Pilates for mature client with osteoporosis Ligia Ji Ae Lee 29 December 2018 2017 Comprehensive Apparatus Program Costa Mesa, California 1
Abstract Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Breaking a bone is a serious complication of osteoporosis, especially with older patients. It can limit mobility, which often leads to feelings of isolation or depression. This papers explore a case of a mature client with Osteoporosis, who wants to strengthen her core and back muscles, correct her faulty posture, improve her overall health condition through pilates. 2
Table of Contents Introduction.... 4 Case Study.... 7 Pilates Program.... 8 Conclusion... 13 Bibliography...... 14 3
Introduction Osteoporosis is a disease caused principally by the significant loss of bone mineral density (BMD). Early in life, more bone is laid down than is removed, and an individual s peak bone mass is typically achieved by around age 30. After peak bone mass is reached, the remodeling process (the process of laying down new bone and removing old bone) takes away more bone than is replaced. Hence making the bones more prone to osteoporosis (and consequently to fracture). Thus, the process of bone loss typically begins between one s early to late thirties. Starting from about that age to the onset of menopause, women lose a certain amount of bone steadily every year, as follows: Trabecular bone (the spongy bone inside the hard, cortical bone) is lost at a rate of about 1% per year Cortical bone (the hard bone) is lost at a rate of about 0.5% per year Estrogen plays an important part in maintaining bone strength because it helps keep bone remodeling (which is now taking away more bone than is added) rates low. There are two lines of cells for bone remodeling, the bone-eating cells (osteoclasts) and the bone-forming cells (osteoblasts). Without estrogen, the osteoclasts are favored and more bone is resorbed (removed) than laid down, resulting in thinning of the bone. Therefore, when women reach menopause and their estrogen levels decrease, the rate of bone loss increases to about 2% to 3% per year. After 8 to 10 years, the rate of bone loss returns to the previous rate of 1% and 0.5% per year, respectively. This loss of bone density, particularly after women reach menopause, is one of the primary causes of osteoporosis in women. Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. The term osteoporosis literally means porous bone. The disease often develops unnoticed over many years, with no symptoms or discomfort until a fracture occurs. Osteoporosis often causes a gradual loss of height and an accompanying dowager's hump (a severely rounded upper back).. Comparison of healthy bone(first one) to osteoporotic. Osteoporosis involves a gradual weakening of the bones. 4
normal spine(left), dowager's hump(right) There are two types of osteoporosis: 1. Type I osteoporosis (postmenopausal osteoporosis) generally develops in women after menopause when the amount of estrogen in the body greatly decreases. This process leads to an increase in the resorption of bone (the bones loses substance). Type 1 osteoporosis is far more common in women than in men, and typically develops between the ages of 50 and 70. The process usually results in a decrease in the amount of trabecular bone (the spongy bone inside of the hard cortical bone). The decrease in the overall strength of the bone leads primarily to wrist and vertebral body (in the spine) fractures. 2. Type II osteoporosis (senile osteoporosis) typically happens after the age of 70 and affects women twice as frequently as men. Type II osteoporosis involves a thinning of both the trabecular bone (the spongy bone inside of the hard cortical bone) and the hard cortical bone. This process often leads to hip and vertebral body fractures. Osteoporosis itself does not cause pain. However, osteoporosis can weaken the vertebral body (spine) so that it can no longer withstand normal stress or a minor trauma (e.g. a fall), resulting in a fracture, what causes pain. In fact, a fracture is typically the first outward sign of the disease, and advanced osteoporosis is potentially very painful and disabling. The most common sources of pain include: Microtrabecular fractures. These are very little cracks in the bone. These tiny osteoporosis fractures can lead to the loss of height that is a red flag for osteoporosis as people age. Compression fractures. Larger fractures of the spine can cause compression of the discs that provide a cushion between the vertebrae. About half of the 5
1.5 million osteoporosis fractures every year are vertebral compression fractures. This compression causes pain and problems with mobility. It can also result in dowager's hump, the permanent arching of the back that results not only in chronic pain but also in challenges with dressing and moving through your daily tasks. Pain may occur in the ligaments and muscles that support the spine as these changes occur. Rib pain. For some people with osteoporosis, osteoporosis fracture of a vertebra can press a nerve against the rib, which causes pain. Rib fracture may be another cause of pain. Stress fractures. These fractures occur during the course of normal daily tasks and activities, sometimes with a fall or other injury that would not ordinarily cause fracture. One of the most troublesome of these fractures is hip fracture. Vertebral body fractures Accordingly to National Osteoporosis Foundation, about 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis. Osteoporosis is responsible for two million broken bones and $19 billion in related costs every year. By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs annually. 6
Case Study Sara is an asian women, with 67 years old, very active and fit. Two years ago she discovered through bone density test that she has osteoporosis. She runs and plays golf twice a week, but decided to try pilates because she started to feel a constant lower back pain. She owns a restaurant and most of the time she is working, she is in a standing position. Sara already presents a slight kyphotic posture. The main goals to be achieved through a pilates program with her will be: - increase bone mineral density with weight-bearing exercises - focus on thoracic extension to improve posture and reduce the risk of fractures - improve cervical and scapular stabilization - improve flexibility of tight neck and shoulder muscles, specially because a kyphotic posture is already present - improve balance and proprioception to reduce risk of falls that lead to fractures - increase core strength - improve lower extremity flexibility - focus on exercises that elongate and decompress the spine General contraindications and precautions: - avoid spinal flexion - avoid all forms of roll ups and crunches - avoid abdominal work with oblique rotation - avoid pressure on the rib cage - avoid weight bearing on the cervical or thoracic spine - limit spinal rotation and lateral flexion - avoid forced external rotation of the hip - avoid unilateral weight-bearing exercises 7
Basi Pilates method program Sara decided to do private classes 2 times a week. For the first 20 sessions we worked in the fundamental exercises, emphasizing pelvic lumbar stabilization, abdominal engagement and strength, shoulder stabilization, trunk stabilization, back extensor strength, hamstring stretch and hip flexor stretch. As she progressed I started to introduce intermediate exercises. While teaching I focused on the 10 principles of Basi Pilates method: Awareness, balance, breath, concentration, center, control, efficiency, flow, precision and harmony. I followed the Basi block system conditioning program, choosing from the list below one exercise/series per block each class, considering the level. Based on our main goals, general contraindications and precautions, these are the exercises we worked on during one year of private classes. Warm up MAT Pelvic curl (omitted the deep lumbar flexion, hip hinge up). Spine twist supine (placed both feet on the floor to make the exercise easier in the first 10 sessions). Chest lift performed over a Bosu balance trainer keeping the range between extension and neutral. Double leg stretch and single leg stretch with head down. Footwork Parallel heels, parallel toes, V position toes, open v heels, open v toes, Calf raises, prances, prehensile. I introduced single leg series just after client showed total control of the pelvis and with a very light spring setting, progressing with time. Parallel heels, parallel toes, V position toes, open v heels, open v toes, calf raises, prances. I introduced single leg series just after client showed total control of the pelvis. Wunda Chair 8
Parallel heels, parallel toes, V position toes, open v heels, open v toes, calf raise. I introduced single leg series just after client showed total control of the pelvis and with a very light spring setting, progressing with time. Abdominal work Mat Single leg lifts, leg changes, hundred prep and hundred with head down. Step barrel Chest lift keeping the range between extension and neutral. Flat Back from short box series. Hundred prep, hundred, coordination with head down. Breathing with push up bar, however lift into the bridge position in neutral spine position, and hinge up rather than rolling up. Wunda Chair Torso press sit Hip Work Frog, circle down and up, openings, extended frog and extended frog reverse. Fundamental series: Frog, circle down and up, walking. I introduced bicycle and bicycle reverse just after client presented pelvis stabilization control. Spine Articulation Mat Shoulder bridge prep, shoulder bridge Bottom lift, bottom lift with extension avoiding spinal articulation, hips hinge up. Wunda Chair Pelvic curl with hip hinge up. 9
Stretches Standing lunge, Kneeling lunge Ladder Barrel Shoulder stretch 1, shoulder stretch 2, gluteals, hamstrings and Hip Flexors. Shoulder stretch Pole Pole series: Shoulder stretch, overhead stretch. Full Body integration 1 Mat: Front support, leg pull front on elbows - those exercises were given just after client presented good scapular stabilization and trunk stabilization. Knee stretch flat back, Up stretch 1, elephant, down stretch, Up stretch 2, long stretch - those exercises were given just after client presented good scapular stabilization and trunk stabilization. Thigh stretch with roll up bar Arm work Mat Magic circle standing series: Chest lift, arms bent, arms straight, arms overhead, single leg side press, single arm bicep. Arm supine series: extension, adduction, up circles, down circles, triceps Arms kneeling series: chest expansion, up circles, down circles, triceps, biceps Arms standing series: Chest expansion, hug a tree, circles up and down, punches, biceps. Push through series: shoulder adduction single arm, shoulder adduction double arm, sitting side prep. 10
Wunda Chair Shrugs, triceps press sit, triceps prone. Ped a pull Arms standing series: extension, adduction, circles up, circles down, triceps, Leg Work Mat Gluteals side lying series: side leg lift, forward and lift, forward with drops. Gluteals kneeling series: hip extension bent knee, hip abduction bent knee, hip extension straight leg. Magic circle sitting series: ankles, below knees, above knees. Magic circle prone series: ankles bent knees, ankles straight knees, hamstrings. Magic circle supine series: knees, ankles. Adductor squeeze, adductor lift. Hamstring curl, side split. Squats. Wunda Chair Forward lunge with, hamstring curl, hip opener. Lateral flexion Mat Side lifts, side kick. Side over on Box without flexion, just holding in the set up position. Ladder barrel Side over prep. Step barrel Supine twist supine, Side lift. Back extension 11
Mat Back extension, single leg kick, cat stretch, double leg kick, swimming. Magic circle swan prep. Breaststroke prep, pulling strap 1, pulling strap 2. Prone 1, prone 2 Wunda chair Swan basic, swan on the floor, back extension single arm. Ladder barrel Swan prep. Step barrel Swan prep. 12
Conclusion After one year practicing pilates twice a week there was a noticeable improvement on Sara s posture and overall strength, balance and coordination. She still feels lower back pain when she stays more than 5 hours in standing position during her working days, but she noticed that after our pilates sessions or after stretching by herself at home, she feels much better. Another noticeable improvement was in her concentration, body awareness and body control. It took a lot of time for her to breathe properly, but after she learned, she could finally focus her mind on what the body was doing and consequently activate the key muscles to execute the exercise with precision. Throughout this case I could experience the benefits of teaching pilates focusing in the 10 principles that form the foundation of BASI pilates method. I couldn t agree more with what Samantha Wood said in her book Pilates for rehabilitation, that it is those principles that make the Pilates method unique and differentiate it from others forms of conditioning. 13
Bibliography Books Wood, Samantha. Pilates for rehabilitation - Recover from injury and optimize function. 2019. Human Kinetics. Isacowitz, Rael. Body arts and science international Movement Analysis workbooks. 2000-2012. Websites https://www.nof.org/patients/what-is-osteoporosis/ http://www.allcaremedical.org/osteoporosis/ https://medical-dictionary.thefreedictionary.com/osteoporotic https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis/ https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc- 20351968 https://www.spine-health.com/conditions/osteoporosis/what-osteoporosis https://www.everydayhealth.com/osteoporosis/pilates-exercises-for-osteoporosis.asp https://www.drweil.com/experts/osteoporosis-and-pilates/ https://www.verywellfit.com/pilates-and-exercise-for-osteoporosis-2704810 14