The Positive Effects of Pilates on a Forward Head Posture

Transcription

1 The Positive Effects of Pilates on a Forward Head Posture By Tarryn Faber BASI Comprehensive Teacher Training Course Pretoria 2017

2 2 Abstract: Change happens through movement, and movement heals. - Joseph Pilates I have chosen to focus my research on Forward Head Posture (FHP). This is due to my personal experience, which resulted in ACDF (Anterior Cervical Dissection and Fusion) surgery in October 2016, as well as the number of individuals I have trained, that have presented with a forward head posture, and the fact that this condition is now so common. This condition comes with a multitude of complications, including chronic pain, a more rounded and immobile thoracic region, with rounded and elevated shoulders, headaches, numbness and nerve pain referring down into their fingers, amongst other noted problems. Breathing capacity, mood and emotions are also affected by FHP. A FHP is the anterior positioning of the cervical spine in relation to the plumb-line. It is described as one of the most common postural problems in modern day society. This is due to the lifestyle that most people live; working behind computers, positioning of the head while looking at cell phones, amongst other causes. The problem with this type of posture is that it causes imbalances in some of the major muscles, for example, the levator scapula, rhomboids, trapezius and pectorals, as well as degeneration of the cervical vertebrae and irritation of the cervical nerves. According to Mayo Clinic, FHP leads to long-term muscle strain, disc herniation, arthritis and pinched nerves. It is said that the health of the neck is determined by the curvature of the spine below and the positioning of the head on top. Research has shown that Pilates is highly beneficial and a recommended type of physical activity for a person with a FHP. This is due to the fundamental principles of Pilates; specifically, the awareness of the positioning of the head and cervical spine during each exercise, concentration during and after the Pilates session of correct posture and the control and precision while performing each exercise. The breath will help to increase lung capacity.

3 3 Table of Contents: 1. Title Page Abstract Table of Contents Anatomy of the Cervical Spine Ideal Posture Vs. FHP Diagnosis of FHP Treatment for FHP How Pilates can be used as a corrective measure for FHP day Pilates programme for FHP Conclusion Bibliography... 22

4 4 1. Anatomy of the Cervical Spine: The Cervical Spine forms the skeleton of the neck. It consists of 7 vertebrae, which are grouped into the suboccipital cervical spine, and the lower cervical spine. The suboccipital spine is made up of the C1 or Atlas vertebrae, and the C2 or Axis vertebrae. These two vertebrae are shaped differently and perform a different function to the rest of the cervical vertebrae. The lower cervical spine is made up of the C3-C7 vertebrae s. All of these 5 vertebrae have the same characteristics. This can be seen in Figure 1 below. Figure 1: Anatomy of the Cervical Spine As seen in Figure s 2-4, the musculature of the neck and upper trunk is very complex. The functions of these muscles are widespread. The muscles that we focus on when taking a FHP into consideration, are the pectoral minor and major, upper and lower trapezius, levator scapula, sternocleidomastoid, suboccipitals, subscapularis, lattisimus dorsi, longus capitis, longus colli, hyoids, rhomboids, serratus anterior, posterior rotator cuffs and the arm flexors and extensors.

5 5 Figure 2: Lateral view of the cervical muscles Figure 3: Anterior view of the cervical muscles Figure 4: Posterior view of the Cervical Muscles

6 6 2. Ideal Posture VS. FHP Figure 5: Plumb-line vs. FHP Ideal alignment is a standard position in which all joints are balanced relative to the others. It represents the most mechanically efficient positioning of the body. An ideal posture is when the ear, shoulder and hip are in alignment, as depicted in the image above as the correct posture. This is also known as the plumb-line. Movement around a correct or ideal posture allows for less energy used on any given task and less strain on muscles and joints while performing the movements. When there are deviations from the ideal posture or plumb-line, these are known as misalignments, which can be present in one or more areas of the body. In the case of a misaligned posture, it generally happens that there are a number of chronically tight muscles around certain joints, as well as chronically stretched muscles around that same joint. This will put a lot of unwanted stress on the body, which will have adverse effects. Forward Head Posture, which is also known as Upper Crossed Syndrome or Proximal or Shoulder Crossed Syndrome, is characterised by a forward placed head anteriorly to the plumb-line, with rounded shoulders and a kyphotic thoracic spine. Ideally, the cervical spine should have a lordotic or concave curvature, but with a FHP the curvature of the cervical spine can disappear completely, affecting the flexibility of the spine. The effects of this posture can be seen on the cervical spine and its corresponding muscles, but over time the effects will transfer down the spine and a chain reaction of a bad posture will start to appear in all segments of the spine.

7 7 It is said that this common posture is directly related to the sedentary lifestyle that many people live these days, as well as the amount of time spent on our cellpones, behind computers, and driving in traffic. For this reason, ergonomics in the workplace is a thoroughly discussed topic. There are other causes of FHP, which include trauma, such as whiplash. As seen in figure 5, every 2,5 cm s that the head is placed past the plumb-line, the weight of the head increases by 4,5 kg s. Even a slight shift forward can cause compression and strain on the bones, muscles, ligaments and other tissues in the neck, upper back, and shoulders and beyond. In Figure 6 below, as well as Table 1, you can see the muscles affected by this postural deviation. Figure 6. Effects of FHP on corresponding muscles Table 1: Muscles affected by FHP Tight, Facilitated Pectorals Upper Trapezius Levator Scapula Sternocleidomastoid Suboccipitals Subscapularis Lattisimus Dorsi Arm Flexors Weak, Inhibited Longus Capitis Longus Colli Hyoids Serratus Anterior Rhomboids Lower Trapezuis Posterior Rotator Cuff Arm Extensors

8 8 3. Diagnosis of FHP 1 Visual: - Position of the head is forward from the plumb-line - Increased Cervical lordosis, especially at C1 and C2, and thoracic kyphosis - Elevated and Protracted Shoulders - Rotation or abduction/winging of the scapula 2 History or feedback from the client: - Client gives a history of instability in the shoulder/s - Numbness in the upper limbs due to nerve pain in the neck and arms - Headaches - Pins and needles down into the fingers - Pain in shoulders due to Rotator Cuff problems - Pain of shoulders or cervical spine due to degenerative joint disease of the acromio-clavicular joint and vertebral facet joints of the cervical spine 3. Tests: - Check the positioning of the head. Have the client lie down in a neutral supine position; take note of the positioning of the head and neck. If the clients chin tends to lift up and away from the chest, and their neck is in a hyperlordotic position, especially at C1 and C2, this shows a positive test for FHP - Checking the individual muscles that are affected by a FHP, namely tight upper trapezius. Palpate this muscle to feel its tightness. Notice tightness in the pectorals as well by doing pectoral stretches, such as the pole series. Notice the ability or inability to control scapula range of motion, to detect the strength in the upper thoracic muscles. - Perform the floor angel test lying supine, can the client keep lower rib cage connected to the floor, while arms are opened up with palms facing the ceiling, bent at elbows in an Ú -shape, with wrists touching the floor continuously, as depicted in Figure 7. If the client is not able to keep the lower rib cage connected, while the neck is in a lengthened neutral position, and the wrists are staying flat on the floor, while arms are opened in the U shape next to the body this is a positive result for a FHP Figure 7. Floor Angel Test

9 9 4. Treatment for FHP: Correcting FHP is very individual, depending on a person s lifestyle, and habits. Taking into consideration that there are many causes for FHP, an individual evaluation for each client is imperative. Take into consideration a person s day-today activities, the way they sleep, what type of work they do, any past injuries to the cervical spine and the type of exercise they do. These are important pieces of information to have to be able to formulate a plan to correct their FHP. The recommended areas to focus on are as follows: 1. Exercise It is important to strengthen the muscles that are weak, and to stretch the muscles that have tightened and are exasperating the misaligned posture in order to start the journey of correcting the FHP. Along with the plan set out to correct the misaligned posture, keep in mind that the body is a whole, and that it is imperative that focus is also put on strengthening the body as a whole to promote healthy joints and a well aligned, strong body from top to bottom. 2. Sleep environment Using a supportive neck pillow will ensure that the neck stays in the correct position while sleeping. A lot of the time, people sleep on pillows that are too high or low, and too hard or soft, and this affects the positioning of the head in relation to the rest of the spine, which puts unnecessary pressure of the cervical spine. 3. Ergonomics of the work space Due to computers being a massive part of our lives today, and many people working 8 hours a day sitting behind a computer, the ergonomics of the workstation is so important. Making sure that the set-up of the computer is conducive to a positive postural alignment; with the screen positioned in a way in which the persons head is not tilting down to look at the screen and is placed directly in front of the individual is a good place to start. The chair that the individual will sit on is also very important. A lumbar cushion will promote a healthy posture as well. 4. Correcting daily habits This is a broad topic, which is dependent on the individual and that person s habits. Awareness of posture, and head placement whilst performing any and all daily habits is always important. Pilates will assist in this awareness of the body and posture.

10 10 5. How Pilates can be used as a corrective measure for FHP: There are 10 important principles of the BASI Pilates method. These are awareness, balance, breath, control, concentration, centre, efficiency, flow, precision and harmony. Keeping in mind these principles, and the fundamental approach of Pilates, which is to create strength and flexibility in each muscle and throughout the body, which improves the elasticity of the muscle and the function of the joints, leads me to believe this approach is perfect for correcting the FHP. It is also important to note that the fact that Pilates can be individually tailored to a person s needs, and that it is a low impact form of exercise, that is safe for rehabilitative purposes, is also a good reason to use this method to correct a misaligned posture. The emphasis on core strength and ideal posture are what makes this method of training so beneficial for people with a FHP. Pilates offers an array of options to be able to use this method as a form of exercise. I would recommend that a person that has a FHP start by doing private sessions twice a week to start the process of improving their posture, and once they have the strength and awareness, as well as the knowledge of how to perform the exercises safely for their personal needs, they can move onto a group class environment.

11 11 6 Pilates Programme for FHP: Block Day 1-7 Day 8-14 Warm Up Roll Down Roll Down Foot Work Mat fundamental Pelvic Curl Chest Lift Chest Lift w. Rotation Spine Twist Supine Leg Lifts/Changes *A support under the clients head will allow for correct posture relative to the misaligned posture, and over time the support can be lowered, until finally no support is needed Choose between Reformer or Cadillac Foot Work *Emphasis must be placed on correct posture, and lengthening through the back of the neck. Reformer specific - Keep the head-rest down. Use a small support under the head to make sure the neck and head are in the correct posture. Cue to relax muscles in the neck and opening the shoulders across the carriage. The Mat fundamental Pelvic Curl Chest Lift Chest Lift with Rotation Spine Twist Supine Leg Lifts/Changes Include: Roll Up Spine Stretch Spine Twist The same applies as in days 1-7. A support under the clients head must be used to ensure correct posture. Try lowering the support and getting the client closer to the plumbline using their own muscle strength and flexibility. Including the few added exercises to gain more mobility through the spine, warming up the body for the rest of the session Choose between Cadillac or Wunda Chair Foot work Alternating between the Cadillac and Wunda Chair FW, will allow for lengthening the hamstrings and length in the spine on the Cadillac, and then strengthening the co-contraction in the abdominals and the erector spinae muscles to keep the posture upright while doing the FW on the Wunda Chair.

12 12 Abdominals pressure in the triceps up into the shoulders will also help to open across the chest. Cadillac Warm up series This series will allow strengthening in the abdominals, will creating mobility in the spine, within a controlled space Step Barrel: Chest Lift, Reach, Overhead Stretch. This piece of equipment helps with posture awareness. Support is needed in the overhead stretch to make sure that there is no over extension of the cervical spine, and rather a reaching through the crown of the head. Hundred Prep, Hundred, Co-ordination To perform these exercises on a light resistance, so to not put too much pressure on the cervical spine. If these exercises are too difficult with the added resistance on the reformer, move onto the mat to start, and move back to the reformer when stronger. Doing Focus on correct posture during these series. Opening across the chest, lengthening through the back of the neck, correct placement of the pelvis with a heavy tail bone and engaged abdominals Standing Pike Standing Pike Reverse Pike Sitting Short Box Series Round Back Flat Back Tilt Twist Step Barrel: Chest Lift, Reach. Overhead Stretch, Teaser Prep Strengthening the abdominals while ensuring correct posture and correct muscles are activating, will allow for a lengthened and supported spine.

13 13 Hip Work Spinal Articulation abdominals while lying down helps gives feedback to the body of where the postural corrections need to be made. Choose between Reformer or Supine Leg Series Basic Leg Springs Emphasis must be placed on the posture during these exercises, the stability in the pelvis, and the disassociation of the hips from the pelvis. Keeping the tailbone anchored is vital, as well as a stable pelvis. Lengthening through the legs and keeping a flowing movement is important. Bottom lift and bottom lift with extension. Be careful that the support under the client s neck is not too high, as lifting the pelvis above shoulders with an elevated head, can exasperate the issue already caused by a FHP. Step Barrel: Roll Over Keeping the thoracic spine against the step barrel when the legs are in the roll over position, helps with feedback for this Supine Leg Series Single Leg Supine Series Performing hip work with an elongated spine; training the pelvic floor to stabilise the pelvis so that disassociation of the hips is achieved, is a great way to strengthen the hips, while still challenging the stability of the pelvis.. Jack Knife Tower Prep Short Spine Ensure that the clients posture is correct while performing these exercises. If the client still needs a support to ensure the head and neck are in the correct position, make sure the support is lowered slightly, and that it is not a hard support that

14 14 Stretches FBI F/I exercise, and support for the spine. Abdominals need to be engaged throughout this exercise, but especially when legs are extended away to avoid lordotic extension in the lumbar spine. Step Barrel: Shoulder Stretch Lying Side Ladder Barrel: Shoulder Stretch 1 Both these exercises help with stretching the pectorals and opening up the rounded shoulders present with the FHP Down Stretch Stomach Massage Flat Back, Stomach Massage Reaching Sitting Forward Side Reach Doing these full body integrated exercises will help with giving perspective of where the head and neck should be in relation to the rest of the spine, as well as creating cannot allow for movement in these types of exercises. Shoulder Stretch Standing Lunge Ladder Barrel: Shoulder Stretch 1 and 2 Stretching the most common tight muscles will allow for the whole body to work harder throughout the rest of the session, all while the posture will improve, as well as flexibility in the rest of the exercises. Knee Stretch Flat Back, Up Stretch 1, Elephant Kneeling Cat Stretch, Sitting Back These exercises are excellent for shoulder strength and stabilisation,

15 15 Arm Work FBI A/M Leg Work the co contraction between anterior and posterior core muscles, at the same time as creating mobility in the spine Arm Supine Series Arm Standing Series Arm Chair: Chest Expansion Circles Up Circles Down Salute Biceps Rhomboids Focus on correct posture while performing these exercises. Strengthening the upper body, especially the arms while in the ideal posture, will allow for maximum strength and control Hamstring Curl Ideal for strengthening the legs, as well as the back extensor especially the muscles of the thoracic spine, which will help to correct the FHP. Single Leg Skating Arms Sitting Series Shoulder adduction single arm, Sitting Side Prep Focus on correct posture while performing these exercises, and engaging the core throughout Tendon Stretch Ensure the scapula are stabilized in this exercise, and that deep abdominal connection is taking place. Jumping Series Squats Forward Lunge Backward Step Down

16 16 Lateral Flexion/Rotation Back Extension Leg Press Standing Hamstring Curl Hip Opener Mat: Gluteal Side Lying Series Ensure the abdominals or the core-set is engaged, and there is a lengthened spine while performing these exercises. Mermaid Butterfly Step Barrel: Side Lift Focus on the positioning of the head and neck throughout these exercises, as well as controlled rib cage placement. Make sure that there is no lordosis of the lumbar spine. Keep the neck lengthened and that there is reaching through the crown of the head. Always keep abdominals and back extensors engaged. The equal length between the rib cage and ASIS is always important. Mat: Basic Back Extension Breaststroke Prep The intensity of these exercises is more difficult, so special attention on posture, recruitment of correct muscles and precision of the movement is imperative. Rather do lower repetitions and focus on performing the exercise correctly. Side Over on Box Side Lift Side Kneeling Stretch Performing these movements correctly will allow for mobility in the upper girdle, as well as correct positioning of the thoracic and cervical spine. There is a cocontraction between posterior and anterior core muscles, which promotes a lengthened spine. Pulling Straps 1, Pulling Straps 2

17 17 Prone 1 Step Barrel: Swan Prep Always cue extending through the crown of the head, and keeping the neck lengthened. Watch that there is no compaction between C1 and C2, which can be seen by extending the chin away from the chest. Strengthening muscles of the thoracic and lumbar spine is very important. Prone 1, Prone 2 Swan on Floor, Back extension single arm Always check placement of the head and neck in back extension movements, especially when going into thoracic extension Keep abdominals in a supportive contraction, to avoid lordosis of the lumbar spine. Block Day Day Warm Up Roll-Down Roll-Down Foot Work Mat:- Intermediate Roll Up Spine Twist Supine Double Leg Stretch Single Leg Stretch Criss Cross Check at which level the client needs the support, and always challenge them moving into the plumb-line posture Reformer or Cadillac Add resistance, and focus on engaging hamstrings to extend the legs, and the quadriceps to control the movement back. Increase pace if the movement can be controlled and more of a challenge is wanted. Mat:- Intermediate Roll Up Spine Twist Supine Double Leg Stretch Single Leg Stretch Criss Cross Spine Stretch Spine Twist Saw Front Support Back Support Cadillac or Wunda Chair

18 18 Abdominals Hip Work Spinal Articulation Roll Up Bottom Loaded, Breathing with PTB, Bottom Lift with RUB Backstroke, Teaser Prep, Teaser Focus on the quality of the movement, and on the correct posture, instead of the quantity of repetitions performed. Supine Intermediate Series Single Leg Supine Series Check that the tailbone is anchored and that the pelvis is placed correctly on a lengthened neutral spine. Make sure that there is no movement in the pelvis, and that legs are lengthened throughout. Short Spine, Long Spine Monkey Original, Tower Prep, Tower Jack Knife Support the clients Short Box Series, including Round About and Climb-a-Tree Cat Stretch Kneeling, Standing Full Pike, Torso Press Sit Single Leg Side Series Step Barrel: Supine Leg Series Short Spine, Long Spine Monkey Original, Tower Prep, Tower Mat: Seal Puppy, Control Balance

19 19 Stretches individual posture, and focus on correct movement and recruitment of the correct muscles in these movements. Shoulder Stretch, Kneeling Lunge, Ladder Barrel: Shoulder Stretch 1 & 2, Hamstrings, Adductors, Gluteals, Hip Flexors Pole: Pole Series Shoulder Stretch, Kneeling Lunge, Ladder Barrel: Shoulder Stretch 1 & 2, Hamstrings, Adductors, Gluteals, Hip Flexors Pole: Pole Series FBI F/I Arm Work Up Stretch 2, Long Stretch Sitting Forward, Side Reach, Thigh Stretch with RUB Mat: Front Support, Back Support Arms Kneeling Series Arms Standing Series Shrugs, Tricep Press Sit,, Tricep Press Prone Scooter, Knee Stretch Group Flat Back, Reverse Knee Stretch Sitting Forward,, Side Reach, Saw Shoulder Push, Shoulder Push Single Arm Shoulder Adduction Double Arm, Sitting Side Prep, Sitting Side

20 20 FBI A/M Leg Work Lateral Flexion/Rotation Balance Control Front Or Balance Control Back Prep As the difficulty has increased in these movements, ensure that posture, especially head and neck placement is correct. Mat: Gluteal Kneeling Series Leg Press Standing Hamstring Curl Hip Opener Hamstring Curl, Single Leg Skating Side Lift Side Over on Box Ladder Barrel: Side Over Prep Ped-A-Pull: Arms Standing Series Frog Back, Side Kneeling Arm Long Back Stretch Or Balance Control Back Jumping Series Squats Forward Lunge Backward Step Down Front Frog Side Lift Side Over on Box Ladder Barrel: Side Over

21 21 Back Extension Side Stretch Breaststroke Prep, Breaststroke Prone 1 & 2 Swan Basic, Back Extension Single Arm Step Barrel: Swan Prep, Swan Mat: Double Leg Kick, Rocking prep Side Pike Ladder Barrel: Swan Prep, Swan Swan on Floor Hanging Back Step Barrel: Swan Prep, Swan Pulling Straps 1 & 2 7 Conclusion: The results that I have seen with my clients, as well as what I feel in myself, leads me to confidently believe, that Pilates is one of the best exercise methods to positively affect the deviations caused by Forward Head Posture. In conjunction with a plan to create positive habits, sleeping patterns and ergonomics of a person s work environment; Pilates will benefit any person that struggles with a Forward Head Posture. Consistency and perseverance to improve this posture are imperative. Working with a private instructor, that has knowledge and experience with corrective measures in respect of this postural deviation is important as one embarks on their Pilates journey. This way a person can learn the areas they need to focus on, and the body awareness to perform exercises correctly.

22 22 Bibliography Anatomy of the Cervical Spine. (n.d.). Retrieved from: Lateral View of the Cervical Muscles. (n.d.). Retrieved from: Anterior View of the Cervical Muscles. (n.d.) Retrieved from: Posterior View of the Cervical Muscles. (n.d.) Retrieved from: 4CQ&q=floor+angel+test&oq=floor+angel+test&gs_l=psyab j psyab j0i8i30k1j0i24k1.0.rleBbbKcEvU#imgrc=8chPItMoMOFcIM: Quote1. (n.d.) Retrieved from: h&tbo=u&source=univ&sa=x&ved=0ahukewitzrtx4l7xahwjffakhtxnbieqsaqing&biw=1024&bih =469#imgrc=TJPJDhm74uR_wM: Ideal Posture VS. FHP. (n.d.) Retrieved from: Effects of FHP on Corresponding muscles. (n.d.) Retrieved from: Table 1. (n.d.) Retrieved from Floor Angel Test. (n.d.) Retrieved from &tbm=isch&sa=x&ved=0ahukewie_oku8mpxahvdlcakhd6ics8q_auicygc&biw=1024&bih=469#i mgrc=8chpitmomofcim: Isacowitz, R (n.d.). Body Arts and Science International Movement Analysis Workbooks Calais-Germain, B. (1999).Anatomy of Movement, Revised Edition. Seattle: Eastland Press Isacowitz, R., & Clippinger, K. (2010). Pilates Anatomy. Human Kinestics

23 23 List of Tables: Table 1 Muscles affected by FHP 8 List of Figures: Figure 1 Anatomy of the Cervical Spine 4 Figure 2 Lateral View of the Cervical Muscles 5 Figure 3 Anterior View of the Cervical Muscles 5 Figure 4 Posterior View of the Cervical Muscles 5 Figure 5 Ideal Posture VS. FHP 6 Figure 6 Effects of FHP on the Corresponding Muscles 7 Figure 7 Floor Angel Test 8