Pilates for Common Alignments in Strength Training Individuals

Pilates for Common Alignments in Strength Training Individuals Connie Youn Comprehensive Program- South Pasadena, CA December 1, 2018

ABSTRACT We see a wide array of athletes these days, from those that are long time weightlifters, recreational athletes that are self-trained, and those that simply try to keep up with a fitness regimen by copying what they see on Instagram or going to group classes. While everyone s experience level is different, there is one constant thing that we seem to find, which is a list of common ailments we see from people who use heavier loads to build strength. The demands of utilizing heavier loads in strength training can lead people to lose proper connection of their muscles which leads to improper compensations of the body, which then sends a chain reaction into ailments and dysfunctions. The most common problems that occur seem to be shoulder impingements, knee pain, and low back pain. This paper will explore how these common problems can be alleviated and prevented through a proper progressive program utilizing BASI Pilates principles. 2

Table of Contents PG. 2 PG. 4 PG. 8 PG. 9 PG. 10 PG. 13 PG. 14 ABSTRACT Basic Strength Movements & Common Issues Benefit of Pilates Case Study BASI Block System - Programming Conclusion Bibliography 3

Basic Strength Movements & Common Issues Some of the basic foundational movements found in strength training are the Squat, Hinge, Lunge, Push, and Pull. These are simple movements that we perform in everyday life however, with improper body mechanics and heavier loads, it is easy to come into an injury. Let s explore some of the common injuries now. Shoulder Impingements Shoulder impingements or Subacromial Impingement Syndrome (SIS) is where the soft tissues like the supraspinatus tendon or bursa, get pinched between the boney structures of the shoulder during elevation of one s arm. Some exercises that can cause SIS are pulling motions such as the lateral arm raise and upright row, where the shoulders end up internally rotated. 4

If those exercises are regularly done in a weight training program, it then gets worse any overhead push motions, such as overhead presses and snatches. This is because bringing the arms over head decreases the space between the boney parts of the shoulder (subacromial space) causes those already aggravated tendons and bursas to get impinged on further. Therefore, to alleviate the shoulder joint, it is important to ensure movements are done in a proper range of motion in respect the weight being used, and to ensure that loaded movements are not being done with internal rotation of the shoulders. 5

Knee Pain Specifically Patella Femoral Pain Syndrome (PFPS) The most common complain of knee pain comes from squatting or lunging. The reasons for knee pain are very complex and have a variety of causes. The most popular seems to be the improper tracking of the knees. This can be causes by a multitude of things such as an imbalance between the quadricep muscles and hamstring muscles, tight muscles or weak muscles in the hip, or misalignments starting with the feet. Depending on which factors that influence improper tracking of the knee cap, adding a heavier load like back squats and front squats in weight training can aggravate this pain even more, or cause an injury. It is therefore, important that we address proper form and placement of the feet in respect to the knees and the hip when performing lunges and squats. Once proper form is taught, we can then address which muscles of the body are weak or tight and need to be targeted to help build the strength and endurance to maintain proper alignment during squat and lunge movements. 6

Low Back Pain There are several different types of back pain, but the most common in strength training seems to be muscle strains in the low back, and on the extreme side, bulging discs. Low back pain during strength training is usually caused by poor postural alignment while lifting a heavy load. Some people may have a posterior tilt, which causes them to continually round in the low back as they work with a heavy load. Some people may have an anterior pelvic tilt, which causes them to start with their pelvis tilted forward and then tuck their pelvis at the bottom range of a squat - which is essentially rounding the lower back at the hardest point of the exercise (also known as a butt wink). Continuously squatting and lunging in these poor postural alignments are what cause strains in the low back, and done with heavier loads, as with squat racks or deadlifts, can lead to compressing the vertebrae and end up with bulging discs. As seen in this photo below, the first photo shows the squat in a posterior tilt. The second photo shows an anterior tilt along with lack of abdominal engagement as the thoracic spine is excessively extended. The third photo shows the proper neutral alignment of the spine, which ultimately provides the most stable position to lift a heavy load. 7

The photo below shows the improper ways of doing a deadlift, again exhibiting posture that is out of neutral alignment. The first shows an excessive lumbar curve, the second shows the cervical spine out of alignment (which can also cause excessive thoracic extension), and the last shows excessive anterior tilt when finishing the deadlift which puts a lot of pressure into the low back. Therefore, it is important to determine the pelvic orientation of the person in order to properly select exercises to ensure the proper muscles are strong enough (or mobile enough if too tight) to assist in creating a neutral spinal alignment to avoid injury when lifting heavy loads with squats or deadlifts. Benefits of Pilates to help Avoid Injuries in Strength Training Now that we have discussed the common injuries, you may notice that they all stem from improper alignment of the body. The ideal alignment of the body starts from the bottom up The feet should be neutral (so not pronated or supinated), knees should be straight, the pelvis should be in a neutral position (not titled forward or back), the shoulders should be open and 8

scapulae should lay neutral (not rolled forward and flared out), and the head should be stacked above the shoulders (not jutting forward). Having said that, it will likely be rare that most of the population would have this perfect alignment, otherwise we d never have these injuries in the first place. However, with the use of Pilates movements, we can strengthen the proper muscles and mobilize the proper muscles to bring the body back into that neutral position the best we can. Several principles in Pilates lean well toward preventing and helping these common injuries. The BASI Pilates Block System ensures that each part of the body is holistically worked in balance. The precision of the exercises and how they are taught and executed ensure that the person is working within their capabilities, instead of forcing it (much like how people try to force lifting hard weights by compromising their body out of alignment). Additionally, the control and concentration that must be used while executing the exercises ensures the person is present, which will lead to less injury when exercising on their own. Case Study Female Client Who Participates in Weight Training My client, Kathy, is a 32 year old female, who works as a pharmacist (where she is required to stand the majority of the day) and works out doing High-Intensity Weight Training classes 3 times a week. She was experiencing an impingement in her right shoulder, and right knee pain during lunges and squats. Her goal with Pilates was to be able to exercise without pain and maybe even get rid of the pain all together. After observing her through the roll down, I noticed her posture was rounded through the shoulder with a posterior tilt in the pelvis. She also has hyper-extended knees. To address her needs, I designed a programmed that focused on mobilizing her shoulders to help with her impingement, strengthening her back extensors to combat her rounded shoulders, improving lumbar/pelvic stability to ensure she is stable during lunges and squats during weight training, and increasing hamstring strength to help with her hyper-extended knees. Additionally, I put a focus on being present in her movements and to pay attention to how she feels when she moves to provide a different pace and exercise environment than what she is used to with weight training. 9

BASI Block System Conditioning Program BASI BLOCK Apparatus Sessions 1-10 Focus Warm Up Mat MAT Standing Roll Down Spinal articulation, loosening up the body and Pelvic Curl finding breath. Supine Twist Spinal articulation and hamstring activation Chest Lift through the top of the pelvic curl. Chest Lift w/ Abdominal control and stretch through the low Rotation back Abdominal strength Footwork Reformer Footwork Series including Single Leg Abdominals Reformer Hundred Prep Isolated Hold of the Hundred Position Hips Reformer Frog Hip circles Openings Warm up the lower body and bring awareness to neutral pelvis and spinal position. Strengthening the quadricep and hamstrings through varied placement of feet. Unilateral work ensures that client does not rely on one side more than the other. Strengthen abdominals Isolating the hundred position provides endurance in holding this fundamental position to gain strength for progressing into other abdominal movements. Work on hip external rotators and inner thigh strength both of which can help with position of knee to feet when doing squats or lunges during weight training. Work on hip mobilization while maintaining pelvic stability (which is important in weight lifting) Spinal Articulation Stretch Ladder Barrel Shoulder Stretch 1 & 2 Bottom Lift Spinal articulation, strengthen hamstrings. Note: Spinal articulation is not recommended until 10 sessions have been completed, however, she is experienced in doing weighted glute bridges and is doing great with pelvic curls which tells me its ok to go through the movement. Modified to do on the heels the first few times before moving to the balls of the feet which requires a bit more hamstring strength. Due to her shoulder impingement, I chose to utilize the ladder barrel to open up the shoulder 10

joint Full Body n/a Integration Arms Reformer Supine Arm Series Practice neutral pelvis and neutral spinal alignment Strengthen shoulder adductors, extensors, and triceps. Mobilize the shoulder and avoiding overhead movements that may irritate shoulder impingement. Legs Reformer Single Leg Skate Strengthen hip abductors while maintaining lumbar pelvic stabilization. Translates well into resistance training and helps with knee pain. Full body n/a Integration (Int. or Adv) (optional) Lateral Mat Saw Stretch hamstrings and low back Flexion Back Mat Backstroke prep Strengthen back extensors to combat slouched Extension shoulders BASI BLOCK Apparatus Sessions 11-20 Focus Warm Up Mat Standing Roll Down Roll Up Supine Twist Double Leg Stretch Single Leg Stretch Criss Cross Footwork Cadillac Footwork Series including Single Leg Spinal articulation and connection to breath. Spinal articulation and abdominal control, along with pelvic awareness. Abdominal strength Warm up the lower body and bring awareness to neutral pelvis and spinal position. This will be more difficult since the legs are drawn up to a 90 degree. Strengthening the quadricep and hamstrings through varied placement of feet. She will visibly be able to look at her feet, and she can make a better mind body connection. Abdominals Cadillac Bottom Lift with Roll Abdominal control, breathing, and hamstring Up Bar strength. Adding a bit more coordination through the movement. Hips Cadillac Frog Continuing with leg extensor and flexor strength, 11

Spinal Articulation Circles (Down, Up) Walking Bicycle Cadillac Tower Prep Tower but this is a progression as the springs will feel a bit heavier since it s sprung from above. The movement will require more stability in the pelvis to keep neutral spine. Spinal articulation and getting a nice stretch through the back. Also using abdominal control to go through the movement. Stretch Cadillac Kneeling Lunge Modified to keep the flow of the workout instead of going to a different apparatus. Hip flexor stretch and hamstring stretch Full Body Integration Cadillac Sitting Forward Side Reach Articulate the spine and focus on scapular control. Side reach will also help open up the shoulders to help with shoulder impingement. Arms Reformer Arms Sitting Series Strength in upper body Chest expansion is particularly good for helping strengthen back extensors to combat slouchy shoulders. If impingement is still present, avoid Salute. Legs Reformer Hamstring Curl Hamstring strength and back extension while maintaining abdominal control to avoid dumping into the low back. Full body Integration (Int. or Adv) (optional) Lateral Flexion Back Extension Side Over on Box Oblique strength and trunk stabilization Pulling Straps 1 Back extensor and shoulder extensor strength 12

CONCLUSION: Upon observing Kathy throughout her sessions, the biggest difference I have seen is the presence and mind body connection she makes as she goes through her workout. This has made her focus more on activating the proper muscles and moving in proper alignment in her weight training as well. This has helped her minimize the knee pain during lunges and squats. Due to the mobility work we did for her shoulder, coupled with the proper exercises to support upper body strength without aggravating the impingement, she no longer has the shoulder impingement. She is also now aware of scapular control to avoid impingement in the future. In conclusion, not only did the movements in BASI Pilates repertoire help my client, but the biggest impact was the basic Pilates principles which go beyond just moving the body. The connection of the mind to the muscles and being present in the movement is ultimately what stuck with my client when she left the studio. In the end, that has helped her moved better on her own and help prevent injury during her weight training. 13

BIBLIOGRAPHY Sources: 1. Kolber, Morey, et. Al., Characteristics of Shoulder Impingements in Recreational Weight-Training Population. Journal of Strength and Conditioning Research. Retrieved on October 2, 2018. https://journals.lww.com/nscajscr/fulltext/2014/04000/characteristics_of_shoulder_impingement_in_the.28.aspx 2. Pope, Dan. Shoulder Impingement: The Thoracic Spine and Ribcage s Role in Impingement. https://fitnesspainfree.com/shoulder-impingement-part-4-the-thoracic-spine-and-ribcages-role-inimpingement/ 3. Wikipedia: Patellofemoral Pain Syndrome. https://en.wikipedia.org/wiki/patellofemoral_pain_syndrome 4. Santos, Thiago, et al., Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients. US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4518569/ 5. Cannon, Kelsey. What in the World is a Butt Wink. Men s Health Magazine. https://www.menshealth.com/fitness/a19528672/what-in-the-world-is-a-butt-wink/ 6. Rusin, John. 4 Most Common Injuries for Lifters. T Nation. https://www.t-nation.com/training/4- most-common-injuries-for-lifters 7. BASI Pilates. Study Guide & Movement Analysis Workbooks, Foundation & Comprehensive Program, (Body Arts and Science International, (2000-2016) Images: 1. Shoulder Impingement : http://physiodirectnz.com/shoulder-impingement/ 2. Upright Row: https://www.dreamstime.com/stock-illustration-exercising-cable-upright-rowsbodybuilding-target-muscles-marked-red-initial-final-steps-image67871884 3. Lateral Raise: http://yourlivingbody.com/2015/04/01/how-to-do-lateral-deltoid-raise/ 4. Knee alignment: https://training-planet.com/importancia-de-la-cadera-en-el-corredor/ 5. Deadlift: https://www.nerdfitness.com/blog/strength-training-101-the-deadlift/ 6. Squats: http://seannal.com/articles/training/squats-lower-back-pain.php 7. Pelvic Tilt: https://www.precisionmovement.coach/posterior-pelvic-tilt-program/ 14