Improving Posture in a Client with Kyphosis

Transcription

1 Improving Posture in a Client with Kyphosis Name: Nicollette Van den Bergh Date: 5 November 2018 Course date: 10 Aug-25 Nov 2018 Course Location: Physio Pilates, Khyber Pass, Auckland, NZ Faculty Member: Simone Wagenaar

2 Abstract When looking at the structure of the human spine, there are natural curvatures that are present. The word kyphosis refers to the curve that is normally present in the thoracic spine. When this curvature in the thoracic spine is beyond 40 to 45 degrees, it is considered to be abnormal. (Adult Kyphosis, University of Maryland Medical Centre) This abnormal kyphosis involves an increased thoracic curvature of the spine. Common characteristics of kyphosis usually involve tight (short) anterior shoulder muscles (pectoralis major and pectoralis minor) and long muscles in the upper back (trapezius, rhomboid major and rhomboid minor). This condition also causes stooped or rounded shoulders which can limit good range of motion for everyday life. In this case study I endeavor to increase my knowledge on the anatomy of the thoracic spine and shoulders and how I can use the block system to improve the posture in a client with kyphosis. 1 P a g e

3 Contents Abstract... 1 Anatomy of the Spine... 3 Anatomy of the Shoulder... 4 Muscles of the Shoulder and Thoracic Spine... 5 Case Study... 6 Exercise Program using the BASI Block System... 8 Bibliography P a g e

4 Anatomy of the Spine The spine consists of 7 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral (fused) and 4 (fused) coccygeal vertebrae. These Cervical, Thoracic and Lumbar vertebrae are separated by intervertebral discs whereas the vertebrae in the sacrum and coccyx are fused together. The thoracic spine consists of 12 vertebrae and these are medium-sized, increasing in size from superior to inferior. There are four features which distinguish them from other vertebrae: 1. Vertebral body is heart shaped 2. Demi-facets on the sides of the vertebral body which articulates with the heads of the corresponding ribs 3. Costal-facets on the transverse process which articulate with the tubercles of the ribs (present only on T1-T10) 4. Spinous processes are long and have a slight inferior slant which serves to increase the protection of the spinal cord, preventing any sharp objects from penetrating the spinal cord. (Teach Me Anatomy) Below is an image of a thoracic vertebra (left) and where the thoracic spine is located in the spine comprised of the Cervical, Thoracic, Lumbar and Sacral (fused) vertebrae (right) 3 P a g e

5 Anatomy of the Shoulder The shoulder consists of the scapula (shoulder blade), clavicle (collarbone) and the humerus (arm bone). The scapula articulates with the humerus at the glenohumeral joint and with the clavicle at the acromioclavicular joint. Scapula Triangular and flat in shape and serves as an attachment site for many muscles. The costal (anterior) surface, called the subscapular fossa, faces the ribcage and is mostly concave. The posterior surface is marked by the o Spine- Divides the surface into two and is the most prominent feature of the posterior surface. o Acromion- The spine terminates into the acromion that arches over the glenohumeral joint. o Infraspinous fossa- The area below the spine of the scapula, convex in shape o Supraspinous fossa- The area above the spine of the scapula, it is smaller than the infraspinous fossa and is more convex in shape. (Teach Me Anatomy) Below is an image of the posterior surface of the scapula 4 P a g e

6 The clavicle (collarbone) runs from the manubrium of the sternum to the acromion of the scapula. The three bones meet together to form the glenohumeral joint (pictured below) Muscles of the Shoulder and Thoracic Spine Anterior Compartment (flexors) of shoulder Pectoralis Major Perctoralis Minor Subclavius Posterior Compartment (extensors) of shoulder Trapezius Latissimus Dorsi Levator Scapulae Rhomboid Major Rhomboid Minor Serratus anterior Deltoid Supraspinatus (Rotator cuff) Infraspinatus (Rotator cuff) Teres Minor (Rotator cuff) Subscapularis (Rotator cuff) (Stone). The effects that kyphosis has on these muscles most commonly lead to the muscles of the posterior compartment being weak and long and the muscles of the anterior compartment being tight and short. The muscles named in the above table will be the muscles of interest in 5 P a g e

7 my case study. The common correction of kyphosis is to stretch the anterior compartment of the chest/shoulder and to strengthen the posterior compartment of the shoulder. (Isacowits) Below are pictures of the muscles of the anterior compartment of the chest/shoulder (Left) and the muscles of the posterior compartment of the shoulder (right) Case Study The chosen topic of my case study, as mentioned in the abstract, is kyphosis. First I reviewed the plumb line in order to compare the postural deviation to what we call the ideal alignment. When ideal alignment is present, there are certain points that the plumb line should fall on: The lobe of the ear Through the bodies of cervical vertebra Shoulder joint Midway through the trunk Greater trochanter of femur Slightly anterior to the midline of the knee 6 P a g e

8 Slightly anterior to the lateral malleolus (Isacowits) The client I have the honor of working with is Matthew Nicholson, a 26 years old Diesel Technician. He works in field service which includes driving a significant amount during the day and lifting heavy objects. He mentioned he experiences pain in the upper back after a long day s work and also experiences stiffness in his shoulders. When we spoke about his previous injuries, he mentioned pain in his right shoulder when he lifts his arm above shoulder height which he describes as a pinching/popping sensation. When I asked him if he had done any previous shoulder rehabilitation work to regain some or all his range motion, he has been doing some foam roller stretches for his back and shoulder mobility. When he began pilates with me, the goals were to strengthen his core and upper back, mobilize the shoulders and stretch the hamstrings and hip flexors. When looking at Matthew s posture, I noted the following: His head and neck are forward of the plumb line (hyperextended neck) Increased curvature of the thoracic spine Increased curvature of the lumbar spine The pelvis is forward to the plumb line and also has more of an anterior tilt I also noted that he has tight anterior shoulder muscles and long posterior shoulder and upper back muscles. In addition, he also has very tight hamstrings and very little range of motion in his hips. Based on these observations, I have compiled a comprehensive exercise program using the BASI block system, focusing mainly on his kyphosis. 7 P a g e

9 Exercise Program using the BASI Block System Warm-Up (Mat) Footwork (Reformer) Abdominal Work (Step Barrel) Hip Work (Cadillac) Spinal Articulation (Reformer) Stretches (Pole & Reformer) Full Body Integration (Reformer & Cadillac) Arm Work (Cadillac) Leg work (Chair) Lateral Flexion/Rotation (Reformer & Chair) Pelvic Curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation. This warm-up will teach Matthew about spinal articulation (which is important to mobilize the vertebrae) and warm up the abdominal muscles Parallel heels and toes, V position toes, Open V heels and toes, Calf Raises and Prances Focus on activating the hamstrings and quadriceps and using the breathing to facilitate pelvic floor and Transverse abdominal connection. Also Pelvic lumbar stabilization Chest Lift, Reach and Overhead Stretch (All on Step Barrel) Encouraging thoracic stretch and shoulder mobility while working the abdominals. (For the first few tries I gave Matthew a box and a few pillows for his head to rest on so that the range wasn t too extreme for him and as he progressed, he needed less assistance) Frogs, Circles (Down & Up), Walking, Bicycles (+Reverse) Focus on hip disassociation and pelvic lumbar stability will allow mobilizing of the hip joint. Teach single leg bicycle first before double leg bicycle to get coordination pattern and create familiarity with the exercise. Short Spine Mobilizing the thoracic while getting hamstring and lower back stretch. Pole series (Shoulder stretch, Overhead stretch, Side stretch, Spine Twist. Focus on anterior shoulder and chest stretch, lower trapezius strengthening, oblique control and stretch. Overall trunk movement is important. Standing Lunge. For improving Hamstring and Hip flexor flexibility as well as back extensor engagement. Downstretch. Provides abdominal challenge while encouraging hip, back and shoulder extensor engagement throughout (good for thoracic and shoulders) Kneeling Cat stretch. Provides shoulder stretch and spinal articulation while still having adequate support from the top loaded springs. Chest Expansion, Hug-a-tree, Circles (Up & Down), Punches, Biceps. Strengthening of shoulder extensors while encouraging trunk stabilization and posture awareness. Increases range of motion in the shoulder and provide an anterior shoulder stretch. Hamstring Curl & Hip Opener. Allows awareness of pelvic lumbar stabilization while working the hamstrings. Strengthens the hip external rotators while providing hip mobility as an extra. Mermaid. Provides spinal mobility while and encourages scapular stabilization. Side stretch. Lateral flexor stretch of the trunk while encouraging length through the spine Back Extension (Reformer) Pulling Straps 1. Improves back and shoulder extensor strength. 8 P a g e

10 Matthew attended a private session twice a week. My aim was to select exercises that met his goals as well as incorporating some goals of my own that I had for him as his instructor. I wanted him to experience pilates as a whole body work out, in addition to improving his postural deviations and general aches and pains. After about five weeks of attending his private sessions, he reported feeling much better in his upper back and shoulders. He became more aware of his posture and tried to use that awareness throughout his daily activities at work. He reported feeling stronger in his upper back and less rounded in his shoulders. He also mentioned that he appreciated the additional work we did working on his hamstring and hip flexor flexibility, which improved his hip mobility, as well as improving his abdominal strength. 9 P a g e

11 Bibliography Adult Kyphosis, University of Maryland Medical Centre. n.d. October 2018 < Isacowits, Rael. Study Guide: Comprehensive Course. Costa Mesa, California, Stone, Robert J. Stone & Judith A. Atlas of skeletal muscles. New York: McGraw-Hill, Teach Me Anatomy. January October 2018 < 10 P a g e