ManagementofBackPainduetoHyperlordosis

WilliamGibbs,April2016

BodyArtsandScienceInternationalComprehensiveTeacherTrainingProgram

Brisbane,Australia,2014

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Abstract

Thepurposeofthispaperistotakeanobjectiveviewatlowerback

pain,causedprimarilybyHyperlordosis.Thispaperwilldemonstrate

examplesofsomeoftheanatomicalandphysiologicalsignsand

symptomsofHyperlordosis.Thepaperwilldefineandprovide

potentialcausesof,Hyperlordosis.Throughuseofacurrentsubject,

thepaperwillprovideaPilatesprogramtoassisttheathletein

alleviatingthesymptomsoflowerbackpaincausedbyHyperlordosis.

ThepaperwillalsodemonstratethattherightPilatesprogramcan,

notjustaddressthesymptoms,butalsotheHyperlordosisitself.The

paperwillthenconcludehavingclearlydemonstratedthebenefitsof

aPilatesprogramforasubjectsufferinglowerbackpaindueto

Hyperlordosis.Thispaperwillbeutilisinganumberofappendices

andreferencesthatwillallbeincludedappropriately.

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CONTENTS

Abstract 2

TableofContents 3

Hyperlordosis 4

CaseStudy 9

Introduction 9

Body 10

Conclusion 14

REFERENCES 15

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HyperlordosisThevertebralcolumnorspineconsistsof26irregularbones.“These

bonesareconnectedinafashionthatresultsinaflexiblecurved

structure”(MariebandHoehn).Inthenormalspinetherearefour

curvespresent.“Thesecurvesplayanimportantroleinbalance,

flexibility,andstressabsorptionanddistribution”(Higgins).Thefour

maincurvaturesaretheCervical,Thoracic,LumbarandtheSacral

curvature,whichalsocontainsthefusedvertebraofthecoccyx,

Figure1.1TheVertebralColumn.(MariebandHoehn,2014)

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TheSacralcurvatureconsistsof5-fusedvertebraeandtheCoccyx

consistsof4-fusedvertebrae,theyareoftenconsideredtobeone

boneeach,i.e.“26”irregularbonesinthespinalcolumn.

Tworeasonsforidentifyingwithlowerbackpainassociatedwith

hyperlordosisarethat,first,lowerbackpainisacommonissuefora

largeportionofoursociety;“Lowbackpainhasalifetimeincidence

rangingfrom60to80%intheindustrialisedworld.”(Shenoy,Eapen

andKumar135).Theotherbeingtheimportanceofthestructures

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involved,“Thelowerspine(thepelvic-lumbarregion)isofparticular

interestinPilates,becausehereinliesthepowerhouse,thecore,from

whichallmovementemanates”(Isacowitz)

Abnormalcurvaturesofthespinecanresultinincreasedstresson

thevertebraandintervertebraldiscs;thisthenleadstopainand

dysfunction.Hyperlordosisisoftencalledswaybackandisdefinedas

“anaccentuatedlumbarcurvature,whichcanresultfrom

tuberculosisorosteomalacia.Temporarylordosisiscommonin

thosecarryingalargeloadupfrontsuchasmenwithpotbelliesand

pregnantwomen”(Marieb&Hoehn).SpinalCurvesareeither

KyphoticorLordotic,asperfigure1.2.

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Figure1.2CurvesofTheSpine(DCFirst.com,2016).

“Althoughmostepisodes(80-90%)oflowerbackpain(LBP)subside

within2-3months,recurrenceiscommon.Anotheraspectofclinical

examinationofLBPsubjectsistheobservationandmeasurementof

spinalcurvature(SC).Thepreservationofnormalspinalcurvesis

requiredforloadbearing,andsoasubstantiallossorincreaseinSC

maycontributetobackpaindevelopment”(Shenoy,Eapenand

Kumar135).Anychangesinthecurvesofthespinewillcausesome

musclestostretchandsomemusclestoshorten,contributingto

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instabilityinthespine.Thisinstabilityleadstochronictensionin

certainmusclegroupsandincreasedstrainonjoints.Aseeninfigure

1.3duetotheabdominalmusclesbeingweakerthanthemusclesin

thelumbarspineandthehamstringmuscles,thereisanimbalance

whichresultsinthepelvisbeingpulledforwardofthebody,creating

theexaggeratedarchor“swayback”inthespine.

Figure1.3Lordosis(Sudy.com,2016).

Othersignsandsymptomsthatwillbegintopresentincludetighthip

flexors,hipflexioncontracture,whichcanleadtoalackofpostural

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awareness,andthoracichyper-kyphosis,whichisanexaggerated

roundingoftheforwardcurvatureintheupperback.Weakiliopsoas

musclesarealsocommonwiththiscondition.

Lordosismaybemoretemporarythaninthecaseofpregnancyor

excessiveabdominaltissue.Someathletesmayevenfindduetothe

typeofexercisetheyengageinorlackofappropriatetutelagethey

mayexperiencebriefepisodesoflordosisresultinginlowerback

pain.Higgins2011putsforwardthenotionthat“afieldhockey

playermaypresentwithlumbarpainandstaticpostureappears

normal,However,forthegreaterpartofatwohourpracticeshehas

torun,pass,andshootwithaforwardflexedspinalposition.This

spinalpostureduringpracticemaybeacontributingfactorinthis

athletesbackpain”(Higgins).

Howtoaddresspainassociatedwithlordosis;“Thiscommon

posturalproblem,oftencanbehelpedbydevelopinggreaterstrength

anduseoftheabdominalsaswellasadequateflexibilityofthelower

spinalextensorsandiliopsoas”(IsacowitzandClippinger).Onemust

takeabalancedandprovenapproachintacklinglordosis.Isacowitz

andClippingeralsostatethatwhenattemptingtotreatthisissueor

othercommon“spinalalignmentdeviations,itisimportanttorealize

thatthegoalisnottoovercorrectandremovethenormalcurvesof

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thespine.Suchanactionwouldcreateanotherspinalproblemin

whichthelumbarandsometimesothercurvaturesactuallyarebelow

normalintermsofmagnitudes”.Thisclearlydemonstratesthe

importanceofcheckingbackinandreassesswithyourclientto

ensureoptimalfunctioningofthespine.

CaseStudyIntroduction:

Name:Miller

Sex:Female

Age:19

Occupation:Rower/Student

Millerisa19-year-oldfemalethathasbeencompetingatstateand

nationallevelsinrowingforapprox.twoyears.Thisyearshehas

takentimeofftoincreaseherbodymassunderthecoach’sdirections.

Duringthistrainingtoincreasemusclemassshehasfoundshehas

beenexperiencingsomelowerbackpain,whichsheneverusedto

experiencewhilstrowing.Ithasbeenaperiodof7monthssinceshe

hasbeenrowingregularlyorcompeted.Thefirststepwastoobserve

Millerinthestudioperformingarolldownandsomefundamental

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Pilatesexercises.Itwasnoticedthatshehadmildhyperlordosis

whilejuststanding,whichincreasedasshefatigued.Thisalso

developedwhilsttraining,whichwasobservedwhileMiller

performed,weightedSquats,Benchpress,andRowingonamachine

andothergeneralweights.Millerdidalsomentionthatshefound

thatherhamstringswereoftentightandshehadtroublesitting

cross-leggedfortoolongasherhipflexorswouldbecomeaggravated.

Inoticedthatduringsomeexerciseherabdominalswouldbulge.

Millerdidconcedethatonceshestoppedcompetingshedidalsohave

alongtimeofffromanytrainingbeforestartingtrainingtoincrease

hermusclemass.

Body:

Asnotedhyper-lordosis“resultsintighteningandweakeningofthe

surroundingmuscles,specifically,shortenedhipflexorsandback

extensors,lengthenedandweakabdominalmuscles,lengthenedand

weakhipextensorsandananteriorpelvictilt”(KendallandKendall).

Havingnotedthis,thePilatesprogrammustaddresstheseissues

whilstalsostartingatafundamentallevelsoMillercanlearnand

adapttothebasicprinciplesofPilates.Theprogramshouldthenalso

progresstokeepMillerandherbodychallengedonherwayto

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buildingmusclemasssoshecancompeteagain.Thebelowprogram

willshowafundamentalprogramforuptotensessionsthenan

intermediatesessionforuptotensessionthenmovingintoamore

advancedseriesofexercises.ItshouldbemadeclearthatMillerwill

onlyadvancefromexercisesasshecandemonstrateinnate

understandingoftheexercise,andonaregularbasis.Theprogramis

modifiablesoifshecanperformcertainexercisesandadvance,great,

howeverifunabletoperformotherswell,thenwewillpersistuntil

shecan,irrespectiveofthesessionnumberweareupto.The

programisfocussedonstrengtheningabdominalsandhamstrings

whilstalsoincreasingflexibilityofthelowerspinalextensors,hip

flexorsandillio-psoasmuscles.Thereshouldbeanobviousfocuson

Abdominalandhamstringstrengtheningexercisesaswellasspinal

articulation,andeventuallyflowingintospinalextensionasthe

Hyper-lordosisreduces.

Thebelowprogrammostlyprovidesmorethanoneoptionforeach

block,thatwayvarietycanbeprovidedfortheclient,notall

exerciseslistedaretobeperformed.Asessioncouldallbedoneon

oneapparatusorwecouldmixitupsotheclientdoesn’tbecome

bored,aslongasflowispreserved.

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SessionPlanforaddressingHyper-Lordosis

BasiBlock Sessions1-10 Sessions2-20 Sessions20-30WarmUp Mat;

RollDown,PelvicCurl(ifneededassistwithballbetweenknees),SupineSpineTwistw/feetflatonfloor,ChestLift,ChestLiftw/rotations.

Mat;RollDown,Pelvic Curl (Nil assistneedednow),Supine Spine Twist intabletop,Chestlift,ChestLiftw/Rotation,Leg lifts and legchanges,RollUp.

Mat;RollDown,PelvicCurlw/singlelegliftedfrommat(ifable),SupineSpineTwist,Doublelegstretch,SingleLegstretch,CrissCross,RollUp.

FootWork Reformer/Cadillac;ParallelHeels/Toes,VPositionToes,OpenVHeels/Toes,Calfraises,Prances,SinglelegHeels/Toes.

Reformer/Cadillac;ParallelHeels/Toes,VPositionToes,OpenVHeels/Toes,Calfraises,Prances,SinglelegHeels/Toes.

Reformer/Cadillac/WundaChair;ParallelHeels/Toes,VPositionToes,OpenVHeels/Toes,Calfraises,Prances,(N/AonWC)SinglelegHeels/Toes(whilststretchingoppositehamstringwithstretchband).

Abdominals Reformer;HundredPrep’Coordination

Reformer;ShortBoxSeriesw/accessoriesifneeded,Cadillac;MiniRollUps,MiniRollupsw/Obliques.

Reformer;Abdominalslegsinstraps,ObliqueAbdominalslegsinstraps,orClimbaTreelongBox.Cadillac;RollUpTopLoaded,thenprogresstotop/bottomloaded.

HipWork Reformer/Cadillac;Frog,HipCirclesDown/Up.

Reformer;Frog,HipCirclesDown/Up,Opening.

Reformer;Frog,HipCirclesDown/Up,Opening,ExtendedFrog,ExtendedFrogReverse

SpinalArticulation

Mat;PelvicCurl,SpineStretch.Reformer;BottomLift

Reformer;BottomLiftw/extensions,ShortSpineCadillac;TowerPrep

Reformer;LongSpineCadillac;Tower

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Stretches LadderBarrel;Hamstrings,Gluteal,Adductors,HipFlexors,Shoulderstretch1&2.Reformer;StandingLunge.

LadderBarrel;Hamstrings,Gluteal,Adductors,HipFlexors,Shoulderstretch1&2.Reformer;KneelingLunge

Cadillac;ShoulderStretch.Reformer;StandingLunge,SideSplit

FullBodyIntegration(F/I)

Reformer;Scooter,Elephant.

Reformer;KneeStretchSeries:RoundFlatReverse,Cadillac;SittingForward,SideReach

Reformer;DownStretchCadillac;KneelingCatStretch,ThighStretchw/rollupbar

ArmWork Reformer;ArmsSupineSeries:Extension,Adduction,UpCircles,DownCircles,Triceps

Reformer;ArmsSittingSeries:ChestExpansion,Biceps,Rhomboids,Hug-A-Tree,Salute,Cadillac;ArmsStandingSeries:ChestExpansion,Hug-A-Tree,Circles(UpandDown),Punches,Biceps

Reformer;ArmsKneelingSeries:ChestExpansion,UpCircles,DownCircles,Triceps,Biceps,Cadillac;ArmsStandingSeries:ChestExpansion,Hug-A-Tree,Circles(UpandDown),Punches,Biceps,Butterfly.

FullBodyIntegration(A/M)

N/A N/A Cadillac;PushThroughSeries:KneelingCatStretch,Saw,SittingBack

LegWork Mat;SupineSeriesw/MagicCircle:Knees,AnklesProneSeriesw/MagicCircle:AnklesKneesBent,AnklesKneesStraight,andHamstrings.

Reformer;HamstringCurl,SinglelegSkating.Cadillac;Squatsw/RollUpBar

Reformer;JumpingSeries:Parallel,VPosition,SingleLegParallel,andLegChanges.Cadillac;SingleLegSideSeries:Changes,Scissors,Circles(F&R)

LateralFlexion/Rotation

Mat;SideLifts,Saw,SpineTwist.

Reformer;Mermaid,

LadderBarrel;SideOverPrep,SideOvers.

BackExtension Mat;BackExtensionandthenRestPosition.Reformer;BreastStrokePrep

Reformer;PullingStraps1Cadillac;Prone1WundaChair;SwanonFloor

Reformer;PullingStraps1&2,Cadillac;Prone1&2.

Finish RollDown RollDown RollDown

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Conclusion

Toconclude,thispaperhasdefinedbackpainassociatedwithhyper-

lordosis,it’ssigns,symptomsandpotentialcauses.Thispaperhas

providedacasestudyintheformofanathletewhohasbeen

experiencingthisconditionandaPilatesprogramtonotonlytreat

butalsohelpresolvethehyper-lordosis.ThePilatesprogramhas

focussedheavilyonstrengtheningtheAbdominalmusclestobegin

withandcreatingmoreHamstringandGlutealcontroland

awareness,thenprogressingtoimprovespinalarticulationandthen

backextensorcontrolandawareness.

Itshouldalsobenotedthatina2011paper,McNellisfoundwhen

comparingwithacontrolgroup,peoplewithhyper-lordosisfounda

significantimprovementinthehyper-lordosisposttreatmentand

that“theresultsprovidemeaningful,objectivedataontheefficacyof

thePilatesmethodofexerciseasitrelatestoimproving

hyperlordosisofthelumbarspine”.(McNellis).Thesubjectinthe

abovecasestudyalsofoundobviousbenefitsfromtheprogram.

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