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SWAYBACK(FATIGUE)POSTURE,DISCPATHOLOGYANDPILATES

AleksandraEllis

BodyArtsandScienceInternational

ComprehensiveTeacherTrainingCourse2018

Wimbledon,London

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Abstract

Lowerbackpainisaverycommonconditionandformanywillimprovewithinafewweeksormonths.Forothers,however,chroniclowerbackpaincanaccountforlongperiodsoftimeoffwork

andcantakeahugepsychologicaltollonsufferers.

Paininyourlowerbackisusuallyasymptomofstressordamagetoyourligaments,muscles,tendonsordiscs.Ifpainpersistsforlongerthanthreemonthsitmaybeclassifiedaschroniclowerbackpain.

InthiscasestudyIwillbelookingattheimpactofSwayBack(orFatigue)Postureonmuscular

imbalancesandhowthatmayleadtoorexacerbatelowerbackpainanddiscpathology.ThepurposeofthispaperistolookattheeffectsofapplyingtheBASIBlockSystemtoaclientwithalonghistoryofpain,discinjuriesandoperations.Ihopetodemonstratethat,throughaweekly

programmeofbodyconditioningapersoncanregainstrength,mobilityandconfidenceintheirownbody,ultimatelyleadingtolesspainandabetterqualityoflife.

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TableofContents

TitlePage............................................................................................................... 1

Abstract................................................................................................................. 2

TableofContents..................................................................................................3

Anatomy................................................................................................................4

CaseStudy/ConditioningProgramme...................................................................8

Conclusion.............................................................................................................11

Bibliography.......................................................................................................... 12

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Anatomy

InapersonwithSwayBackposture,thepelvisispushedforwardfromthecentreofgravityortheplumbline.Thiscausesachainreactioninthepostureasthebodyattemptstocompensatefortheshiftinalignment(image1).

Image1

WhatarethecharacteristicsofSwayBackposture?

• Pelvispushedforwardsinfrontofcentreofgravity• Posteriorlytiltedpelvis• Painandtensioninthethoraco-lumbarjunction(wherethoracicmeetslumbarspine)

• Upperbackshiftedbackwardsoftheplumbline• Hyperextensionofhips• Hyperextensionofknees

• Forwardheadposture*• Upperbackcurvedforwardandlengthened/sunkenchest*• Shouldersprotracted*

• Tightupperabdominal(internalobliques)

* Thesechangesinpostureareusuallybodyattemptingtocompensatefortheforwardpositionof

thepelvis.

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Whatarethecausesofswaybackposture?

a)Over-active/tighthamstrings:

Tightand/orover-activehamstringsdrivethepelvisforwardsinswaybackposture.Thishamstring

dominancecanbeasaresultofgeneticfactors,lackofstretching,poorglutealmusclegroupfunction,sittingposture.

b)Ligamentlaxity:

Whetheryouarebornwithit,oryouaresomeonewhohasexcessivelystretchedthemselves,

ligamentlaxitycancauseswaybackposture.Sincethestabilityofthejointshasbeencompromised,swaybackpostureoccursasitallowstheweightofyourbodytorestontheexcessivecurvesofthespine.Strengthenandimprovecontrolofmuscleswhichsupportthespine.

c)Poorposture:

Forsomereason,yourbrainhaslearnttoholdyouinaSwaybackposture.Thiscouldbeattributedtobadhabitssuchassleepingonyourstomachandpoorpostureinsitting(bothrelevantinthiscase).TheclientinquestionplayedgoalinhockeyforEnglandfromtheageof18(co-incidentallythe

ageatwhichhehadhisfirstprolapseddisc).Thestanceofahockeygoalkeeperdoesresemblessomeonewithaswaybackpostureandduckfeet(image2).Whatexacerbatedtheissueisthatthisclientisverytall,veryslimwithlittlemusclemass.It’salmostasifthereisn’tenoughmuscletohold

hislongspineupright.Heisalsosomeonewhorideshismountainbikeforlongperiodsoftime,andhadneverstretched.

Image2 Image3

(image3courtesyofwww.posturedirect.com)

InadditiontoSwayBackposture,theclientinthiscasestudyalsopresentedwithDuckFeetPosture,whichiswhereaposturaldeviationcausesthefeettoturnoutwards...likeaduck(seeimage4).

Ifsomeonealreadyhasaposteriortiltofthepelvisfromaswaybackposture,thiscanturnthehipjointoutwardswhichmaythenleadtoturnedouthips,kneesand“duck”feet.

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Inthiscasethefollowingimbalancesmaybefound:

Tight/overactivemuscles(externalhiprotators)

-gluteusmaximus

-posteriorportionofgluteusmedius

-piriformis

Image4

Weak/inhibited(internalhiprotators)

-pectineus

-anteriorgluteusmedius

-TensorFasciaLatae

-AdductorMagnus

Image5

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Thiscaninturncausetight/overactiveandweakinhibitedmusclesinthelegs,externalrotationinthetibia,limitedankledorsiflexionandfootpronation,leadingtoturningoutofthefeet.

Ifapersonhashadoutturnedfeetandstoodinthiswayforaverylongtime,therecouldbeastructuralreasonrelatedtothebonesandjointsthatcouldbecausingthis,suchasexcessive

femoralretroversion.Inthiscaseexercisealonewouldnotbeabletoamendthis.Aphysiotherapistwouldbeabletotestforastructuralproblemsuchasthis.

Issuesrelatedtoduckfeetcanbe:

-lowerbackdiscbulgesandsciatica

-piriformissyndrome.

Image6 Image7

Image8

Commonsymptomsofsciaticainclude:

• -Lowerbackpain.

• -Painintherearorlegthatisworsewhensitting.

• -Hippain.

• -Burningortinglingdowntheleg.

• -Weakness,numbness,ordifficultymoving-thelegorfoot.

• -Aconstantpainononesideoftherear.

• -Ashootingpainthatmakesitdifficulttostandup

•

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CaseStudy

ThesubjectofmycasestudyisSJ.Heis44yearsold,istheMDofalargeroofingcompanyandisacompetitiveandhighlyskilledmountainbiker.SJfirstbeganexperiencingbackpainwhilstplayinggoalinhockeyforEnglandaged18.Hesufferedhisfirstprolapseddiscattheageof20andwas

immediatelyreferredforadiscectomy.Atthetimeofapproachingme,he’dhad4moresurgeriesandhadbeentoldheneededafifth,butthatthistimehisspinewouldhavetobeaccessedthroughhisabdominalsastherewastoomuchscartissuearoundhisspine.

SJwasextremelydistressedbythisoptionandwasnowlookingforalong-term,maintainablesolutionforhisproblem.Hehadbeentakingpainkillersdailyonandofffortwodecadesandwas

scaredtostoptakingthem.Hehardlysleptandwasoftenbedriddenwithpain.Hisgoalsweretobeabletowork,playwithhischildrenandridehisbikewithoutpain.Hewasveryemotionalattheprospectofgivinguphishobbyofmountainbiking,andIbelievetherewasalotoflongtermmental

stresslinkedtothepaininhisbody.Developingtrustandconfidenceinhisownbodywascrucial.Heneededtofeelstrongandnotbroken.Aprogrammeofstretchingalongsideconditioningwasalsoessential,forbalancebutalsotohelpde-sensitiseandreducepain.

TheBASIblocksystemisthenucleusoftheBASIapproachtothePilatesmethod.Itisessentiallyafilingsystemoftheentirerepertoirepresentedinasequentialstructure.Followingisaprogramme

designedforSJ.Duetothequiteprofoundphysicalandmentalbarrierswewerefacing,Ihavepresentedthistoshownecessaryregressions/modificationsandtheprogressionthatwasmadeoverathecourseof6months.

BASIBlockSystemConditioningProgramme

Sessions1-20

Sessions11-20

Sessions21-30

Rationale

WarmUp

Matwork:• Pelvictilt• Controlled

spinetwist(feetdown)

• Chestlift• Chestliftwith

rotation• Leglifts• Sidestretch• Basic

extension• Gentle

hamstringstretch

Matwork:• Pelviccurl• Spinetwist

(kneefoldw/rollerbetweenknees)

• Chestliftoversoftball

• Chestliftwithrotationoversoftball

• LegLifts• Gentle

hamstringstretch

Matwork:• Pelviccurl• Spinetwist

(kneefoldw/rollerbetweenknees)

• Chestliftoversoftball

• Chestliftwithrotationoversoftball

• LegLifts• Legchanges

aslongasspineneutral

Usewarmuptorelaxandwarmupmuscles,establishbreathing.ChestliftusingsoftballtokeepROMbetweenextensionandneutral.

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Footwork

WundaChair:• Parallelheels• Paralleltoes• V-positiontoes• WideV-

positiontoes• Calfraises• Prances• Singlelegheels• Singlelegtoes

Reformer:• Parallelheels• Paralleltoes• V-positiontoes• WideV-

positiontoes• Calfraises• Prances• Singlelegheels• Singlelegtoes

Lightsprings

Reformer:• Parallelheels• Paralleltoes• V-position

toes• WideV-

positiontoes• Calfraises• Prances• Singleleg

heels• Singleleg

toesHeaviersprings

NofootworkonCadillacasclientisverytallwithtighthamstringsanddidnotfeelcomfortable.Focusedonincreasingawarenessofandincreasingtrunkstabilization.

Abdominal

Work

Matworkprogressions:• HundredPrep• Hundredwith

feetdown,thenup

• DoubleLegStretch

• SingleLegStretch

Allbeganwithheaddown,legsdownifneeded.

Reformer:• Hundredprep

Cadillac:

• HalfrollupwithRUBar,progressingtofulllater.

Reformer:• HundredPrep• Hundred• Co-ordination

Trunkstabilization,createcorsetlikestructureforspine,checkingforneutralpelvisandactivatinginnerthighswithsoftballwherepossible.Headdowntobeginwithifneeded.

HipWork

Matworkwithband:• SinglelegFrog• Singleleg

circles

Reformer:• Frogs• Circlesdown• Circlesup• Openings• Adductor

stretch

Reformer:• Frogs• Circlesdown• Circlesup• Openings• Adductor

stretchCadillac:

• Frog• Circlesdown• Circlesup

Stabilityandcontrolinallcoremuscles,hipROMandstrength.Lightspringsandslowlyincreasedduetoclientfeelingprotectiveofback.

Spinal

Articulation

None

• BottomLifton

archeswith3Rsprings

• BottomLift

ontoeswith2Rsprings

Thiswasbarelypossibleforseveralweeks,sowebuiltupveryslowly.

Stretches

Matwork:• Hamstring

stretchusingtheraband

• Standingorkneelinghipflexorstretch

Reformer:• StandingLunge

WundaChair:

• Piriformisstretch

Reformer:• Kneeling

lungeCadillac:

• Shoulderstretch

Stretchedhamstringsmorethanhipflexorstocreatebalance.Shoulder

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Stretches

Matwork:• Hamstring

stretchusingtheraband

• Standingorkneelinghipflexorstretch

• QLseatedsidestretch

Reformer:• StandingLunge

WundaChair:

• Piriformisstretch

Reformer:• Kneeling

lungeCadillac:

• Shoulderstretch

Stretchedhamstringsmorethanhipflexorstocreatebalance.Shoulderstretchverygoodfortightpectorals.

FBI(F/I)

Reformer:• Scooter

Reformer:• ReverseKnee

Stretch(flatback)

• Elephant

Reformer:• ReverseKnee

Stretch• Elephant• UpStretch

Cadillac:

• Pushthroughseries(w/outsittingforward)plusuprightSaw.

Theseexercisesworkedwelltoengagethelowerabdominalsandbackatthesametime,disassociatinglimbsfromtrunk,plusgoodrotation.

ArmWork

ReformerArmSpineSeries:

• Chestexpansion

• Adduction• Circlesup• Circlesdown• Triceps

AsbeforeplusWundachair:

• Modifiedswanonfloor

• Pronetriceps• Basicswan

ReformerArmKneelingSeries:

• Chestexpansion

• Circlesup• Circlesdown• Triceps

ArmworkwithstabletrunkhasgivenSJafeelingofbeingstrong,similartoliftingweightsinthegym.

FBI(A/M)

FrontsupportonthemattoprogresstoBalanceControlFront

Asbefore.

Reformer:• Balance

ControlFront

BalanceControlFrontgaveclienttrustandconfidenceinhisbody.

LegWork

Matwork:• Glutealside

lyingworkWundaChair:

• Standinglegpress

Reformer:• Skating• Splits

Reformer:• Skating• Splits

Wundachair:

• Backwardstepdown

Cadillac:• Assisted

squats

BackwardStepDownandSquats–mentalboostfortheclient.Glutes,internalhiprotatorsandadductorstohelpcorrectduckfeet.

LateralFlex/Rot

Matwork:• Sidelift• Sidestretch

withpole• Twistwithpole

Reformer:• Mermaid

WundaChair:

• Sidekneelingstretch

Reformer:• SideoverBox

WundaChair:

• Sideover

Carefulwithrotation/Flexion.SidestretchingverytightQL.

Extension

Matwork:• Swanbasic

Reformer:

• Breastrokeprep

Reformer:• Breastroke• PullingstrapsI

Reformer:• Pullingstraps

I&II

Lowertrapactivationtohelpcorrectroundedshoulders.

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Conclusion

SJcomesweeklyfor1:1sandhasbeenfor18months.Hisprogrammecontainedregressionsandmodificationsnecessarygivenhislongtermhistorywithpainanddiscpathology.Weaddressedand

haveimprovedmuscularimbalancespotentiallycausedbyhisSwayBackposture.Trunkstabilisation(multifidusandtransverseabdominus)wasessentialtohisrecovery,aswellasstrengtheningaroundthehipsandshoulders.Wefocusedonglutealandhipstrength,plusstretchingtoaddresshamstring

over-dominance.

Althoughsittingandstandingpostureawarenesshasbeenveryimportantforthisclient,Ihavetriednottoputtoomuchemphasisonhimcorrectinghispostureperse.Idon’twantextrastressplacedonhisbodybyholdinghimselfinwhatwouldbeanunnaturalpostureforhim.Hisfeetarefindinga

moreparallelpositionnaturally,andhischestisliftingoutofasunkenposition.

Within3monthsSJreportedlesspainandstiffness,regainedfeelinginwhathadbeenanumbleftfootandwasoffdailypainkillersforthefirsttimein10months.Heissleepingbetter,canplayfootballwithhissonandthe5thspinaloperationisalongdistantmemory.Sincewebeganhehas

come26/140inadownhillmountainbikingcompetition,top10inanovernightEnduroandhasbookeda3day/70kmrideintheAlpsthisSummer.

Ouraiminitiallywastoincreasethegapbetweenrelapseswhichhavegotwiderandwider.Achallengeforhimwastodevelopmentalresiliencewhenrelapseshappened.Nowwhenpainand

stiffnessreturn,regularweeklysessionsandahomeexerciseplanincludingstretchinghelphimmoveonandrehabilitatefaster.

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Bibliography

Isacowitz,Rael.StudyGuide:ComprehensiveCourse.CostaMesa,California:BodyArtsandScienceInternational,2013

Isacowitz,RaelandClippinger,Karen.PilatesAnatomy.Champaign,IL:HumanKinetics

Wood,Samantha(ForewardbyIsacowitz,Rael).PilatesforRehabilitation:RecoverfromInjuryand

OptimizeFunction.Champaign,IL:HumanKinetics

“HowtofixSwayBackPosture”:http://posturedirect.com/how-to-fix-sway-back-posture/