how can pilates equipment training help …...1 how can pilates equipment training help improve...
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How Can Pilates Equipment Training Help Improve Pelvis Instability?
SvenjaHampel
September2018
May-Nov2018,DubaiTraining
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Abstract
ThroughoutmyjourneyteachingandpracticingPilates,Icameacrossalotofclientswhohadahardtimeunderstandingneutralpelvicalignment.Furthermore,themajoritycametometoseekforhelpforlumbarsacroiliacpain,nervepainshootingdownonelegorundefinedtinglingintheleg.Therefore,Ichoosetowriteonpelvic–lumbarstabilization.
Firstofall:Whatispelvisinstability?Whereisthepelvisregion?Andwhatcanbeinstable?
Thepelvis–hip–legconnectionisaquitesolidbonestructureandbuildsasolidconnectionbetweenupperandlowerhalfofthebody.Thisiswhatitshoulddo.Unfortunatelyforalotofpeoplenowadaysthepelvisregiongetslessmovementandlessstrengthtrainingthanitshouldget.Asaconsequence,itislessstableanditgetsmoreunstable,creatingpainwhiledoingnormaleverydaymovementslikewalkingandrunning,gettingonandoffbedorachair.Allthesemovesshouldnotcreateanydiscomfort.Sadly,tosee,themajoritytothepopulationareseatedtolongeitheratworkbehindthedesk,drivingthecartoorfromworkorrelaxingafteralongworkingdayathomeonthesofa.
Onlyfewofthemtakeactionandtrytoworkagainstthissedentarylifestyle,beingmoreactiveandhealthyintheirdailyliving.
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TableofContents
Abstract ............................................................................................................................. 2
TableofContents............................................................................................................... 3
Anatomy............................................................................................................................ 4
CaseStudy ....................................................................................................................... 11
Conditioningprogram ...................................................................................................... 13
Conclusion ....................................................................................................................... 15
Bibliography..................................................................................................................... 16
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Anatomy
Thepelvisisasymmetricalbonyringstructureconnectingthevertebraecolumnandthelowerlimbsviathehipjoint.Thevertebraecolumnfunctionasshockabsorption.Ifeachvertebraearecorrectlyalignedthevertebraecolumnwillabsorbtheshocktoitsbest,ifthealignmentoftheholebodyisincorrectitwillhaveaknockdowneffectoftheweakestpartinthesystem.Thepelvisholdstheabdominalorgansofthebodyasbladder,intestine,uterusforwomanandprostateinman.Thepelvisconsistsofthreestrongbonesfusedtogether:theilium,ischiumandpubis.Theyformtheacetabulum,thesocketjointofthehipwhichconnecttothefemurhead.Theiliumisthelargestflatboneoneachsideoftheupperportionofthepelvisgirdle,includingtheiliaccrestwiththeanteriorsuperioriliacspine(ASIS),thehipbonewhichcanbeeasilyfeltwithpalpation.Thepubisistheanteriorsideofthepelvisfusedtogetherbythecartilaginouspubissymphysis.Theanatomyofthepelvisdiffersinmaleandfemale:thefemales’pelvisiswiderandthepubisshorterthanmale.Thepubissymphysiswillwidenforchildbirthinwoman.
ThesacrumcontainsfivefusedvertebraeS1toS5creatingatriangularshapeattheposteriorsideofthepelvisgirdle.TheiliumconnectsoneithersideofthesacrumS1toS5andbuildsthesacroiliacjointconnectedviapowerfulposteriorandanteriorligamentsandmuscles.Thenetworkofligamentsandmusclearoundthesacroiliacjointlimitsmovementwithinthejoint.
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Sacrumfromposteriorview
Thesacroiliacjointhasnormallyonlyasmallrangeofmovement,2–4mminanydirection.Thesacroiliacligamentsarelessstiffinwomenallowingtoprepareforchildbirth.Causethissegmenthaslessmovement,theprimarymovementinthesacrumoccursrelativetothelastlumbarvertebrae.“Movementsatthisjointhasaprofoundinfluenceonalignmentofthelowerbackandpelvis”,statein‘PilatesAnatomy’.
SacroiliacJoint(SI)andLumbosacralJoint(S1toL5)
Atthelowerpartofthespinalcordnumerousnervesofthecaudaequineextendfromtheforamenofthelumbarspineintothesacralcanalandexitingthesacrumthroughthesacralforaminaoneachsideofthecanal.Correctbodyalignmentincreasesthepossibilitythatallnervesworkinthemostefficientway.
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SacrumincludingNervesroots
Thepelvicgirdleconnectstheupperandthelowerpartofthebody.Thehipjoint,amajorball–and-socketjoint,connectthepelvistothelongbonesofthefemur.Thehipjointallowsawiderangeofmovementsofthelowerlimbsasitisusedinrunning,walking,climbingandbending.Thehipjointbearsthebodyweightandissupportthroughlarge,strongtendons,ligamentsandmuscle–gluteusmaximus,medius,minor,iliacusandpiriformis.
Themuscleofthepelvisandhipcontrollingthelegsanduppertrunk.Posteriorthegluteuscomplexcontrollinghipextensionasthehamstrings;anteriorthedeephipmuscle,thePsoasconsistingofpsoasmajorandiliacuscontrollinghipflexionandtrunkflexionandtrunklateralflexion.ThePsoasisconnectedinthelowestthoracicvertebrae,12ththoracicvertebratothe5thlumbarvertebrae,andcrossestothefrontofthebodyalongthepelvisandattachestothefemurwhichmakesitoneofthemostimportantmusclesinthebody.ThePsoasistheonlymusclewhichconnectsthespinetothelowerlimbs.
PsoasMajorandminorGluteusMaximusandmedius
Thegluteusmaximus is the largestmuscleof thebody, consistingofgluteusminimusandgluteus medius, connecting to the sacrum above the iliac crest. The gluteus maximuscontrols hip extension as in running and walking. It attaches as well to the ilio-tibial (IT)band,acomplexconnectivefibre.
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A big group of deep pelvis muscle controlling movements of the leg are the Piriformis,Obturatorinternus,Obturatorinternus,Obturatorexternus,GemellussuperiorandinferiorandQuadratus femoris connecting the pelvis girdle to the femur. Furthermore, there areTensorfasciaelataetostabilisethefemoralheadintotheacetabulumandthekneeduringextension,Rectusfemorisactingashipflexorbelongingtothequadriceps.TheSatoriusisathinandthe longesthumanmuscleofthe innerthigh,originates inthe iliaccrest, runningdiagonallydowntothekneetoinserttotheinnertibiaassistinginexternalrotationofthehip.Furthermore,thepelvisgirdleincludesthemuscleofthepelvicfloorandtheperineumtoholdtheinnerorgans.
Themusclesoftheabdomenareconnectedalsotothepelvisgirdle.Theabdominalmusclescanbedividedintofourparts:theexternalobliques,originatesiliumtolineaalba,theinternalobliques,originatesiliumtolineaalba,thetransversusabdominal,originatesiliumandribstopubisandlinaealba,andtherectusabdominal,originatespubistosternum.Thedeepestmuscleintheabdomen,thetransversusabdominal,isarrangedtransverselyaroundtheabdomensimilartoabelt.Thisarrangementofthelayeredmusclesoftheabdomenallowsvariousmovementsinalldirectionsofthetrunk–flexion,extension,lateralflexionandrotation.Theabdominalmusclesalsoprotecttheabdominalorgans.
Abdominalmusclelayering
OntheposteriorsideofthebodytheQuadratuslumborumconnectsfromtheiliaccresttothe12thribandthelumbarvertebraeL1–L4.Thequadratuslumborumisacontinuationofthetransverseabdominalmuscleontheposteriorsideofthebodyandthedeepestabdominalmuscle.
TheMultifidusspinaemuscle,alsoamuscleontheposteriorchainofthebody,consistsofanumberoftendinousfasciculiwhichfillupthegrooveonbothsidesofthespinousprocessesofthevertebrae.Themultifidioriginateatthesacrumandiliaccrestandinsertsatthespinousprocess.Itplaysanimportantroleinstabilizingthejointswithinthespine.
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QuadratusLumborumMultifidiusspinaemuscle
Raelstatedinhisbook‘PilatesAnatomy’“MuscleactingasForceCouples”.Allthesemuscledescribedaboveconnectedtothepelvisgirdleposteriororanterioractinginsomekindonpelvisstability.Forexample,theabdominal–hamstringsforcecoupleisactingonbothsidesofthepelvis.Contractionoftheabdominalcanproduceaposteriorpelvictiltasdesiredinapelviccurl,asthehamstringsatthesametimelengthenawardtosupportthismovementofposteriortilt.Ifaneutralspineandpelvisisdesiredbothmuscleshavetoworktogethertocreatestabilityoverall.Asonemuscleisinmisalignmentothermusclehavetotakeoveranditcreatesanimbalancebetweenmuscleswhichcanledintodiscomfortorfurtherworsentopain.Iftheoptimumpositionofthespineandpelvicgirdlecannothavebeenmaintained,itcausespelvicinstability,whichcanchangethegaitofwalkingand/orrunningandplacingunnecessarypressureonthelowerspine.Instabilityinthepelvicregioncanplacepressureonthesciaticnervewhichrunsdownthelengthofthebodyfromthelowerbacktothelegs.Pelvicgirdleinstabilitycanalsooccurduringpregnancyandchildbirth.Physicaltherapyisthemostcommontherapytoworkagainstthemuscleimbalancestargetingstrengtheningtheweakenedmuscles,mostlikelytheabdominals,stretchingandstrengthenthehipextensorsandstrengthenthebackextensorstostabilizethepelvicjointsandmuscles.Astrongpelvisgirdleislesslikelytobeunstable.
NeutralPelvis
NeutralpelvisreferstothepositionofthepelviswhentheASIS(anteriorsuperioriliacspine)oneachsideofthepelvisandthepubissymphysis(PS)areinthesamehorizontalplaneandthetwoASISareinthesametransverseplane.Thespinewillthanresultinaneutralspinepositionwithitsnormalcervicalandlumbarcurve.Traininginaneutralspineandpelvispositionbenefitinabalancedtrainingofallmusclesurroundingthepelvis,encouragedbalancedmuscledevelopmentofthepelviscomplexandcorrectmusclerecruitment.Workinginneutralspinepositionmeansteachingidealpostureandalignment,reinforcingfunctionalandpositivemovementpattern.
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Asthepelvisanatomicalliesbetweenupperandlowerpartofthebody,itwillbeinfluencedbymovementinthespineandlegs.Correctpelvisalignmentwilldevelopbalancemusclegroupsactingonthepelviscomplexstrivingforidealpostureandfunction.
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PositionofthePelvis
Thepelvisisinaposteriortilt(tuck)whenthePubissymphysisishigherthantheASIS.Thelowerspineislengtheningintothematandforcestheupperbacktoroundmoreforward,thenaturallumbarcurvehaschangedtoaflexedlumbarspineposition.
Thepelvisisinananteriorpelvictilt(arch)whentheASISishigherthanthepubissymphysis.Thelowerspineisarchedofthematandforcestheupperbacktoflattenmoreintothemat,creatinganextendedpositionofthelowerspine.
Pelvisinstability
Pelvisinstabilitycanpresentatanyage,buttendstodeclinewithaging,duetostiffeningofligamenttissue.Itoftenpresentsinyoungfemaleswhoareinvolvedinsportsthatrequiresahighdegreeofmobilitysuchasdancers,gymnastsandswimmers.Thesethreehavealsoincommonahighintensityintrainingloadandwithinitstraininganincreasedamountofbackbending.
Thepelvisisbearingthebodyweightanddistributeitthroughthehipsandlegs.Ifligamentsareinjuredoroverstretched,thepelvislosesitsstabilityandbeginstomoveexcessively.Duetoexcessiverangeofmotionwithoutnecessaryadequatemuscularcontrolstructuresinspineandpelvisasjointandligamentscanbedeformed.Holdingthejointsinorneartheirendrangeofmotionstressesandstretchestheretainingligamentswhichwillbenoticedinpainsymptomsassacroiliacjointpain,lowerlumbarspinepainorpubicpain.
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CaseStudy
Marcy,16yearsold,isanambitiousswimmer.Shetrains9timesaweekeachtrainingsession2hours,andsometimestwiceperday.Ascrosstrainingsheisdoingrunningandweighttrainingintheschoolgym.Shestartedtoswimwiththeageof5anddevelopedovertheyearsarealpassionforswimming.HerdreamistobecomeanOlympicswimmersinceGrade3asshewroteherfirstassayabout“BeinganOlympicswimmer”.
SheachievedtostarttwiceintheGermanJuniorNationalSwimChampionship2016and2017qualifiedfor100breastand200breast.ShewasaswellqualifiedfortheGermanJuniorNationalChampionshipsin3events–100Breast,50free,200Breastandshecouldhavequalifiedformoreevents.
Unfortunately,herbackpainincreasedoverthelast1/2year,correlatingwithliftinghigherweightsintheschoolgyminbadposture.Causeofincreasedpaininthemidback,lowerbacknearthesacroiliacjointsheneededtostepbackandreducehertrainingloadtotrytohealofpain.Shehasseenseveraldifferentmedicalprofessionalsasphysiotherapists,osteopathsandorthopaedics.TheMRIshowedthatnobonedamagedinthesacralvertebraeoccurred,thattheligamentsandmusclesareworkingtotheirnormalfunction.Shewasthanreferredtothenextphysiotherapist.
ShedecidedtochoosePilatesashercrosstrainingtohavealow-impacttrainingwhichtrainsherbodytobeincorrectbodyalignmentwhileworkinginsupine,prone,sidelyingandFourPointKneelingposition.TrainingonPilatesequipmentwillhelphertothentransferneutralalignmenttoperformherfavouritesport-swimming.Ingeneral,shefeelsPilatesisboringandsheonlydoesittoimproveherperformance.
Istartedtoassessherwiththepostureplumblineandnoticedthatherpelvisisanteriortilted.Heroverallpostureisshowinganincreasedlumbarcurve,lumbarHyperlordosis.Thispostureisassociatedwithweakabdominals,tighthipflexorsandtightlowerbackextensors.Wewillfocusonworkingagainstthisfindings:strengthentheabdominals,stretchinghipflexorsandlowerbackextensors,strengthenthehipextensorsandmaintainingpelviclumbarstabilityinallbodypositions.
WecontinuedwiththestandingRollDown.InthestandingRollDownitwasquietobviousthatherleftmidbackmusclewereoverdevelopedcomparedtoherrightmidbackmuscles.ThePilatesconditioningprogramforMarcyshouldalsoincludebalancedworkforbothsidesofthebody-rightandleft–andspeciallytostrengthenthebackmusclesandabdominalsinanequalbalancedmanner.
ShestartedwithPilatestwiceperweek,butshestillcontinuedswimtraining4timesaweekeach2hoursandcrosscountryrunning3timesperweekeach1,5hour.
Thefirstsessionswerefundamentalreformerworkoutsfocusedonmaintainingthepelvislumbarareainaneutralposition.Marcy,assheisoverseveralyearsanathlete,hasagreat
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understandinghowherbodymovesinspace.Shepicksuptheconceptveryquick;sowecouldmoveontointermediateworkontheReformerandCadillacasforexamplesingleleghipworkontheCadillactochallengeherpelvisstabilityevenmore.SheprogressedveryquicklywiththePilatesworkonequipment.
WealsofocusedonhipflexorsstretchasinthelungeseriesonReformer,andworkedonstrengtheningtheabdominalsinneutralspineasdoneinabdominalwork,hipworkandarmsupineseriesonthereformer.Sheisoverallverystrong,butneedstofocusondetailstoachievethebestresults.Workingevenlythroughbothhipjointswasquietchallenging.
SlideSpinalarticulationasinbottomlift,pelvictiltandbackextensionasinswanbasicsonthechairweregraduallyincorporated.
Singlelegskatingwasoneofthemostchallengingexercisesforher.
Asthetrainingloadforschoolcrosscountryandswimmingteamincreasedshestartedtogetmorepainagain,whichmadeherthinktoreduceheroveralltrainingloadforawhile.Shereducedthecrosscountryrunningforschoolteam,butstillcontinueswithswimtrainingfortheschoolteam.Herpainisonandoff,buthasimprovedasherstabilityofthetrunkandpelvisgirdlehasimprovedoverall.Hermusclespamonthelefterectorspinaehasreducedbutisstillnotcompletelyhealed.
Wearestilltryingtoimprovehermusclememorytoworktowardsabalancedmusclerecruitmentsothatsheisabletocompeteagaininswimmeets;shewillfurthercontinuewiththeprogram.
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Conditioningprogram Session
Basiblock 1–10 11-20 21-30
WarmUp
PelvicCurlSpineTwistsupineChestliftChestLiftwithrotation
PelvicCurlSpineTwistsupineChestliftChestLiftwithrotation
RollupSpinetwistsupineDoublelegstretchSinglelegstretchCrisscross
Footwork Reformer:ParallelHeels&Toes,SmallV,WideVheels&toes,Calfraises,Prances,Singlelegheel&toes
Reformer:ParallelHeels&Toes,SmallV,WideVheels&toes,Calfraises,Prances,Singlelegheel&toes
ReformerorChair:ParallelHeels&Toes,SmallV,WideVheels&toes,Calfraises,Singlelegheel&toes
Abdominals Reformer:HundredPrep,Coordination
Reformer:HundredPrep,Hundred,Coordination,
Cadillac:Roll-UpwithRollupBar,MiniRollUps,MiniRollUpsObliques,RollUpTopLoaded,
HipWork Refromer:FrogCirclesDown/UpOpening
Cadillac:BasicLegsprings
Cadillac:BasiclegspringsorSinglelegsupine,orReformer:extendedfrog,extendedfrogreverse
SpinalArticulation
none Reformer:bottomliftOrCadillac:BottomLiftwithRollUpBar
Reformer:Bottomlift,Bottomliftwithextension
Stretches Reformer:StandingLunge
Reformer:KneelingLunge
Cadillac:ThighStretchwithRollupBar,LadderBarrel:Gluteal,hamstrings,abductor,hipflexors
FullBody none ReversekneeStretch,Scooter,
Cadillac:sittingforwardorside
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DownStretch reachorreformer:Downstretch
Arms Reformer:armsupineseries
Reformer:SittingarmseriesorCadillac:Standingarmseries
Reformer:ArmKneelingSeriesorSidekneelingArmSeries
FullBody none none Reformer;UpStretch1+2+3,LongstretchorDownStretch
Legs Reformer:Singlelegskating
Reformer:SingleLegskating,WundaChair:Legpressstanding
WundaChair:Legpressstanding,ForwardLungeorFrogFront
LateralFlexionRotation
Reformer:Sideoverbox Ladderbarrel:sideoverprep,orWundachair:Sidestretch
Ladderbarrel:sideover,orWundachair:Sidestretch
BackExtension Reformer:Backextensionorbasicbackextensionmat
Reformer:Breaststrokeprep,PullingStrap1+2
Cadillac:ProneoneWundaChair:SwanbasicorBackextensionsingleArm
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ConclusionMarcyincludedPilatesequipmentworkintoherweeklytrainingprogramconcludinginimprovementinherpelvisstabilityandbodyawarenessovertime.ThisconditioningprogramforMarcyisdesignedtoimproveherpelvic-lumbarareastability,focusingonthefollowing:
1. Strengtheningtheabdominalmuscle,astransversabdominalsandobliquemusclestoincreasepelvic-lumbarstability;
2. Strengthenandstretchhipflexor;3. Strengthenthehipextensors,hamstringsandglutes;4. Strengthenthespinalextensors;5. Mobilisethepelvislumbarregion6. Createawarenessofgoodbodyposture
Marcybecameawareofheroverallbodyandwasgratefultomovemorefreelywithlesspain.Shenoticedthatmisalignmentwillresultineitherovercorrectionorovercompensationfromothermusclegroupsandmaytriggerothermuscletogointospasm.Shelearnedalotaboutherbody,evenassheisnotcompletelypainfreebutmoreawareofherself.Raelstatedin‘StudyGuide–ComprehensiveCourse’thatstudieshaveshownthatatighterectorspinaemusclewillbeactiveduringitsreverseaction–trunkflexion–andthiswillinhibititsactionofitsantagonist,theabdominals.IfMarcy’smuscleimbalanceonhermidbackiscausedinthefirstplacebyatrainingoverloadandpainfulstimuliasthemovementcontinuedrepetitivethefurthertreatmentshouldbere-educatingmovementpatternandpreventingundesirableover-activationandsubstitutionpattern.Qualityandprecisemovementpatternaremoreimportantthanquantityorintensity.HopefullythiswillhelpMarcylongterm.
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Bibliography• Isacowitz, Rael and Clippinger, Karen: Pilates Anatomy, Human Kinetic 2011 • Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body
Arts and Science International, 2013. • Miller, J. Physio Works. Web. https://physioworks.com.au/injuries • http://anatomy.lexmedicus.com.au/pathologies/pelvis-hip • https://fadavispt.mhmedical.com/content.aspx?bookid=1899§ionid=141191031