Rheumatoid Arthritis and the Pilates Client

Transcription

1 Rheumatoid Arthritis and the Pilates Client Clare Lucy Proctor 3/19/ Pilates Indy inc, Indianapolis

2 Abstract Rheumatoid arthritis is a long lasting autoimmune disorder that primarily affects the body s synovial tissues ie those in freely moving joints. It typically results in warm, swollen and painful joints. Pain and stiffness often worsens following rest (e.g. first thing in the morning.) The causes of Rheumatoid Arthritis are unclear, combining both genetic and environmental factors. The underlying mechanism involves the body s immune system attacking the joints resulting in inflammation and thickening of the joint capsule. This in turn can also affect the underlying bone and cartilage. These episodes or flares vary in frequency and severity. Treatments usually include the use of steroids to reduce the inflammation but these also come with their own risks and side effects. A program of Pilates exercises is created for a female client who has suffered with the disease for approximately 12 years. Through such a program we seek to develop balanced muscle strength which in turn can maintain and develop increased range of motion, for an improved quality of life. Contrology develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind, and elevates the spirit 1 This is the magic of Pilates. 1

3 Table of Contents Title Page Abstract page 1 More information about RA page 3 Case Study page 4 Pilates Conditioning Program page 4 Conclusion page 11 Bibliography page 12 2

4 More information about RA Autoimmune disease appears to be on the rise and researchers at the Center for Disease Control and Prevention (CDC) are uncertain why 2 Environmental factors are thought to play a part but research continues in this area to understand why. With the rise in popularity of social media and increased access to the world's medical information more and more people are looking to alternative methods to control and relieve their symptoms. Exercise has been to shown to be especially beneficial for patients with RA, and is encouraged. The disease can accelerate the loss of muscle mass that typically occurs with ageing, it is therefore imperative that patients work to increase muscle through weight bearing exercise. 3 Doctors will always encourage patients with RA to keep moving to avoid muscle atrophy. This can be incredibly hard given the nature of the disease. This paper seeks to show that consistent movement using the BASI Pilates structure can improve quality of life in the Rheumatoid Arthritis patient and reduce the need for both steroidal and non-steroidal intervention. 3

5 Case Study Karina is a 58 year old woman who was first diagnosed with Rheumatoid Arthritis in In the last 12 years her mobility has gradually decreased to the point where she is unable to do certain activities she had previously enjoyed (e.g. Cycling and hiking.)she continues to swim and practices Tai Chi. In addition to her RA, she underwent surgery in 2008 for Thyroid cancer and in 1998 was treated for breast cancer and underwent a mastectomy. She came to me in 2015 having recently given up cycling after suffering very regular flares. Her symptoms at this time seemed to be getting worse and she sought something that would keep her body moving. She had some limited experience of Pilates many years before, but had not practiced it since her diagnosis. 4

6 Pilates Conditioning Program Karina has a full time job and needed to feel better equipped to deal with the everyday rigors of work and socializing. We took our time particularly in our initial sessions to discuss Karina s needs and built up the number and intensity of the exercises gradually. She struggles particularly with her wrist and ankle joints. My initial assessment of her work on the reformer showed a weakness in her adductors (noted through the single leg work in the footwork block). She struggles to maintain a neutral pelvis on the left side where the hip tends to hike. When performing a roll down I observed the left knee wanting to move inwards, tight hamstrings and a tendency towards Hyperextended Knees (Genu Recurvatum). Pelvic instability in this case can be corrected through the use of both bilateral and unilateral exercise in order to create balance (the third Pilates principal). The Pelvis serves as a bridge between the upper and lower body in terms of structure and function 4 Work on Spinal Flexors (abdominals), Pelvic Floor, Spinal Extensors and Hip Adductors (inner thighs) is essential in this situation. This work was achieved through a gradual build up of exercises ie a progressive layering of the block system (see table). The Principles of Training are also acknowledged, that of the Overload Principle, the Principle of Specificity and the Principle of reversibility (use it or lose it). 5

7 I developed a program for Karina using the layering of the BASI block system. The following table illustrates a program based on 2 sessions a week for 5 weeks. In the Studio I have access to the following equipment: Allegro Tower of Power and a Balanced Body Wunda Chair. Block Equipment Exercise Notes/Observatio ns Warm Up Mat Fundamental warm up: Pelvic Curl Spine twist Supine Chest lift Chest lift with rotation Weeks 3-5 we added rotation. Karina lay on Cadillac bench instead of the floor. This was much easier for her. Foot Work Reformer Fundamental Footwork Series Parallel heels Parallel toes V position toes Open V heels Open V toes Calf raises Prances Single leg heel Single leg toes Some sessions we did footwork on the Weeks 1 & 2 no rotation. Difficulty finding oblique pattern. Focused on using breath and abdominal engagement to lift head. Cue head heavy in hands, length through the back of the neck. Medium spring setting initially meant easier to find neutral pelvis and engage Hamstrings. Calf raises and prances - managed very few at first but appreciated the stretch through the calf muscles 6

8 Chair chair which was more appropriate when Karina had foot pain. (Soleus, Gastrocnemius). This enabled work on lower abs and work on posture. (No footwork on the Cadillac at the beginning, too intense on the Hamstrings and discomfort using the PTBar) Abdominal Work Reformer Hundred Prep Weeks 1 & 2 no straps, 3-5 with straps. As in the mat version of the exercise we used no straps initially. Focused on engagement through the Lats and low abs. Legs bent with ankles crossed and knees drawn in closer meant easier to engage low abs and less gripping in hip flexors. Throughout cued long wrists, arms reaching out away from shoulder joints, slight lead with pinkie fingers to promote opening in collar bone (external rotation of the A/C joint). 7

9 Hip Work Reformer Fundamental Hip Work Series Frog Circles Down Circles Up Openings Used longer foot loops with soft lining - more comfortable for sore feet. Plus Karina has long legs. Found Frog very hard at first and difficulty maintaining external rotation in the circles particularly the left hip. Weak inner thighs and Glutes. This improved over time as muscle memory developed. Spinal Articulation In accordance with the layering of the block system no spinal Articulation was deemed appropriate during the first 10 sessions. Stretches Ladder Barrel (we used the top of the Wunda Chair). Hamstrings and Hip Flexors Use of the Wunda Chair made these stretches less intense and more achievable for Karina. Weeks 4 & 5 (sessions 8 thru 10) we progressed to Standing Lunge on the Reformer With a pad on the carriage for her knee Karina enjoyed being able to do this stretch. 8

10 Full Body Integration No Full Body Integration was included at this time. Arm Work Ped-A-Pul (we used springs at the end of the tower with a stool to sit on). Fundamental Arms Standing Series Extension Adduction Circles up Circles Down Triceps This version of arm work is perfect for Karina who struggles to maintain tabletop position for any length of time. Here I especially focused on stabilization of the shoulder girdle, and use of the lats and Shoulder Extensors.in this position I was able to give better tactile feedback. Full Body Integration No Full Body Integration was included at this time. Leg Work Wunda Chair Leg Press Standing In the course of these initial sessions this particular exercise was especially beneficial in helping Karina find her Hamstrings. It is also a great balance challenge. Over time this unilateral work also improved recruitment of the pelvic stabilisers. 9

11 Lateral Flexion/Rotation Reformer Tilt - Short Box Series. Sessions 1-5 This was a safe way to explore lateral Flexion. In the sitting position I was able to uthe co-contraction of se palpation and tactile feedback to help engage Abs and Back Extensors. Wunda Chair Side Stretch Slight increase in spring setting here meant it was more achievable whilst still being a challenge. Cue to move as if between two panes of glass or a toaster! 10

12 Conclusion At this time in 2015 when Karina first came to me, she struggled greatly with motivation as there were times when she was in a great deal of pain. The immediate response to this is to want to stay home and not move and in those days we had several weeks when she would cancel her sessions. As time went on and she started to feel the benefit of our sessions in her body, she grew to rely on Pilates and the benefits it could afford her. Two and half years later she still attends two sessions a week and reports far fewer flare ups than ever before and great improvements in both her balance and range of motion. After vacations or time away from the studio for surgeries etc she is always keen to come back and renew her practice with me. We continue to work with every physical challenge that arises including modifications after surgeries. Change happens through movement, and movement heals 5 11

13 Bibliography 1. Pilates, Joseph. Return to Life Pilates Method Alliance, inc Miami, FL 2. I.B.H.R.I (Integrative Behavioral Health Research Institute) Are Autoimmune Diseases on the rise? 3/5/ Mayo Clinic RA: Is Exercise Important? matoid-arthritis-exercise/art Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California. Body Arts and Science International, 2013 Images Cross section showing normal and RA joint 12