BASI Pilates

PILATES FOR MULTIPLE SCLEROSIS

Melinda Louise Harvey

Submitted: 24.04.17

Course: Mar-Jul, 2016

Studio: Pilates Studio64

Brisbane, Australia

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Abstract

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) which interferes with nerve

impulses within the brain, spinal cord and optic nerves. Depending upon where it develops within the

CNS, it can manifest into various different symptoms and can be any combination of the five major

health problems, including:

1. Motor control

2. Fatigue

3. Other neurological symptoms

4. Continence problems

5. Neuropsychological symptoms

Treatment of MS is with medication, and it‟s believed the addition of moderate physical activity can

help, which is where Pilates can assist. As MS affects people in different ways, there is no single

exercise that can be an „MS exercise‟, however the MS Society UK recommends exercises that include:

Strengthening exercises

Stretching

Range-of-motion

Passive stretching

Posture exercises to help keep feet, knees, pelvis, shoulders and head aligned, reducing strain

on the muscles and bones.

All of which the correct BASI program can provide.

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Table of Contents

Abstract page 2

Table of Contents page 3

Anatomical Description page 4

Case Study page 5

Exercise Selection Reasoning and Details page 6

BASI Program page 7-8

Conclusion page 9

Bibliography page 10

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Anatomical Description

For the purpose of this case study, the client requires not only a full body exercise program, but a

program that will focus on strength, movement, and overall improvement in conditioning and use of

her lower limb muscles & joints.

Refer to images provided below:

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Case Study

Client: Rachel, 34 year old female, diagnosed with MS at the age of 26.

MS symptoms are varied and unpredictable, depending upon which part of the CNS is affected and to

what degree, and no two cases of MS are the same. The client has been recommended to undertake

weekly Pilates training, in conjunction with both her medicinal intervention program and regular work

with a specialist Physiotherapist, to assist with muscle strengthening, joint mobility, stretching, co-

ordination and correct muscle activation, with a focus on her lower limbs.

Current Issues - In this case study MS has manifested the following symptoms:

1. Motor Control Symtoms in Lower Limbs - client suffers regular muscular spasms in her calves,

hamstrings, quads & gluteals, and has problems with muscle weakness, co-ordination, balance

and general functioning of her legs and hips.

2. Neurological Symptoms – client regularly experiences a “pins and needles” sensation in her

lower limbs, and visual disturbances of “seeing stars” and/or minor fogging or blacking-out

issues when altering between upright or vertical positions to horizontal positions (both prone &

supine).

Wishes to improve / work toward:

General strengthening of all muscles, with a focus on lower limbs to help prevent further

degeneration.

Increased flexibility, and regular stretching of muscles which tend to spasm and tighten in her

lower limbs.

Practice and improvement of co-ordinated movements and mind-body connection.

Improve overall well-being and fitness.

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Exercise Selection Reasoning and Details

The program has been designed to address the clients MS symptoms, the issues these present, and

the clients goals, via the Principles of Pilates and the BASI Block system, coupled with the use of

adaptions and assists as/when necessary. Whilst focus is placed on the lower limbs, the program

promotes a full body work-out, with the goals of assisting with balance & mobility, improving muscle

strength, helping reduce fatigue, and aims to create an overall feeling of well-being and achievement.

Exercise Selections pertaining to specifics of the Lower Limb symptoms and principle of Flow:

BASI Block system and Principle of Flow – Please note: the BASI Block System order has been altered

to work within the clients limitations in movement between and on differing apparatus, and to improve

the overall flow between these differing exercises / apparatus as best suits the clients abilities and

needs. These adjustments to the Block system are noted as they occur in the program.

Foot Work – Due to current physical limitations Single Leg Work is not included in this program. Client

is unable to maintain the pelvic-lumbar stability or properly co-ordinate the movement of a single leg

action at this time. As strength & ability improves, Single Leg work will be added to her program.

Hip Work – Focus is on the Fundamental hip exercises, and we adapt these with each visit depending

upon the severity of Rachel‟s MS attacks. We‟ve found by implementing the adaption of an altered

strap position at times she is unable to stabilise sufficiently to have both feet in straps, allows her to

continue to mobilise the joint and strengthen the muscles, without causing undue stress & frustration.

General Adaptions / Assists – Rachel‟s MS symptoms require many adaptions and assists through-out

in order to allow her to complete each exercise to the best of her ability. As symptoms subside or flare

on a daily basis, adaptions and assists may or may not be required during any particular lesson. For the

purpose of the below lesson plan, notes of any adaptions, assists, or exercise changes to the plan due

to flare ups or “bad days” are provided.

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BASI Program

BLOCK APPARATUS EXERCISE ADAPTION / ASSIST

Warm-up Mat Beginner Warm-up:

Pelvic Curl

Spine Twist Supine

Chest Lift

Chest Lift with

Rotation

Assist - Small ball placed between knees as

client has difficulties with holding legs stabilised

positions during movement, the ball allows her

to “grip” her knees against it to maintain hip

distance during both Pelvic Curls & Chest Lift

exercises.

Foot Work Reformer Parallel Heels

Parallel Toes

V Position Toes

Open V Position

Heels

Open V Position Toes

Calf Raises

Prances

Prehensile

Assists: Small ball placed between clients

knees during Parallel Heels/Toes to help

maintain correct positioning. Client also utilises

her hands as assists for maintaining correct

knee & leg positions whilst practicing Open V

positions on days where her muscle strength in

not enough.

Hip Work

* altered Block for Flow (Abdominal work occurs in Barrel)

Reformer Frog

Circles (Down/Up)

Openings

Adaption / Assists: Client sometimes places

straps over her knees instead of on her feet,

completing all exercises with this greater leg

support on particularly difficult days in regards

to leg strength & control. The higher strap

placement & use of her hands on her legs

during the movements helps alleviate some of

her muscular control issues and she can

complete the exercises.

Spinal

Articulation

Reformer Bottom Lift

Bottom Lift with

Extension**

** 2nd exercise is only included

on “good days” when no

hamstring/gluteal cramping is

being experienced.

Adaption: On days the client is suffering severe

cramping in her hamstrings & gluteals, we

adapt the first exercise down by lowering the

foot bar & doing Bottom Lift with clients feet on

the grip (creating a Pelvic Curl on the

Reformer)

Abdominal Work

* altered Block

for Flow (normally

after Foot Work)

Ladder Barrel Chest Lift (standing

adaption of exercise –

refer to Adaption

notes)

Adaption: Chest Lift (standing) adapted from

the Step Barrel Chest Lift exercise. Client

couldn‟t get in to the low position required of

the Step Barrel, and supine positions affect her

vision (seeing “stars”) contra-indicating the

Step Barrel or supine ab work.

Back Extension

* altered Block for

Flow (normally

final exercise)

Ladder Barrel Swan Prep

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Stretches

* altered Block for

Flow (normally

after Spinal

Articulation)

Ladder Barrel Gluteals

Hamstrings

Adductors

Hip Flexors

FBI Reformer Round Back

Flat Back

Down Stretch

Arm Work Reformer Arms Sitting Series:

Chest Expansion

Biceps

Rhomboids

Hug-a-tree

Salute

Adaption / Assist: Long Box. Client sits in a

straddle position on the long box through-out

exercise series. This assists with her balance

issues (able to grip with legs to help maintain

upright back position) and helps with transitions

between back & front facing positions. The

change of position is much simpler for her to

manage when in the higher, bent knee position,

as opposed to trying to lengthen her legs &

position them between the shoulder pads.

Leg Work Reformer Single Leg Skating Adaption: Client keeps supporting leg on the

floor instead of standing up on the grip when

her balance is a concern. On particularly

difficult days she also either gently holds the

foot bar (highest position) or holds on to a pole

to further assist her to balance & complete the

exercise.

Lateral Flexion /

Rotation

Reformer Mermaid

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Conclusion

Rachel’s MS continues to inhibit her day to day life, and with no known cure, requires constant

vigilance and effort on her behalf, as well as the on-going support of her Doctors and others working

with her as she battles this debilitating CNS disease.

Through the BASI Program, Rachel has been able to continue to work on both maintaining and

improving her joint mobility and posture, motor skills, and her mind-body connection through

focussed exercise. She is working to strengthen and stretch not only her required area of the lower

limbs, but is also getting a full-body work-out which is improving her general fitness and creating a

sense of achievement she can both see and feel.

Pilates and the BASI Block system have allowed the client to comfortably and confidently face her

challenges. The BASI Pilates essential use of cuing has helped focus her movement, the ability to

adapt BASI exercises has meant we can meet her specific needs, and the additional use of assists

when they are necessary, all come together to ensure Rachel can effectively work not only her

specifically required lower limb areas, but the rest of her body and mind.

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Bibliography

Websites

“VCTC: The Muscles of the Lower Limb”. Webset-lms.com. Vocational Training Charitable Trust 2017.

18 March, 2017.

“Bones of the Leg & the Foot”. Corpshumain.ca/en. TEXT© 2000-2015 René St-Jacques. 18 March,

2017.

“What is MS” and “Symptoms of MS”. MSAustralia.org.au. Webprophets, n.d. Web 24 February, 2017.

“About MS” and “Treatments and Therapies”. MS-uk.org. Multiple Sclerosis Society, n.d. Web. 24

February, 2017.

Tobias, Ed. Column article; “Pilates: A Good Therapy for MS?”. Multiplesclerosisnewstoday.com, 4

October, 2016.

Books

Isacowitz, Rael. Study Guide: Comprehensive Course. Brisbane, Australia: Body Arts and Science

International, 2016.

Isacowitz, Rael. Reformer Movement Analysis Workbook. Brisbane, Australia: Body Arts and Science

International, 2016.

Isacowitz, Rael. Wunda Chair - Ladder Barrel Movement Analysis Workbook. Brisbane, Australia: Body

Arts and Science International, 2016.

Isacowitz, Rael. Auxiliary Movement Analysis Workbook. Brisbane, Australia: Body Arts and Science

International, 2016.