Pilates Protocols for Kyphosis Body Arts and Science International

Debra Andersen October 2015 Costa Mesa, California

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ABSTRACT

Balanced posture keeps your body in proper alignment. Poor posture can affect the

resting length of muscles and will cause dysfunction in the muscles, joints and bones. When

muscles and joints don’t function at their peak there can be pain and or injury over time. When

slouching the head tilts forward, the chest and anterior shoulder muscles are shortened, the

shoulders are rounded, the breath is constricted, and the back and posterior shoulder muscles are

lengthened. These changes can affect the alignment of the shoulders and spinal regions while at

rest or during movement. Pilates professionals utilize assessment tools to review posture, the

findings help guide in the development of conditioning programs that address deviations,

injuries, imbalance and or pain to restore clients bodies and minds.

Pilates develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind, and elevates the spirit. –Joseph Pilates

by

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TABLE OF CONTENTS

ABSTRACT 2

ANATOMY 4

INTRODUCTION 7

CASE STUDY 8 CONDITIONING PROGRAM 8 GOALS AND CONTRAINDICATIONS 8 ACTIVITIES OF DAILY LIVING 9 AMY’S CONDITIONING PROGRAM 11

CONCLUSION 16

WORKS CITED 17

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ANATOMY

The skeleton is partitioned into two sections the axial skeleton and the appendicular

skeleton. Figure 1 shows the axial skeleton, in

blue, made up of the skull, sternum, ribs,

vertebral column, sacrum and coccyx.

According to Isacowitz and Clippinger the

“axial skeleton forms the central upright axis

of the body to which the limbs are attached.

The appendicular skeleton consists of the

bones that make up the limbs or appendages”

(Pilates Anatomy 9).

The spine has 33 bones, Isacowitz and

Clippinger state, “that are stacked one upon

the other and form a column like structure” (Pilates Anatomy 9). Figure 2 illustrates the 3

primary regions of the spine and the attendant 24 vertebrae

within these regions. The cervical spine consists of 7

vertebrae; the thoracic spine consists of 12 vertebrae; and the

lumbar spine consists of 5 vertebrae. An article on WebMd

states the curves of the spine are designed to support the

body’s weight; the upper portion, the cervical spine, supports

the weight of the head—which can weigh up to 15 pounds—

Figure 2 Regions and Curves of the Spine

Source: Isacowitz, Rael, and Karen Clippinger.

Pilates Anatomy, pg. 11.

Figure 1 The Skeleton

Source: Human Anatomy. www.oustormcrowd.com

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the middle and lower portions of the spine, thoracic and lumbar spine—allow the mid and lower

back to flex, extend, move laterally and rotate (Types of Spine Curvature Disorders).

The large movements of the spine utilized in Pilates include: flexion, forward bending;

extension, straightening from flexion or backward bending; lateral extension, bending the spine

sideways and rotation, rotating the head and or upper trunk so that the head or chest faces right

or left.

There are many muscles involved in the movement of the spine as illustrated in figure 3

below when a spine is kyphotic a protruded chin produces shortened neck muscles

(sternocleidomastoid); rounding of the shoulders produces shortened chest and anterior shoulder

muscles (pectoralis major and

minor and anterior deltoids,

respectively) and the back and

posterior shoulder muscles are

lengthened (rhomboid minor &

major, trapezius, latissimus

dorsi, erector spinae and

posterior deltoid respectively).

Movement is affected

by postural deviation. To

assess posture Pilates

professionals view clients in

Figure 3 Major muscles of the upper extremities a) front view b) back view

Source: : Isacowitz, Rael, and Karen Clippinger. “Pilates Anatomy,” 38.

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stationary positions referred to as static alignment and during movement referred to as dynamic

alignment. Isacowitz and Clippinger state, “movement, stability and alignment of the spine are

an essential focus in Pilates” (Pilates Anatomy 9). Pilates can develop understanding of

alignment during movement or within a given position.

Balanced posture is described by Isacowitz and Clippinger as the relative positioning of

body segments in relation to one another; for example, the

head over the shoulders, shoulders over hips etc. (Pilates

Anatomy 9).

As seen in figure 4 a balanced posture entails the

specific arrangement of bones in relation to one another.

Stationary postural alignment can be assessed by viewing

the body from the side or sagittal plane and taking note of

landmarks along a plumb line, theses landmarks include:

lobe of the ear, middle of the tip of the shoulder, middle of

the rib cage, greater trochanter, the area just in front of the

middle of the knee and the area in front of the ankle.

Additional observation points, from the front and back

view or coronal plane, include the head (tilted), shoulders

(elevated or rounded), space between the arms and the

trunk, the pelvis (elevated), the knees and the feet (together or apart, rolled in or out) (Study

Guide 42). Dynamic postural alignment is on going during a session; however, it can be viewed

early in the session by having the client complete the roll down and viewing their movement

Figure 4 Balanced Posture

Source: fixthenexk.com “Slouched Posture: Efficient or Not?”

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from the front and back or coronal plane and the side or sagittal plane and taking note of

deviations within the regions of the spine, shoulders, arms, pelvis, legs or feet.

INTRODUCTION

An increased curve in the thoracic region is termed kyphosis; often common with aging is

becoming increasing more prominent in populations

who spend a majority of their working day seated in

front of a computer. Postural deviations known to

accompany kyphosis can include jutting chin, rounded

shoulders, rounded upper or mid back and possibly a

tilted pelvis when standing. An article on All About

Back and Neck Pain states postural kyphosis can be

corrected “with education about proper posture,

including some retraining on how to sit and stand

correctly. Special bracing or casting is usually not

necessary. Strengthening exercises for your back

muscles can be helpful in correcting posture”

(Kyphosis). BASI Pilates states that correction focuses

on strengthening the thoracic extensors and stretching the anterior shoulder muscles […] and

pectorals (Study Guide 44).

Figure 5 a) ideal standing alignment with plumb line, and b) cervical lordosis and kyphosis

Source: Isacowitz, Rael, and Karen Clippinger. “Pilates Anatomy,” pg. 22.

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CASE STUDY

Client: Amy

Age: 40

Gender: Female

Amy has been working out in the fitness center 3 days a week for over 10 years. Her

workouts include cardio and weight lifting. In 2014 Amy added Pilates sessions 2 days a week.

At that time sessions were general with jump board emphasis.

During the BASI Fundamental and Comprehensive Apparatus programs I learned about

assessment techniques. I assessed Amy’s back using the roll-down technique and discovered

Amy has kyphosis of the thoracic spinal region. Shortly thereafter, I began integrating the BASI

block system to design workouts. Next, I began using BASI designed and produced equipment.

Finally, I developed a conditioning program for Amy addressing her current needs.

CONDITIONING PROGRAM

The conditioning program utilizes the Block System from the BASI approach focusing on

the whole and highlights exercises that emphasize strengthening and stretching the trunk

accordingly. The conditioning program is designed for Amy and includes fundamental,

intermediate and advanced level work, which encompasses the BASI approach to balance. Goals

and contraindications have been outlined. Also included are activities for daily living, Amy has

agreed to do some additional work while working and at home.

GOALS AND CONTRAINDICATIONS

Adhere to the principles of a complete and comprehensive program within the BASI Block

system placing emphasis on Amy’s needs, as follows:

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Re-educate Amy on the use of her thoracic extensors.

Strengthen Amy’s thoracic extensors—the erector spinae, the semispinalis, the deep posterior

spinal group (interspinales, intertransversales, rotatores, and multifidus) as well as the

transversus abdominis.

Stretch Amy’s pectorals, as she has a slight rounding forward of the shoulders, and hip

flexors.

Stabilize scapulae and pelvic lumbar spine.

Cueing to “extend versus collapse into the upper back” (Study Guide 44).

Contraindications for kyphosis include minimizing forward spinal flexion for example an

excessive amount of exercises within C-Curve; and exercises with internal rotation of the

shoulders for example Rowing Back I & II.

ACTIVITIES OF DAILY LIVING

I asked Amy to consider adding the following

activities to her daily living. While Amy is at the office I

recommended that she:

1. Take frequent breaks, stepping away from

the computer. Stretch out, move and breathe (“Good

Posture Helps Reduce Back Pain”).

2. Become mindful of posture while seated.

While the illustration in figure 6 is comical the

Figure 6 Bad Posture

Source: thebootcampeffect.com

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implications of poor posture are quite serious.

3. Change the setup of office equipment and or furniture, see figure 7 depicting the

ideal computer station. The illustration depicts several landmarks at 90 degrees,

they are: the back and thighs, thighs and shins, upper and lower arms and shins

and feet. Feet and wrists are supported. Computer monitor is 18 to 30 inches

away, display is at an angle, keyboard is sloping, and the chair and table are

adjustable. There even exists a recommendation for a document holder to prevent

the head from tilting forward.

Figure 7 Ergonomic Office

Source: www.rosecityacupuncture.com

And while Amy is at home she agreed to do the following:

1. Lying prone on foam roller or Pilates ball– roll out pectoral major

2. Shoulder Stretch (theraband modified from Pole) (Auxiliary 42).

3. Overhead Stretch (theraband modified from Pole) (Auxiliary 43).

The preceding stretches will allow Amy to stretch and relax her pectorals, shoulders, and lower

trapezius muscles and stabilize the scapulae.

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AMY’S CONDITIONING PROGRAM

Each session begins with roll-down allowing Amy to center and connect breath with movement.

Mat

Roll-up

Spine Twist Supine

Double-leg stretch

Single-leg stretch

Criss-cross

This compliment of exercises provides abdominal strength, pelvic lumbar stabilization, trunk

stabilization, and abdominal strength with oblique emphasis (Study Guide 34).

FOOT WORK

Wunda Chair - From the perspective of comprehensive apparatus a preponderance of the

footwork’s muscle focus and objectives address the foot and leg with some hip included, the

Wunda Chair offers the additional aspect of trunk and pelvic stabilization. Due to this added

benefit Amy will complete her footwork on the Wunda Chair (Wunda Chair – Ladder Barrel 1-

8).

ABDOMINAL WORK

Spine Corrector with F2 System/Avalon

Reach

The reach muscle focus is abdominals; the objectives are abdominal strength, abdominal stretch and shoulder stretch (Avalon 46).

Hundred Prep

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The hundred prep muscle focus is abdominals; the objectives are abdominal strength and abdominal stretch (Avalon 47).

Teaser Prep

The teaser prep muscle focus is abdominals and hip flexors; the objectives are abdominal strength and hip flexor strength (Avalon 48).

HIP WORK

Cadillac – Single Leg Supine

Frog

Circles Down/Up

Hip Extension

Bicycle

While this block is standard its single leg focus allows for identification of handedness and

weaknesses that may appear due to compensation (Cadillac 23-26).

SPINAL ARTICULATION

I’ve chosen not to use the more popular spinal articulation exercises such as short spine, long

spine and jack knife because they emphasize the kyphotic posture that we are trying to reduce

and instead have chosen monkey original.

Cadillac

Monkey Original

The monkey original muscle focus is the abdominals; the objectives are abdominal control,

spinal stretch and mobility and hamstring and calf stretch (Cadillac 27).

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STRETCHES

Pole – Pole Series

Shoulder Stretch

The shoulder stretch muscle focus is the lower trapezius; the objectives are shoulder stretch and

scapulae stabilization (Auxiliary 45).

Overhead Stretch

The overhead stretch muscle focus is pectorals; the objectives are chest stretch and shoulder

stretch (Auxiliary 46). The preceding stretches were introduced to Amy for homework I’ve asked

her to do them daily with a theraband.

Spine Corrector/Step Barrel

Shoulder Stretch Lying Side

The shoulder stretch lying side muscles focus are latissimus dorsi and pectorals; the objectives

are shoulder control, shoulder stretch and thoracic stretch (Auxiliary 11).

Spine Corrector/Step Barrel

Kneeling Lunge

The kneeling lunge muscles focus are hip flexors and hamstrings; the objectives are hip flexor

stretch and hamstring stretch (Avalon 57).

FULL BODY INTEGRATION

Cadillac – Push Through Series

Kneeling Cat Stretch

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The kneeling cat stretch muscles focus are the abdominals and back extensors; the objectives are:

shoulder stretch, spinal articulation and trunk stabilization (Cadillac 34).

Sitting Forward

With sitting forward the muscle focus is the abdominals; the objectives are: abdominal control,

hamstring stretch and spinal mobility. It isn’t surprising that Amy moves through the first 4

phases of this exercise quite well; however, when cued to move from flexion to extension she is

unable to extend the spine (Cadillac 31).

ARM WORK

Reformer – Seated Arm Work Series

This series will benefit Amy as it focuses on trunk stabilization, shoulder extensor strength,

shoulder horizontal abductor strength, shoulder horizontal adductor strength, scapular adductor

strength, elbow flexor strength and elbow extensor strength (Reformer 57-61).

LEG WORK

Wunda Chair

Leg Press Standing

The leg press standing muscle focus is hamstrings; the objectives are balance, hip extensor

control and knee extensor control. The balance objective will help Amy center and concentrate

on her postural alignment (Wunda Chair – Ladder Barrel 23).

LATERAL FLEXION/ROTATION

Spine Corrector/Step Barrel

Side Lift

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The side lift muscle focus is abdominal obliques; the objectives are: lateral flexor stretch and

abdominal control with oblique emphasis (Auxiliary 13).

Spine Twist Supine

The spine twist supine muscle focus is abdominals with oblique emphasis; the objectives are:

spinal rotation, abdominal control with oblique emphasis and pelvic lumbar stabilization

(Auxiliary 12).

BACK EXTENSION

Spine Corrector/Step Barrel

Swan Prep

The swan prep muscle focus is back extensors; the objectives are trunk stabilization and back

extensor strength. This exercise provides a great opportunity for Amy to work the muscles from

the rib cage up to the head (Auxiliary 16).

Cadillac

Hanging Back

The hanging back muscle focus is back extensors, the objectives are back extensor strength and

chest stretch (Cadillac 54). This exercise can assist in reeducating Amy on spinal articulation,

and utilization of mid and upper back extensors.

Conclude session with roll-down allowing Amy to relax and center.

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CONCLUSION

In summary, Pilates protocols for kyphosis allow the Pilates professional to reeducate

movement patterns, improve the quality and precision of movement through strength, flexibility

and balance. This wonderful compliment of mind-body work restores balance to the client. Amy

is beginning to experience the benefits of greater chest and shoulder flexibility. Her back is

stronger with greater extension. Amy is excited to continue to work with the BASI Pilates

method and equipment.

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WORKS CITED

Body Arts and Science International. Study Guide. Costa Mesa, California. 2014. Print.

---. Auxiliary: Movement Analysis Workbook. Costa Mesa, California. 2014. Print.

---. Avalon: Movement Analysis Workbook. Costa Mesa, California. 2014. Print.

---. Cadillac: Movement Analysis Workbook. Costa Mesa, California. 2014. Print.

---. Mat: Movement Analysis Workbook. Costa Mesa, California. 2002. Print.

---. Reformer: Movement Analysis Workbook. Costa Mesa, California. 2012. Print.

---. Wunda Chair * Ladder Barrel: Movement Analysis Workbook. Costa Mesa, California. 2014.

Print.

DuPey Synthes Spine. Kyphosis. AllAboutBackandNeckPain. DuPey Synthes Spine, 2003-2015.

Web. October 4, 2015.

Isacowitz, Rael, and Karen Clippinger. Pilates Anatomy: Your illustrated guide to mat work for

core stability and balance. Champaign, Illinois, 2011. Print.

Isacowitz, Rael. Pilates.

Ratini, Melinda. Types of Spine Curvature Disorders. WebMD. Back Pain Health Center,

November 24, 2014. Web. September 20, 2015.

Schubbe, John. Good Posture Helps Reduce Back Pain. Spine-Health. May 17, 2004. Web.

September 27, 2015.