Utilizing Pilates to help with Hyperlordosis Julie K. Ruxton November 30, 2017 2017 Cincinnati, OH 1
Abstract! Each year as many as 25 million Americans seek a doctor s care for backache. According to some experts, next to the common cold, back pain is the leading medical complaint in the United States and will be experienced by 80 percent of all adults at some point in their lives. (Fitness for Life) Hyperlordosis is a problem that can lead to backache.! A major cause of hyperlordosis is from muscle imbalances in the back, hips or legs. The muscles imbalances are weak abdominal and gluteus/hamstrings and tight hip flexor and low back. Pilates can strengthen the weak areas and stretch the tight. This will shift the pelvis from an anterior position with a protruding stomach to a balanced, neutral position resulting in less stress on the spine. 2
Table of Contents!!!!!!!!! Page I. Abstract 2 II. Visual Diagram of Hyperlordosis 4 III. Case Study 6 IV. Conditioning Program 7 V. Conclusion 10 VI. Bibliography 11 3
Anatomical Description (posturedirect.com)! Hyperlordosis, is an excessive inward curvature of the lower back. When the pelvis tilts too far forward, it affects the curvature of the lower back, causing the person to look like they are sticking their bottom out. A small amount of lordosis is normal, but an excessive curve can cause problems over time. The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. (www.spine-health.com)! Some muscles around the hip and spine become tight and some become weak and stretched, causing an imbalance. The muscles that are often tight are trunk 4
extensors and hip flexors requiring stretching. The muscles that are often weak and stretched are the abdominals muscles and hip extensors and gluteus. (www.sportsinjursyclinic.net)! 5
Case Study! Kristen is a 38 year single mother of one child. She works at an asset management firm which entails her to sit most of the day. She is a tennis player but hasn t had as much time to play as she would like. She came to me as she wanted to get more active but noticed her back was constantly tight, resulting in holding off playing tennis or doing much of any type of exercise. She had tried yoga and found some relief but still had the low back tightness that was limiting her. A friend suggested she try Pilates as it had helped her friend with similar low back tightness.! When I met with Kristen, I asked her what she wanted to achieve and the main goal was to be able to move more freely without a tight low back and be more active. My first initial assessment, I asked Kristen to do a roll down. I noticed her pelvis was rotated anteriorly, her abdomen was protruding forward and she was sitting back on her heels. I asked her to put weight into her toes, pull her abdomen up and in and to slightly rotate her pelvis forward while engaging her hamstrings and adductors. Using a mirror, I showed her what standing in neutral looked like - her abdomen was flat, her pelvis had a slight posterior tilt, she looked more balanced and taller. While she said that standing like that did not feel natural, she did like how she looked. We discussed her activity and she mentioned that she predominately used her quads when playing tennis and did not stretch or do any abdominal work.! I suggested she commit to doing Pilates twice a week. We decided that one private session and Mat work she could do at home would work best being a single mother. I suggested that when doing the abdominal exercises at home to start with a towel under her low back so she could feel the engagement better and to make sure 6
she was in a neutral spine. Kristens initial way to engage her abdominals was to posteriorly tilt (tuck) her pelvis. The towel will help to provide feedback as she learns to keep her pelvis neutral and we discussed this was only to be done for a short period of time so as not to become dependent on the towel. For the private sessions, the focus was on strengthening her abdominals, gluteus/hamstrings, stretching her hip flexors and low back. BASI Block Exercises Comments Warm Up pelvic curl, chest lift, chest lift w rotation, single leg changes articulating through the spine focusing on low back articulation and maintaining a neutral pelvis Foot Work Ref: foot work series lengthening out from the hamstrings with minimal use of the quads Abdominals Hip Work Ref: hundred prep, hundred, coordination Ref: frog, circles down/up, openings strengthen abdominals by adding arm movement and holding pelvis stable when legs open and close in coordination abdominals engaged to keep pelvis stable and hamstrings and adductors strengthened Spine Articulation Cad: monkey original works the abdominals while stretching the back and improving movement of the spine and strengthen back extensors when holding back completely straight 7
BASI Block Exercises Comments Stretches Full Body Integration F/I hip flexor stretch, low back stretch Cad: sitting forward, side reach basic hip flexor stretch to lengthen tight hip flexors; lying on back drawing knees to chest and holding knees to relax and stretch tight low back focus on low abdominals,stretching hamstrings and spine articulation; mobility of spine, oblique strength and stabilizing pelvis Arms Standing Arm Series trunk stabilization, engagement of hamstrings and gluteus while strengthen upper body Full Body Integration I/A n/a n/a Legs Ref: hamstring curl -long box; single leg skating strengthen hamstrings in addition to abdominal and back extensor engagement Lateral Flexion/Rotation Ref: mermaid oblique strength and stretch, spine mobility and scapular stabilization Back Extension Cool Down Ref: breaststroke prep and breaststroke prep with variation - long box rest position and final roll down back extensor strength,abdominal engagement, hamstring control; variation adds additional control as lifting trunk up requires more abdominal engagement and scapular engagement stretch and relax low back; engagement of low abdominals,hamstrings and spine articulation on roll down and up 8
For Kristen s at home Mat routine, she asked that it be compact and take roughly 30-45 minutes. Mat BASI Block Exercises Comments Foundation Abdominals Spine Articulation Bridging Lateral Flexion/Rotation Side Line Work Back Extension pelvic curl, spine twist supine, leg changes, chest lift, chest lift w rotation, roll up leg circles, single leg stretch, double leg stretch, hundreds, criss cross rolling like a ball and spine stretch shoulder bridge prep, front support, back support side lifts, side kick, corkscrew side leg life, forward and lift, forward with drops - gluteals side lying, adductor lift back extension, single leg kick, cat pelvic stability and control, conditioning abdominals and obliques abdominal strength and control, oblique strength focus on maintaining ball shape in order to roll through the entire spine not skipping low back; articulate spine up and down and initiating movement with low abdominals abdominal, hamstring strength, trunk stabilization and hip extensor strength oblique strength, trunk stabilization, hip extensor control pelvic lumbar stabilization, hip abductor strength, adductor strength back extensor and upper back strength, hamstring stretch, abdominal control Cool down rest position stretch and relax low back 9
As Kristen s abdominal and hamstring strength increase and her hip flexors and low back lengthen, the sessions will incorporate more challenging exercises. I suggested to Kristen to be aware of how she is standing and to correct her posture when she finds herself falling back to her comfortable posture. Conclusion! Kristen s hyperlordosis was not a severe case but it was limiting her activity and how she viewed herself. By committing to put the time in, she has noticed within the first month that she is more aware of how she is standing and noticed that she didn t have to take breaks during the abdominal work. In strengthening her hamstrings she feels more balanced and supported. The hip flexors are still tight and we are continuing to work carefully stretching them, as we do not want to over stretch her hip flexors. As such, I ve suggested she wait until she has more strength in her hamstrings and abdominals before we start to incorporate exercises such the teaser, reverse knee stretch and single leg side series on the cadillac. She has reduced low back tightness when she plays tennis. Kristen has also found that she was a new way to deal with the stress of her job and is able to focus more clearly on the various tasks. 10
Bibliography Wong, Mark. How to Fix Hyperlordosis (Arched Back). January 27, 2017. www.posturedirect.com Virtual Sports Injury Clinic Limited. Hyperlordosis. 2017 Virtual Sports Injury Clinic. Registered in England and Wales. www.sportsinjuryclinic.net Isacowitz, Rael. Study Guide: Comprehensive Course. Body Arts and Science International. 2000-2014. Costa Mesa, California Isacowitz, Rael, Clippinger, Karen. Pilates Anatomy. 2011. Printed in the United States Freutel, Natasha. Core and Hip Exercises to Correct Lordosis Posture. January 28, 2016. www.healthline.com Peloza, John MD. Lower Back Pain Symptoms, Diagnose and Treatment. April 20, 2017. www.spine-health.com Conversations with Professionals Karman, Sondra. BASI Pilates 11