REPETITIVE STRESS SYNDROME AND ITS EFFECTS ON THE LOWER PELVIS Kim Turney Body Arts and Science International Comprehensive Global Feb 2018 London, UK
ABSTRACT In many lines of work people are subjected to working in positions that put their body in positions of distress and discomfort for many hours at a time. These positions over time can eventually lead to injuries and consequently pain for many people. Overuse of certain muscles can create imbalances and repetitive stress on joints can create inflammation and tears on the surrounding ligaments and tendons. This case study focuses on numerous areas of pain and dysfunction around the pelvis that have resulted from repetitive stress. The sacroiliac joint, an area that is fundamental for good alignment, without this it can create many imbalances and compensations throughout the entire body. And the Piriformis, which often overused can create sciatic pain due to the location of the sciatic nerve running through the muscle and when contracted can compress the nerve itself. Pilates is particularly effective for this area as it can help to stabilize the joint by correcting imbalances through strengthening the muscles that are weak and stretching those that have been overused. 2
CONTENTS ABSTRACT 2 CONTENTS 3 ANATOMY 4 CASE STUDY 5 BASI CONDITIONING PROGRAM 6,7 CONCLUSION 8 BIBLIOGRAPHY 9 3
ANATOMY At the bottom of the spine lie the two Sacroiliac Joints, they connect the Ilium (hip bones) to the sacrum. The SI joints primary function is to absorb shock between the upper body and the pelvis and legs. Strong ligaments around the joint help to stabilize it in supporting the weight of the upper body. Sacroiliac joint dysfunction is often caused by irregular motion in the sacroiliac joint. This motion will wear down the cartilage and can lead to inflammation in the joint itself by the two bones rubbing together (Sacroiliitis). A dense network of muscles and ligaments support the SI joints and allow for very little movement. Small tears through years of overuse can eventually lead to too much movement in the joint itself, resulting in pain. Many large and small muscles have relationships with the ligaments of the Sacroiliac Joint, and damage to these ligaments will often affect the nearby large muscle groups. If one or more of these muscles becomes tight or weak, it will lead to huge imbalances in the pelvic area. The sciatic nerve runs very close to the joint itself and can often become irritated by a tear in the joint capsule or further down the nerve at the Piriformis muscle- which if overused can result in the muscle spasming and compressing the nerve (Piriformis Syndrome)- which will also result in sciatic pain shooting down the leg. 4
CASE STUDY Tetiana is a beauty therapist, at 35 she is healthy and leads an active lifestyle; she runs, plays tennis and practices yoga. Her job requires her to spend all day on her feet, and working in an awkward position of bent over in forward flexion and rotated to one side, working mainly stood with most pressure on just the one leg (the side affected). She has had recurring unilateral pains in her lower back, buttocks and hips for a few years, she complains of sciatic pains that shoot down the top of her leg. The program will focus on working on strengthening the larger muscles that stabilize the area (glutes and hamstrings) and improving the flexibility of the muscles that attach to the spine and the pelvis (psoas). Plus stretching the Piriformis and strengthening of the hip abductors- A common cause of Piriformis syndrome is having tight adductor muscles. This means the abductors on the outside cannot work properly and so put more strain on the Piriformis, resulting is spasms. The program starts by focusing on working in neutral pelvis, this is to gain understanding and awareness of neutral and to create alignment within the muscles and pelvis. In the absence of FBI in the beginning sessions, extra stretches are added, the ladder barrel which will help with her sciatic pain, the kneeling lunge to stretch out the psoas, and an added thoracic stretch on the Step Barrel due to her consistent forward flexion. Back extension is with a very small ROM and will help strengthen her back extensors that have become very weak due to her repeated position of forward flexion, yet deep forward flexion is avoided as this can create pain around her pelvis. 5
CONDITIONING PROGRAM 1-10 Sessions BASI BLOCK EXERCISE FOCUS WARM-UP MAT Pelvic curls Chest Lift Chest Lift Rotation Working in neutral pelvis and small amount of flexion on the chest lifts. Spine Twist Supine is removed to avoid pelvic rotation- to avoid putting too much stress on surrounding SI ligaments. FOOTWORK ABDOMINALS HIP WORK SPINAL ARTICULATION STRETCHES ARM WORK LEG WORK LATERAL FLEXION BACK EXTENSION Footwork series 100 Prep CADILLAC Supine Single Leg Series Bottom Lift LADDER BARREL Gluteals Hamstrings STEP BARREL Shoulder Stretch Lying Side Standing Lunge Supine Arm Series CHAIR Leg Press Standing CHAIR Side Kneeling Stretch MAT-MAGIC CIRCLE Swan Prep The footwork will help establish working in neutral pelvis and building up strength in supporting & stabilizing muscles for the SI. Working in neutral pelvis whilst working on the abdominals, particular emphasis on the TA muscle. Focusing on stabilizing the pelvis and working in neutral, working one leg at a time so that one side cannot take over. One leg also makes it easier to see and work on imbalances around the pelvis. And working in a parallel position is safer for the stabilizing SI muscles. Working on the glutes and lower back muscles helps support the SI joint. Ladder Barrel - These will stretch out the Piriformis muscle- helping with the sciatic pain. Step Barrel - Stretching out the thoracic spine and shoulders (due to the clients repeated forward flexed position). Reformer- to stretch out the Psoas. Good series for maintaining neutral spine/pelvis position. This will work on the hamstrings which support the SI and will also work on the clients balance. Maintaining neutral pelvis throughout. Starting with a very small range of movement to not throw the pelvis off, working on engagement of abdominals. Would be beneficial for client as she works flexed forward for many hours a day. 6
10+ Sessions BASI BLOCK EXERCISE FOCUS WARM-UP FOOTWORK ABDOMINALS HIP WORK SPINAL ARTICULATION STRETCHES FULL BODY INTEGRATION ARM WORK LEG WORK LATERAL FLEXION BACK EXTENSION MAT Pelvic Curl Spine Twist Supine Chest Lift Chest Lift Rotation CHAIR Footwork series Short Box Series: Flat back Tilt CADILLAC Supine Leg Series Bottom Lift With Extensions LADDER BARREL Gluteals Hamstrings Kneeling Lunge Flat Back CADILLAC Standing Series CHAIR Frog Front MAT Side Kicks CADILLAC Prone 1 Working in neutral pelvis and small flexion on the chest lifts. Spine Twist Supine - This should be performed with minimal range of movement at first to avoid causing tension in the lower back. This will work on hip flexor strength whilst the client is able to keep a neutral pelvis. Removing the twist & roundabout so not avoid too much possible pelvic lumbar rotation. Can progress to working with both legs at the same time. Added extension for greater strengthening of the hamstrings. Continued stretching of the Piriformis and surrounding muscles on the ladder barrel. Reformer- stretching out the Psoas and recently worked hamstrings. Loading with a heavy spring to make the hip extensors the focus of the exercise. Working on maintaining correct alignment and posture throughout. Focus on strengthening the external rotators of the legs. Working on the hip abductors for the Piriformis syndrome. Working with a very small range of movement to not throw the pelvis off. 7
CONCLUSION Pilates is a very effective method for correcting pelvic dysfunction, a condition that often stems from muscular and postural imbalances. By training these specific muscle groups and teaching the client to focus on alignment, not just in the studio but also in everyday life, they will continue to learn to re-stabilize, correct and self-adjust posture and movement, which will help to support them throughout their rehabilitation. With the use of the BASI block system not only am I able to create a program that addresses the injury but also tailor the program to the clients lifestyle and body, addressing other areas of need. 8
BIBLIOGRAPHY Books: BASI Pilates. Movement Analysis Workbooks, Body Arts Science International Websites: https://en.wikipedia.org/wiki/sacroiliac_joint_dysfunction https://www.britannica.com/science/sacroiliac http://elitesportstherapy.com/sacroiliac-joint-dysfunction/ https://www.mayfieldclinic.com/pe-sijointpain.htm https://www.spine-health.com/conditions/sciatica/what-piriformis-syndrome http://www.sportsinjuryclinic.net/sport-injuries/hip-groin-pain/piriformis-syndrome 9