Cervical, Thorasic, Lumbar and Sacrum Dysfunction WHERE AND HOW DO I START? FAITH CLEMENTS SEPTEMBER 2016 COPENHAGEN 2015
ABSTRACT This paper examines the conditions of the author, Faith Clements and her journey with Pilates as a form of physical rehabilitation. Faith suffered increasing chronic pain and movement dysfunctions over a period of several years, starting with double vision 3 years ago. It has been a long and uphill fight for Faith to try to return to health. Faith chose to follow the BASI CTTC Course, firstly use her year at home recovering well, and secondly to try to gain a depth of knowledge about her conditions to a level to understand the best way for her to recover. This paper examines the anatomical description of my conditions, combined with major muscle groups involved, and Faith s notes in relation to how it was for me. Further analysis is provided of the BASI block system in relation to the physical rehabilitation program she followed. This paper ends with conclusions in this respect.
TABLE OF CONTENTS 1. Title 2. Abstract 3. Table of Contents 4-6. Anatomical description 7. Diagnosis 8. BASI Training Programme 9. Conclusion 10. Bibliography
ANATOMICAL DESCRIPTION Detailed on the following pages are diagrams and details of the major areas and muscle groups affected in this study. DIAGRAM OF HUMAN VERTIBRAL SPINE The diagram highlights in colour the different vertebral sections of the spine Vertebrae Number Placement Purpose Cervical Orange C1 C6 Atlas to base of neck Head and neck movement Thoracic Green T1 to T12 Neck base to base of rib cage Move with rib cage Lumbar Blue L1 L5 Below last rib to Pelvic girdle Largest, weight bearing, support lower back movement Sacral Red S1 S5 Fused at Stability to pubity. Each pelvis, provides side joins a hip bone movement between S1 and L5 (lumbosacral joint). Significant to lumbar and Coccyx Purple Coccygeal vertebrae- 4-5 vertebrae Fused pelvis alignment Tailbone
PRIMARY MUSCLES OF THE SPINE ABDOMINALS Purpose: enhance movement technique, improve postural deviations, significantly reduce instability in the back. Muscle Placement Movement Rectus abdominis Central portion of Spinal flexion abdomen (linea alba) Lateral flexion-oblique focus External oblique Internal oblique Transversus abdominis Diagonal down towards centre, aside Rectus abdominis. Deep to external oblique, fibres run to centre laterally to rectus abdominis. Deepest, horizontal direction Rotation-external oblique Spinal flexion Lateral flexion-oblique focus Lateral flexion-oblique focus Contraction rotation opposite side Spinal flexion Lateral flexion-oblique focus Lateral flexion-oblique focus Contraction-rotation same side Assists rotation Postural corset function Protects spine Contracts stabilising spine & pelvis Aids respiration SPINAL EXTENSORS Purpose: Paired extensors, commonly extend the spine. Key to optimal movement, prevent back and postural injuries. Strengthening the spinal extensors positively impacts spinal posture. Muscle Placement Sub muscle group Erector spinae Most powerful Spinalis, longissimus, ilicostalis Semispinalis Deep to Erector Spinae. Placed thoracis spine and up Deep posterior spinal group interspinales, intertransversales, rotatores, multifidus.
DEEP POSTERIA SPINAL GROUP Purpose: Parallel in function to transversus abdominis. Stabilises spine and adjacent segmental vertebral movements. Muscle Placement Purpose Interspinales Spans and attaches to many Stabilises local spinal extension vertebrae Intertransversales Spans and attaches to many vertebrae Stabilises local spinal extension Stabilises local spinal lateral Rotators Multifidus Spans and attaches to many vertebrae Spans and attaches to many vertebrae, as a result produces great force flexion Stabilises local spinal extension Stabilises local spinal lateral flexion Stabilises local spinal rotation Stabilises local spinal extension Stabilises local spinal lateral flexion Stabilises local spinal rotation QUADRATUS LUMBORUM AND ILIOPSOAS Iliopsoas Quadratus Lumborum Purpose: Deep Muscle Purpose Placement Movement Quadratus lumborum Same side contraction.. Pelvis, lumbar spine & last rib attachments Spinal lateral flexion Iliopsoas Maintains lumbar curvature/lateral flexion lumbar spine Lift leg high
MEDICAL DIAGNOSIS & COMMENTS Diagnosis: Osteoarthritis in the Spine CERVICAL SPINE Diagnosis: degenerative disc C6/C7. Authors symptoms: Chronic cervical pain and weakness in neck, radiating to upper trapezious, scapular, mid thorasic and spinal extensors, Pectoralis, nerve tightness to hand. Reduced capacity and exhaustion. My jaw had a significantly shifted, reducing muscle mass one side as highlighted by both my dentist and Osteopath. I suffered the onset of overnight double vision left sided Mid 2013. After a brain scan and testing over several months, there were no Medical findings. Authors notes: The double vision was a warning sign to the severe dysfunctions within my body. THORACIC SPINE Diagnosis: degenerative disc Th 4/5 Authors symptoms: Chronic tightness in all areas, lack of mobility in all planes of motion. Diaphragm dysfunction due to affected nerves. LUMBAR SPINE Diagnosis: degenerative disc L3/4, L4/5 Authors symptoms: Cronic lumbar pain, dysfunction, weakness and tightness in all areas. SACRUM & PELVIC Diagnosis: degenerative disc L5/SI Authors symptoms: Severe sacral pain, dysfunction and issues with weight bearing and walking. Exhaustion and low capacity. Iliopsoas and Pubic symphosis issues. I realise now I had spent years with reduced capacity and pain which had become normal. These conditions had reduced my ability to recruit deep core stabilising muscles, leading to the instabilities and lack of strength and alignment. PHYSICAL REHABILITAITON PROCESS I started a rehabilitation process combining both Osteopathic treatment and Pilates based movement rehabilitation. The whole body approach of both worked for me. At the time of writing this paper, I had received Osteopathic treatments approximately once a month for almost two years. Towards the end of the BASI CTTC course I built a Pilates Machine studio at home to be able to train on a daily basis with rehabilitation and study. BASI BLOCK SYSTEM
Detailed below is the BASI block system I followed with modifications according to pain levels and capacity. LEVEL EXECISE BLOCK 10 11-20 30 Pre- Lateral Warm up Decompression of lumbar Same Same Foundation breathing and cervical spine. Foundation Pelvic Curl Warm up Modified rotations to Caution According to capacity pelvis. Foundation Balance Foot work Balance work introduced Same Reformer at 20 weeks Foundation Spine twist supine Abs Modified, feet on floor, small rotations. Same Same + full movement Foundation Chest lift with Abs oblique Modified Foam roller Same. Introduced Full movement rotation emphasis behind scapula, lateral rotations. Reformer at 20 weeks Foundation Single leg lift Abs Caution loading on neck Continued easy Continued easy level. due to TA weakness. level. Foundation Hundred prep Abs No Introduced with caution. Full Movement as capacity. Foundation Roll up-note due to a lack of deep TA connection this exercise severly loaded Lumbar/Sacral Abs Modified, breath/pelvic, & Thorasic flexion/ extension Foundation Leg circles Hip Work Contraindications L5/SI Modified Foundation Roll like a ball Spinal Articulation Foundation Cat Stretch Spinal Articulation Modified, breath/pelvic, & Thorasic flexion/ extension Bent leg. Reformer at 20 weeks, caution (loading lumbar & SI). Modified, breath/pelvic, & Thorasic flexion/ extension With bent leg. Reformer with caution. Contraindications Caution Ok according to cervical thorasic capacity. Extremely small movements Foundation Spine stretch Stretches Contraindications. Bent legs, length in lumbar spine. Thoracic mobility, opening neck & chest fascias Modified & caution. Same on arc. Foundation Side lift Leg work Modified + Side skating Reformer. Foundation Saw Lateral Modified Mermaid flexion/rotation Reformer, light resistance. Foundation Back extension Back extension Contraindication. 2 cm lift Same only, focus on length Foundation Rest position Rest Position Ok Ok Ok Full movement Modified with caution Full movement. Side skating on Same Improving.
CONCLUSION Authors notes: The author noted that within a month of introducing light Reformer training, the support of the machine enabled her to establish some deep connections from which to move forward from. The training I did at home alone on a daily basis in a relaxed environment deepened my awareness in movement, enabling deep connections throughout the entire body. The dysfunctions and pain remained up and down on a daily basis, the neck being a very weak problematic, area, later I understood that when my trunk had stabilisised and strengthened the neck had the grounding to also gain deep strength. I remember one day I rotated to the back seat of the car and noted I had actually rotated from the Thorasic spine and not the L5/SI joint a great realisation of a big change in stability and mobility! I chose to follow the BASI Comprehensive education which initiated the above training programme to understand movement science and how I could move apply it to my situation. The BASI CTTC Course had a very positive effect on me in many ways, physically and mentally. I was highly motivated learning the theory and practical side because of the potential huge impact on my desperate situation After completing the BASI CTTC exams I started to teach immediately on a voluntary basis from my home. This was a significant part of my own physical and mental rehabilitation. At times physical pain overload made it extremely hard, but seeing others gain stability, strength and freedom of movement with improved posture was an overwhelmingly positive experience, and a contributory factor in my increasing knowledge and awareness of how movement heals. During the last year I have attended international conferences and workshops with exceptional trainers to understand as much as I possibly can. My confidence in this area has improved tremendously as has my ability to see dysfunctions in others. I have had the good fortune to have recommended to me potential BASI students to mentor. This is bringing me great happiness to help others grow in an area I have become so passionate about, and I look forward to helping them towards examinations. I have also had international BASI students contact me for advice and networking opportunities which is fabulous. Thank you to the greater BASI family for your energy and inspiration which drives me forward daily I look forward to attending one of the BASI conferences in the future.
BIBLOGRAPHY Pilates Anatomy, Rael Isacowitz & Karen Clippinger 2011, Human Kinetics. Dance Anatomy & Kinesiology, Karen Clippinger second edition, Human Kinetics.