BASI PILATES IMPACT OF PILATES EXERCISE IN MULTIPLE SCLEROSIS

Transcription

1 BASI PILATES IMPACT OF PILATES EXERCISE IN MULTIPLE SCLEROSIS ILKA VON WITZENDORFF SUBMITTED: OCTOBER 31ST 2018 COURSE: FEBRUARY -JUNE 2017 STUDIO: BEACH PILATES TORONTO, CANADA

2 TABLE OF CONTENT TABLE OF CONTENT PAGE 1 ABSTRACT PAGE 2 ANATOMICAL DESCRIPTION PAGE 4 CASE STUDY PAGE 9 EXERCISE SELECTION PAGE 10 BASI BLOCK PROGRAMM PAGE 11 CONCLUSION PAGE 14 BIBLIOGRAPHY PAGE 15 PAGE 1

3 ABSTRACT There are 2.5 million people worldwide suffering from Multiple Sclerosis (MS) today. The majority is to be found in Europe (around 500,000) and in North America (around 400,000). So, it is obvious that there is a correlation between the number of ill people and living in industrialized countries. Canada has one of the highest rates of MS in the world. An estimated 1 in every 385 Canadians must live with the disease. While it is most often diagnosed at young adults aged 15 40, younger children and older adults are nowadays are more and more affected as well. Multiple Sclerosis is currently classified as an autoimmune disease of the central nervous system (CNS -brain, spinal cord). The disease attacks myelin, the protective covering of the nerves, causing inflammation and often damaging the myelin. Myelin is necessary for the transmission of nerve impulses through nerve fibres. If damage to myelin is slight, nerve impulses travel with minor interruptions. However, if damage is substantial and if scar tissue replaces the myelin, nerve impulses may be completely disrupted and the nerve fibres themselves can be damaged irreparable. MS is unpredictable, shows different symptoms and causes various restrictions in people. That is the reason why this disease is also called the disease with many different faces. Depending upon where it develops to within the CNS, it can manifest into various neurological and neuropsychological parts of the body and can cause different symptoms. The frequency and duration of symptoms vary and may include: Extreme fatigue Poor muscle coordination Weakness and tingling PAGE 2

4 Motor control Impaired sensation Vision problems Incontinence Cognitive impairment Sexual problems Depression/emotional changes There are 4 types of MS. They are named accordingly to the way the disease acts on the body over time 1. The 4 types of MS: Relapsing-Remitting (RRMS). This is the most common form of multiple sclerosis. About 85% of people with MS are initially diagnosed with RRMS. People with this form of MS have temporary periods called relapses, flare-ups or exacerbations when new symptoms appear. Secondary-Progressive MS (SPMS). Symptoms worsen more steadily over time, with or without the occurrence of relapses and remissions. Primary-Progressive MS (PPMS). Symptoms worsen from the beginning, with no relapse or remissions. Progressive-Relapsing MS (PRMS). A rare form of MS. It is characterized by steadily worsening disease state from the beginning, with acute relapses but no remissions, with or without recovery. 1 Hooper, K. Managing Progressive MS. New York, NY; National Multiple Sclerosis Society; 2011 PAGE 3

5 MS is a disease that cannot be healed but some treatments help to ease the symptoms of MS, while others control MS itself. It is believed that the addition of a healthy life style including special diets, complementary and alternative medicines and moderate physical activity can help to enhance and improve the quality of life of the affected individuals. This is where Pilates can assist and may even play a major role. As MS affects people in different ways, there is no one and only Pilates exercise that can be considered a specific MS exercise or workout, however there are recommendations from the MS societies worldwide that include: Core exercises ening exercises Posture exercises Range-of-motion and mobility exercises Stretching exercises Balance exercises An exercise program for someone with MS needs to be appropriate to the capabilities and limitations of the individual. Age, overall physical constitution prior to having MS and the type of MS are relevant. Above that, the program may need to be adjusted as MS symptoms change over time 2 : ANATOMICAL DESCRIPTION For this case study, the client requires a full body exercise program with emphasis on the core. The National Academy of Sports Medicine (NASM, USA) defines the core as: 2 National Multiple Sclerosis Society. Exercise. PAGE 4

6 The Cervical Spine, the thoracic spine and the lumbo-pelvic-hip complex. There are 29 muscles that have attachments within this area. The main muscles that are involved in the core movement are: Hip adductors Gluteus Medius Gluteus Minimus Gluteus Maximus Erector Spinae Rectus Abdominis Hamstring Piriformis Hip Flexors Transverse Abdominals Internal Oblique External Oblique Multifidus Pelvic floor Essentially the core consists of everything within the center of gravity and where all body movements begin. Therefore, core exercises strengthen the hips, back and muscles in the midsection of the body. The goal is an overall improvement of the use of the deeper abdominal muscles as well as the lower limb muscles and joints. Besides the fundamental core training, the purpose of this study is to determine the effect of Pilates on the walking performance. The client therefore needs a program that will focus on strength, control, flexibility, mobility and movement in general. PAGE 5

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10 CASE STUDY My clients name is Anke. She is a 55 years old female, married and has no children. She has been diagnosed and came public with Primary Progressive MS (PPMS) at the age of 50 but has lived with the disease for at least 10 years. Progressive is the word to be used to describe the change towards more disability in MS and although Anke s disability increases the rate at which this happens varies. Her symptoms were minor in the beginning but since approx. four years her general well-being including her mobility is slowly but constantly declining. Today she has multiple problems related to her disease: she remains weak and numb on the right side of her lower limb making walking very difficult. She has impaired urinary bladder functions and persistent balance problems with some sensation of lack of control. Also, extreme fatigue is determining her daily life. In her day to day life she works full time and tries to stay as active as possible. The client has been recommended to undertake weekly physical training including Pilates exercises to assist with muscle strengthening, joint mobility, stretching, coordination and correct muscle activation with the focus of her lower limbs. She needs support to walk, most of the times she takes a scooter to move around. She can also walk slowly with the use of crutches. The following symptoms and problems have been identified in this case study: 1. Weak core muscles such as rectus abdominis, transverse abdominals, internal and external 0blique, pelvic floor, multifidus, erector spinae (sacrospinalis), longissimus thoracis and the diaphragm. The client complains about instability and imbalance especially during walking. She has problems with muscle weakness and co-ordination. 2. Motor control symptoms in the left lower limb. General dysfunctionality of her right leg and hip PAGE 9

11 What can and needs to be done? ening the core muscles in general but also in particular the pelvic floor and transverse abdominals to gain more bladder control and strength. ening all main muscles groups with the focus on lower limbs to improve overall mobility. Practicing and improving the coordination of movements and the mind-body connection. Exercising breathing to work the diaphragm. Increasing flexibility through regular stretching exercises. EXERCISE SELECTION: To meet the client s needs the exercises should be a challenge but never a struggle and it is put into consideration that there are good days and bad days relating to the unpredictable disease runs of MS. Therefore, the whole program has been designed to address the client s goals, namely to overcome the limitations in mobility and to take into consideration the need to adapt and assist wherever the unpredictable development of MS symptoms makes it necessary. The program is following along the Principles of Pilates and the BASI Block system promoting a full body work-out with the goals of improving muscle strength, increasing mobility and flexibility and achieving an overall feeling of well-being and satisfaction. Hip Work: Single Leg Work is included in this program although most of the times it could not be practiced due to Anke s physical limitations. Furthermore, it was necessary on certain days to reduce resistance and even skip exercises to complete the program. In general, the resistance needs to be light. PAGE 10

12 BASI BLOCK PROGRAM Block Exercise Muscle Focus Warm-up Mat (Beginner) Foot Work - Pelvic Curl - Spine Twist Supine - Chest lift - Chest lift with rotation Abdominals Hamstring Obliques Objectives Warm up - Pelvic stability - Abdominals strength - Spinal Rotation Warm up Adaption/Assist Small ball is placed between knees as Anke has difficulties with holding legs in a stabilised position during movement. The ball allows her to grip her knees against it to maintain hip distance during both Pelvic curl & chest lift exercises. Abdominal Work Hip Work Parallel Heels Parallel Toes V Position Heels V Position Toes Open V Position Heels Open V Position Toes Calf Raises Prances Prehensile Single Leg Heel Single Leg Toe Hamstrings Quadriceps Ankle Plantar Flexors Hamstring Quadriceps - Hip Extensor - Knee Extensor - Plantar Flexor - Hip Extensor - Knee Extensor - Ankle Plantar Hundred Prep Abdominals - Abdomnial - Shoulder extensor control Small ball is placed between knees for stability. Anke sometimes needs to use her hands as an assist for keeping the position especially during Open V Position and Single Leg exercises. Anke needs to put down her feet on foot rest since she is sometimes not able to keep both legs in table top position during the whole exercise PAGE 11

13 Frog Circles (Down/Up) Openings Hip Adductors Hamstring - Hip Adductor - Knee Extensor Control - Pelvic Lumbar Stability Anke needs to place the straps over her knees instead of on her feet. She is then able to complete the exercises because of a better leg support. Spinal Articulation* Stretches Bottom lift Bottom lift with extension* *first set of this exercise was introduced after the 10 th session Abdominals Hamstrings - Spinal Articulation - Hip extensor control Anke needs to lower her legs on the foot rest like it is done on the mat (Pelvic Curl). A small ball assists during the exercise Full Body Integration I* Arm Work Kneeling Lunge Knee Stretch Series Scooter Round Back Flat Back Arms Supine Series: Extension Adduction Hip Flexors Hamstring - Hip Flexor - Hamstring Abdominals - Trunk and shoulder stabilization - Hip and Knee extensor control/strength Latissimus Dorsi - Scapular Stability Resistance differs from left to right leg. Adjustment needs to be done due to the weakness of the right leg (Hamstring) During Scooter Anke has problems to maintain pelvic lumbar stabilization therefore the movement becomes on her weak side smaller with no or low resistance One and sometimes both legs need a rest on the foot rest during the exercise PAGE 12

14 Up Circles Down Circles Triceps Triceps - Shoulder Adductor - Shoulder Mobility - Shoulder Extensor to concentrate on arm work. Leg Work Lateral Flexion and Rotation Back Extension Single Leg Skating Mat Side Lifts Breaststroke Prep Gluteus Medius Abdominal Obliques Back extensors - Hip Abductor - Pelvic Lumbar Stability - Knee extensor strength - Lateral Flexion - Trunk Stability - Back Extensor - Elbow Extensor Few repetitions and more rests in between are necessary. She holds gently onto me as a supported to further assist her to keep balance during the exercise * Spinal Articulation and Full Body Integration I has only been introduced to the Workout plan after session 10 PAGE 13

15 CONCLUSION In this controlled study with my client Anke the effects of Pilates on body control, balance and muscle strength were investigated. The effects of Anke s MS symptoms are obvious and the disease influences, inhibits and interferes with her daily life. The most profound aspect of the disease is her increasing immobility which hinders her from being as active as she would like to be. With no known cure so far, her aspiration is to maintain and even improve constantly her mobility, flexibility and general fitness. Through the BASI Program Anke was able to gain a mind-body awareness which helped her to feel better insight out. She was able to improve her joint mobility and posture and through special core exercises she even felt more stable and stronger. She has been working constantly and diligently over a period of 16 weeks strengthening, stretching her body not only to improve her required area of the lower limbs, but also getting a full body workout, creating a sense of accomplishment. Especially the work with the reformer has helped Anke to strengthen und elongate her spine because adjustments of the tension to the exact level of challenge is possible. Anke has learnt through the BASI Block System to confront her challenges and overcome certain weaknesses and fears that had been manifested in her brain. She gained more and more confidence in what she can do and noticed tremendous improvements in her posture and alignment. Love your body, know your limitations, push to learn and have gratitude for your personal commitment to fitness. PAGE 14

16 BIBLIOGRAPHY: Books Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California, USA: Body Arts and Science International, Isacowitz, Rael. Movement Analysis Workbook. Costa Mesa, California, USA: Body Arts and Science International, Isacowitz, Rael. Mat Movement Analysis Workbook. Costa Mesa, California, USA: Body Arts and Science International, Hooper, K. Managing Progressive MS. New York, NY; National Multiple Sclerosis Society; 2011 Isacowitz, Rael., Karen Clippinger: Pilates Anatomy, 2011 Blandine Calais-Germain, Anatomy of Movement, Seattle, WA 2014 Websites What is MS?, Diagnosis, Exercise for MS symptoms, What is primary-progressive MS, Epidemiology of MS, Working with MS on the Pilates, by Mary Kay Hausladen, PT, GCFP, Cruz-Ferreira A, Fernandes J, Larjano L, et al : A systematic review of the effects of pilates method of exercise in healthy people. Arch Phys Med Rehabil, 2011, 92: , PAGE 15

17 Facts about MS, PAGE 16