Pilates for Pelvic Lumbar Instability in CrossFit Athletes Emily Von Fange 11/28/2018 Comprehensive Program 2018 Herndon, VA
Abstract! Lauren is a CrossFit athlete and coach who injured her lower back during a workout and was unable to perform her regular CrossFit exercises and core program. Even after completing physical therapy she was still experiencing pain and was concerned about re-injuring her back. After a Pilates assessment, as well as watching her demonstrate her form during typical CrossFit exercises under load, it was clear imbalances in her muscular development were affecting her form, placing undue stress on her joints, particularly in her lower back.! As a professional athlete and coach, Lauren was interested in a Pilates program that would help her gain core strength as well as balance between some of her overdeveloped agonists and underdeveloped antagonists/ synergists/ stabilizers so she could continue her athletic training. To help her achieve her goal, I created a 30 session program, focused on developing deep core strength, pelvic lumbar stability and bringing and awareness to unwanted deviations in her form. 2
Table of Contents Abstract!! Page 2 Table of Contents! Page 3 Anatomical Description Page 4-5 Case Study Page 6-7 Conditioning Program Page 8-9 Conclusion Page 10 Bibliography Page 11 3
Anatomical Description! The spine is composed of 33 bones, stacked one on top of the other, to form the spinal column. A heathy spinal column allows us to stand upright, provides structural support for the body as we move and protects the spinal cord. The full length of the spine is categorized into 5 regions called the cervical (C1 - C7), thoracic (T1-T12), lumbar (L1 - L5), sacral (S1 -S5 fused) and coccygeal (fused) spine. The spine is connected to the pelvis where the sacrum meets the ilium, at the sacroiliac joint. Spine - Lateral View Spine - Posterior View Pelvis - Posterior View 4
! The pelvis is composed of of 2 hip bones, each made of 3 separate bones that fuse together during adolescence, the ilium, pubis and ischium. The pelvis attaches to the spine at the sacroiliac joint. It also connects to the lower extremities at the hip joint, where the the head of the femur meets the acetabulum. The Pelvis Hip Bones Hip Joint! There are 10 muscle groups that attach to, and act on the pelvic complex. These muscle groups include the spinal flexors, spinal extensors, pelvic floor, hip flexors, hip extensors, hip adductors, hip abductors, hip external rotators and hip internal rotators. The central location of the pelvis and it s complex musculoskeletal connections make it like a bridge between the upper and lower portions of the body. Consequently, any deviation that occurs in the position of the pelvis is thought to have an effect on the structures above and below. 5
Case Study! Lauren is a 28 year old CrossFit athlete and coach who suffered from ongoing low back pain and then an injury to her paraspinal muscles. After her injury she was unable to perform any of her typical CrossFit workouts or demonstrate exercises as a coach. She also stopped doing her usual core workouts because she felt pain in her paraspinal muscles when in deep spinal flexion. Her doctor prescribed physical therapy, which Lauren completed but would still feel occasional pain in certain positions as well as during some exercises particularly when bearing weight, heavy weight being a typical component of a CrossFit workout. Lauren was uncertain how to move forward with her training and was fearful that she might re-injure her back. As a CrossFit coach with an understanding of the importance of proper body mechanics and muscle recruitment, she was open to the idea that Pilates could bring an awareness to her workouts, improve her form and prevent another injury.! After doing a Pilates assment, including the Roll Down and Fundamental movements on the mat, it was clear that Lauren lacked pelvic lumbar stability and was weak in several key muscle groups that act on the pelvic complex. In addition, she had a hyper mobile spine from years of cheerleading.! In her squat position, especially under load, she was unable to control her pelvic position leading to an exaggerated anterior tilt, accompanied by a hyperlordotic curve of the lumbar spine. Although she had very strong quadriceps, pecs, biceps and rectus abdominis and was visibly fit, she had difficulty controlling her trunk and hamstrings 6
during a Pelvic Curl. Simply holding the legs in tabletop position was challenging and when asked to perform a Leg Circle while keeping the pelvis completely still she could only control a very small circle, approximately 8 inches in diameter, no larger.! Our goal was to implement a BASI Pilates program that would improve her core strength and stability, encourage proper recruitment of stabilizing muscles, help her maintain proper alignment and bring an awareness to her form in all physical activities. 7
Conditioning Program BLOCK EXERCISE SESSION # NOTES warm up pelvic curl spine twist chest lift chest lift w/ rotation leg lifts/ leg changes leg circles watch pelvic lumbar stabilization in leg changes and leg circles footwork reformer footwork wunda chair footwork 5-30 reformer for added stability. Wunda chair for a more challenging position. Focus on neutral spine. abdominal work hundred prep reach - step barrel hundred double leg double leg w/ rotation pike sitting 1 1 1 1 Pike Sitting and Short Box series for controlling the spine and pelvis while unsupported/ moving. round back flat back tilt twist 1 1 1 1 hip work reformer: frog, circles down/up, openings. include extended frog, extended frog reverse 1 Focus on squeezing inner thighs and activate pelvic floor. spinal articulation bottom lift bottom lift + extensions short spine 1 1 Work glutes and hamstrings. Great stretch on short spine. stretches standing lunge kneeling lunge side split 1 1 Very tight hamstrings. Very weak inner thighs. Side split hits several of her weak areas, excellent to practice.
FBI Fun. + Int. upstretch 1 elephant upstretch 2 1 1 2 To strengthen and stabilize abs, hips and back. arm work arms supine series arms sitting series arms kneeling series 1 2 Focus on stabilizing trunk in each series. FBI Adv. balance control back prep 2 Practice maintaining neutral spine. She s going to want to posterior tilt. leg work leg press standingwunda chair hamstring curlwunda chair Work hamstrings and small stabilizing muscles to balance over-developed quads. lateral flexion/ rotation side lift - step barrel corkscrew - mat 1 Address weak obliques. Control pelvis in corkscrew. back extension back extension - mat swan basic - wunda chair swan on the floor - wunda chair pulling straps 1 pulling straps 2 1 1 2 Correct major tendency to let go of abs and arch back. Lauren must learn to support the back when using it. Think posterior tilt 9
Conclusion! We saw a dramatic improvement in Lauren s pelvic lumbar stability within the first 5 sessions. In part due to increased core strength and in part due to a growing awareness of her form. After 10 sessions Lauren had increased her range of motion while maintaining proper form in all exercises. She said she was also constantly applying the principals of pelvic lumbar stabilization and alignment to her CrossFit workouts, didn t feel any pain, and had no new injuries. As we continued the program Lauren showed improvements in all exercises practiced. She greatly improved her pelvic lumbar stability, was able to maintain a neutral spine when necessary, was able to continue exercising and felt that all of our initial goals had been met. 10
Bibliography Isacowitz, Rael. Study Guide: Foundation Apparatus Program. Costa Mesa, California: Body Arts and Science International, 2016. Isacowitz, Rael and Clippinger, Karen. Pilates Anatomy. Champaigne, Illinois: Human Kenetics, 2011. Isacowitz, Rael. Pilates: Second Edition. Champaigne, Illinois: Human Kenetics, 2014. Pelvis Hip Anatomy. LexMedicus, n.d. Web. 2018 http://anatomy.lexmedicus.com.au/ pathologies/pelvis-hip Anatomy - Index. Colorado Comprehensive Spine Institute, n.d. Web 2018. https:// www.coloradospineinstitute.com/education/anatomy/ Hip Bone. Wikipedia, n.d. Web. 2018. https://en.wikipedia.org/wiki/hip_bone 11