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Transcript of Management of Back Pain due to Hyperlordosis. - BASI Pilates · As noted hyper-lordosis “results...
ManagementofBackPainduetoHyperlordosis
WilliamGibbs,April2016
BodyArtsandScienceInternationalComprehensiveTeacherTrainingProgram
Brisbane,Australia,2014
2
Abstract
Thepurposeofthispaperistotakeanobjectiveviewatlowerback
pain,causedprimarilybyHyperlordosis.Thispaperwilldemonstrate
examplesofsomeoftheanatomicalandphysiologicalsignsand
symptomsofHyperlordosis.Thepaperwilldefineandprovide
potentialcausesof,Hyperlordosis.Throughuseofacurrentsubject,
thepaperwillprovideaPilatesprogramtoassisttheathletein
alleviatingthesymptomsoflowerbackpaincausedbyHyperlordosis.
ThepaperwillalsodemonstratethattherightPilatesprogramcan,
notjustaddressthesymptoms,butalsotheHyperlordosisitself.The
paperwillthenconcludehavingclearlydemonstratedthebenefitsof
aPilatesprogramforasubjectsufferinglowerbackpaindueto
Hyperlordosis.Thispaperwillbeutilisinganumberofappendices
andreferencesthatwillallbeincludedappropriately.
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CONTENTS
Abstract 2
TableofContents 3
Hyperlordosis 4
CaseStudy 9
Introduction 9
Body 10
Conclusion 14
REFERENCES 15
4
HyperlordosisThevertebralcolumnorspineconsistsof26irregularbones.“These
bonesareconnectedinafashionthatresultsinaflexiblecurved
structure”(MariebandHoehn).Inthenormalspinetherearefour
curvespresent.“Thesecurvesplayanimportantroleinbalance,
flexibility,andstressabsorptionanddistribution”(Higgins).Thefour
maincurvaturesaretheCervical,Thoracic,LumbarandtheSacral
curvature,whichalsocontainsthefusedvertebraofthecoccyx,
Figure1.1TheVertebralColumn.(MariebandHoehn,2014)
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TheSacralcurvatureconsistsof5-fusedvertebraeandtheCoccyx
consistsof4-fusedvertebrae,theyareoftenconsideredtobeone
boneeach,i.e.“26”irregularbonesinthespinalcolumn.
Tworeasonsforidentifyingwithlowerbackpainassociatedwith
hyperlordosisarethat,first,lowerbackpainisacommonissuefora
largeportionofoursociety;“Lowbackpainhasalifetimeincidence
rangingfrom60to80%intheindustrialisedworld.”(Shenoy,Eapen
andKumar135).Theotherbeingtheimportanceofthestructures
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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.
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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
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instabilityinthespine.Thisinstabilityleadstochronictensionin
certainmusclegroupsandincreasedstrainonjoints.Aseeninfigure
1.3duetotheabdominalmusclesbeingweakerthanthemusclesin
thelumbarspineandthehamstringmuscles,thereisanimbalance
whichresultsinthepelvisbeingpulledforwardofthebody,creating
theexaggeratedarchor“swayback”inthespine.
Figure1.3Lordosis(Sudy.com,2016).
Othersignsandsymptomsthatwillbegintopresentincludetighthip
flexors,hipflexioncontracture,whichcanleadtoalackofpostural
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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
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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
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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
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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.
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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
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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
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.
16
References
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Kendall,FlorencePetersonandFlorencePetersonKendall.Muscles.Baltimore,
MD:LippincottWilliams&Wilkins,2005.Print.
Marieb,ElaineNicponandKatjaHoehn.HumanAnatomy&Physiology.Boston:
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McNellis,JenniferL."TheEffectsofaPilatesTrainingProgramasaTherapeutic
InterventionforLumbarHyperlordosisinAsymptomaticMenandWomen."
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ProQuest.Web.23May2016.
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