pilates - dealing with a moderate structural scoliosis ......fundamentals to be sure she understood...
TRANSCRIPT
Pilates - Dealing with a Moderate
Structural Scoliosis Condition
BASI Comprehensive Course
Maria del Carme Farré Carbonell
April 7, 2016
Studio Carme, London, U.K.
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Abstract
The purpose of using Pilates to help alleviate the negative effects of structural scoliosis, is to
balance the physical asymmetry resulting from the condition by working on flexibility, posture,
lengthening and muscle strengthening. Pilates can help create awareness by the client of
proper posture and reeducate their body to improve functional and positive movement patterns
during daily life.
My case study focuses on structural scoliosis, which involves a spinal curvature and twisting of
the spine that is always present. This condition has a physical impact on the torso, making it
appear uneven. In addition, the body’s muscles are overdeveloped on one side of the spine and
underdeveloped on the curved side. Over time the bossy or stronger muscle group will become
even stronger and more dominant vs. the underemployed, which will become weaker with lack
of use.
The purpose of my paper is to provide a practical Pilates guide based on the BASI block system
to partly rectify the negative effects on the body of scoliosis.
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Table of Content
A Look at Structural Scoliosis ______________________________________ Page 4
Dunia Oriol – My Case Study ______________________________________ Page 6
BASI Block System Conditioning Program ______________________________Page 8
Conclusion _________________________________________________Page 12
Biography __________________________________________________Page 12
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A Look at Structural Scoliosis Scoliosis occurs when the spine curves sideways and the individual vertebrae also twist and
rotate around the vertical axis of the spinal column. Because the ribs are attached to the
vertebrae, this rotation of the vertebrae may create a ‘hump’ or prominence on one side of the
back.
Source: http://patient.info/health/scoliosis-curvature-of-the-spine-and-kyphosis
We distinguish between structural scoliosis which is always present when taking an x-ray and
non-structural scoliosis where the curve disappears when and x-ray is taken lying down or
bending sideways. The best way to assess which type of scoliosis a client has is by doing a roll
down, If the rib cage and/or lower back are asymmetrical then it is the second, or structural
type.
Source: http://www2.massgeneral.org/ortho/scoliosis.htm
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Scoliosis can occur in either the upper back (thoracic area), lower back (lumbar area), or more
rarely, in the neck (cervical area). Depending on the type and severity of the curvature of the
spine, scoliosis may be unnoticed early on but eventually symptoms such as the shoulder or the
hip being uneven become more noticeable, Other symptoms include protrusion of the shoulder
blade,a, tendency to lean to one side or a bulging on one side.. Most cases of scoliosis occur
during adolescence and have no known cause. Scoliosis occurs in approximately 2-3% of
children between the ages of 10 and 16.
The curvature may be acute, such as that seen in the case of a fracture (the type for my case
study as discussed on page 6). More often, it is smooth as shown below.
Source: http://rad.washington.edu
The Cobb technique for measuring the degree of the
curvature uses the vertebrae at the upper and lower end of
the curve that are most severely tilted towards the curve, to
measure the degree of scoliosis. Mild cases have between
10 to 25 degrees of curvature. Moderate cases are between
25 and 40 degrees and can be helped with bracing of some
sort. Severe cases are those in which the angle is greater
than 40 degrees and are likely to require surgical treatment.
Source: http://www.boneandjointburden.org/2013-report/iii-spine-deformity-and-related-conditions/iii
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Dunia Oriol – My Case Study Dunia Oriol is a forty-two year old economist who was diagnosed with s-curve scoliosis at the
age of 12 years old. When she was 10 years old she suffered a motor accident as a result of a
collision with a car, which left her in a coma for three days. The accident left her with multiple
broken bones and the recuperation was lengthy.
Two years later, Dunia was diagnosed with a double major curve with the thoracic curve to the
right and lumbar to the left as seen in the photo below.
On the left we have a photo of Dunia’s back and on the right an x-ray of a similar condition showing the bone structure. X-ray source:
http://www.coreconcepts.com.sg/wp-content/uploads/2010/07/S-shape-Bistol-Chiropractic.gif
As a teenager she travelled to the USA to assess her condition and they explored the possibility
of having a surgical intervention, or to wear a brace for two years to improve her spine.
However, she opted for Lateral Electrical Surface Stimulation {“LESS”}. LESS treatment is a
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neuromuscular stimulation treatment for idiopathic scoliosis. Dunia followed this therapy for
four years, throughout her teen years. This helped her condition from becoming worse.
However, throughout the years, Dunia has always complained about back pain and started
exercising with a personal trainer, to strengthen her body, combining PT with high intensity
interval training to improve her cardiovascular capacity.
One year ago, Dunia came to my studio to try Pilates. We started working with the
fundamentals to be sure she understood basic concepts like neural pelvis, neural spine and how
to activate her abdominals muscles. Because of scoliosis, her body awareness is limited and
finding her neutral spine and keeping her body in line has been a difficult process.
In our Pilates sessions I have observed the following that her muscles are stronger, tighter and
well-developed on the right side of the spine, but weak and sunken on the left side. The
stronger side will do all the work so we need to switch it off. I have tried to make Dunia aware of
this so she would use the weaker side more consciously.
I have worked with her to do the following as corrective measures:
• Lengthening and stretching the collapsed side
• Strengthening the muscles of the collapsed side so they are more active
• Achieving pelvic stability awareness
• Improving flexibility of the spine
• Rotation and lateral work to mobilize the facet joints and vertebrae so as to counteract
any further spinal rotation
• Used visual awareness with mirrors to teach her to reeducate her habits and to start to
become more aware of weight bearing thoughout her body
• In some exercises I have made her work one side and stabilize the opposite to become
more aware of her dominant side.
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BASI Block System Conditioning Program Block Apparatus Exercise Objective
Warm up Mat Roll down
Pelvic curl
Spine twist supine
Chest lift
Chest lift with rotation
Fundamental is perfect for her to
start her session. PC helps Dunia
to connect with her body and
sets her up for spine mobility
throughout the session.
Footwork Reformer Parallel heels
Parallel toes
Open V heels
Open V toes
Calf raises
Prances
*Single leg heels
*Single leg toes
I put her in the reformer so she
can have straight shoulders and
a well -aligned body while
working the hamstrings and
feet. I make her do extra reps on
the single leg to encourage
pelvic stability.
Abdominal work Reformer Hundred prep
Coordination
The reformer makes it easier to
align her body. She found
difficult the coordination
because of her body awareness,
so it took a few sessions to
achieve.
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Block Apparatus Exercise Objective
Hip Work Reformer Frog
Circles (down, up)
Openings
*Single leg frog
*Single leg openings
Her range is small so she could
keep pelvic stability. I make her
work on single leg frog and
openings to make her aware of
the weaker side and to feel each
leg getting equal amounts of
work.
Spinal Articulation Reformer Bottom lift
Semi-circle
These exercises were excellent
for her to improve spinal
mobility. Particularly helpful has
been the semi-circle, her body
alignment from the first rep to
the eight has improved
dramatically. She was able to
feel her body flow.
Stretches Reformer Kneeling lunge
Side split
Easy to maintain her alignment
with the right cues and to help
Dunia to stretch her hip flexors
and hamstrings. She needs to
improve her flexibility so the side
split allowed her to work on the
adductor stretch and strength.
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Block Apparatus Exercise Objective
Full Body Integration
– F/I
Cadillac Sitting forward
Side Reach
Thigh stretch with roll
up bar
The Cadillac is fantastic to give
that feeling of length and with
Dunia she benefits from having
her hips stable and then moving
through the exercises to gain
abdominal control,
Hamstring/oblique stretch and
spine mobility.
Arm Work Reformer Arm supine series:
Extension
Adduction
Up Circles
Down Circles
Triceps
*Single arm extension
*Single arm adduction
Dunia could feel the positioning
of her shoulders while working
on the scapula, trunk and legs
stability as well as shoulder
mobility. It is safe for her
alignment and she is able to
maintain pelvic stability while
increasing the weight gradually.
Leg Work Mat Gluteal side lying series:
Side leg lifts
Forward and lift
Forward and drop
Dunia was able to work on each
leg individually as well as to work
on the pelvic lumbar stability, rib
cage awareness and alignment.
She found it difficult to lie on her
side straight.
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Block Apparatus Exercise Objective
Lateral Flexion and
Rotation
Wanda
Chair
Side stretch
*work twice reps on the
collapsed side to
strengthen and stretch
the oblique.
Having a long leaver as a
reference (her foot) allowed her
to work through out her full side
keeping pelvic stability.
Step
Barrel
Side lift
*work twice reps on the
collapsed side to
strengthen and stretch
the oblique.
The step barrel helped her to
stretch each lateral flexor
individually, so important to
improving side mobility and to
strengthen each oblique
individually.
Back Extension Step
Barrel
Swan Prep She was able to keep trunk
stability. Her spine curves were
visible and she had to work to
extend her back evenly.
Finish with back stretch and roll down.
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Conclusion Dunia has benefitted from the program as she has been able to work precisely in the different
areas of her body and to understand how to reeducate her imbalances. Pilates has established
the foundation for her to do other physical activities more efficiently. Her back pain has
disappeared after attending regular Pilates classes. After each class, Dunia feels that her body
has lost its rigid structure and feels loser, more flexible and straighter.
Her bone structure can not change, but the BASI Block System is giving my client a clear path
and steps to a more flexible and more balanced body
Biography
BOOKS Annette Wellings and Alan Herdman. ‘Curves, Twists and Bends’ - A practical guide to Pilates for Scoliosis, 2010. Jane Paterson. ‘Teaching Pilates for Postural Faults, Illnesses & Injuries’ – A practical guide, 2009. Rael Isacowitz, Karen S. Clippinger. ‘Pilates Anatomy’, 2011.
Websites http://patient.info/health/scoliosis-curvature-of-the-spine-and-kyphosis http://www2.massgeneral.org/ortho/scoliosis.htm http://rad.washington.edu http:// www.boneandjointburden.org/2013-resport/iii-spine-deformity-and-related-conditions/iii http://www.coreconcepts.com.sg/wp-content/uploads/2010/07/S-shape-Bistol-Chiropractic.gif