Pilates for an Unstable/Hypermobile Spine

Transcription

1 Pilates for an Unstable/Hypermobile Spine Aryanna Aronson June 14, 2018 Summer/Fall 2017 Santa Barbara, CA & Brooklyn, NY USA 1

2 Table of Contents: Title Page.1 Table of Contents...2 Abstract...3 Anatomical Description Case Study..6 Conditioning Program Goals/Focus 8-10 Conclusion...11 Bibliography.12 2

3 Abstract In this paper I discuss the benefits of pilates for a client who is hypermobile in her thoracic spine. Generalized hypermobility of joints is a condition in which a person has a range of movement beyond what would be considered normal. Hypermobility in the thoracic spine can lead to general instability and pain. Other symptoms can include joint stiffness, muscle spasms and soreness, and reduced muscle strength and stabilization. In this case study I provide background on the thoracic spine and hypermobility and highlight how pilates has been incorporated into this client s conditioning program. Ultimately I have guided this patient toward increased stability in her thoracic spine by building gentle movements into smoothly coordinated muscle patterns. Ameliorating the patient s imbalances has led to increased relaxation and decreased fatigue and anxiety from building stabilization by strengthening around the joints. 3

4 Anatomical Description The thoracic spine is the longest region of the spine. It has 12 vertebrae, T1-T12 (T1 starting closest to the head and running down the spine to T12). These vertebrae make up the foundation to our sturdy spinal column that is the thoracic spine, supporting the neck above, the rib cage, soft tissues, flexible joints, blood vessels, and nerves.the thoracic spine s most important role is to protect the spinal cord and anchor the ribcage. T1 and T12 Vertebrae. T1, the top thoracic vertebra, connects with C7 in the cervical spine above while T12 connects below with L1 in the lumbar spine. In addition to being connected to adjacent vertebrae, the thoracic vertebrae are also connected to ribs. When you view the spine from the side, the thoracic spine vertebrae form a kyphotic curve that runs from T1 to T12. Meaning, the spine curves outward towards the back of the body, allowing more room for the internal organs, the heart and lungs, that are situated inside the rib cage. The thoracic curve is the opposite of the cervical and lumbar spines which both have lordotic curves, going inward toward the front of the body. T2-T8 Vertebrae. T2-T8 are alike, except that they gradually increase in size going down the spine. A typical thoracic vertebra consists of the following: vertebral body, vertebral arch, facet joints and costovertebral joints. Commonly T2-T8 are considered typical thoracic vertebrae, however variations will occur from person to person regarding which vertebrae are typical and which are unique. Intervertebral discs. There is a total of 23 intervertebral discs in the spine, 12 of which are located in the thoracic spine. The thoracic discs sit between two vertebrae providing cushioning and shock absorption while also preventing the vertebrae from grinding against each other. 4

5 Thoracic discs are usually thinner than cervical and lumbar discs. These thinner discs may contribute the relative lack of mobility compared to the neck and lower back. The discs of the thoracic spine are also unique in the sense that all but the bottom two connect with the ribs. Intervertebral disc Compared to the cervical and lumbar spines the thoracic is less mobile. However, there are varying ranges of motion at the different thoracic vertebral levels. The thoracic spine has ability for axial rotation with limited forward/backward and side bending movements. As you gradually move down the spine this mobility flips, allowing less axial rotation but more forward/backward and side bending motion. Around T7-T8, the size and shape of the vertebrae start to sequentially come to be more like the vertebrae of the lumbar spine enabling changes in range of motion. Because T10-T-11 involve the ribs that are not attached to the chest wall, these changes become more pronounced around these vertebrae and down. In the image below you can see the size of the vertebrae gradually increasing as you move down the spine. 5

6 Case Study The client is a 22 year old professional dancer who spends most of her day on her feet either dancing, teaching children, or exercising. She has been dancing since the age of three and started experiencing back pain at an early age. She started with physical therapy which seemed to help for a time, but then during high school the pain came back and more intense. She looked to pilates because one of her former dance teachers owned and taught at a studio nearby. She said her sessions were difficult, not for the rigour or strength required, but solely for the stabilization. During college she took a break from pilates, having moved across the country, and upon graduating in May of 2017 found her way back to pilates. This time, however, not for the support her back seemed to need rather for the numerous other benefits she understood it to have. As I began teaching the client I noticed her thoracic spine was hypermobile and lacked stability. The conditioning program outlined below is designed for a client who is very active, strong and flexible yet lacks stabilization. I had to focus on having her find stability as well as flexion in her spine to counter the wide range of extension she has. The ultimate goal of our sessions was to find a complete and total well being. Conditioning Program Warm Up: Mat Roll Down Pelvic Curl Spine Twist Supine Double Leg Stretch Single Leg Stretch Criss Cross Footwork: Wunda Chair Parallel Heels Parallel Toes V position Toes Open V heels Open V toes Calf Raises Single Leg Heel Single Leg Toes Abdominal work: Reformer Abdominals Legs in Straps Series: 6

7 Double Leg Double Leg with Rotation Hip Work: Reformer Supine Leg Series: Frogs Circles Down Circles Up Openings Spinal Articulation: Reformer Bottom Lift Bottom Lift with Extension Stretches: Reformer Standing Lunge Full Body Integration Fundamental/Intermediate: Reformer Scooter Reverse Knee Stretch Arm Work: Wunda Chair Shrugs Triceps Press Sit Side Kneeling Arm Full Body Integration Advanced/Master: N/A Leg Work: Wunda Chair Front Front Lateral Flexion/ Rotation: Reformer Side Over on Box Back Extension: Cadillac Prone 1 Prone 2 7

8 Goals/Focus The goals of the conditioning program include: Increasing stability Ameliorating imbalances Building strength Warm Up Observing the Roll Down from all sides is a very simple but great tool in assessing posture and alignment. I always began my sessions with the client with three roll downs, so I could assess her body for that given day and so she had a ritual to begin our sessions, warming up the spine. The pelvic curl targets the exact muscles I wanted to focus my session on, the spinal flexors (rectus abdominis, the external oblique and internal oblique). This of course uses many more muscles to execute, all of which create a movement of sequentially articulating the pelvis and spine. The intermediate BASI warm up includes the Double Leg Stretch, Single Leg Stretch and the Criss Cross all targeting the spinal flexors and rotators in the Criss Cross. I chose to use this series with my client because she is strong enough to execute it, and it is a great challenge for her to maintain the constant spinal flexion throughout the series. The focus on stability and emphasis on the abdominals is a great way to warm up my client. Footwork Using the footwork series on the Wunda Chair gives my client the challenge of keeping a neutral pelvis and neutral spine without the assistance of the carriage on the reformer or mat of the cadillac. This tested her mind body connection to keep herself from sticking her ribcage out and going into her hypermobility. Cueing the idea of a flat back helped her find her positioning. Although, of course, the cue is not intended literally because I wanted to still see her natural curves of her spine, it helped align her chin, neck, shoulders, ribcage and pelvis. The contraction of the abdominals and spinal extensors simultaneously help create the desired alignment I was looking to get. Since most of the program is set to focus on encouraging flexion of the spine, the footwork on the Wunda Chair is great to encourage the core muscles to contract to result in maintenance of a neutral spine. This training aids in creating a stable spine for everyday movements. Abdominal Work Once again focus on the spinal flexors was my priority of my sessions with the client. However, just focusing on strengthening the abdominals to help fix the back is not ideal. I had to work the client to help her mind and body learn to engage the abdominals, through strengthening, to transfer the information and skill to other exercises and her everyday life which is full of activities needing this support. Using the Abdominals Legs in Straps Series gave my client another set of movements to work her spine in flexion to provide a balance and complement to her hyperextension. Often my client had the tendency of sticking her chin out, so using the cue of 8

9 bringing the weight of the head into the palms of her hands helped lengthen the neck as well as cueing the chin to the chest to put a greater emphasis on the abdominals versus straining and stressing the neck. Hip Work I used the Reformer for hip work to allow my client to work on pelvic lumbar stabilization. I also chose to use the fundamental series to complement a lot of the intermediate work that has been done previously in the session. In a session I want my client to feel challenged and stimulated, but not frustrated and discouraged, so incorporating fundamental exercises is a great way to plan my session of the intermediate/advanced client. To achieve the desired long line that I was looking for in her legs, I cued her to reach her limbs outward. Spinal Articulation Choosing to do spinal articulation on the Reformer pulled my client s focus back to her mind body connection of feeling her placement and alignment while executing movement. In the beginning sessions, she would begin the Bottom Lift and I would have to remind her about her flaring ribs. She was easily able to always knit them together, but relied on my constant reminding. After a few sessions however, she would still go into her hypermobility and splay the rib cage through habit and sometimes tiredness, though now she fixes it without my persistent nudging. Nearing our tenth session or so, she was executing the movement properly without a problem, a tendency to splay the ribs still present, however she was more aware and proactive in self correcting. Stretches The standing lunge is a great stretch for the hip flexors and hamstrings. The setup of stretches is extremely important to allow the maximum stretch of the exercise. My client had difficulty keeping her hips squared, but a simple adjustment helped. However, because of her extreme range of flexibility, it was less of a stretch for her in the correct alignment, though she was able to find stability in her pelvis this way and then go deeper slowly into the stretch to feel it more aiming to keep the hips square. Full Body Integration (F/I) Both the Scooter and Reverse Knee Stretch are great full body exercises that require a consistent C curve throughout. In the Scooter the body has to maintain a rounded position of the spine all while feeling the freedom of the leg that is moving and dissociating that movement from the rest of the body. The Reverse Knee Stretch required my client to maintain shoulder stability during the entirety of the exercise, avoiding sinking into her hyperextension; dipping into the thoracic. Using the abdominals to establish a stable spine and pushing away from her hands on the rails, she was able to find more shoulder stability. A light touch of my hand on her thoracic reminded her to keep the curve of her spine. 9

10 Arm Work I chose to use the Wunda Chair for arm work because it requires trunk stabilization. These three exercises also have different objectives, targeting different muscle groups. Shrugs specifically was great for my client to work on her scapulae depressor strength while avoiding giving into her hypermobility and sticking out the ribcage. Triceps Press Sit adds onto the shrugs with requiring the triceps to work and also the scapula now to stabilize. The scapulae now maintain depression while the movement occurs just at the elbow. Then finally moving onto Side Kneeling Arm to finish up our exercises for the arm work block intensifies the control needed from the body adding the obliques into the equation. Overall my client is strong in her arms, but the support of her trunk was challenged with this set of exercises. Leg Work Front Front target s the external rotator strength, quadricep strength and trunk stabilization. The legs move in a pumping action targeting the quadriceps. This exercise tested my client s stability and not to drop into her hypermobility. Instead, I encouraged her to reach her thoracic up towards my hand that I placed on the upper spine. This lifting up into my hand pulled her out of her hyperextension and it become stronger and more stable. Lateral Flexion/ Rotation Side Over on Box is a great lateral flexion exercise. It worked to strengthen my client s abdominals with a specific focus on her obliques. It was necessary for her to maintain a co-contraction of her abdominals and back extensors during the exercise. The movement occurs in the spine creating a nice big arch. This exercise was very challenging and effective for my client. Cueing, staying in between two panes of glass, aims to teach my client to pull her ribcage in and stay broad through the back and shoulders with the elbows wide. Back Extension I chose Prone 1 for my client to work on her back extension as it establishes the back work for many more advanced back work exercises. The spine gets to find articulation during this exercise while the arms support the movement. The back extensors work to lift the back into the arch. I chose this exercise because it is a simple exercise where my client could focus solely on the elements required to maintain the stabilization in her thoracic while going into extension. Adding Prone 2 to the program gave my client an intense stretch of her shoulders while still focusing on strengthening her back extensors with the stabilization coming from her abdominal control. 10

11 Conclusion My client s unstable/hypermobile spine needed a program that directed her movements consciously with quality and precision as the focus in order to build new body mind patterning. She needed to find her own proper alignment in movement through exercises that allowed her to scan her body in different and various positions and sensations. With my help of cueing and a tactile hands on approach she was able to find support and stability as opposed to collapsing into her excessive range of movement. Being mindful of the difference is crucial in change. I created a program that had a goal. It included exercises as a tool for evaluation to therefore identify imbalances and weaknesses. I addressed all muscle groups as well as different functions of the muscle groups and various types of muscle contractions. Through this Pilates program of functional movement, the importance and stress was on maintaining integrity of body alignment while performing the given movement. The proper technique of the movement was refined and practiced during our time together. This program for a client with an unstable and hypermobile spine should subsequently help the correction of imbalances and avoid the reinforcement of current imbalances. The mind and body work together in harmony, and when you find this harmony your body is in a total well being. 11

12 Bibliography Yezak, Mark. Thoracic Spine Anatomy and Upper Back Pain. SPINE-health, 3 Apr. 2018, Isacowitz, Rael, and Karen S. Clippinger. Pilates Anatomy. Human Kinetics, Isacowitz, Rael. Study Guide: Comprehensive Course. Body Arts and Science International, Goldman, Sharon. How to Handle the Hypermobile Client. IDEA Health and Fitness Association, 24 Dec. 2011, 12