PILATES AS A TOOL TO AID IN THE TREATMENT OF MILD TO

PILATES AS A TOOL TO AID IN THE TREATMENT OF MILD TO MODERATE SCOLIOSIS BETH NICKS FEBRUARY 16, 2014 SANTA BARBARA 2013-2014

ABSTRACT: Scoliosis is a spinal condition characterized by the appearance of one or more irregular lateral curvatures of the spine. Different treatment protocols are used depending on the severity and degree of these spinal curvatures. Extreme cases can be treated surgically or with the use of corrective braces, but in mild to moderate scoliosis cases the use of Pilates can be used with positive results. In formulating this research paper and case study, I sought to identify the ways in which a Pilates program could benefit a client with mild to moderate scoliosis; specifically focusing on utilizing the BASI repertoire to facilitate appropriate trunk flexion and extension as well as proper recruitment of the core. 2

TABLE OF CONTENTS ABSTRACT...PAGE 2 TABLE OF CONTENTS...PAGE 3 ANATOMICAL DESCRIPTION...PAGES 4-5 CASE STUDY...PAGE 6 CONDITIONING PROGRAM...PAGES 7-10 CONCLUSION...PAGE 11 BIBLIOGRAPHY...PAGE 12 3

SCOLIOSIS Figure 1 shows two views of the average person s spine. When viewed in the anatomical position the spine appears relatively straight with no lateral deviations. When the spine is viewed from the side, natural curvatures of the spine will occur in both the lumbar and thoracic regions. Scoliosis occurs in approximately 2-3% of the population, a person who has scoliosis will present an abnormal lateral deviation or deviations of the spine in the coronal plane. The lateral abnormality is often accompanied by a rotation of the vertebrae in the axial plane, in the direction of the concavity of curvature. There are many methods for identifying the type of curvature, but the most common distinction is the classification between single, double and a FIGURE 1 triple scoliosis curves. Single curve, or C-curve scoliosis, pertains to single abnormal curvature, usually occurring in the thoracic vertebrae. Double curve, or S-curve, features a double curvature usually in the lumbar and thoracic spine. Triple curve scoliosis features a triple curvature of the spine, one in the lumbar, one in the thoracic and one in the cervical spine. A slight degree of compensatory curvature can occur in most scoliosis sufferers in order for the body to try and remain aligned. Figure 2 illustrates what would be classified as a S-curve, or double curve scoliosis. The x-ray also illustrates some of the compensation that occurs in the rib cage due to these curvatures. The Cobb technique for measuring the degree of curvature uses the end-vertebrae or the vertebrae at the upper and lower ends of the curve that FIGURE 2 4

are most severely tilted towards the curve to measure degree of scoliosis. Figure 3 illustrates how lines are drawn from these vertebrae and their intersecting angle becomes the degree of curvature. Mild cases of scoliosis can be defined as having a degree of curvature between 10 and 25 degrees. Moderate cases of scoliosis occur between 25 and 40 degrees. Severe cases are those that present an angle greater than 40, and almost always need surgical treatment. Mild and moderate cases can be aided by the use of physical therapy treatments or through properly structured exercise programs such as FIGURE 3 Pilates. Structural forms of scoliosis are most often caused from neuromuscular diseases, but the larger part of scoliosis suffers have what is known as idiopathic scoliosis. Idiopathic scoliosis is the term used for scoliosis in which there is no apparent causing factor, and it accounts for 75% of diagnosed scoliosis cases. INTRODUCTION: Many of the people who are diagnosed with scoliosis have mild cases that do not cause much pain. As the degree of curvature increases, more clients experience pain and discomfort. In some extreme cases, the severe degree of the curvature and the increased rotation of the spine and corresponding ribs can have a detrimental effect on respiratory health. Pilates can be utilized, in mild to moderate cases, to help improve posture, muscle imbalances and overall bodily awareness. 5

CASE STUDY: Ann is a twenty year old dancer who was diagnosed with s-curve scoliosis at the age of eleven. When first diagnosed the degree of her lumbar curvature was still considered mild, but over the course of the next few years the degree rapidly increased to nearly 41 degrees, and she was prescribed a corrective brace to be worn 22 hours of the day. By the age of seventeen her curvature had decreased back into the mild designation, and she was cleared from wearing the brace. Currently she has an 18 degree lumbar curve (convex to the right) and an 8 degree thoracic curve (convex to the left). Her alignment issues are further aggravated by her right leg being shorter than her left. While she experiences little pain from her condition, she says she often feels achey in her back after rehearsing for long hours. Ann has been practicing Pilates for a little over a year in group mat classes and some private apparatus sessions. In her first individualized sessions, we started with the fundamentals to be sure she really understood the concepts like neutral pelvis, neutral spine and how to properly recruit her abdominal muscles. One of the most difficult things for Ann was finding her neutral pelvis, because of her scoliosis her left hip naturally lay more forward than her right, so a true neutral pelvis felt to her as if she were lifting her right hip. Individualized sessions have proved to be much more beneficial than group classes to Ann and her condition, because in these sessions we were better able to focus on the quality of her movement, and make sure she was maximizing her body awareness. One of the great things about Pilates is its ability to recondition the body, and replace old habits with the correct ways of moving. Pilates is able to give Ann a new knowledge and appreciation for her body that she can carry into all aspects of her life. 6

With Ann s scoliosis my primary focus was on strengthening her abdominals and back extensors, especially the transverse abdominus and multifidus. My program sought to build her strength and develop patterns of proper recruitment in those muscles in order to correctly support the spine. Often clients with scoliosis have trouble stabilizing the trunk with out some compensating rotation in the pelvis or vice versa, so my next focus for Ann was pelvic lumbar stabilization. One of my other goals with this conditioning plan was addressing the imbalances of the musculature of the back that is inherent in people with scoliosis. Trying to focus on finding the strength in the weaker muscles that go along the convex side of the curve, and finding a stretch for the tight muscles that go along the concavity of the curve. The following is a condition plan I made for Ann using the BASI Block System. BASI BLOCK SYSTEM CONDITIONING PROGRAM: Block Apparatus Exercise WARM-UP Roll Down MAT *Pelvic Curl Spine Twist Supine Chest Lift Chest Lift w/ Rotation *This is still one of my favorite exercises for Ann. Articulating through her spine and finding that correct neutral position, where her both of her ASIS and her PS are in line, sets her up for success in the rest of her session. FOOTWORK WUNDA CHAIR Parallel Heels 7

Parallel Toes V-Position Toes Open V-Heels Open V-Toes *Single Leg Heels *Single Leg Toes This entire series of exercises is great for someone who has scoliosis because sitting in that upright seated position they need to find the co-contraction of their abdominals and back extensors. The single-leg heels and single-leg toes are especially good for finding trunk and pelvis stabilization with out rotating compensation. ABDOMINAL WORK WUNDA CHAIR *Standing Pike REFORMER Hundred Prep Hundred Coordination Short Box Series: Round Back Flat Back *Tilt Twist Round About Climb-A-Tree All abdominal work would benefit those with scoliosis in further strengthening their core. The Standing Pike is a great lower back stretch. Tilt is such a great exercise for stretching out the tightness in Ann s spine, while still maintaining abdominal control. HIPWORK CADILLAC *Frog Single Leg Supine Series *Down Circles *Up Circles 8

*Hip Extension *Bicycle Because of the different length of her legs Ann can sometimes feel an unevenness when both legs are used at the same time. The single leg series on the Cadillac is great for people who have a similar issue because it truly allows them to feel each leg getting equal amounts of work. These exercises are also great for Ann to work on her pelvic lumbar stabilization. SPINAL ARTICULATION REFORMER *Bottom Lift *Bottom Lift w/ Extension *Semi-Circle Similarly to the pelvic curl, all of these exercises are excellent tools for Ann to work on finding correct alignment as she articulates down her spine. STRETCHES REFORMER Kneeling Lunge Full Lunge Side Split Being a dancer, Ann has pretty great flexibility, these exercises challenge her control of that flexibility. FULL BODY INTEGRATION F/I REFORMER *Round Back *Flat Back *Up Stretch 1 Round Back and Flat Back are great exercises for working on trunk stabilization with shoulder stabilization. Up Stretch 1 provides Ann a stretch for her back extensors that we challenged in previous exercises, as well as a challenge for her abdominals. ARM WORK REFORMER *Chest Expansion Arms Sitting Series *Biceps *Rhomboids *Hug-a-tree *Salute 9

The seated position of this series requires Ann to stabilize her trunk and find great posture, without sinking down in her lumbar spine as she sometimes does. FULL BODY INTEGRATION A/M CADILLAC *Saw Sitting Back Great focus on back extensor control and moving from the correct place in her body. LEG WORK REFORMER Parallel Position Jumping Series V-Position Single Leg Parallel Leg Changes Being a dancer, this series is great exercise that helps work articulation and proper positioning of her feet and ankles which will translate well to jumps she performs in ballet. LATERAL FLEXION AND ROTATION WUNDA CHAIR *Side Stretch *Side Kneeling Stretch Both of these exercises are great for finding pelvic stabilization without any compensation. As well, these boost a great stretch for the tight parts of Ann s back. BACK EXTENSION MAT *Swan Prep w/ Magic Circle WUNDA CHAIR *Swan Basic *Back Extension Single Arm The focus on sequentially extending the spine with abdominal control with help build stronger back extensors and help Ann focus on her alignment. Back extension single arm is great for pelvic lumbar stabilization. For Ann this is a great exercise for her to focus on controlling both sides of her spine equally, and not just muscling through it, but finding the correct muscles to recruit. concluding the session with Roll Down 10

CONCLUSION: Scoliosis creates a muscular imbalance along the spine, the weakened muscles on the side of the convex curve combined with the tightened muscles along the concave curve. Pilates can be a great exercise program for those who suffer from scoliosis because it places an emphasis on managing and correcting muscular imbalances such as those. One of the most beneficial aspects of beginning a Pilates program is the incredible amount of body awareness it brings to each client. For a client like Ann, the first step in her progression was finding that awareness and seeing how her scoliosis altered her alignment. Pilates proved to be a great tool for Ann, it helped her to access those crucial core muscles that aid in the support and carriage of the spine, as well as develop more balance in her spine. The BASI Pilates repertoire allows for functional movement that enhances the overall health and well being of its clients. 11

BIBLIOGRAPHY Cheung, W.Y. and K.D.K Luk. Classification of adolescent idiopathic scoliosis. The British Editorial Society of Bone & Joint Surgery. Web. 28 Jan 2014. <http:// www.boneandjoint.org.uk/content/focus/classification-adolescent-idiopathic-scoliosis> Isacowitz, Rael. 2013. Comprehensive Body Arts and Science International Comprehensive Course Movement Analysis Workbooks. Costa Mesa, CA: Body Arts and Science International. "Musculoskeletal Radiology."Scoliosis UW Radiology Department of Radiology University of Washington, n.d. Web. 28 Jan. 2014. < http://www.rad.washington.edu/ academics/ academic-sections/msk/teaching-materials/online-musculoskeletal- radiologybook/scoliosis> "National Scoliosis Foundation." National Scoliosis Foundation. National Scoliosis Foundation, n.d. Web. 27 Jan. 2014. <http://www.scoliosis.org/info.php> Slup, Joanna. Scoliosis. Scoliosis In London. Web. 28 Jan. 2014. < http:/ /www.scoliosisinlondon.co.uk/scoliosis.html> 12