Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results...

16
Management of Back Pain due to Hyperlordosis William Gibbs, April 2016 Body Arts and Science International Comprehensive Teacher Training Program Brisbane, Australia, 2014

Transcript of Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results...

Page 1: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

ManagementofBackPainduetoHyperlordosis

WilliamGibbs,April2016

BodyArtsandScienceInternationalComprehensiveTeacherTrainingProgram

Brisbane,Australia,2014

Page 2: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

2

Abstract

Thepurposeofthispaperistotakeanobjectiveviewatlowerback

pain,causedprimarilybyHyperlordosis.Thispaperwilldemonstrate

examplesofsomeoftheanatomicalandphysiologicalsignsand

symptomsofHyperlordosis.Thepaperwilldefineandprovide

potentialcausesof,Hyperlordosis.Throughuseofacurrentsubject,

thepaperwillprovideaPilatesprogramtoassisttheathletein

alleviatingthesymptomsoflowerbackpaincausedbyHyperlordosis.

ThepaperwillalsodemonstratethattherightPilatesprogramcan,

notjustaddressthesymptoms,butalsotheHyperlordosisitself.The

paperwillthenconcludehavingclearlydemonstratedthebenefitsof

aPilatesprogramforasubjectsufferinglowerbackpaindueto

Hyperlordosis.Thispaperwillbeutilisinganumberofappendices

andreferencesthatwillallbeincludedappropriately.

Page 3: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

3

CONTENTS

Abstract 2

TableofContents 3

Hyperlordosis 4

CaseStudy 9

Introduction 9

Body 10

Conclusion 14

REFERENCES 15

Page 4: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

4

HyperlordosisThevertebralcolumnorspineconsistsof26irregularbones.“These

bonesareconnectedinafashionthatresultsinaflexiblecurved

structure”(MariebandHoehn).Inthenormalspinetherearefour

curvespresent.“Thesecurvesplayanimportantroleinbalance,

flexibility,andstressabsorptionanddistribution”(Higgins).Thefour

maincurvaturesaretheCervical,Thoracic,LumbarandtheSacral

curvature,whichalsocontainsthefusedvertebraofthecoccyx,

Figure1.1TheVertebralColumn.(MariebandHoehn,2014)

Page 5: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

5

TheSacralcurvatureconsistsof5-fusedvertebraeandtheCoccyx

consistsof4-fusedvertebrae,theyareoftenconsideredtobeone

boneeach,i.e.“26”irregularbonesinthespinalcolumn.

Tworeasonsforidentifyingwithlowerbackpainassociatedwith

hyperlordosisarethat,first,lowerbackpainisacommonissuefora

largeportionofoursociety;“Lowbackpainhasalifetimeincidence

rangingfrom60to80%intheindustrialisedworld.”(Shenoy,Eapen

andKumar135).Theotherbeingtheimportanceofthestructures

Page 6: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

6

involved,“Thelowerspine(thepelvic-lumbarregion)isofparticular

interestinPilates,becausehereinliesthepowerhouse,thecore,from

whichallmovementemanates”(Isacowitz)

Abnormalcurvaturesofthespinecanresultinincreasedstresson

thevertebraandintervertebraldiscs;thisthenleadstopainand

dysfunction.Hyperlordosisisoftencalledswaybackandisdefinedas

“anaccentuatedlumbarcurvature,whichcanresultfrom

tuberculosisorosteomalacia.Temporarylordosisiscommonin

thosecarryingalargeloadupfrontsuchasmenwithpotbelliesand

pregnantwomen”(Marieb&Hoehn).SpinalCurvesareeither

KyphoticorLordotic,asperfigure1.2.

Page 7: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

7

Figure1.2CurvesofTheSpine(DCFirst.com,2016).

“Althoughmostepisodes(80-90%)oflowerbackpain(LBP)subside

within2-3months,recurrenceiscommon.Anotheraspectofclinical

examinationofLBPsubjectsistheobservationandmeasurementof

spinalcurvature(SC).Thepreservationofnormalspinalcurvesis

requiredforloadbearing,andsoasubstantiallossorincreaseinSC

maycontributetobackpaindevelopment”(Shenoy,Eapenand

Kumar135).Anychangesinthecurvesofthespinewillcausesome

musclestostretchandsomemusclestoshorten,contributingto

Page 8: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

8

instabilityinthespine.Thisinstabilityleadstochronictensionin

certainmusclegroupsandincreasedstrainonjoints.Aseeninfigure

1.3duetotheabdominalmusclesbeingweakerthanthemusclesin

thelumbarspineandthehamstringmuscles,thereisanimbalance

whichresultsinthepelvisbeingpulledforwardofthebody,creating

theexaggeratedarchor“swayback”inthespine.

Figure1.3Lordosis(Sudy.com,2016).

Othersignsandsymptomsthatwillbegintopresentincludetighthip

flexors,hipflexioncontracture,whichcanleadtoalackofpostural

Page 9: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

9

awareness,andthoracichyper-kyphosis,whichisanexaggerated

roundingoftheforwardcurvatureintheupperback.Weakiliopsoas

musclesarealsocommonwiththiscondition.

Lordosismaybemoretemporarythaninthecaseofpregnancyor

excessiveabdominaltissue.Someathletesmayevenfindduetothe

typeofexercisetheyengageinorlackofappropriatetutelagethey

mayexperiencebriefepisodesoflordosisresultinginlowerback

pain.Higgins2011putsforwardthenotionthat“afieldhockey

playermaypresentwithlumbarpainandstaticpostureappears

normal,However,forthegreaterpartofatwohourpracticeshehas

torun,pass,andshootwithaforwardflexedspinalposition.This

spinalpostureduringpracticemaybeacontributingfactorinthis

athletesbackpain”(Higgins).

Howtoaddresspainassociatedwithlordosis;“Thiscommon

posturalproblem,oftencanbehelpedbydevelopinggreaterstrength

anduseoftheabdominalsaswellasadequateflexibilityofthelower

spinalextensorsandiliopsoas”(IsacowitzandClippinger).Onemust

takeabalancedandprovenapproachintacklinglordosis.Isacowitz

andClippingeralsostatethatwhenattemptingtotreatthisissueor

othercommon“spinalalignmentdeviations,itisimportanttorealize

thatthegoalisnottoovercorrectandremovethenormalcurvesof

Page 10: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

10

thespine.Suchanactionwouldcreateanotherspinalproblemin

whichthelumbarandsometimesothercurvaturesactuallyarebelow

normalintermsofmagnitudes”.Thisclearlydemonstratesthe

importanceofcheckingbackinandreassesswithyourclientto

ensureoptimalfunctioningofthespine.

CaseStudyIntroduction:

Name:Miller

Sex:Female

Age:19

Occupation:Rower/Student

Millerisa19-year-oldfemalethathasbeencompetingatstateand

nationallevelsinrowingforapprox.twoyears.Thisyearshehas

takentimeofftoincreaseherbodymassunderthecoach’sdirections.

Duringthistrainingtoincreasemusclemassshehasfoundshehas

beenexperiencingsomelowerbackpain,whichsheneverusedto

experiencewhilstrowing.Ithasbeenaperiodof7monthssinceshe

hasbeenrowingregularlyorcompeted.Thefirststepwastoobserve

Millerinthestudioperformingarolldownandsomefundamental

Page 11: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

11

Pilatesexercises.Itwasnoticedthatshehadmildhyperlordosis

whilejuststanding,whichincreasedasshefatigued.Thisalso

developedwhilsttraining,whichwasobservedwhileMiller

performed,weightedSquats,Benchpress,andRowingonamachine

andothergeneralweights.Millerdidalsomentionthatshefound

thatherhamstringswereoftentightandshehadtroublesitting

cross-leggedfortoolongasherhipflexorswouldbecomeaggravated.

Inoticedthatduringsomeexerciseherabdominalswouldbulge.

Millerdidconcedethatonceshestoppedcompetingshedidalsohave

alongtimeofffromanytrainingbeforestartingtrainingtoincrease

hermusclemass.

Body:

Asnotedhyper-lordosis“resultsintighteningandweakeningofthe

surroundingmuscles,specifically,shortenedhipflexorsandback

extensors,lengthenedandweakabdominalmuscles,lengthenedand

weakhipextensorsandananteriorpelvictilt”(KendallandKendall).

Havingnotedthis,thePilatesprogrammustaddresstheseissues

whilstalsostartingatafundamentallevelsoMillercanlearnand

adapttothebasicprinciplesofPilates.Theprogramshouldthenalso

progresstokeepMillerandherbodychallengedonherwayto

Page 12: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

12

buildingmusclemasssoshecancompeteagain.Thebelowprogram

willshowafundamentalprogramforuptotensessionsthenan

intermediatesessionforuptotensessionthenmovingintoamore

advancedseriesofexercises.ItshouldbemadeclearthatMillerwill

onlyadvancefromexercisesasshecandemonstrateinnate

understandingoftheexercise,andonaregularbasis.Theprogramis

modifiablesoifshecanperformcertainexercisesandadvance,great,

howeverifunabletoperformotherswell,thenwewillpersistuntil

shecan,irrespectiveofthesessionnumberweareupto.The

programisfocussedonstrengtheningabdominalsandhamstrings

whilstalsoincreasingflexibilityofthelowerspinalextensors,hip

flexorsandillio-psoasmuscles.Thereshouldbeanobviousfocuson

Abdominalandhamstringstrengtheningexercisesaswellasspinal

articulation,andeventuallyflowingintospinalextensionasthe

Hyper-lordosisreduces.

Thebelowprogrammostlyprovidesmorethanoneoptionforeach

block,thatwayvarietycanbeprovidedfortheclient,notall

exerciseslistedaretobeperformed.Asessioncouldallbedoneon

oneapparatusorwecouldmixitupsotheclientdoesn’tbecome

bored,aslongasflowispreserved.

Page 13: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

13

SessionPlanforaddressingHyper-Lordosis

BasiBlock Sessions1-10 Sessions2-20 Sessions20-30WarmUp Mat;

RollDown,PelvicCurl(ifneededassistwithballbetweenknees),SupineSpineTwistw/feetflatonfloor,ChestLift,ChestLiftw/rotations.

Mat;RollDown,Pelvic Curl (Nil assistneedednow),Supine Spine Twist intabletop,Chestlift,ChestLiftw/Rotation,Leg lifts and legchanges,RollUp.

Mat;RollDown,PelvicCurlw/singlelegliftedfrommat(ifable),SupineSpineTwist,Doublelegstretch,SingleLegstretch,CrissCross,RollUp.

FootWork Reformer/Cadillac;ParallelHeels/Toes,VPositionToes,OpenVHeels/Toes,Calfraises,Prances,SinglelegHeels/Toes.

Reformer/Cadillac;ParallelHeels/Toes,VPositionToes,OpenVHeels/Toes,Calfraises,Prances,SinglelegHeels/Toes.

Reformer/Cadillac/WundaChair;ParallelHeels/Toes,VPositionToes,OpenVHeels/Toes,Calfraises,Prances,(N/AonWC)SinglelegHeels/Toes(whilststretchingoppositehamstringwithstretchband).

Abdominals Reformer;HundredPrep’Coordination

Reformer;ShortBoxSeriesw/accessoriesifneeded,Cadillac;MiniRollUps,MiniRollupsw/Obliques.

Reformer;Abdominalslegsinstraps,ObliqueAbdominalslegsinstraps,orClimbaTreelongBox.Cadillac;RollUpTopLoaded,thenprogresstotop/bottomloaded.

HipWork Reformer/Cadillac;Frog,HipCirclesDown/Up.

Reformer;Frog,HipCirclesDown/Up,Opening.

Reformer;Frog,HipCirclesDown/Up,Opening,ExtendedFrog,ExtendedFrogReverse

SpinalArticulation

Mat;PelvicCurl,SpineStretch.Reformer;BottomLift

Reformer;BottomLiftw/extensions,ShortSpineCadillac;TowerPrep

Reformer;LongSpineCadillac;Tower

Page 14: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

14

Stretches LadderBarrel;Hamstrings,Gluteal,Adductors,HipFlexors,Shoulderstretch1&2.Reformer;StandingLunge.

LadderBarrel;Hamstrings,Gluteal,Adductors,HipFlexors,Shoulderstretch1&2.Reformer;KneelingLunge

Cadillac;ShoulderStretch.Reformer;StandingLunge,SideSplit

FullBodyIntegration(F/I)

Reformer;Scooter,Elephant.

Reformer;KneeStretchSeries:RoundFlatReverse,Cadillac;SittingForward,SideReach

Reformer;DownStretchCadillac;KneelingCatStretch,ThighStretchw/rollupbar

ArmWork Reformer;ArmsSupineSeries:Extension,Adduction,UpCircles,DownCircles,Triceps

Reformer;ArmsSittingSeries:ChestExpansion,Biceps,Rhomboids,Hug-A-Tree,Salute,Cadillac;ArmsStandingSeries:ChestExpansion,Hug-A-Tree,Circles(UpandDown),Punches,Biceps

Reformer;ArmsKneelingSeries:ChestExpansion,UpCircles,DownCircles,Triceps,Biceps,Cadillac;ArmsStandingSeries:ChestExpansion,Hug-A-Tree,Circles(UpandDown),Punches,Biceps,Butterfly.

FullBodyIntegration(A/M)

N/A N/A Cadillac;PushThroughSeries:KneelingCatStretch,Saw,SittingBack

LegWork Mat;SupineSeriesw/MagicCircle:Knees,AnklesProneSeriesw/MagicCircle:AnklesKneesBent,AnklesKneesStraight,andHamstrings.

Reformer;HamstringCurl,SinglelegSkating.Cadillac;Squatsw/RollUpBar

Reformer;JumpingSeries:Parallel,VPosition,SingleLegParallel,andLegChanges.Cadillac;SingleLegSideSeries:Changes,Scissors,Circles(F&R)

LateralFlexion/Rotation

Mat;SideLifts,Saw,SpineTwist.

Reformer;Mermaid,

LadderBarrel;SideOverPrep,SideOvers.

BackExtension Mat;BackExtensionandthenRestPosition.Reformer;BreastStrokePrep

Reformer;PullingStraps1Cadillac;Prone1WundaChair;SwanonFloor

Reformer;PullingStraps1&2,Cadillac;Prone1&2.

Finish RollDown RollDown RollDown

Page 15: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

15

Conclusion

Toconclude,thispaperhasdefinedbackpainassociatedwithhyper-

lordosis,it’ssigns,symptomsandpotentialcauses.Thispaperhas

providedacasestudyintheformofanathletewhohasbeen

experiencingthisconditionandaPilatesprogramtonotonlytreat

butalsohelpresolvethehyper-lordosis.ThePilatesprogramhas

focussedheavilyonstrengtheningtheAbdominalmusclestobegin

withandcreatingmoreHamstringandGlutealcontroland

awareness,thenprogressingtoimprovespinalarticulationandthen

backextensorcontrolandawareness.

Itshouldalsobenotedthatina2011paper,McNellisfoundwhen

comparingwithacontrolgroup,peoplewithhyper-lordosisfounda

significantimprovementinthehyper-lordosisposttreatmentand

that“theresultsprovidemeaningful,objectivedataontheefficacyof

thePilatesmethodofexerciseasitrelatestoimproving

hyperlordosisofthelumbarspine”.(McNellis).Thesubjectinthe

abovecasestudyalsofoundobviousbenefitsfromtheprogram.

Page 16: Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results in tightening and weakening of the surrounding muscles, specifically, shortened

16

References

"ChiropracticChartsAndPosters".Dcfirst.com.N.p.,2016.Web.30May2016.

Higgins,Michael.TherapeuticExercise.Philadelphia:F.A.DavisCompany,2011.

Print.

Isacowitz,Rael.Pilates,SecondEdition.Champaign,IL:HumanKinetics,

2014.Print.

Isacowitz,RaelandKarenSClippinger.PilatesAnatomy.Champaign,IL:

HumanKinetics,2011.Print.

Kendall,FlorencePetersonandFlorencePetersonKendall.Muscles.Baltimore,

MD:LippincottWilliams&Wilkins,2005.Print.

Marieb,ElaineNicponandKatjaHoehn.HumanAnatomy&Physiology.Boston:

Pearson,2013.Print.

McNellis,JenniferL."TheEffectsofaPilatesTrainingProgramasaTherapeutic

InterventionforLumbarHyperlordosisinAsymptomaticMenandWomen."

OrderNo.1504276SouthernConnecticutStateUniversity,2011.AnnArbor:

ProQuest.Web.23May2016.

Shenoy,P.D.,Eapen,C.,&Kumar,S.P.(2013).Associationofpressure-pain

thresholdandlumbarlordosisinsubjectswithandwithoutlowbackpain-A

casecontrolstudy.IndianJournalofPhysiotherapyandOccupationalTherapy,

7(2),130-134.Retrievedfrom

http://gateway.library.qut.edu.au/login?url=http://search.proquest.com/docvie

w/1428297281?accountid=13380

"WhatIsLordosis?-Definition,Symptoms&Treatment|Study.Com".Study.com.

N.p.,2016.Web.30May2016.