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.