1

PILATES FOR SCOLIOSIS FOCUSING ON LATERAL PELVIC TILT

RAWYA ROTILY MARCH 2020

COMPREHENSIVE GLOBAL 2019 STUDIO RITUEL PARIS

2

ABSTRACT

A lateral pelvic tilt is the asymmetric positioning of the pelvis where one

hip is ‘hiked’ up higher than the other due to certain muscle imbalances that

exist in the body. This paper addresses how a lateral pelvic tilt is a common

postural misalignment, which results in a drastic chain effect that reverberates

up and down the body. It will explore how this condition develops, how it’s

treated, and how to improve it.

Our bodies aren’t all perfectly symmetrical and everyone has some

asymmetry to some degree due to how we hold and use our bodies throughout

our lives. This asymmetry is expected and perfectly normal.

However, there can be times where a little too much asymmetry, such as

in the case of a lateral pelvic tilt, can leave us more prone to injury, reduce

mobility and negatively affect our overall physical performance.

The good thing is that in most cases a LPT can be fixed through stretching

and corrective exercises that I have designed using the BASI Comprehensive

Program.

3

TABLE OF CONTENTS

TITLE PAGE 1 ABSTRACT 2 TABLE OF CONTENTS 3 ANATOMICAL DESCRIPTION 4 CASE STUDY 7 CONDITIONNING PROGRAM 9 CONCLUSION 12 BIBLIOGRAPHY 13

4

ANATOMICAL DESCRIPTION

A lateral pelvic tilt (LPT) is a common postural misalignment characterized by

the tilting of the pelvis to one side. Individuals with this condition will appear to

have unbalanced hips, with one side sitting lower than the other.

There are several known causes of a lateral pelvic tilt, including scoliosis and

leg length discrepancy, but one of the most common culprits of this postural

discrepancy is poor posture. In order to understand how improper posture

contributes to a lateral pelvic tilt, it’s important to consider how the pelvis is

structured.

The pelvic bone sits at the top of the thigh bones (femurs) and is supported

by a network of muscles that help stabilize the hips and allow for a full range of

movement of the legs. The muscles and ligaments include:

° Adductors

° Gluteus medius

° Obliques

° Quadratus lumborum (QL)

° Tensor fascia lata (TFL)

When a muscle imbalance occurs between these muscles, whether due to

injury, tightness, weakness or overuse, a lateral pelvic tilt may develop.

Specifically, a lateral pelvic tilt is the result of the tightening and shortening

of the adductors, gluteus medius, and quadratus lumborum on one side of the

5

body, and the simultaneous weakening and lengthening of the same muscles

on the opposite side of the body.

Other than one hip being heigher than the other, the presence of a lateral tilt

can result in a drastic chain effect which reverberates up and down the body. A

few of the structural problems include:

• Uneven hips & gait • Uneven shoulder heights

• Leg length discrepancies • Internal rotation of the leg

While mild to moderate cases of lateral pelvic tilt usually do not produce any

noticeable symptoms, severe or longstanding cases of LPT may cause muscle

6

tightness and low back pain. If left untreated, it can lead to more serious

medical conditions such as:

• Disc degeneration • Disk herniation • Sacroiliac joint pain

There are a few things that can cause a lateral pelvic tilt:

• Bad posture habits - holding the body in the same position for hours

each day, every day, for several months or years, the body’s tissues will

adapt to this position.

• Sitting too much with incorrect posture – prolonged sitting not only

places undue stress on the spinal column, but also changes how the

muscles and ligaments of the lower body (specifically those that

support the pelvis) interact. This can lead to a negative feedback loop

of injury, overcompensation, and re-injury of the muscles and ligaments

that stabilize and mobilize the pelvis.

• Injuries and structural issues – hurting oneself on one side of the body is

possible to create a hip hike in order to avoid pain in the injured area.

• Pronated foot – a flat foot or a collapsed arch on one side will cause

the foot to roll inwards, causing the tibia and fibula (muscles of the

shin) to internally rotate and the knee will turn inwards. With the inward

turn of the knee (knee valgus) the femur also internally rotates and the

hip will drop, causing the lateral pelvic tilt.

7

CASE STUDY

Introduction: When I was around 13 years old, I used to love carrying my

little sister on my right hip and twist her around. As this was a critical time for

spinal growth and maturation, little did I, or my parents know, that I would be

diagnosed with scoliosis at the age of 15 with a 20 degree lumbar curve and a 5

degree tilt angle in the thoracic spine.

I was told I would have to be fitted for and wear a back brace to prevent

the curve from progressing. I wore the brace for 23 hours a day over 2 years and

did some yoga exercises that were given to me. I am now 31 years old and my

lumbar curve has progressed to 27 degrees. Had I known and discovered pilates

at the time, I would have prevented that increment.

I designed a BASI Comprehensive Block System program to target my

problematic areas which are: adductors, gluteus medius, obliques, quadratus

lumborum (QL) and hamstrings. The goal of this program is to restore symmetry

to the pelvic girdle by strengthening weak and/or elongated muscles while

stretching tight, constricted muscles.

8

My current imbalances are seen in the images below:

9

CONDITIONING PROGRAM

BLOCK SESSIONS 1-10 SESSIONS 11-20 NOTES

WARM UP

[Mat] Pelvic curl

Spine twist supine Chest lift Leg Lifts

[Mat] Pelvic curl

Spine twist supine Chest Lift

Chest Lift w/ rotation Leg Lifts / Changes

These warm ups help me achieve a neutral pelvis and

wakes up my transversus abdominus.

FOOTWORK

[Reformer] Parallel Heels Parallel Toes

V Position Toes Open V Heels Open V Toes Calf Raises

Prances Prehensile

Single Leg Heels Single Leg Toes

[Cadillac] Parallel Heels Parallel Toes

V Position Toes Open V Heels Open V Toes Calf Raises

Prances Single Leg Heels Single Leg Toes

Hip Opener

These exercises help me strengthen my overpronated

left foot by doing all footwork that require me to

dorsi flex. I work on strengthening my

ankles with calf raises, prances and prehensile.

Hip Opener on the Cadillac is magical. It helps me strengthen hip external

rotators (which are internally rotated on one side)

ABDOMINALS

[Mat] Roll up

Hundred prep Double leg stretch Single leg stretch

Criss cross Teaser prep

[Wunda Chair] Standing pike

Standing pike reverse Full pike

Pike Sitting

Strengthening my abs is essential for me as it helps decrease my lower back pain. In the Wunda chair

exercises, I love the pike ab work as it lengthens the curves of my spine while

strengthening my abdominals and stretching

my tight hamstrings.

BRIDGING / HIP WORK

[Mat] Shoulder bridge prep

Shoulder bridge Back support

Scissors Push up

[Reformer]

Frog Circles [down, up]

Openings Extended frog

[Cadillac]- Basic leg springs:

Frog Down circles

Up circles Walking Bicycle

Strengthening weak adductors and my weak

hamstrings is very important to gain balance when

having a lateral pelvic tilt.

10

SPINAL ARTICULATION

[Mat] Rolling like a ball

Spine stretch Roll over

Open leg rocker

[Cadillac] Monkey Original

The Mat work for Spinal

Articulation was extremely difficult to do in the first 3

sessions. With my scoliosis I would fall on one side when attempting (rolling like a ball or open leg rocker) but ive learned that the stronger

your core is, the more control you will have. Spine stretch is

great for opening up that lumbar curve, the arched

back at the end loosens all curvatures and helps elongate the spine.

As for the monkey – it feels great because it gives you this deep hamstring stretch

and the plantar /dorsi flexion helps me stretch out my calf muscle of my right supinated

foot.

STRETCHES [Reformer]

Standing lunge

[Cadillac] Shoulder stretch

Standing lunge on the reformer is my fav! At a

posterior tilt I feel a yummy stretch of the hip flexors and at an anterior tilt I focus more

on my right leg as I have tight hamstrings and hip

extensors. Since I also have a right

hiked shoulder, the shoulder stretch is great for release.

FBI - 1

[Reformer] Elephant

Up stretch 1 Up stretch 2 Long stretch

[Cadillac] Sitting forward

Saw

These all scream hamstring stretch, and ab strength!

Exactly what a scoliosis client needs.

ARMS

[Reformer] Arm sitting series: Chest expansion

Biceps Rhomboids Hug-a-tree

Salute

[Reformer] Rowing series: Rowing Back 1 Rowing Back 2 Rowing Front 1 Rowing Front 2

Reformer arm work helped me sit up right as it was

diffuclt in the beginning. I still use a small pad under my

left sitting bone to balance my pelvis. As for rowing

series, the rowing back 2 + the rowing front 2 are lovely for strengthening the back

11

extensors. Scoliosis clients have weak back extensors on one side of their spine, and its important to wake

those muscles

LEGS [Reformer]

Single leg skating

[Leg Weights] Side leg lift

Forward + lift Forward with drops Adductor squeeze

Single leg skating for my weak gluteus medius + hip adductor + knee extensor

strength

All the leg weight exercises are great for hip abductor strength and pelvic lumbar

stability

LATERAL FLEXITION / ROTATION

[Reformer] Mermaid

Side over on box

[Wunda chair] Side stretch

When I lift up and into my concave side, these

exercises straighten up my back and bring me into

neutral spine. For my case, the one side that stretches out my QL is

the same side that straightens my back . Feels

amazing! For the Wunda chair side stretch, not only are you

uncurving the spine but also lengthening the leg that is

stretched out and elongating it,

BACK EXTENSION

[Mat]

Cat stretch Single leg kick

Double leg kick Swimming

[Wunda Chair]

Swan Basic Back extension single arm

Cat stretch is great for breathing into the

compressed rib cage.

Swan basic on wunda chair requires activation of the hip extensors – I do more reps on

the right side to strengthen my glutes that will help with

the lateral pelvic tilt.

12

CONCLUSION

I got introduced to Pilates about 2 years ago and it has changed my

entire mindset on the whole mind-body connection / awareness. I started

noticing my imbalances and that made me understand why my left pelvis is in

an anterior tilt, or why my left ribs are externally rotated and protruded, or why

my right foot is supinated and so on. Doing Pilates twice a week, I’ve started

noticing that my alignment, movement and posture have improved.

I know that at this age, I cannot reverse the curve with Pilates exercises

but a targeted program taught me how to release tight areas, improve my

awareness of alignment and strengthen the internal muscles that support and

control my spine. And who best knows your body other than you? That’s when I

decided to dive in and learn Pilates myself to understand my scoliosis, heal my

own body and hopefully help others.

13

BIBLIOGRAPHY

Isacowitz, R. (2000-2014). Refomer Movement Analysis Workbook. Body Arts and Science International Isacowitz, R. (2000-2014). Mat Analysis Workbook. Body Arts and Science International Isacowitz, R. (2000-2014) Cadillac Movement Analysis Workbook. Body Arts and Science International Isacowitz, R. (2000-2014), Wunda Chair & Ladder Barrel Movement Analysis Workbook. Body Arts and Science International. “Back muscles” Lose the back pain, [online] Available at: https://losethebackpain.com/back-muscle-pain“Lateral Pelvic Tilt” Lateral Pelvic Tilt: How to Fix Unever Hips and (Apparent) Leg Length Discrepancies, [online] Available at: https://www.drbodygadget.com/lateral-pelvic-tilt/ “Left AIC Pattern” What is the Left AIC Pattern? [online] Available at: https://pritrainer.com/left-aic-pattern/