Improving Daily Life for Scoliosis With Pilates

Transcription

1 Improving Daily Life for Scoliosis With Pilates Maranda Zimmerman 3/3/ Chicago, IL

2 Abstact Scoliosis is the abnormal curvature of the spine. The severity of this can vary from person to person, but the effects can sometimes be quite painful. For some people, the pain can hinder daily living. Back, hip, and neck pain are just a few of the issues experienced. With its strong focus on abdominal strength and postural balance, Pilates can be a huge resource for people with scoliosis. The purpose of this paper is to look the effects of applying the BASI Block System to a male client, Matt, in his mid-thirties who suffers from pain and tightness due to his scoliosis. Matt started out only coming in once a week for an hour session. After experiencing some relief, he increased to coming in twice a week. Each week, he is making new connections in his body and is able to apply what he learns to improve his daily living.

3 TABLE OF CONTENTS: Title page. Page 1 Abstract....Page 2 Table of Contents... Page 3 Anatomical Description..Page 4 Case Study/Exercise Program.Page 5 Bibliography..Page 12

4 Anatomical Description The spine is made up 33 vertebrae, which are divided into five regions: cervical, thoracic, lumbar, sacral, and coccyx. The cervical and lumbar regions curve towards the front of the body, while the other three regions curve towards the back of the body. When looking at the spine from the back, it should run straight up and down in the middle of the back. Scoliosis involves one or more lateral curvature(s) of the spine, primarily in the coronal plane. However, it also usually involves rotation of the involved vertebrae, (Study Guide: Comprehensive Course, p 44). Scoliosis can be described as a C-shaped or S- shaped curve.

5 Each case of scoliosis varies from person to person. The different curvatures can have different effects on the body. If it is left untreated, these curvatures can lead to; changes in walking, reduced range of motion, trouble breathing, cardiovascular problems, and pain (spine-health.com). With such a strong focus on postural balance and abdominal strength, Pilates can be a great resource to improve these conditions of scoliosis. When I first started working with Matt, he had already been doing Pilates once a week for a couple of months. He is in his mid-thirties and was suffering with low back pain and lack of range of motion on his left side, especially in his shoulder. He also complained of right hip pain and occasional neck pain. He didn t have much body awareness and he has S-curved scoliosis: right thoracic curve and left lumbar curve. He also seams to have some slight rotation of the ribs to the right. His sessions will focus on discovering his imbalances, abdominal strengthening, increasing mobility, and increasing his postural awareness. My first session with Matt, I had him begin with a roll-down. This was a great tool for me to assess his alignment and to take note of any tightness or imbalances. Next I had him lay in a supine position with his knees bent and feet hip-width apart. I wanted to emphasize breathing early in his sessions because he held a lot of tension in his back, causing his ribs to push forward. His ribs where almost stuck in that position so it was difficult to get his ribs to relax into a neutral position. Thus, making it difficulty to find a neutral pelvis. We started with thinking of filling the back of his lungs, especially his right, and then as he exhaled, letting his ribs soften towards his midline and his back to release. Once

6 he was feeling the connection into his abdominals, we began his warm up. For the first 5 sessions, we began with small pelvic curls. I limited the range of motion in the beginning because it was difficult to connect into the back of his legs and he wanted to lift from his back. Pelvic curls proved to be a key in his sessions, because it helped increase his connection and awareness of his abdominals and mobility in his spine. We would then move to leg lifts and leg changes. This is where his pelvic-lumbar instability was obvious. His biggest challenge was disassociating his legs from the pelvis and his right hip loved to hike up into his side. I had him think back to directing his breathing into his right lung to help expand that side of his body and to relax his ribs and this instantly help him connect better. We would then move onto the supine spine twist. He struggled staying connected in his abdominals and kept feeling his back extensor overwork, so we added the assist of a swiss ball under his calves. This gave him enough support the he could maintain abdominal control so he could work on his pelvic-lumbar stability. Next was chest lift and chest lift with rotation. This was great to help Matt continue to work on finding his neutral pelvis and making sure his ribs did not flare (staying connected into the abdominals) as he lowered his spine down. Since Matt had previously been practicing Pilates before working with me, I started to add intermediate level exercises to his program after his 5 th session. I included the roll up with the roll up bar on the cadillac at the beginning of the warm up and the roll up top loaded at the end of the warm up. Both of these continued to help work on spinal mobility and abdominal strength/control.

7 For his first 5 sessions with me, we did footwork on the reformer. This was to allow him to focus on his breathing, connecting into his core, develop pelvic-lumbar stability, and to work on connecting into hip and knee extensors. We would work through parallel heels, parallel toes, calf raises, v-position toes, open v-position heels, and single leg heels. We focused more on the heels because it was easier from him to connect into his hamstrings and allowed his back extensors to release. After his 5 th session, we moved footwork to the wunda chair. This put Matt in an upright position and allowed him to begin focusing on his trunk and pelvic stability in a more challenging way. Placing him in front of a mirror allowed him to see if one side of his body was more collapsed and helped him work on lengthening his spine. For abdominal work within the first 5 sessions, we work on the hundred prep on the mat and the reformer. Matt would typically jut his head forward and didn t have much flexion in his thoracic spine. His left rib also flared out more than the right (right side was shortened). We made sure he could achieve the chest flexion without straining his neck on the mat before attempting it on the reformer. I also gave Matt he imagery of connecting the bottom front of his ribs to his pubic bone, especially his left side. This helped him work on his imbalances in his core. We also did a modified hundred on the mat. We kept his knees bent to tabletop so he could maintain abdominal control. We also gradually added the reach and overhead stretch on the step barrel to have an added shoulder stretch. Once strength and awareness was gained, the hundred was progressed to the reformer.

8 For hip work, we started with basic leg springs on the cadillac. The frog, circles, bicycle, and walking were all great challenges for Matt s pelvic stability. This also allowed him to continue to work on his hip disassociation and connection into his abdominals and hamstrings. After about 5 sessions we took the hip work to the reformer to challenge the pelvic-lumbar stability in a different manner. After about the 10 th session, we incorporated the single leg supine series on the cadillac. This really helped challenge Matt unilaterally and emphasized his pelvic stability. We did not incorporated spinal articulation until after the 5 th sessions. Once Matt was connecting better into his hamstrings in his pelvic curl and was keeping his hips level, we incorporated the bottom lift on the reformer. This has proven to be one of the most beneficial exercises for Matt. He struggled with wanting to initiate the movement from his back. Him just being aware of this was an accomplishment. Once he was able to do the bottom lift without straining his back, we added the bottom lift with extension. After his 10 th session, we added the shoulder bridge prep and shoulder bridge to Matt s sessions. We began the shoulder bridge prep with his feet elevated on an arc. This was to allow him to keep his hips slightly lower so he would not pull into his back extensors. This gave him the opportunity to work on his symmetry without compensating to do so. Once his pelvis was stable in the shoulder bridge prep, we advanced to the shoulder bridge. Stretching is a key part of Matt s sessions. We would begin with hip stretches. We would do the hamstrings, hip flexors, gluteals, and adductor

9 stretches on the ladder barrel. We would really focus on his right hip, since it would tend to be the tighter side. Matt would also be able to focus on the placement of his pelvis in these stretches. Next we would do shoulder stretch 1 and 2 on the ladder barrel as well. Matt was use to compensating his shoulder mobility with his back. So we really focused on the position of his spine in th shoulder stretchs. We advanced these stretches after about 5 sessions to the standing lunge hamstring stretch on the reformer and the overhead stretch with the pole. For full body integration I, the scooter was a great exercise to incorporate after about 5 sessions. This challenged his hip disassociation unilaterally. It also challenged the length through the sides of his body, since he tended to shorten his right side. This progressed well to the round and flat back knee stretch series. He would always draw his focus to his rib placement and pelvic stability. Within his first 5 sessions, we started his arm work with the supine arm series. This helped him to work about scapular stabilization while continuing to improve his core stabilization. We progressed this to the arms sitting series, modifying with him sitting on a block. This helped him develop trunk and scapular stabilization. We had a strong focus on the back of the shoulders, trying to help open his chest. Once he felt strong enough, we progressed this to the arms standing series at the cadillac.

10 For full body integration II, we gradually progressed in the up stretch series. We started incorporating up stretch 1 and long stretch around the 10 th session, when Matt was gaining mobility in his hamstrings and stability in his shoulders to achieve both exercise. After about the 20 th session, we progressed to up stretch 2 and up stretch 3. For leg work, we began with gluteals side lying series. While strengthening his gluteus medius, Matt was able to work on his pelvic-lumbar stability. We progressed this after the 5 th session to the single leg skating. We also incorporated the leg series on the step barrel to work on his hip mobility and control. Lateral flexion and rotation began with the side stretch on the wunda chair. This was a great place to keep working on directing his breath the help expand his lungs (especially his right lung) and to connect into his obliques. With increased hip mobility, we progressed to the mermaid after out 5 th session. For back extension, we started with back extension on the mat for our first session to make sure he was maintaining abdominal support. During our second session, we worked on the swan basic on the wunda chair. After the 5 th session, we moved on to single arm back extension on the chair. This really helped work on the imbalances he had in his back extensors and challenged him to keep his abdominal support. We then end each session with a roll down to check back in with his body and to see how he feels. After each session, Matt is walking away with new

11 connections into his body. His connection into his core has helped minimize his back pain. This is also helping him improve his pelvic-lumbar stability and making him feel more symmetrical in his work out. His mobility in his hips and shoulders has increased, as well as his posture. Most importantly, his body awareness has significantly improved. This has helped him stay pain free throughout the week and has helped his own personal workouts outside of the Pilates studio. No two cases of scoliosis are alike. Some people can live pain free with it. For those whose daily living conditions are affect from scoliosis, Pilates can be the answer. It can improve pelvic stability, core strength, postural awareness, and mobility. Matt continues to come in twice a week for Pilates and is improving every week.

12 Work Cited: Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Print. Isacowitz,Rael. Pilates. Champaign, II. : Human Kinetics, Nordqvist, Christian. Scoliosis: Treatment, Symptoms, and Causes. Medical News Today, MediLexicon International, 2017, Scoliosis. Spine-Health, 2017, Types of Spine Curvature Disorders. WebMD, WebMD, 2017,