PILATES FOR POSTURAL KYPHOSIS AND LOW BACK PAIN ANA HUBNER JANUARY 15, 2018 COMPREHENSIVE APPARATUS PROGRAM SOUTH PASADENA, CA 2015
Abstract Kyphosis is a spinal disorder in which an excessive outward curve of the spine results in an abnormal rounding of the upper back. The condition is sometimes known as roundback. Kyphosis can occur at any age but is common during adolescence. In most cases, kyphosis causes few problems and does not require treatment. Occasionally, a patient may need to wear a back brace or od exercises to improve his or her posture and strengthen the spine. In severe cases, however, kyphosis can be painful, cause significant spinal deformity, and lead to breathing problems. This paper focuses on a case study of a 40+ female, diagnosed with postural kyphosis as a teenager, who is looking for an exercise program that would help to improve her posture, strengthen her back, and help alleviate occasional pain in thoracic and lumbar spine. We will look at how the BASI approach to the Pilates method can help us achieve those goals. PAGE 1
Table of Contents Abstract... 1 What is Kyphosis?... 3 Anatomy of the Spine... 4 Case Study... 5 Conditioning BASI Program Overview...6 Conditioning Program... 7 Conclusion...9 Bibliography... 10 PAGE 2
What is Kyphosis? The spine, or vertebral column, is made up of 33 bones called vertebrae that are stacked upon next to form a long column like structure. The vertebrae get larger from top to bottom as they progress from the neck to the pelvis. The vertebrae are arranged in five regions; cervical, thoracic, lumbar, sacrum, and coccyx. The spine has a series of distinct curves when viewed from the side. These curves help to better absorb the loads applied to the spine from the weight of the body. The cervical and lumbar regions are curved such that they are concave to the back, while the thoracic region is curved such it is concave to the front. Kyphosis is a spinal disorder in which an excessive outward curve of the spine results in an abnormal rounding of the spine. There are three main types of abnormal kyphosis; postural, Scheuermann s kyphosis, and congenital kyphosis. Postural kyphosis, the most common type of kyphosis, usually becomes noticeable during adolescence. It is caused by poor posture and a weakening of the muscles and ligaments in the back. The vertebrae are typically shaped normally in postural kyphosis. It is often slow to develop and usually does not continue to become progressively worse with time. These patients have symptoms of pain and muscle fatigue. This type of kyphosis does not lead to a severe curve, and there is little risk of neurologic, cardiac, or pulmonary problems. Scheuermann s kyphosis also often becomes apparent during teenage years. This type of kyphosis is the result of structural deformity of the vertebrae. Congenital kyphosis is the least common type of abnormal kyphosis. This is caused by an abnormal development of the vertebrae during development prior to birth. This can lead to several of the vertebrae fusing in kyphosis. PAGE 3
Anatomy of the Spine PAGE 4
Case Study Mary is 45 years old, small business owner, married. Her job requires several hours of computer work daily. She is physically active, enjoys running, weight lifting, and has been practicing yoga for over 20 years. She was diagnosed with postural kyphosis as a teenager. Lately she is noticing that she is slouching more, especially when fatigued, and started experiencing occasional pain in her upper back. She complains about the lower back weakness and tenderness. Mary has taken Pilates before, and is aware of the benefits of the Pilates method. However, she would like to get a little more detailed approach, the one that would help her learn how to safely perform the exercises, that is breath oriented, and like yoga, helps her create the union of body and the mind. PAGE 5
Conditioning BASI Program Overview Mary will start her 5-week program, taking private sessions twice a week. Since Mary is in good physical shape, is familiar with the Pilates repertoire, and has a good body awareness, we will create an intermediate level program for her. The goal is to strengthen the abdominal muscles to create a better support for the lumbar spine and to help overall posture; to strengthen muscles of the back to help decrease the roundness of the upper back, and to stretch pectoral muscles, hip flexors, and hamstrings. To help deepen the connection of mind and body, we will pay special attention to the breath. Since Mary is a long-time yoga practitioner and is used to the diaphragmatic breathing which demands relaxation of the abdominals during inhalation, we will spend some time focusing on lateral breathing. Mary also feels that in the past, while performing Pilates exercises she wasn t aware how to stabilize her body, so we will focus on pelvic-lumbar and scapular stabilization. PAGE 6
Conditioning Program 1. WARM UP mat Roll down, Lateral breathing, Roll up, Spine twist supine, Double leg stretch, Single leg stretch, Criss cross 2. FOOT WORK reformer Foot work series: Parallel heels, Parallel toes, V position toes, Open V heels, Open V toes, Calf raises, Prances, Single leg heel, Single leg toes 3. ABDOMINAL WORK step barrel Chest Lift, Overhead Stretch 4. HIP WORK reformer Frog, Circles (Up and Down), Openings 5. SPINAL ARTICULATION - reformer Bottom Lift, Bottom Lift with Extensions 6. STRETCHES reformer Kneeling Lunge 7. FULL BODY INTEGRATION reformer Up Stretch 1, Knee Stretch Flat Back, Down Stretch 8. ARM WORK Cadillac Arms Standing Series: Chest Expansion, Hug-A-Tree, Circles (Up and Down), Punches, Biceps 9. LEG WORK reformer Single Leg Skating PAGE 7
10. LATERAL FLEXION /ROTATION reformer Side Over on Box 11. BACK EXTENSION - reformer Pulling Straps 1, Pulling Straps 2 PAGE 8
Conclusion After 10 sessions, Mary feels that her posture has greatly improved. She still finds that she slouches when fatigued, but now she feels that she has developed a better body awareness and knows which muscles need to be engaged to correct her posture. She feels that she learned how to stabilize her pelvis and shoulders while performing the exercises, so she doesn t experience tension in low back and neck area anymore. Mary will continue with her Pilates sessions and her yoga practice to keep her back strong and pain free. PAGE 9
Bibliography 1. Isacowitz Rael and Clippinger, Karen 2011. Pilates Anatomy. Champaign, IL: Human Kinetics 2. Body Arts and Science International 2000-2013. Study guide, Comprehensive Course 3. www.orthoinfo.aaos.org 4. www.mayoclinic.org PAGE 10