities, we compromise its health leading to low back stress, pain, and serious injuries. Most of the pain stress and injuries of the low back occur at L4, L5 and L5,S1.! The low back is not the only body structure that suffers from a tight, kyphotic mid back. When the thoracic spine is restricted from being able to properly extend, the scapula will compensate by moving away from the spine. This prevents natural scapular action during overhead movements of the arms. The compensation will lead to injuries of the shoulder complex. Most pain and injuries of the shoulders involve the rotator cuff.! Just like the lumbar spine is meant to stabilize, so is the scapula. The scapula stabilizes the shoulders in closed chain weight bearing positions. When the scapula is not properly aligned with the spine due to restrictions in mobility it can not longer properly do it s job to stabilize. This makes exercises like planks and push ups very risky for the health of the shoulders and pathology is likely. 7

8 ! The key to back and shoulder health lies in safe and effective thoracic mobility. Pilates exercises take the spine through all ranges of motion. Performing these exercises properly by keeping the movement in the correct spinal segment and keeping within a safe range of motion will mobilize the thoracic spine. Working privately with a certified Pilates instructor will help one correctly and safely perform the exercises.! With improved thoracic mobility, one will benefit widely in the health of the shoulders and the back. Reduced pain and risk of injury, coupled with increased stability and range of motion are benefits any athlete would strive for. Not to mention, freeing the thoracic spine will also increase lung capacity and improve ones posture. Thoracic mobility is not only important for athletes, everyone can benefit from feeling less pain, moving easier, breathing easier, and looking taller and thinner. Case Study - Meet Julie! Julie is a 45 year old female. She stays very physically active by running, swimming, cycling, and hiking. She is competitive and enjoys participating in half marathons and triathlons. Her swimming mainly consists of the crawl stroke and she likes to swim for distance. She cross trains with yoga and Pilates for flexibility and core strength. She has been taking mat Pilates classes for 7 years, but has not used the apparatus. She came to me because she was frustrated with still not being able to do a smooth Pilates roll-up or teaser after 7 years. She has seen many benefits from mat Pilates including no longer experiencing knee pain when running and hiking. Although she feels that her core is strong and understands how to engage her transverse 8

9 abdominals, she is confused as to why she often suffers from low back pain. In addition, she is also experiencing lack of shoulder mobility and hyperextension in the elbows. She has quite a bit of body awareness and mentions that she notices a lot of space under back when lying supine with neutral pelvis and wonders if she has hyperlordosis.! Our first session was very fundamental, exploring some of the mat work she was familiar with. I started by having her stand and find some breath. Although she was concerned about too much lumbar lordosis, her pelvis was not in an anterior tilt. She did, however, arch the back and flare the ribs when standing tall. I had her do a rolldown and I noticed that much of her forward flexion was initiated from the shoulders followed by lumbar flexion with very little flexion through the mid back. I had her lie supine with knees bent and feet on the floor and asked her to find neutral pelvis. Although she felt neutral, she was in a posterior tilt. I had her keep the pelvic tuck and come into pelvic curl. Again, there was very little mobility in the thoracic spine. We did spine twist supine and she admitted that she felt little more than a stretch in this exercise and that it was uncomfortable as she felt like she was just rocking side to side on her tailbone. She was only able to bring the back to the mat with a deep pelvic tuck. Placing a couple small towels under her head seemed to really help. When doing a chest lift, she initiated the movement with a deep pelvic tuck. When I brought her pelvis into neutral she said that it felt like her back was really arching and I noticed her ribs flaring. In preparing for the roll-up with legs extended and arms overhead, her ribs flared and her back was arching off the mat. Only as the arms came forward was she able to bring the back to the mat. She was able to articulate up the the shoulder blades, although she really rolled her shoulders forward to get there. Then she got stuck and 9

10 tucked the pelvis and had to use momentum and her back to come up. Again she mentioned her frustration at an exercise that seemed so easy for others in mat class. I placed the towels under her head to allow the ribs to relax a bit and had her use the rollup bar on the cadillac. Although she still initiated with the shoulders, she was able to roll all the way up and was thrilled. I kept her head elevated and really focused on her rib placement when doing leg circles. She admitted it felt so much better like that. That she could feel her abdominals working as opposed to just her back. When doing back extension, all of the extension came from the lumbar spine. She really struggled with extending from the thoracic spine. She said her low back always hurt during the swimming mat exercise. Which made perfect sense after observing her with other exercises. Lack of mobility in the thoracic spine combined with tight shoulders and extension coming out of the lumbar spine would absolutely make that particular exercise painful.! After the session, I discussed with her that I didn t think she had hyperlordosis. However, I told her how I noticed a struggle with thoracic mobility throughout the workout. She was surprised and admitted that she didn t ever think about her mid back being the issue. Once I explained how the thoracic spine can be involved in her pain, immobility and posture, it made sense to her. We set up sessions twice a week with the apparatus. We expected that one on one attention and focus on correct alignment and muscle recruitment, using the apparatus, would enhance her mat classes and alleviate her lower back pain and shoulder immobility. With a long term goal of doing a the rollup and teaser with ease. 10

11 Julie s Conditioning Program Sessions 1-10 Sessions Sessions Warm up - Fundamental Pelvic Curl Spine Twist Supine Chest Lift Chest Lift w/ rotation Footwork Reformer Warm up - Fundamental + Roll-up with Rollup Bar. Footwork Cadillac Warm up- Intermediate Roll-up Spine twist supine Double leg stretch Single leg stretch Criss-cross Footwork Wunda chair Abdominals 100 prep progressing to Coordination and 100s Abdominals Chest lift Reach Overhead stretch progressing to Teaser Prep (all on Step Barrel) Abdominals Breathing with push through bar and Teaser 1 (Cadillac) progressing to Teaser prep (Reformer long box) Hips Supine Leg Series (Reformer) Spinal Articulation Spine stretch (Mat) Stretch Standing lunge Hips Extended frog and Extended frog reverse or Supine Leg Series (Step Barrel) Spinal Articulation Bottom lift, Bottom lift with extension, progressing to Semi circle Stretch Shoulder stretch lying side Hips Supine Leg Series (Cadillac) Spinal Articulation Roll-over (Step Barrel) progressing to Tower prep or Short spine Stretch Shoulder stretch lying side or Shoulder stretch prone 11

12 Sessions 1-10 Sessions Sessions Full Body Integration F/I Sitting forward (Cadillac) progressing to Stomach massage series (Reformer) FBI F/I Up stretch 1 and Down stretch or Kneeling cat stretch (Cadillac) Arms Arms supine series (Reformer) Arms Arms sitting series (Reformer) Arms Rowing series Legs Hamstring curl (Wunda Chair) Lateral Flexion and Rotation Side kneeling stretch Back Extension Swan prep (Step Barrel) Legs Skating single leg or Backward step down LFR Spine twist supine and Side over (both on Step Barrel) Back Extension Breast stroke prep progressing to Basic Swan FBI A/M Saw (Cadillac) Legs Hamstring curl (Reformer) or Backward step down and Forward lunge (WC) LFR Mermaid or Butterfly Back Extension Prone 1 or Pulling Straps 1 12

13 Goals and Intentions of Conditioning Program! My immediate goals with Julie were to safely add mobility to the thoracic spine, effectively recruit the abdominals, and to allow the low back to relax. The fundamental warm up and supine abdominal work on the reformer were exercises she was already familiar with. We worked on making them better by recruiting muscles more efficiently and focusing on flexion. I chose a spinal articulation during the first 10 sessions since she was already familiar with Pilates. I chose Spine stretch from the mat repertoire, it is an effective and safe way to teach that articulation. I wanted to be hands on with her and focus on keeping her lateral flexion out of the lumbar spine. For this reason, I chose Side kneeling stretch. Julie is short in stature making Side stretch on the Wunda chair awkward. Since she used her low back so much in back extension, Swan prep on the Step barrel helped her to find the posterior tilt necessary to protect the low back and extend from the upper back extensors. Julie had a hard time initiating the hamstrings during footwork, so I added Hamstring curl on the Wunda chair for Leg work.! As Julie progressed beyond the first 10 sessions, she understood how to properly flex the spine and was experiencing more movement. My goals now included increasing the mobility in the thoracic spine, adding more articulation and safe, supportive back extension. I also wanted to keep the workouts challenging and exciting. I added roll-up with the roll-up bar for more articulation. I also challenged her by progressing from the Pelvic curl to Bottom lift and eventually to Semi circle. Safe and supportive back extension was important as we did not want to cause any low back pain. Abdominal work on the Step Barrel safely coupled abdominal recruitment with 13

14 back extension. The goal of more stretch for the shoulders and mobility for the thoracic spine were included with the exercises I chose for the Stretch, Arms, and LFR blocks. Now that she was able to segment the spine in back extension, we advanced to exercises that provided less external support for the lumbar spine and challenged her to use her muscle recruitment for support and stability. I kept the workout exciting by changing the footwork and the hip work. As her spine became more mobile and her shoulders became more stable, I added hip work on the step barrel, I used these exercises to prepare Julie for being unsupported on the shoulder girdle in more challenging spinal articulation exercises. I challenged Julie where she was strong by adding Skating single leg and Backward step down.! By session 21, Julie had a great understanding of movement in her own body along with increased abdominal strength. She also had more thoracic mobility and shoulder flexibility than she ever remembers having. She could now painlessly reach her arms overhead. My goals were now to challenge her and to help her work toward her goal of doing a teaser while continuing to open the shoulders and the upper back. I also challenged her to be able to work holding her new found posture. She was now able to do a mat roll-up effortlessly without the assistance of the roll-up bar. I chose Breathing with the push through bar and Teaser 1 on the cadillac to help her with her teaser goal. With the freedom in her shoulders, we added exercises where she could work with arms overhead. These included the Rowing series, Shoulder stretch prone, up stretch 1 and Prone 1. We continued to work on the thoracic mobility through rotation and lateral flexion with Mermaid and Butterfly. With much improved shoulder stabilization, spinal articulation, and proper preparation, Julie progressed from Roll-over 14

15 on the Step barrel to Tower prep and Short spine. I challenged her to hold her new found postural alignment by doing footwork on the Wunda chair.! I set specific goals with my client, Julie, and used the BASI block system to provide a balanced, full body workout to each session. I used the wide variety of exercises in the BASI repertoire to carefully plan each session for safe progress towards Julie s goals of thoracic mobility and shoulder flexibility. Conclusion! Mobility of the thoracic spine is key to back and shoulder health. The thoracic spine is designed for movement. For the athletic individual it is advantageous to maximize mobility in the thoracic spine for improved performance and to avoid injury. To obtain and keep this mobility, we must safely move the spine through all planes of movement. A conditioning program using Pilates exercises can safely and effectively add imperative mobility to this often neglected segment of the spine. With increased mobility we can enjoy increased range of movement throughout the body, increased lung capacity, less pain, less risk of injury, and improved posture. 15

16 Bibliography 1. Basi Pilates. Study Guide, Comprehensive Course. Costa Mesa, CA: Body Art and Science International 2. Isacowitz, Rael. Pilates. Champaign, IL: Human Kinetics, Print. 3. Written by Stewart G. Eidelson, MD. "Thoracic Spine." SpineUniverse. N.p., n.d. Web. 07 Nov "Skeletal System." InnerBody. N.p., n.d. Web. 07 Nov "The Importance of Thoracic Spine Mobility Mark's Daily Apple." Marks Daily Apple. N.p., Web. 07 Nov By Learning These Exercises, We Can Teach People How T... "Workshop 645: Back Care Workshop with Brent Anderson." Pilates Anytime. N.p., n.d. Web. 07 Nov