basi pilates as a corrective tool for upper ......basi pilates uses the block system that ensures...

BASI PILATES AS A CORRECTIVE TOOL

FOR UPPER CROSS SYNDROME

Dagmar Delmarco

BASI Pilates, 2017 September

Johannesburg South Africa

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“When all your muscles are properly developed, you will, as a matter of course,

perform your work with minimum effort and maximum pleasure.”

- Joseph Pilates, 1920s

I have opted to centre my Comprehensive Teacher Training Course Research Paper on my personal

postural diagnosis of Upper Crossed Syndrome (UCS). Exploring this syndrome intellectually and

physically has empowered me to empathize with my fellow suffers, and potential clients, on all

levels.

Ideally a person’s ear, shoulder and hips should be aligned above one another – depicted by the red

plumb line below (normal posture). For every inch the head is forward from its natural position it is

twice as heavy. The outcome is muscle imbalances as they strain to keep the head in position. The

muscles in the base of the neck, sub-occipitals, will tighten to enable the head to tilt up so the person

can see in front and around them.

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Figure 1: Deviations from the plumb line (red line) from a sagittal view.

Such deviations mean that there’s a weakening and lengthening of the posterior upper back and neck

muscles and a tightening and shortening of the opposing anterior pectoralis (chest) and neck

muscles.

Dr Vladimir Janda, a Czech Physician was the first to identify and name this condition of muscle

imbalance pattern located at the head and shoulder regions as Upper Cross Syndrome.

My symptoms experienced were headaches, referred numbness in upper limbs, nerve pain in neck

and shoulder, shoulder and pectoral minor pain/tenderness, instability overhead and limited range of

motion in shoulder joint. These symptoms brought me to the rooms of Chiropractor Martin Khoury

(based in Ballito, KwaZulu Natal) who subsequently diagnosed me with UCS. My posture was

reflective of the extreme right image in Figure 1 above (3 inch anterior shift of head from plumb line).

DIAGNOSIS OF UCS

1. Visually: observing forward and backward deviations of posture from the plumb line. This

contributes towards shoulder joint instability, as depicted in the figure 1.

2. Tests: (This is not a complete list, only some options that are accessible to Pilates trainers:

a. Tightness of trapezius. Palpating points of increased tenderness.

b. Evaluate scapular muscle. Range of motion; firing of upper traps vs mid and lower

traps; winging and pain report

c. Loss of neutral position of the head (lying supine, chin tends to lift up and away from

chest)

d. Side assessment of client. Note typical UCS deviations.

e. Floor Angel self-test. (Lie supine, can you simultaneously anchor back ribs to floor

whilst both wrists also stay firmly on the floor? If negative….. test positive for UCS)

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MUSCLE IMBALANCES PRESENT IN UCS

Shortened/tightened/over used/facilitated levator scapulae, upper trapezius & pectoralis

major

Weakened/lengthened/inhibited lower stabilizers of the scapula (rhomboids, serratus

anterior, middle and lower trapezius) and deep neck flexors (longus colli and scalenes)

Figure 2: Illustration of Upper Cross Syndrome

It is also worth mentioning that the human body is divided into two muscle group types, Tonic

(flexors) and Phasic (extensors). Due to the tonic muscles being dominant as they activate to resist

the forces of gravity they tend to become tightened and shorter, whereas the extensor muscles are

flaccid and thus weaker and have less tone. Many people have incorrect muscle patterns resulting in

tight (facilitated) and weak (inhibited) muscles, commonly in the upper body, UCS.

Tonic (Postural) Muscles Phasic Muscles

(Facilitated muscles and tend to overuse) (Inhibited by facilitated muscles and tend to under use)

Upper limb flexors Upper limb extensors

Sternocleidomastoid Deep neck flexors

Scalenes Rhomboids

Levator Scapular Serratus Anterior

Upper Trapezius Lower Trapezius

Pectoralis Major

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POSTURAL CHANGES IN UCS

I had “the look”……

Pokey chin - Forward head posture

Hunchback - Increased thoracic kyphosis and cervical lordosis (shoulders compensate for

overhead position)

Douchebag Shoulders - (from Kelly Starrett, author of the bestseller, “Becoming a Supple

Leopard”) Elevation and protraction of shoulders (rounded shoulders – this is when your pecs

are so tight and your sub-scapular muscles (the ones between and below your shoulder

blades) are too weak to hold your shoulders back so they round forward instead.

Wing & Winging - Wing look is when the scapulae is abducting/protracting ie: moving away

from the midline. Winging is when the scapulae lift away from the ribcage so you can slide

your fingers under the scapulae and grab hold of it.

POSSIBLE REPERCUSSIONS OF TIGHT UCS MUSCLE GROUPS IF LEFT UNTREATED

“Never slouch, as doing so compresses the lungs, overcrowds the vital organs, rounds the back and throws you off balance.”

- Joseph Pilates, on the importance of upright spinal posture.

Besides this grossly accurate reasoning by Mr. Pilates, further repercussions are: shoulder joint

(glenohumeral) instability, dysfunction, poor exercise technique, compensation patterns, chronic

migraine headaches, neck, shoulder and back pain, injuries, rotator cuff problems and depression of

sternum will make it difficult to breathe. The culprits are the trapezius and elevator scapula, the

pectoralis major and minor and the sternocleidomastoid (the bulging muscles along the side of your

neck).

So “shoulder problems” has stemmed from overuse of the traps and neck.

This overcompensation of some muscles means they are turning off other areas which should be working but are not. A process where muscles on one side of a joint are relaxing to accommodate contraction on the other side of that joint. Joint dysfunction is particularly prevalent at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Janda noted that these focal areas of stress within the spine correspond to transitional zones in which neighboring vertebrae change in morphology. Hence the deviation of the alignment of the spine from the plumb line – cervical spine shifting forward (cervical lordosis) and thoracic spine shifting backward (thoracic kyphosis). Furthermore shoulders become elevated and protracted, and scapulae rotate or abduct and winging

http://www.mobilitywod.com/about/kellystarrett/http://www.suppleleopard.com/http://www.suppleleopard.com/https://www.theptdc.com/2014/01/guide-to-pain-2/

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occurs. These postural changes lessen glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988)

In the long term, UCS can also lead to osteoarthritis and chronic cervical and thoracic degenerative joint disease.

CAUSES OF UCS

Lifestyle – sedentary existence (e.g.: prolonged sitting with bad posture), poor exercise technique (e.g.: biking with rounded upper back position) as well as imbalanced training (e.g.: over training pecs and under training back extensors) all contribute to muscle imbalance pattern in UCS worsening posture further. Emotional state of depression / hopelessness / lack of self-worth also has a fair share to play.

TREATMENT OF UCS

Deep tissue massage, dry needling targeting trigger points and laser therapy are some short term

treatment options. For a permanent result, treating the source and not only the symptom is needed.

This means balancing muscles, for correct alignment, through exercises. Janda determined that a

tight, short muscle can inhibit its opposing muscle e.g.: a tight pectoralis major muscle will result in a

weak serratus anterior muscle. But he also identified that just stretching the tightened muscles

allows the opposing muscles to function better.

Some general tips to consider:

The first step to counter UCS is releasing tight pectoralis muscles

(ie: Activation Therapy and stretching)

Learn how to “set” the shoulders and tuck the chin. (ie: roll the shoulders onto the back and draw the chin back and up to occipital lobe)

Then strengthen the weak extensor muscles (inhibited muscles)

(Serratus anterior - moving blades down and to the side and not just together)

Pay attention to posture, and incorporate some mobility drills and corrective exercises.

Focus more on extension and minimize flexion exercises to re-align skeleton over the plumb line.

PILATES AS THE CORRECTIVE TOOL FOR UCS

Pilates (Contrology) is named after the athlete who created it, Joseph Pilates (1920s). It is a method of low impact exercise that includes stretching with muscle strength and endurance training. Pilates focuses on correct postural alignment and awareness, core stability and eliminates muscle imbalance, thus support functional movement patterns. It also helps in prevention and treatment of chronic pain especially back pain.

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Pilates elongates and strengthens, improving muscle elasticity and joint mobility. A body with balanced strength and flexibility is less likely to be injured.

BASI Pilates involves 10 principles that address the person as a whole. These originated from both Joseph Pilates and the BASI Pilates approach:

Awareness, Balance, Breath, Concentration, Centre, Control, Efficiency, Flow, Precision and Harmony. These principles, when incorporated into the training, allow for a far greater part of the human potential to be realized as the mental aspect is included into the learning process. End result is well-being. Something that each human strives for.

BASI Pilates uses the block system that ensures all areas of the body are addressed during a session. Hence the holistic, well rounded approach again is adhered to.

UCS requires effective exercises to strengthen inhibited (lengthened) muscles ad stretch facilitated (tight and overused). Pilates practice nurtures ideal posture and body alignment making it a safe an effective tool of correcting Upper Cross Syndrome.

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CASE STUDY

Subject: Dagmar Delmarco. 42 year old female. Work: Part-time Pilate’s teacher Fitness/familiarity to Pilates: Been exposed to mat Pilates for 2 years, training twice per week (1 hour sessions). Average fitness level. Have always avoided stretching as I found this challenging and uncomfortable. Tight UCS muscles as well as tight hip flexors and lower back (typical of anterior tilted pelvis). Classic UCS posture (as explained earlier on). Life style: Outside classes however I had lived a passive and sedated life over the last few years. Sitting slouched at the computer / TV / reading for hours at end. Bad sleeping patterns of lying on my side forcing my shoulder to inwardly rotate for hours at an end worsened my already degenerating posture. I would often wake up with excessive pain around the shoulder joint (rotator cuffs) coupled with numbness down my arm and hand. All boney structures, supportive muscle groups and nerves in the shoulder region suffered due to this detrimental sleeping behavior, which persisted for 2 years and intensified over the last 6 months.

Looking back there was a lot of personal emotional stress in my life during this period and hence this insecure / unworthy posture adopted during sleeping hours as well as a significant unconscious change of my daily posture….. I became the Pokey chin, Hunchback, Douchebag Shoulders, Wing & Winging girl. I was forced into a conscious awareness when progressive pain set in and I took action. No better way of nature getting my attention!

“Contrology develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind and elevates the spirit”


Thus I devised a comprehensive BASI program 2 sessions per week, totaling 20 sessions, to address my Upper Cross Syndrome, which I subsequently utilized as my CTTC research paper.

GOAL

To be relieved of shoulder pain! ie: To decreasing the deviations from the plumb line in the upper body, so as to attain a more normal/ideal posture, by addressing the muscle imbalances and limited range of motion in the shoulder region brought about by UCS.

OBJECTIVE

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Activate tight/facilitated muscles (using Muscle Activation Techniques which is designed to improve muscle imbalances, alleviate pain, improve range of motion and overall muscle function). This is a manual therapy applied to muscle groups that have been over used for extended time periods. (Note this is not the same as trigger point therapy which is used specifically to alleviate the pain associated with knots in your muscles.) Muscle Activation Therapy is not part of the BASI system but has been a huge aid in helping in treating the body holistically as it frees the antagonist muscles (inhibited muscles for corrective strength training)

Stretch facilitated muscles of the chest, shoulders and neck. (the 2 points above release the inhibited muscles and are essential in order to train/strengthen the inhibited muscles)

Encourage good neck, chin and shoulder alignment (ie: draw chin back towards occipital lobe, length in the back of the neck and roll shoulders onto the back; however first align shoulders then neck and chin to follow.)

Strengthen inhibited muscles of mid and lower back (back extensors)

Strengthen core muscles to lengthen and support spine

Enhance shoulder extension and shoulder rotation

Reinforce scapulae stabilization (slide scapulae back (retract) and down (depress) into your mid-back and press them in towards rib cage (slight outward rotation))

Strengthen deep core and pelvic floor muscles

Stretching any excessively tight (inhibited) muscle in core and lower body (ie: latissimus dorsi, lower back, hamstrings, hip flexors, and adductors)

Muscle chains in the body, aid the body working as a whole unit, thus all inhibited muscle linked to the core need to be addressed to achieve functional range of motion (ie: release them (stretching the antagonistic muscle) then strengthen them)

Keep the workout diverse, challenging and engaging the body as a whole

BASI PILATES PROGRAM

BASI Block Sessions 1 – 10 Sessions 11 - 20

Warm Up Roll down

Mat (fundamental): pelvic curl, spine twist supine, chest lift, chest lift + rotation

Mindful movement is needed to harness awareness, balance, breath, concentration, control and centredness.

Roll down

Alternate between Mat (fundamental) and the Cadillac warm up below

Cadillac abdominal warm up: roll up with RU bar, mini roll up, mini roll up with oblique, roll up top loaded

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Important not to become absent minded and keep intent of the alignment and core connection

Foot Work Session 1-5: Reformer: foot series. Using the support of the carriage helps create awareness of rolling shoulders onto back and open the collarbone line. (ie: stabilizing through the shoulder girdle)

Sessions 6-10: Cadillac: foot series. Great for stretching tight hamstrings and support of back alignment. Keep latissimus dorsi activated to pull the shoulders back and down. Keep rib cage drawn in and tail bone anchored.

Alternate between Reformer, Cadillac and Wanda Chair. (select 1 series per session)

Wanda Chair: foot series. Challenges the co-contraction of abs and back extensors and encourages/demands good spinal alignment.

Abdominals Alternate between the following equipment (select 3 exercises per session)

Step Barrel: chest lift, the reach, overhead reach

Reformer: (short box series) round back, flat back, tilt, round-about

Cadillac: roll-up top loaded, breathing with push through bar

Wanda Chair: standing pike reverse, pike sitting,

Effective stretch for tight shoulder and upper thoracic region and start mobilizing shoulder joint whilst

Alternate between the following equipment (select 2/3 exercises per session)

Reformer: legs in straps series (long box series) backstroke, teaser prep, teaser

Cadillac: roll-up bottom loaded, bottom lift with RU bar, teaser 1

Wanda Chair: torso press sit, cat stretch

Good alignment and core activation prior to movement is essential

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strengthening abdominals. Slow precision is essential here.

Hip Work Alternate between the following equipment (select 1 series per session)

Reformer: supine leg series (fundamental)

Cadillac: supine double leg series

Awareness on stabilizing the upper body whilst legs in straps yet not allowing tension to creep into the shoulders and neck. (Activate latissimus dorsi throughout)

Alternate between the following equipment (select 1 series per session)

Reformer: supine leg series (intermediate)

Cadillac: supine single leg series

The latter unilateral work challenges imbalances in the body.

Spinal Articulation

Alternate between the following equipment (select 1/2 exercises per session)

Reformer: bottom lift, bottom lift with extension, short spine

Cadillac: monkey original

Spine articulation helps stretch back muscles which in turn allow for the anterior core muscle to function more optimally. (ie: tight back muscles inhibit the abdominal development)

Add to the choice of exercises…

Reformer: long spine, semi-circle

Cadillac: tower prep

Wanda Chair: jack-knife

Stretches Alternate between the following equipment (select 2 exercises per session or 1 series)

Pole series

Step barrel: side lying shoulder stretch


Cadillac: shoulder stretch

Ladder barrel: gluteal, hamstring, adductor, hip flexor

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Ladder barrel: shoulder stretch 1, shoulder stretch 2

Critical block in addressing stretching out facilitated/tight muscles of UCS.

Important to address the body as a whole and also address the lower body.

Full Body Integration 1

(fundamental + intermediate)

Alternate between the following equipment (select 3 exercises per session)

Reformer: knee stretch group: flat back up stretch group: (all except up stretch 3 - advanced) stomach massage series: only flat back and reaching

Cadillac: sitting forward, side reach, kneeling cat stretch

Excellent for back extensor strength and torso mobilization. Reach lengthens tight pectorals, latissimus and hamstrings.

Alternate between the following equipment (select 2 exercises)

Reformer: down stretch knee stretch group: reverse knee stretch up stretch group: up stretch 3

Cadillac: saw, sitting back

Arm Work Alternate between the following equipment (select 2 exercises or 1 series per session)

Reformer: shoulder push, shoulder push single arm, arm sitting series

Cadillac: push through group: shoulder adduction single arm, shoulder adduction double arm, sitting side prep

Add to the choice of exercises… (select 1 or both of the options below)

Reformer: arm kneeling series, rowing series

Cadillac: push through group: sitting side

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Wanda Chair: shrugs, triceps press seated, triceps prone, side kneeling arm

Establishing mobility and control of the shoulder joint for functional movement.

Full Body Integration 2

(advanced)

Sessions 6-10:

Reformer: balance control front

Addressing the body as a whole and making the muscle chains work in unison. Self-empowering exercises.

Add to the choice of exercises… (Selecting a total of 2)

Reformer: balance control back prep, balance control back

Legs Alternate between the following equipment (select only 1 exercise/series per session)

Reformer: side spilt, single leg skating

Cadillac: squats

Wanda Chair: leg press standing, hip opener

All the leg exercises listed require good shoulder placement and general body alignment – an excellent discipline to harness.


Gluteal kneeling leg series

Gluteal side lying series

Lateral Flexion Alternate between the following equipment (select only 1 exercise per session)

Reformer: mermaid

Wanda Chair: side stretch kneeling side stretch


Reformer: side over on box

Cadillac: Butterfly

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Step Barrel: side lift

Ladder Barrel: side over prep

These exercises support mobility of upper limbs and torso, also stretch and strengthen the core and in doing, the spine.

Back Extension Alternate between the following equipment (select 3 exercises per session)

Reformer: long box group

Cadillac: prone 1

Wanda Chair: swan basic, swan on floor

Step Barrel: swan prep

Ladder Barrel: basic back extension

Strengthening mid and upper back extensors which ultimately decrease UCS deviations from the plumb line.

Add to the choice of exercises… (select 2 of the options below and 1 from the previous list)

Wanda Chair: back extension single arm

Step Barrel: swan

Magic Circle: swan

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OUTCOME

Pain in my shoulder region has reduced 80%. My posture has improved, the deviations from the plum line are closer to normal and range of motion in my neck and shoulder is exceedingly better. Welcomed lessening of pain in and around the shoulder region; Stabilization of shoulder girdle and strength of back extensors; and overall harnessed strength of core has improved significantly. Best of all are the accompanied side effects. My mood has lifted and I feel more optimistic and hopeful in life. I put this down to improved concentration and focus that Pilates has harnessed in me. Also disciplining the body with intense focus on good technique during the training sessions has added to my sense of achievement and “can do” attitude. I can look the world in the eye now and no longer sheepishly glance downward. Living a life, free of postural pain, I have unwittingly freed my captive soul and attained a healthy sense of self-worth and hope. Thank you Joseph Pilates and all the BASI teachers who have facilitated my learning process and ignited my passion for the art of functional movement.

“Through the Pilates method of body conditioning this unique trinity of a balanced body, mind and spirit can ever be attained. Self- confidence follows.”


LONG TERM CONSIDERATION “PREVENTION INSTEAD OF CURE”

What I can do to prevent this syndrome from reoccurring?

Obvious response is weekly Pilate’s sessions. “Keep coming back. It works if you work it!” Bottom line is…

Move! Little yet often. Take notice of my posture inside and outside the studio. Letting awareness and self-correcting become apart of my daily life, as breathing is for existence. When sitting in a static position especially if it is for an extended time, sit well supported with good neck and shoulder alignment (chin tucked in, length in the back of the neck and slide scapulae back and down onto your mid-back) and take frequent rest breaks. During a rest-break simple stretching even strengthening exercises can be done to improve the mobility and dynamic stability of the neck and shoulders.

To personalize my UCS prevention action plan, over and above Pilates, harnesses self-love with acknowledgement: “This world is a safe place to live in & I am loved”. Self-love is intertwined with self-worth which in my case has manifests physically in Upper Cross Syndrome posture.

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Pilates has proven to be an excellent corrective tool for those of us suffering from UCS, whatever the cause, and allow the once was Pokey chin, Hunchback, Douchebag Shoulders, Wing & Winging sufferer to live a functional, balanced pain free life.

“Study your body, know its good and bad points, eliminate the bad and improve the good and what will be the results?

A perfect man physically and mentally!”


BIBLIOGRAPHY

Websites:

http://hohasheville.com/using-integrative-massage-treat-upper-cross-syndrome/

http://www.physiotherapy-treatment.com/Upper-Cross-Syndrome.html

http://www.aoasm.org/default/assets/File/OMED2016/Kerger_CrossedSyndromes.pdf

http://www.crossfitinvictus.com/blog/identifying-upper-cross-syndrome-for-dummies-part-1/

https://www.theptdc.com/2014/07/upper-crossed-syndrome/

http://www.pilatesplusphysio.co.uk/

http://www.muscleimbalancesyndromes.com/janda-syndromes/upper-crossed-syndrome/

http://www.livestrong.com/article/551738-muscle-activation-technique-vs-trigger-point-therapy/

“Behind every successful man there is a great woman!”

- Groucho Marx, 1960s
http://hohasheville.com/using-integrative-massage-treat-upper-cross-syndrome/http://www.physiotherapy-treatment.com/Upper-Cross-Syndrome.htmlhttp://www.aoasm.org/default/assets/File/OMED2016/Kerger_CrossedSyndromes.pdfhttp://www.crossfitinvictus.com/blog/identifying-upper-cross-syndrome-for-dummies-part-1/https://www.theptdc.com/2014/07/upper-crossed-syndrome/http://www.pilatesplusphysio.co.uk/http://www.muscleimbalancesyndromes.com/janda-syndromes/upper-crossed-syndrome/http://www.livestrong.com/article/551738-muscle-activation-technique-vs-trigger-point-therapy/

basi pilates as a corrective tool for upper ......basi pilates uses the block system that ensures...

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