Elizabeth  Ottenwalder,    Comprehensive  Teacher  Training  Course,  BASI  Pilates  Academy,  Costa  Mesa    2013  

September,  2015  

 

How  Pilates  Benefits  Individuals  

with  Scoliosis    Mastering  Control  of  the  Curves,  Twists  and  Bends  

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ABSTRACT

The purpose of this paper is to provide information on how to cope and manage

symptoms of living with scoliosis. Since scoliosis involves one or more lateral curves in

the spine, primarily on the coronal plane; and differs in each individual, it is a complex

condition to treat.

This paper will explain the condition and how it manifests, include a diagram on how to

notice it, and provide exercises to help counteract the curve(s), lengthen and strengthen

the spine and body. It will provide strategies and a Pilates exercise program that I have

found effective, as an adult, in managing my symptoms. Pilates works the whole body

and builds strength from the inside out. Exercises will teach proper posture and

alignment and how to engage and strengthen the important stabilizing muscles. This

information is from research and successful case studies and explains how this can be

accomplished.

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TABLE OF CONTENTS

1. COVER PAGE .…………………………………………………………….1

2. ABSTRACT ………………………………………………………..……... 2

3. TABLE OF CONTENTS..…………………..………….……….…..….…3

4. SCOLIOSIS, HOW TO DETECT IT AND WHY IT IS PROBLEMATIC

.............................................................................................................4

5. CASE STUDY ....................................................................................8

6. HOW PILATES CAN HELP................................................................ 9

7. CONDITIONING PROGRAM UTILIZING THE BLOCK SYSTEM

FROM BODY ARTS AND SCIENCE INTERNATIONA

BASI)…….……………………………………………………………......11

8. CONCLUSION ..................................................................................15

9. BIBLIOGRAPHY................................................................................16

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SCOLIOSIS, HOW TO DETECT IT AND WHY IT IS PROBLEMATIC

Scoliosis involves one or more lateral curves in the spine, primarily on the coronal plane.

It can also involve rotation of the vertebra, usually in the C spine and upper thoracic

spine. Therefore, the torso appears uneven. It can be characterized by one or more

abnormal side-to-side spinal curves, sometimes the shape of an S, L or a C. The curves

can cause the spine to rotate and eventually and potentially constrict other organs such

as the heart and lungs and affect their function. The average curve progresses one

degree per year. Although small degree curves up to 30 degrees, can be helped with

exercise, over 50 degrees, surgery is usually required. There can often be a bulge or

hump on one side of the spine opposite the curve. This hump forms a dominant muscle

block. It will be a well-developed muscle block and will be prominent to the weaker less-

developed side of the spine.

This is known as the “bossy muscle”. It is a strong, tight and overworked muscle. It is

similar to “handedness” where there is a tendency for the structure, or in this case

dominant muscle to do all the work. Annette Wellings, a Physical Therapist, 40 years of

age, noticed with her own Scoliosis a correlation between the physical curvature and

mind patterns. The bossy muscle focused on doing, trying hard, determination and both

with and without stress. Physical symptoms of bracing her mind included:

1. The bossy muscle kicks in and does all the work

2. The weaker side seeks into the curve

3. The spine shortens and the helix shape of the spine increases like retreating into

itself.

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4. The rib cage rotates more, and the bossy muscle group feels tight and

uncomfortable, and is actually pulling and rotating the rib further.

In her case, she realized her bracing was making her condition worse and found

less pain and distortion when stayed in tune with her scoliosis rather than bracing

against it. Also, because the spine bends under pressure, she had to learn not

to: carry heavy loads; do strong weight-bearing exercises; allow herself to

become extremely physically tired due to overexertion or lack of sleep; become

extremely fatigued; grip, tense or brace the body when doing physical exercise or

activity; and sit, stand without moving for long periods of time. Also, stressful

social and emotional situations and mindsets of bracing, striving or straining to

achieve can attribute to the spine buckling.

Other physical signs of the condition can be manifested as follows:

1. One shoulder is higher than the other

2. The head is not centered directly above the pelvis

3. One hip is higher than the other

4. Two sides of the rib cage are different heights

5. The trunk leans to one side

6. One side of the back is higher when performing the roll down.

Therefore, it is important to let go of the tendency to brace, control and try hard.

The focus must be on acceptance, observing and exploring how your own or an

individual’s scoliosis is impacted. In terms of the physical exercise program for

Scoliosis, it must involve:

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1. Lengthening and increasing flexibility of the spine

2. Teaching the bossy muscle block to let go and turn off

3. Developing and strengthening the weak sunken side

4. Realigning the body

5. Avoiding high-impact and heavy weight bearing exercises

There is much variation in each case of scoliosis; however, there are four

common patterns of curvature as shown in the diagram below. The number on

the diagram represents the numerated description here:

1. Right Thoracic curve-occurs in the mid-back area

2. Lumbar Curve-occurs in the lower back

3. Thoracolumbar curve-creates a C Shape curve, and

4. Double or S shape curve-is a combination of curves.

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CASE STUDY

At the time, I am a 56-year young female with symptoms of occipital, neck, and

shoulder, scapula and left arm pain. I was diagnosed with Thoracic scoliosis with disc

degeneration at all levels T4-T12; T8-T9 has left para-central disc protrusion. I had low

back pain due to L5 on S1 disc bulge and facet osteoarthrosis which causes mild to

moderate degree of right stenosis with mild central canal and left stenosis. There is a

disc bulge at L4-5 and L2-3 with facet osteoarthrosis causing mild central canal

narrowing and stenosis. I had difficulty sleeping and awoke several times per night. I am

shifted to the left side, and flexed to the right and rotated to the left with right hip hike

and had an anterior pelvic tilt. Due to this shift, there are cervical, thoracic and sacroiliac

dysfunction and muscle imbalances. There are significant postural and strength deficits

that cause pain and weakness in the right gluteal area similar to piriformis syndrome or

sciatica. As Annette’s case displayed, I had similar imbalances.

With the thoracic shift to left, it was critical to mobilize the spine right and rotate it to the

left, strengthen the right obliques and stretch the muscles of the thoracic spine and

shoulders to lengthen and strengthen them. Considering this and the lumbar issues, I

decided I would benefit from a skilled progressive Pilates program with core exercises

to increase gluteal strength, balance, posture. Initially a stretching exercise program,

learning proper body mechanics with standing and sitting were used. Long-term

rehabilitation included a program to increase abdominal, back extensor, oblique and

gluteal strength.

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HOW PILATES CAN HELP

One of the wonderful advantages of a Pilates exercise program is that the exercises are

performed slowly, with control, while utilizing the breath through each movement.

Pilates can help by encouraging suppleness and flexibility of the spine; however, it will

not restructure the curve. Lengthening and flexibility of the spine is important because

with scoliosis the spine can become compressed and rigid. By performing lengthening

and flexion exercises the spine will become more flexible, less compressed and reduce

rigidity. By including de-rotation exercises, the facet joints and vertebrae are mobilized

and will counter act the tendency of the spine to rotate further. With Pilates breathing

and precision of movement, the weak muscle can be re-educated to work and the

dominant, strong, tight, bossy muscle trained to let go. It helps to stretch out tight

muscles and release the tension. The pelvis is the foundation to the spinal column and

it is important to keep it aligned and stable to provide the spine with a balanced

platform.

In general conditioning and rehabilitation, it is important to consider the mind body

connection in the work to accomplish superior potential, rather than thinking the body

and mind are separate operating systems. While incorporating movement and training

the mind needs to understand how movement can enhance the muscles that support

the spine. Pilates provides this based on how the method was developed. Thus utilizing

the mind body connection allows the individual with Scoliosis to re-educate how they

move and enables them to overcome and not compensate for the spinal diversion.

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Therefore, by incorporating Pilates exercises, one can re-educate, tone and strengthen

the muscles of the pelvic girdle so that the pelvis is aligned and stable.

Following is a program of Pilates exercises based on the BASI Block System that

provides a full body workout to strengthen the pelvis, abdominal and back muscles and

restore pelvic and lumbar stability and flexibility of the spine. The first ten sessions are

fundamental to assess movement and determine needs. Sessions 11-30 are selected

to increase strength and resistance as appropriate; however, if the client is not ready for

the exercise other fundamental exercises may be continued or others selected.

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CONDITIONING PROGRAM FOR SCOLIOSIS

I. Sessions 1-10 BASI Block System Roll Down for posture assessment from front, back and side view observing deviations, symmetry and posture.

A. Warm up - Mat Work (Perform 10-12 repetitions of each exercise Adjust lower number according to the client’s ability.

a. Pelvic Curl b. Chest Lift –ensure head is aligned with spine and pelvis is stable and

tailbone down. c. Leg Lifts/Changes d. Leg Circles e. Spine Twist Supine with pole on large ball

Observe the flow of movement insuring movement on the tighter side and de-rotate the thoracic vertebrae or where there is tendency for the curve.

B. Footwork on Reformer

Parallel heels & toes; V Heels, Open V heels & toes, Calf raises, Prances, Single leg heels and toes. Observe carefully that there is no compromise of spine in supine position-may have to use modifications or props to support empty spaces under the spine to level the Ilium or elevate back of the reformer in accordance with the severity of the scoliosis.

C. Abdominal Work-Reformer a. Hundred prep- for pelvic stability and symmetry

D. Hip Work- Reformer

a) Frog, Circles down & up, Openings

E. Stretches a. Standing Hamstring stretch-Reformer b. Pole Series: Shoulder, Overhead, Side, and Spine Twist –helps create

C spine and thoracic movement with trunk stability.

F. Arm Work-Cadillac – be sure to avoid lateral deviation a. Sitting side prep/sitting side b. Shoulder Adduction Single Arm-shoulder adduction control c. Side Reach-lengthen and stretch side of body; trunk stability

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G. Leg Work a. Gluteals Side Lying Series: Leg Lift, Forward and Lift, Forward with

Drops-focus on pelvic stability while moving extremity

H. Lateral Flexion/Rotation-Reformer a. Mermaid

I. Back Extension-Mat-Swan (may need to use a towel toward hips to help

focus on keeping scapula stable while extending upper spine) Rest Position and Roll down

II. Sessions 11-20 BASI Block System

Roll Down A. Warm up

a. Pelvic Curl b. Mini Rollups and w/Rotation c. Spine Twist Supine d. Spine Stretch e. Breathing f. Rollups

B. Footwork-Cadillac

Parallel heels & toes; V Heels, Open V heels & toes, calf raises, Prances, single leg heels and toes. Observe carefully that there is no compromise of spine in supine position-may have to use modifications or props to support empty spaces.

C. Abdominal Work-Reformer a. Hundred

D. Hip Work- Reformer

b) Frog, Circles down & up, Openings

E. Spinal Articulation -Mat a. Roll-Like-a-Ball

F. Stretches-Cadillac

a. Shoulder Stretch

G. Full Body Integration-Cadillac a. Sitting Forward-strengthen abdominals and stretch back b. Saw

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H. Arm work-Cadillac-for shoulder adductor control

a. Shoulder Adduction both arms b. Sitting Side prep/Sitting Side

I. Leg Work-Select one depending on the clients progression

a. Mat-Gluteal Kneeling Series and leg front pull b. Cadillac -Single Leg Side Series-Changes, Scissors, Circles forward&

back, Squats

J. Lateral Flexion/Rotation-Chair a. Side Over-for abdominal control with oblique emphasis

K. Back Extension

a. Swan on Floor – Wunda Chair b. Swimming on Mat -good to help move one side at a time

Rest Position and Roll Down

III. Sessions 21-30 BASI Block System Roll Down A. Warm up

a. Pelvic Curl b. Rollup c. Double Single Leg Stretch d. Double Leg Stretch e. Criss Cross

B. Foot Work-Chair

Parallel heels & toes; V Heels, Open V heels & toes, calf raises, Prances, single leg heels and toes. Observe carefully that there is no compromise of posture sitting. May have to use props/modifications depending on the severity of the scoliosis.

C. Abdominal Work-Chair a. Standing Pike b. Standing Pike Reverse

D. Hip Work-Cadillac-Basic Leg Springs- reinforce pelvic stability

a. Frog, Hip Circles down, up, Walking, Bicycle

E. Spinal Articulation-Reformer a. Bottom Lift and with extension

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F. Stretches-Reformer a. Single-Leg Skating-pelvic lumbar stability & hip adductor strength b. Side Split-for hip adductors c. Step Barrel-Shoulder Stretch Lying Side-shoulder thoracic control

G. Full Body Integration I – Kneeling Cat Stretch-Trunk stabilization

H. Arm Work-Chair-Trunk stabilization and scapular control

a. Shrugs b. Triceps Press Sit c. Single Arm Press

I. Full body Integration II

a. Thigh Stretch with Roll-up Bar

J. Leg Work-Chair a. Leg Press Standing-for balance b. Hamstring curl-for pelvic lumbar stability c. Hip Opener

K. Lateral Flexion/Rotation-Cadillac

a. Side Reach-oblique stretch

L. Back Extension-Chair a. Prone I, II-back extensor strength

Rest position and Roll Down Note: In all exercises, observe carefully that there is no compromise of spine in any

position. It may be necessary to make modifications or props to support empty spaces depending on each individual case.

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CONCLUSION

Joseph Pilates, creator of the Pilates Method, wrote that, “His exercise regimen

develops the body uniformity, corrects wrong postures, restores physical vitality,

invigorates the mind and elevates the spirit”. This method has been proved to be

effective for those who wish to maintain a healthy spine and specifically addresses

problems and limitation that come with spine disorders. The breathing component,

focus and precision helps the mind to let go of holding the body and to focus on

performing the exercises fluidly, controlled, with precision and utilizing the muscles that

need to be strengthened. It is rehabilitative and reduces pain also for people who have

already had spinal surgery as it strengthens the trunk muscles that support and protect

the spine.

Performing Pilates exercises for 13 years was challenging at times due to the

complexity of scoliosis; however, I’ve strengthened my core muscles, created balance

that allowed me to work and strengthen the weaker muscles. I feel balanced, sleep well,

have pain reduction, body awareness, and have stabilized my spinal imbalances with

the Pilates Method. Therefore, by incorporating Pilates exercises, working the whole

body, instructors can teach individuals with Scoliosis to correct postural alignment, how

to engage and strengthen the important stabilizing muscles while working the whole

body from the inside out.

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BIBLIOGRAPHY

BASI Comprehensive Course Study Guide; 2010-2013, Rael Isacowitz (Author) Curves, Twists and Bends - A Practical Guide to Pilates for Scoliosis, 2010 Annette Wellings Pilates for Fragile Backs; 2006, Lynne Robinson, Helge Fisher, Paul Massey Return to Life -2012, Joseph Pilates and William John Miller (Authors) (Originally Published in 1945-Revised Edition for 21st Century)