Pilates for the Seated Musician: Muscular Imbalances and Injury Prevention The Pilates Clinic, Wimbledon 2015-16 Veronica Fulton 10/09/2016
Joseph Pilates method has appealed to physical performers from the day he opened his studio doors. Athletes, dancers and musicians have used the Pilates method when experiencing overuse injuries to help with functional muscle imbalances and postural deviations. This paper will focus on a guitarist s posture, spending their working day in prolonged hours of flexion, neglecting posture, which can lead to imbalances and injuries resulting in neck and back pain. This is likely due to recruitment of incorrect muscles to hold their position, accompanied by poor posture and asymmetry. I will evaluate the posture and muscular imbalances of a healthy guitarist and using the BASI Block System, create a program to prevent injury to the shoulder girdle. Making a specific program will correct imbalances and focus on strength and endurance as well as improving their mind-body connection, performance and minimising pain. 2
Table of Contents Page 1: Cover Page Page 2: Abstract Page 3: Table of Contents Page 4 and 5: Anatomical Description of the Shoulder Girdle Page 6 and 7: Anatomical Description of the Spine and Postural Deviations Page 8, 9, 10, 11: Case Study Page 12: Bibliography 3
Anatomy of the Shoulder Girdle The shoulder girdle is comprised of paired clavicles and scapulae. The only bony attachment to the axial skeleton is via the clavicle at the sternoclavicular joint. Laterally, the scapulae create a shallow indentation called the glenoid fossa for articulation with the upper arm bone, the humerus. As the shoulder joint is a ball and socket joint, it allows a wide range of movement, however there is a lack of stability in this joint due to the size of the glenoid fossa and very little bony or ligamentous support. Scapula movement contributes to the fine tuning of the upper extremity kinetic chain permitting the glenoid fossa to move in synergy with the humeral head. The small muscles surrounding the scapulae are otherwise known as the rotator cuff muscles, they include the supraspinitus, infraspinatus, teres minor and subscapularis. These muscles connect the scapulae to the proximal humerus and provide shoulder stability and facilitate subtle desired mechanics of the shoulder. 4
Scapula balancing muscles, serratus anterior and trapezius, assist scapular movement around the thorax. The rhomboids, levator scapulae and pectoralis minor are the group of muscles which connect the scapulae to the surrounding bones, but do not have direct connection with the humerus. Finally the largest muscles which produce gross movements of the arm include the pectoralis major, deltoids, latissimus dorsi and teres major. 5
Postural deviations found in the thoracic and cervical spine can affect the normal function of the glenohumeral joint. Scapular balancing muscles can also be adversely affected. It is important to ensure the scapular is in the correct position and then begin scapular stabilization exercises to strengthen the joint and prevent injuries such as scapula disassociation, where the misaligned position of the scapula and repetitive activities e.g. playing guitar, can affect the biomechanics of the shoulder and can result in abnormal posturing. Anatomy of the Spine The spine is made up of 33 individual bones called vertebrae. The spinal column, which is protected deep inside the bones provides the main support for your body. Between each vertebrate is an intervetebral disc, a cushion to stop the bones from rubbing against each other. The cervical spine (neck) is made up of 7 vertebrae which support the weight of the head, the thoracic (mid-spine) has 12 vertebrae and holds the rib cage in place. The lumbar spine (lower back) has 5 vertebrae and holds the main weight of the body. The 5 sacral vertebrae attaches the spine to the 6
pelvis and the 4 fused bones of the coccyx provide attachment for ligaments and muscles. When viewed from the side, the adult spine has an S-shape curve. The cervical and lumbar regions have a slight concave curve and the thoracic and sacral regions have a slight convex curve. The curves act as shock absorbers, help maintain balance and allow a range of motion for the body. Faulty alignment can occur when a postural deviation is present resulting in undue stress or strain on bones, joints, ligaments and muscles. I will determine if there is a postural deviation (structural or functional). The most important muscles to develop for good posture and core control are the multifidus and Transverse Abdominus. These deep muscles help to protect the spine and pelvis, I will ensure these muscles are strong in order for functional daily life. 7
Case Study Oliver is a 26 year old, male professional guitarist. He practices in a flexed, seated position for up to 6 hours a day. To play the guitar, his left arm is in external rotation and his right arm is in internal rotation. His upper body is rotated around the longitudinal axis to the left. Naturally, his spine is slightly lordotic with his shoulders rolling slightly forward of the plumb line. He has tight pectorals, his shoulder joints have a limited range of movement and he has a weakness in the thoracic spine. He also has extremely tight hamstrings and hip flexors, no doubt from his days spent sitting. He aims to do exercise once a week but it is not a priority. He has experienced lower back pain and for therapies, Oliver has received treatment from physiotherapy, chiropractors and osteopaths and studied the Alexander technique to help his posture. The goals for this conditioning program using the BASI block system will enable him to strengthen his deep abdominal and back muscles, especially in the thoracic region. Stretch out his pectorals and increase the range of movement of the shoulder joint without pain. Lengthen and strengthen the hip flexors and hamstrings. I will also focus on exercises to strengthen the rotator cuff muscles in the shoulder to allow him to practice safely. Ultimately, I will help him to become more self-aware and help improve his posture. Warm Up Foot Work Initial Programme Roll Down Pelvic Curl Spine Twist Supine Single leg lifts Chest Lift on the Step Barrel Parallel Heels Parallel Toes V-Position Toes Open V Heels Progressions Chest Lift on Mat 8
Abdominal Work Hip Work Spinal Articulation Stretches FBI (Fund) Arm Work Open V Toes Calf Raises Prances Single leg heels Short Box Group Round Back Flat Back Tilt Twist Frog Down Circles Up Circles Openings Bottom Lift Standing Lunge Pole Shoulder Stretch Overhead stretch Ladder Barrel Gluteals Up Stretch1 Cadillac Thigh Stretch w/ RU bar (Arm Supine Series) Extension Adduction Up Circles Down Circles Triceps Cadillac Mini Roll Ups Bottom Lift with Extension Down Stretch Cadillac Kneeling Cat Stretch Ped-A-Pul Adduction Extension Up Circles Down Circles Triceps 9
Leg Work Lateral/Flexion Back Extension Additional Exercises Wunda Chair Leg Press Standing Ankle Weights Adductor Lift Hip Abduction Bent Knee Hip Extension Bent Knee Hip Extension Straight Leg Step Barrel Side Lift Mat Cat Stretch Wunda Chair Swan Basic On Foam Roller Remedial Shoulder Stretch or Circles Magic Circle Arms Bent Arms Straight Ankle Weights Side Leg Lift Forward and Lift Forward with Drops Mat Swan Basic Arms Overhead 10
Conclusion This program was specifically designed to target Oliver s goals, giving him an increased understanding and awareness of his body and adhering to the ten Pilates Principles. Having followed this program for 3 months, Oliver has now become aware of which muscles to recruit to help posture correction including significantly strengthened abdominals and has taken steps to improve his practise pose. He has demonstrated improved flexibility of the pectorals and an increased range of movement in the shoulder joint. He has improved his understanding of the upper back muscles, particularly rhomboids and scapula stabilisation. An important part of his Pilates classes have been focused on stretching of the glutes and hamstrings and remedial work to the shoulders, preventing injuries to the shoulder and addressing his lower back pain. In addition, his increase in stamina and strength will help him during his hours of practise and performance. Oliver has been able to use his new knowledge and self-awareness learnt in the studio and incorporates them into his practise and daily life, preventing himself from injury and leading him to a pain free life. 11
Bibliography Isacowitz, Rael, Body Arts and Science International, 2000-2013, Study Guide: Comprehensive Course Isacowitz, Rael, Body Arts and Science International, 2000-2012, Auxiliary Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Cadillac Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Mat Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Wunda Chair Movement Analysis Workbook Pilates, Joseph, Pilates Return To Life Through Contrology, Revised Edition for the 21 st Century, 1998 Brownstein, Bruce and Bronner, Shaw, Functional Movement in Orthopaedic and Sports Physical Therapy: Evaluation Treatment and Outcomes,1997 Berque, Patrice, n.d., Musculoskeletal Disorders Affecting Musicians And Considerations For Prevention, http://www.musicianshealth.co.uk/musiciansmusculoskeletaldisorders.pdf 12