FROZEN SHOULDER USING THE BASIÒ PILATES METHOD TO REGAIN SHOULDER FUNCTION

Transcription

1 FROZEN SHOULDER USING THE BASIÒ PILATES METHOD TO REGAIN SHOULDER FUNCTION Samantha Tisdale Costa Mesa, CA /16/2018

2 ABSTRACT Adhesive capsulitis (commonly known as frozen shoulder ) presents as severe pain with moderate to severe loss of range of motion of the shoulder. Over the course of 1 to 3 years, the body ultimately heals itself of the condition/disease. Many individuals regain almost full range of motion after their shoulder thaws, while others are left with permanent limitations. Conservative treatment, at present, consists of physical therapy to maintain and increase shoulder range of motion, steroid injections into the shoulder capsule, and ice packs to control inflammation. A small percentage of individuals are referred to surgery (manipulation under anesthesia or shoulder arthroscopy). There is currently no known cure for the condition. Pilates - a mind body practice - has numerous benefits that work extraordinarily well in conjunction with the more traditional approach of physical therapy for the rehabilitation of frozen shoulder. Pilates increases flexibility and joint mobility; it builds strength in a controlled manner; it heightens body awareness, balance, and coordination. It teaches correct muscle activation; and corrects posture and body alignment. It provides an emphasis on correct breathing which itself has healing benefits. Pilates offers a vehicle for concentration and focus; promotes relaxation and a release of tension; helps keep musculature and bone structure in an optimal state; and provides a path to inner harmony. Pilates offers the mind a connection to the body and adds the psychological benefit of an uplift, a feeling of being energized which is particularly helpful to anyone living with chronic pain (e.g., a person living with frozen shoulder). 1

3 Regaining function after living with a severe case of frozen shoulder for 1 to 3 years is no small task. Coupling the BASIÒ Method of Pilates and its Block SystemÒ with dedication and perseverance, the long-term effects of frozen shoulder can certainly be overcome. 2

4 TABLE OF CONTENTS ABSTRACT. Page 1-2 TABLE OF CONTENTS. Page 3 ANATOMICAL DESCRIPTION Page 4-5 INTRODUCTION... Page 6-7 CASE STUDY Page 7 PROGRAM SELECTED & REASONING Page 8-11 CONCLUSION Page

5 ANATOMICAL DESCRIPTION THE SHOULDER GIRDLE The shoulder is one of the most complicated joints in the body. It is a ball-and socketjoint with greater range of motion than any other joint. The coordinated activity of numerous muscles working together in set patterns is required to produce motion. To allow such significant movement, the joints need to be free to move; therefore, the shoulder is relatively unstable by its nature. Unlike many other joints which depend on bone structure for support, the shoulder relies on musculature for support, and thus is often called a muscle dependent joint. In addition to the necessary musculature, the scapulae are essential. In fact, the scapulae have been coined the gateway to correct shoulder function and healthy movement. (Isacowitz, Rael, Powerhouse of the Upper Girdle, Shoulder Mechanics, Functional Movement and the Pilates Repertoire. ) 4

6 A. The Bones of the Shoulder The shoulder girdle is made up of paired bones: clavicles (collarbones) and scapulae (shoulder blades). The clavicle is the only bony attachment between the axial skeleton and the upper extremities (shoulder girdle, arms, and hands). This attachment occurs at the sternoclavicular joint. The clavicle articulates at one end with the sternum (chest bone) and at the other end with the acromion of the scapula. This articulation between the acromial end of the clavicle and the acromion of the scapula forms the roof of the shoulder. The scapula is a large, triangle shaped bone that forms the back portion of the shoulder girdle and articulates with the humerus at the glenoid fossa. This glenohumeral articulation is the shoulder joint proper. The term scapulohumeral rhythm refers to a coordinated, linked movement of the scapula and humerus when the arms are involved in movement. B. The Muscles of the Shoulder The muscles of the shoulder can be divided into three groups: 1) scapular stabilizers (the trapezius, rhomboids, levator scapulae, pectoralis minor and serratus anterior muscles); 2) the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis); and 3) the large shoulder muscles (pectoralis major, deltoids, latissimus dorsi, and teres major). Although the latter group is often given the most attention, inclusion of exercises of the scapular stabilizers and the rotator cuff is key to promote correct shoulder mechanics. (Isacowitz, Rael, Study Guide: Comprehensive Course: Muscles of the Shoulder Region.) 5

7 INTRODUCTION - FROZEN SHOULDER [The photograph [above left] depicts a healthy shoulder capsule and [above right] depicts an inflamed shoulder capsule indicative of the beginning stages of frozen shoulder.] Frozen Shoulder affects the shoulder joint causing the shoulder capsule to thicken and become tight. Stiff bands of tissue develop called adhesions. In many cases, there is less synovial fluid in the joint. The hallmark sign of this condition is being unable to move the shoulder passively or actively. Regular activities of daily living such as dressing, showering, reaching for a glass in a cupboard, or brushing ones own hair or teeth can become very difficult and painful, if not impossible, for a prolonged period of time. Postural issues result. Frozen shoulder occurs in three stages: freezing; frozen; and thawing. In the freezing stage, severe pain develops that worsens at night making sleeping difficult. As the pain worsens, the individual loses range of motion. The freezing stage typically lasts from 6 to 6

8 9 months. In the frozen stage, painful symptoms may decrease somewhat, but the stiffness remains. During the frozen stage, daily activities may remain very difficult. This phase usually lasts approximately 6 months. Shoulder motion slowly returns during the thawing stage. This last stage typically takes anywhere from six months to 2 years. The focus of treatment for frozen shoulder is to control pain and improve range of motion through passive and active mobilization of the joint. Strengthening is initiated once pain is under control and range of motion is returning. CASE STUDY Heidi is a 45-year-old female with right and left frozen shoulder; although, she does not have any of the other common factors that are associated with frozen shoulder (e.g., diabetes, auto-immune disease). Both of Heidi s shoulders are at the end of the second/frozen stage of frozen shoulder and are beginning to thaw. Both of Heidi s shoulders were severely affected by frozen shoulder. Flexion, extension, and external rotation have been severely limited making dressing, showering, and many activities of daily living very difficult and painful. For quite some time, her right shoulder was frozen and stuck in internal rotation. Heidi has average flexibility, core, and leg strength for her age, except her upper back and shoulder girdle have limited mobility. Her shoulder and arm strength are below average due to frozen shoulder. Her trapezius, scalene, and sternocleidomastoid muscles have been overused causing fatigue, tension and pain in her neck and upper back. 7

9 PROGRAM SELECTION & REASONING The Program Selection incorporates the following goals: (1) mobilization of both shoulders within a comfortable range, ultimately gaining full range of motion over time; (2) awareness of correct muscle recruitment patterns to facilitate correct shoulder mechanics; (3) core stabilization including recruitment of local and global stabilizers using eccentric, concentric and isometric contractions; (4) strengthening beginning with active movement at first with no resistance followed by adding resistance (first open chain, then closed kinetic chain) only when range of motion and correct mechanics are in place; and (5) focus on movement being key to restoring functional movement and a positive state of mind. Heidi s Pilates Program BLOCK Early Program (Months 1-2) Mid Program (Months 3 4) Late Program (Months 5 6) Warm-Up Pelvic Curl; Spine Twist Supine; Leg Pelvic Curl; Spine Twist Supine; Chest Roll Up; Spine Twist Supine; Dbl. Leg Lifts; Leg Changes; Lift; Chest Lift w Stretch; Single Leg Leg Circles Rotation Stretch; Criss Cross. Foot Work Cadillac (Reformer w springs too painful on Cadillac or Chair Reformer; Cadillac; and Chair shoulders currently) 8

10 BLOCK Early Program Mid Program Late Program Abdominal Work (Select 2) Chest Lift; Reach; Overhead Stretch Hundred Prep; Hundred; Coordination Torso Press Sit; Pike Sitting; Full Pike; Short Box Series; Legs in Standing Pike; Standing Pike Reverse; Roll Up Hamstring Pull 1; Teaser Prep Straps Series Roll Up; Hamstring Pull 2 and 3 Hip Work Reformer Supine Leg Series Cadillac Supine Leg Series Teaser (Step Barrel) Cadillac Supine Single Leg Series; or Reformer Extended Frog (& Reverse) Spinal Articulation N/A Spine Stretch; Roll Like a Ball Short Spine Stretches (Select 1) Shoulder Stretch; (Spine Corrector); Pole Series w Theraband; Kneeling Pole Series; Ladder Barrel Stretches Standing Lunge Lunge Full Body Articulation (Select 2 4) Sitting Forward; Side Reach; Stomach Massage Series (skip Flat Back or modify) Up Stretch 1; Elephant; Reverse Knee Stretch; Knee Stretch Group Scooter; Up Stretch 2 and 3; Down Stretch; (Mat Bridging) Front Support; Leg Pull Front 9

11 Arm Work (Select 1 Series, or 2 3 exercises) Mobilization exercises on Foam Roller; Sitting Side Prep; Shoulder Adduction Reformer: Arms Supine Series; Sitting Side; Triceps prone; Triceps sitting; F2 Chair: Arms Sitting Side Series (for Rotator Cuff); Reformer: Arms Sitting Series Single/Double Arm; Shrugs Leg Work (Select 1-2) Gluteal Kneeling, Box Series; Leg Press Standing; Hamstring Skating Single Leg; Side Split Cadillac: Squats; Backward Stepdown; Forward Lunge Curl Lateral Flexion / Rotation (Select 1) Ladder Barrel: Side Over Prep; Step Barrel: Side Over Prep Chair: Side Stretch; Side Kneeling Stretch Mermaid; Side Over on Box Back Extension (Select 1) Back Extension; Cat Stretch Single Leg Kick; Double Leg Kick (modify w towel); Swan Basic; Breaststroke Prep Swimming. Swan on Floor; Back Extension Single Arm; Breaststroke (on floor w gliding discs); Pulling Straps 1 & 2 (light spring); Prone 1; Prone 2 All three phases of the above Program were utilized. Modifications were made as necessary (primarily with shoulder/arm position) until the exercise could be performed without modifications. Some modifications are listed above. 10

12 One of Heidi s favorite exercises was the BASIÒ Roll Up. The Roll Up starts with the arms overhead hovering above the floor in flexion, something Heidi was unable to achieve in the beginning. She would start with her arms reaching up towards the ceiling at a slight angle in a modified position, a good starting position for her. With the forward flexion of the spine her arms would move forward gently, exhaling, then inhaling to pause with shoulders over the hips, followed by the gentle articulation back of the spine and flexion of the shoulders. This was not only an abdominal exercise for Heidi, it was a challenging shoulder mobilization and stabilization exercise (scapula neutral). Over time, she could gauge her progress. Eventually, her shoulders allowed her straight arms to lower so they were hovering barely above the floor. A measureable accomplishment! She later moved on to perform Prone 2. The feeling of moving past restriction was far more valuable than the objective of the exercise itself. It was a true breakthrough. CONCLUSION By utilizing the BASIÒ Block System Method of Pilates, Heidi was able to increase her bilateral shoulder range of motion from severely limited (approximately 50% of normal) to slightly limited (approximately 90-95% of normal) in flexion, extension, and external rotation in both shoulders after approximately 6 months of regular Pilates sessions three times a week. She has continued on with BASIÒ Pilates with a continued focus on gaining full range of motion while stabilizing and strengthening the shoulder girdle. Her ultimate goal is to regain 100% full function (range of motion, stability and strength) of her shoulders and upper torso. 11

13 The additional benefits of Pilates - reducing stress, improving mental focus, and generally improving one s sense of well-being - all contributed greatly to getting Heidi back on track and through the most painful stages of frozen shoulder into a better functioning mind and body. In conclusion, the BASIÒ Method of Pilates and its Block SystemÒ proved to be an invaluable tool to create a recovery program for a complicated shoulder condition with no known cure and limited treatment possibilities. 12

14 BIBLIOGRAPHY Isacowitz, Rael, Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael, Powerhouse of the Upper Girdle, Shoulder Mechanics, Functional Movement and the Pilates Repertoire. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael, Pilates, Second Edition. Champaign, Illinois: Human Kinetics, Isacowitz, Rael; Clippinger, Karen, Pilates Anatomy. Champaign, Illinois: Human Kinetics, Benjamin Widmer, M.D., Diseases and Conditions, Frozen Shoulder. OrthoInfo. AAOS.org, January Shoulder Anatomy. medicalartlibrary.com, Web, The Body Almanac, American Academy of Orthopaedic Surgeons,