Using pilates to strengthen and stabilise a winging scapula

Transcription

1 Using pilates to strengthen and stabilise a winging scapula Lauren Brayshaw January /2018 Pilates Clinic UK

2 Abstract Throughout my journey of practicing and teaching pilates, I have developed a special interest in the muscles involved in the stabilisation of the scapula. These relatively small, often forgotten muscles, when underused or allowed to become imbalanced, can lead to compromised posture, alignment and the individual s overall sense of wellbeing. This paper will first investigate the causes and implications of poor scapula stabilisation, in particular a condition known as winging scapula. Winging scapula occurs when the muscles of the scapula are too weak (or in extreme cases paralyzed) resulting in an impaired ability to stabilise the scapula. As a result, the medial border of the scapula protrudes and forms an image of wings on the back. Following an anatomical review, the paper will then seek to address this condition and improve scapula stabilisation through a conditioning programme based on the BASI comprehensive block system. 2

3 Table of contents I Title page 1 II Abstract 2 III Contents page 3 IV Anatomy of the scapula 4 V Case study 6 VI Conditioning programme 7 VII Conclusion 9 VIII Bibliography 10 3

4 Anatomy of the scapula Although a complex region with numerous superficial and deep muscles involved in movement, for the purposes of this paper the following key muscles of the scapula will be reviewed: (1) Serratus anterior: a fan-shaped muscle at the lateral wall of the thorax. Its main part lies deep under the scapula and the pectoral muscles. (2) (3) Rhomboids and levator scapulae: a group of muscles which keep the scapula pressed against thoracic wall and retract the scapula toward the vertebral column. (4) Trapezii: extends lengthways from the occipital bone to the lower thoracic vertebrae of the spine and laterally to the spine of the scapula. The trapezii are involved in both scapula elevation (upper trapezius) and scapula depression (lower trapezius). Movements of the scapula: There are numerous muscles involved in the various movements of the scapula. Below the major primary and secondary muscles are identified. 4

5 Scapula destabilisation A number of activities and injuries cause a winged and unstable scapula to manifest. Most commonly, symptoms arise due to a lack of recruitment of the scapula stabilisers - that is the muscles described above - alongside activities that overly strengthen the chest muscles to the detriment of these vital back muscles. As the pectoralis tighten and/or shorten, this can further impede the ability of the stabilisers to operate normal functioning and result in scapula winging. One of the most common culprits of weakness is the serratus anterior. Weakness in the serratus anterior often presents itself in a client having excessive elevation of the scapula while raising the arms - leading to vulnerability and muscle strains in the region. Equally, those in sedentary desk based jobs may find themselves suffering neck and back pain and discomfort due to weakness in other stabilising muscles from poor posture or not putting the shoulder through a full range of motion on a day to day basis. Separately to muscle weakness, scapula winging can occur as the result of nerve or muscle damage to those supporting and supplying the scapula and its motion. Weakness in the serratus anterior can sometimes occur due to damage to the long thoracic nerve that supplies the serratus anterior muscle. If a client demonstrates severe scapula winging, or has been involved in an injury or trauma, they must be appropriately assessed by a medical practitioner prior to embarking on any pilates conditioning programme. 5

6 Case Study Name: Lauren Brayshaw Age: 30 I am a 30 year old marketing professional, and spend the majority of my day sitting at a desk and performing computer based tasks. I have always been active, and spent much of my childhood and teenage years horse-riding. From the age of 15 I have suffered neck and shoulder tension, fluctuating in severity, and often resulting in strained muscles around the neck and scapula and considerable discomfort. In addition, I have a lack of mobility in the cervical and thoracic spine and have been diagnosed by a physiotherapist as having moderate winging of the scapula. I have practiced pilates on and off since diagnosis, but prior to studying the BASI method I have often struggled to properly focus on developing scapula stabilisation and engaging the correct muscles. Instead I have progressed through the movements with poor form. As such, the recommended series of exercises based on the BASI comprehensive block system will aim to: (1) mobilise and strengthen the thoracic spine, enabling greater recruitment of the scapula stabilisers to control correct movement (2) strengthen the key stabilising muscles to better support the movements of the scapula in all ranges of motion and reduce pain and discomfort in the neck and shoulder region and (3) aid cocontraction of the abdominal and back extensors to provide greater support to the trunk region. While this programme incorporates all ten BASI principles of pilates, concentration, control and precision will be paramount in ensuring the recruitment and correct execution of the movements throughout the conditioning plan. 6

7 Conditioning plan I will work with a fellow BASI pilates instructor (or trainee) to ensure that the goal and focus of each exercise is achieved and to externally assess my movement. Block Equipment Exercise Goal / Focus Body scan Mat Standing roll down To begin warming up the back, encourage flexion in the thoracic spine. Identify areas of tightness or imbalance - correct pelvic position if required Warm up Mat Pelvic curl, chest-lift, chest-lift with rotation, spine twist supine, roll up Footwork Wunda-chair Footwork series; parallel heels/toes, V position toes, open V heels/toes, calf raises, single leg heel/toes Abdominal Work Reformer Hundred prep, coordination Hip Work Reformer Hip series; frog, downcircles, up-circles, openings Wake up body and warm up abs. Ensure that rotation in chest lift is coming from thoracic spine. Focus on keeping scapula in correct neutral position. Ensure co-contraction of back extensors and abdominals before initiating movement - sitting position was chosen above supine to encourage postural stabilisation. Ensure scapula does not hike during movements. Actively challenge scapula in varying arm positions throughout series. Encourage arm movement initiation from beneath arm to ensure latissimus dorsi engagement. Ensure pelvic stability and neutral spine. Hundred to be included once abdominals strengthen. Focus on hip adductors and knee extensors as well as hip dissociation throughout. Scapula to stay strong and serratus anterior lightly engaged when stabilising pelvis. Spinal Articulation Cadillac Tower prep / tower Focus on maintaining scapula stability throughout articulation of spine, particularly thoracic. Ensure weight is taken across shoulder girdle and not cervical spine. Progress to tower once form is correct in tower prep. Stretches Reformer Full lunge Keep chest lifted and open and scapula down and wide. Bias towards posterior pelvic tilt in hip flexor phase and anterior pelvic tilt in hamstring phase. 7

8 Full Body Integration (F/I) Cadillac Push through series; sitting forward, side reach Both exercises focus on movement (flexion in sitting forward, rotation in side reach) from thoracic spine. Keep back extensors engaged and head aligned. Focus on using serratus anterior to keep scapula in correct position. Arm Work Reformer Arms sitting series; chest expansion, biceps, rhomboids, hug-a-tree, salute Use seated position to ensure cocontraction of back extensors and abdominals. Focus on small movements in short sets, resetting regularly. Think about keeping scapula wide and do not allow excessive elevation. In rhomboids, begin with simple retraction of arms before adding adduction/abduction to movement. In hug-a-tree, try to lengthen through arms to greater engage the serratus anterior. Arm Work (additional) Full Body Integration (A/M) Wunda-chair Shrugs Include in addition to above to develop strength of mid and lower trapezius to effectively depress scapula. Reformer Balance control front Bias towards posterior tilt to ensure abdominal engagement, begin with small arm movements and pressing away from shoulder posts to encourage engagement of scapula stabilisers. Ensure shoulder flexion and extension is recruited through serratus anterior not trapezii as these tend to take over. Leg Work Wunda-chair Leg press standing Hip extensor and knee extensor control, hamstring strengthener. Focus on balance throughout. Lateral Flexion / Rotation Cadillac Side lift Maintain deep abdominal engagement throughout - ensure top arm does not allow scapula to lift as trunk rises into lateral flexion. Back Extension Reformer Breaststroke prep Engage thoracic extensors as arms press away - do not allow head and neck to lead movement. Keep scapula wide and depressed, ensure active engagement as arms return to start position. 8

9 Conclusion In summary, this paper aimed to address my own experiences of poor scapula stabilisation and moderate winging of the scapula since an early age. As we have found, scapula stabilisation requires a high degree of focus and commitment to a pilates conditioning programme in order to see results and reduce associated symptoms and discomfort. I am pleased that having followed the programme for the past eight weeks, I have noticed significant improvements in the following areas: 1. Improvement in the recruitment of scapula stabilisers throughout the exercises within the conditioning plan above, as well as within other student practice time 2. Improved postural alignment and thoracic mobility - I have noticed through the strengthening of my back extensors I find myself sitting more comfortably in an upright position day-to-day. 3. A small but noticeable improvement in mobility of my thoracic region has also contributed to reducing shoulder and neck pain brought on by the slight kyphotic posture I initially presented. Pilates, and the BASI block system in particular, has greatly contributed to helping me develop more balance across my practice and day-to-day life. I very much look forward to continuing my development and learning, in both body and mind, on my journey with BASI. 9

10 Bibliography Cummings, Benjamin: Muscles of the Head, Trunk and Shoulder, Pearson Education Inc 2008 Isacowitz, Rael and Clippinger, Karen: Pilates Anatomy, Human Kinetics 2011 Wong, Mark: How to Fix a Winged Scapula, Posture Direct, April Shoulder 101, Osteopathy Singapore, May