The Benefits of Pilates for Myofascial Pain Syndrome By: Ifigeneia Kontou 26 May 2018 Dubai, United Arab Emirates Course Year 2017-2018 | BASI Comprehensive Global Program
TheBenefitsofPilatesforMyofascialPain
Syndrome
By:IfigeneiaKontou
26May2018
Dubai,UnitedArabEmirates
CourseYear2017-2018|BASIComprehensiveGlobalProgram
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Acknowledgments
IwasinspiredtotakethiscourseafterIattendedaworkshopinthesummerof2016inAthens
withRaelIsacowitz.IameversogratefulforRaelandBASI’svisionformakingsuchanamazing
courseandforalltheknowledgeandinspirationitgaveme.
Firstofall,Iwouldliketodedicatethispapertomylovinghusbandandmydearestchildren,
notonlyforalltheirsupportbutmostlyfortheirunderstandingforallthetimeItookfrom
themfromtheverybeginningofmytraining.
Secondly,tomymuch-lovedfriendKapi,whokindlyandpatientlybecamemyfirststudent
andshowedherdevotiontomeuntiltoday.
Tomybelovedfaculty instructorsPatriciaandTash.Thankyou,Patricia,forcaringandfor
sharing your knowledge so generously with me. Thank you, Tash, for all your support,
encouragementandboostingmyconfidencewhenIreallyneededit!
I’malsoverygratefultoLucy,whowasbymysidefromdayoneofthisprogramhelpingand
believinginme.Additionally,abigthankyoutoMirkawhospenthourswithmepracticing
andteachingeachother!
Lastbutnot least,tomypreciousfriendandteacherMaryliz,withwhomImadetheBASI
journey,stepbystep,handbyhand,andwhogrewtobecomea“sister”tome!
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Abstract
ThispaperaimstodescribethebenefitsofPilatesforMyofascialPainSyndrome,whichisa
common syndrome occurring nowadays, not only due to spinal alignment deviations and
muscleimbalances,butalsoduetobadhabitsineverydaylife.
My student came tome after the doctor’s recommendation to do Pilates as one of the
treatments forherMyofascialPainSyndrome,mainly located inherupperbackandneck
area. I spent some time understanding her case, and based on the BASI Block System, I
preparedtwoconditioningprogramsoveraneight-weekperiod,whichI’veoutlinedinthis
paper.
We’vestartedour lessonstogetherandthefirstresultsprovedtobeeffective inrelieving
pain and tension. The aim is to continue the conditioning program to achieve overall
improvementsinthespinalalignmentandposture.
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TableofContents
Acknowledgments 2
Abstract 3
AnatomicalDescription 5
TheMyofascial(Muscle+Fascial)System 5
MyofascialPainSyndromeanditsCauses 6
Kyphosis 6
MyofascialPainCycle 8
Symptoms 10
CaseStudy 11
Introduction 11
Body 11
ConditioningProgram 14
Weeks1-4 15
Weeks5-8 17
Conclusion 20
Bibliography 21
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AnatomicalDescription
TheMyofascial(Muscle+Fascial)System
Fasciaisa“web”-aconnectivetissuethatenvelops,connects,supportsandinvestsallofthe
structuresofthebody.(Oscar,E.andBussard,M.,2015).
Figure1:Fasciaisaweb.
Thefascialsystemofthehumanbodyhasbeencalledthe‘OrganofStabilityandMechano-
regulation’(Myers,T.W.2011,citingValeraandFrenk),whichmeansthatitsjobistodojust
that: to provide stability and maintain it by adapting to whatever mechanical forces it
encounters(Oscar,E.andBussard,M.2015).
TheMyofascialSystemreferstotheinterwovenandinseparablenatureofthemusclesand
thefascia;together,themyofascialsystemcreatesstabilityandintegrityinthebodythrough
tensileforces.(Oscar,E.andBussard,M.2015).
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MyofascialPainSyndromeanditsCauses
MyofascialPainSyndrome,whichisaverycommonconditionnowadays, isacollectionof
signsandsymptomsinaparticularareaofthebodythatindicatesmuscletrauma.Ideally,the
fit of the bones is designed to keep the body’s posture upright and moving smoothly;
however,whenthisisnotoccurring,musclestakeoverthejobandeventuallygetfatigued.
Assuch,poorpostureisoneoftheprimarycausesofMyofascialPainSyndrome.Otherfactors
can include serious lackofexerciseandmovement, generalized fatigueand lackof sleep.
(Asher,A.2018).
Citing the words of Dr. Sheriff Gamil, Specialist Orthopedic Surgery, “Myofascial Pain
Syndrome”isnotadisease;itisasyndromeoutofwhich50%isa‘muscular’issueandthe
other 50% is ‘psychological’; so, tension, stress and emotional problems (e.g. depression,
anxiety)playavitalrole.Besides, ithasbeensaidthatmusclesareawindowtothebrain
(Butler,D.andMosely,L.2013).Truly,ourthoughts,emotionsandbeliefsarereflectedinour
postureandmovementpatternsandthemechanicaltensionsassociatedwiththem.(Oscar,
E.andBussard,M.2015).
Kyphosis
Beforedescribinghowthe“MyofascialPainCycle”occursandaffectsthepersonandthebody
itwouldbenecessarytotalkalittlebitmoreabouttheprimaryandmostcommoncauseof
thesyndrome,thatof“poorposture”.Forthepurposeofthispaperwewillbereferringto
“poorposture”focusingontheareaoftheupperbackandneck.
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Oneofthemosttypicalalignmentproblemsisan“exaggerationofthecurvatureinagiven
regionofthespine;exaggerationofthecervicalcurveisoftenassociatedwiththealignment
problem called ‘forward head’ inwhich the chin juts forward and the earlobe is forward
relativetotheplumblineandshoulders.Thisincreasedcurveinthethoracicregionistermed
asKyphosis”.(IsacowitzR.andClippinger,K.2011).
In thatpostural syndrome, as theupperback appears curved, the shoulders are rounded
(rolledshoulders)andthescapula(shoulderblades)areprotracted,meaningthattheyare
positionedfurtherawayfromthespine.(SportsInjuryClinic).
(a) (b)
Figure2:(a)Idealstandingalignment,(b)kyphoticposture.
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Thus,thiscervicalpoorpostureismainlycausedbythefollowingimbalancesofmusclesin
theupperbackandneck:
- Thepectoralismajorandminormusclesandthemusclesinthebackoftheneckare
shortenedandtight.
- Themusclesofthebackoftheshouldersandupperback(trapezius,latissimusdorsi
andrhomboids)areweakenedandstretched.
- Inparticularthesternocleidomastoidmuscleistightandshortenedcausingthejawto
beposturedforwards.(SportsInjuryClinic).
Mostofthesemusclesmentionedabove,pectoralisminor,trapezius,rhomboids(ofcourse
alongwiththeserratusanteriorand levatorscapulae)aremainmusclesthattheshoulder
girdledependson.AndthisbringsustowhatRaelIsacowitzandKarrenClippingerpointed
out in their book “Pilates Anatomy, that “movements of the shoulder girdle are very
dependedonmusclesandmuscleimbalancescaneasilyleadtoalignmentproblems”.
MyofascialPainCycle
Whilsttalkingaboutalignmentproblemsandmuscleimbalancesitisworthgivinganexample
fromeverydaylifethatIbelieveanyonecouldrelateto.Whenyousitatyourcomputerall
daylongandyourupperbodybeginstoslumpforwardtoraiseyourheadtoseethescreen,
youuseyouruppertrapeziusmuscle–whichislocatedatthetopofyourshoulders.
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Figure3:Commonposturaldeviations.
The‘uppertrapezius’muscleisnowworkingatsomethingitisnotreallysupposedtodoand
itisdoingsocontinuouslyandforaprolongedperiodoftime.Thereislittleornotimefor
rest and relaxation; instead the continual contractionof the trapezius causesmicroscopic
injurytothismuscle.Thenormalorself-protectiveresponseofaninjuredmuscleistoseize
upor spasm.But in this case, theextra inputof tension into the trapezius intensifies the
situation;theconstrictioninthemusclereducesnourishingbloodflowtothearea,whichin
turncausespain,thepainsignalsthecycletobeginagainwhicheventuallycausesthemuscle
tocreatetriggerpoints,whichmayleadtodisability.
If the spasm-pain-spasm cycle is not interrupted to be treated, it will most likely repeat
endlessly and the problem will become chronic; “Chronic Myofascial Pain Syndrome”.
Therefore,MyofascialPainSyndromeshowsupas‘activetriggerpoints’inmusclesandifleft
untreated,it’softenexperiencedasarecurring‘cycleofspasm’(restrictioninthesofttissue):
spasm–pain–spasmagain.(Asher,A.2018).
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‘ActiveTriggerpoints’,canbefeltnotonlywheretheyarelocatedbutalsoaspainreferred
tootherareas.Eachmusclehasaparticularreferralpattern;inotherwords,painthatgoes
fromatriggerpointinaspecificmuscletoanotherplaceinthebodywillshowupprettymuch
thesamewayineverypersonwhohastriggerpointsinthatparticularmuscle.
Whenthis‘spasm-pain-spasmcycle’occurs,bloodflowdecreases,anditcausesthemuscle
todevelop‘activetriggerpoints’,whichcausepainthatleadsbacktomorespasms,andthe
cyclerepeatsitself.
Figure4:Triggerpoints.
Symptoms
MyofascialPainSyndromecanaffectyourqualityoflife;youmaynotbeabletoparticipate
inphysicalactivitiesthatyouusedtoenjoy.Itlimitsflexibilityandmusclesbecometight,tense
andtautand joint rangeofmotiondecreases;all thesecausepainanddysfunction in the
musculoskeletalsystemandallthesetogethercouldleadtodepressionandevenisolation.
Generally, myofascial pain can be found in the shoulders and neck but also arms, face,
low/upperback,and/orlegs.(Asher,A.2018andOsborn,C.2017).
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CaseStudy
Introduction
Thewholeproblemfeels likeoneviciouscircle itself;upperbackmuscle imbalances,poor
posture, incorrect scapular movements leading to further muscle imbalances and more
alignmentdeviations,musclesgetfatigued,tensedandtightandifremaineduntreated,they
get traumatized, then range of motion decreases and movement is poorly performed.
Eventually,ifalltheseconditionsremainwithouttreatmentorcorrectionsthiswillleadtoa
“ChronicMyofascialPainSyndrome”.
Itcanoccurinallsectionsofthepopulation.Even,inthesportsworldforexample,cyclists
and baseball catchers are at risk as they have to hold postures for long periods of time.
(Internet,SportsInjuryClinic).
Body
Sophia,my40-yearoldclientwasdiagnosedwithMyofascialPainSyndromethreemonths
ago.Sophiahadbeenverysportyandactiveallherlife;fromballetandcontemporarydance
inheryouth,tovolleyballandtennis.Sincegivingbirthinherearlythirtiesto2children,she
wasfollowinggymfitnessprograms,doingcardioclasses(e.g.stepclass,bodycombat)and
alsolightweightliftingclassesforstrength(bodypump).PilatesMatclasseshavebeenpart
ofherlifeforthelast6yearsalongwiththeotherfitnessprogramsandsherecently(2months
ago)startedprivatesessionsusingthePilatesapparatus.
In the meantime, being a full-time active mom, Sophia got a new part time job which
demandedalotofreading,writingand‘computerwork’whichinvolvedspendingalotoftime
atadesk.
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Coordinatingandkeepingupwithallresponsibilitiesoffamilyandwork,andmaintainingher
veryactiveathleticlife,Sophiastartedfeelingalotoftensionandstress.
WhenIfirstmetSophia,Icouldnotavoidnoticingher‘kyphotic’tendency,whereherupper
backappearedtobecurvedwiththeshouldersroundingforward,herscapulaeprotracted
(positioned away from the spine) and her chin slightly poking forward rather than being
tuckedin.
PuttingallthesedetailsaboutSophiaandherlifestyletogether,itseemsthatshefulfillsall
thepreconditionstodevelopaChronicMyofascialPainSyndromemainlyaffectingthearea
ofherupperback,hershouldergirdleandherneck.Thus,aftervisitingthedoctor,Sophia
waspartially treatedwithoralmedication, includinganalgesics,pain relieversandmuscle
relaxantsfor10days.Accordingtothedoctor,thisalonewouldneversolvetheproblembut
wouldratheronlyrelievethepain.Shewasalsoprescribedwith20sessionsofphysiotherapy.
Duringherphysio-sessionshertherapistusedtherapymessagetoincreasethebloodflowin
theareaandtowarmupthemusclesinordertoreleasemusclestiffness,tensionandpain.
Duringthetherapeuticmessages,thetherapistavoidedusingthethumbtoputpressureon
the trigger points as this only aggravated the pain. Instead, it was decided to follow the
method of ‘dry needling’, one of the most effective and quickest methods to inactivate
myofascialtriggerpoints.However,afterallthesetreatments,citingDr.Sherif’swords,“when
medicationisfinishedandphysioisover,thisiswhenPilatescomesin”toassistintargeting
theproblemfromitsroot.
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AndthisismoreorlesshowSophiaandIgottogether.Fromourfirstsessionafterhearingall
the details about her life, I assessed her posture and itwas obvious that her back had a
kyphotic tendency. As I correctly suspected after our first session, most of her arm and
scapularmovementswerebeingperformedinanundesirablemanner.
ItisexactlywhatRaelIsacowitzandKarenKlippingerveryaccuratelyandclearlyexplainedin
theirbook“PilatesAnatomy”:“Oneofthemostcommondysfunctionalmovementsofthe
shouldergirdle,themovementsofthescapula,iswhenthearmrisestothesideortothe
front.Ideally,whenthearmmovesthescapulawouldmoveinacoordinatedmannerthat
wouldallowthehumerustomaintainproperpositioningintheshouldersocket.”However,
inourcase, “as thearmmovesupwards, there isanundesiredexcessiveelevationof the
scapula”, whichmeans that thewrongmuscle has taken over tomake an unnecessary
movement.
(a) (b)
Figure5:(a)Upwardanddownwardrotation,(b)useofscapulardepressorstoavoidexcessiveelevationofeachscapulaasthearmsareraisedoverhead.
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ConditioningProgram
ThemaintargetoftheConditioningProgramdesignedforSophiais,ofcoursetostrengthen
themusclesthatareimportantforhercorrectalignmentandnottoforgethercorestability.
Equallyimportantistomakeherfeelthecorrectalignment;toguideherhowtohonethe
skillsforquicklyachievingthiscorrectalignmentandtopracticewithherhowtoutilizethis
alignment,inbothhersportsandhereverydaylifeactivities.“Researchsuggeststhatwith
repetitiveactivationofthedesiredmusclesintheappropriatemanner,overtimeyourbody
willautomaticallystartutilizingthesemoreoptimalstrategies”.(IsacowitzR.andClippinger,
K.2011).
Moreanatomicallyspeaking,I‘lltrytoeducateSophiaonhowtouseherscapulardepressors
topullthescapulaeslightlydownbeforeliftingthearms,toencourageuseofthesemuscles
asthearmsmove.Wewilltrytobalancetheusebetweentheuppertrapezius,whichelevates
the scapulae and the lower trapezius which depresses the scapulae. (Isacowitz R. and
Clippinger,K.2011).At thesametime,wewillattempt tostrengthenherbackextensors,
‘ErectorSpinaeMuscleGroup”,whicharealsoresponsibleforthepostureaswellasthehead
andarmmovement.Finally,wewillworkonstrengtheningthe“Rhomboid”muscles,right
underneath the trapezius as they bothwork together to adduct (or to bring towards the
middleofthebody)theshoulderblades.(Salyer,J.2017).
ItisnecessarytoclarifyherethatSophia’slevelisintermediateasshehasbeendoingPilates
forquitealongtime.Moreover,dueherprolongedexperiencewithsportssheisalsoquite
awareofherbody.
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Weeks1–4
BASIBlockSystem Exercise ReasonsandPurpose
WARMUP
Basic:• PelvicCurl• SpineTwistSupine• ChestLift• ChestLiftwith
Rotation
Wewanttomakesurethattheclientisabletoperformallthesefundamentalexercises.Weneedtostartmobilizingthespineindifferentdirectionsandstartfocusingontherightalignmentespeciallythatoftheupperback.(E.g.keepingshouldersrelaxedanddownonmatduringspinetwist;orkeepingtheheadinalignmentwiththespineduringchestlift).
FOOTWORK
Wundachair:• ParallelHeels• ParallelToes• VpositionToes• OpenVheels• OpenVtoes• CalfRaises• SingleLegHeel• SingleLegToes
Givingagoodopportunitytoworktheclient’suprightposition,tolearntokeepthetrunkstable,tobeabletofocusonco-contractionofabdominalsandbackextensorsandthroughthedifferentarmpositionstolearntocontrolthemovement(especiallytheunnecessaryelevation)ofthescapula.
ABDOMINAL
StepBarrel:• ChestLift• Reach• OverheadStretch
Itisanextraordinaryandyetsafeway,especiallyforacurvedthoracicspinetostartopeningupandstretching,whileyoustrengthentheabdominals!Atthesametime,youeducatethespine,whilesafelysupportingit,toworkinalldirections;fromanupperbackextension,throughneutral,allthewaytoflexion.Theclientlearnstokeeptheheadinalignmentwithandwithoutsupportsotheneckmusclesarenottensedoroverworked.Anditisawonderfulwaytomobilizeandstretchtheshoulders!
HIPS
StepBarrel:• Openings• Helicopter• Scissors• Bicycle• Bicyclereverse
Itcanhelptheclientgetthefeelingthattheupperbackissupportedbythemat;tolearntoavoidputtingtensionontheneckbutkeeptheweightontheshouldergirdle.Andwhileworkingthehips,shecanfeelperhapsastretchhappeningacrossthechest,controlshouldersfromroundingforwardandworkonhertrunkstabilitywhilelegsaremoving.
SPINALART Stepbarrel:• RollOver
Fromtheretheclientisreadytomoveintoarolloverasshecancontrolnowtoavoidputtingtensionontheneck.Thearticulationofthespinewiththesupportofthebarrelhereallowstheclienttostretchmoreofthelowerbackwhilekeepingshouldergirdleonthemat.
STRECHES
StepBarrel:• ShoulderStretch
LyingSideLadderBarrel:
• ShoulderStretch1• ShoulderStretch2
Whatanincrediblewaytostretchthethoracicspineandthetightshouldersofourclient;toreleaseallhertensionfromherneckmusclesbyallowingherheadtorollbackandforward,naturallyfollowingthepathofthebody.Atthesametime,wearefocusingontheLatissimusdorsiandpectorals,musclesofgreat
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importanceifwewanttocorrectourclientspostureandscapulamovement.Andofcourse,ashoulderextensorandflexorstretchattheLadderBarrel,willencourageespeciallywiththeshouldermobility.
FBI1
Mat:• FrontSupport• BackSupport
KeepingtheflowofthesessionbymovingintotheMat,totargetnotonlyabdominalsbutwecaremoreaboutinourcasestudy,thescapularstabilizers.Strengtheningboth(abdominalsandscapularstabilizerswillsupportourclientinherefforttomanagetokeepherbodyinastraightlinefromheadtotoes!Afterhavingstretchedhershoulderextensors(justinthepreviousblock)nowwewillstrengthenthemwithBackSupport;theclienthere,willalsohavetomaintainco-contractionoftheabdominalsandbackextensorstokeepthatneutralityofthespine,theneutralityofthescapulae,andatthesametimetheshoulderextensorsarestrengthening!
ARMSWundaChair:
• Shrugs• TriceptsPressSit
Shrugs:whatabetterwaythanthisfundamentalexercisetomakesomeoneunderstandandcontrolthescapularmovement.Supportingtheoverworked‘uppertrapezius’toelevatethescapulaewiththehelpofthepedalandthenengaging/strengtheningthe‘middletrapezius’(muscleresponsiblefortheretraction[adduction]ofthescapula’andthenstrengtheningthe‘lowertrapezius’whoisresponsibleforthedepressionofthescapulaeand(alongwiththeuppertrapezius)itwillrotatescapulaetoliftthearmoverhead.It’sawonderfulexerciseforourclienttocontrolandatthesametimesupport,anuprightpositionandthescapulaemovementfromrollingforward.ThenfocusingonstabilizingthescapulaetheclientwillstrengthenTriceptswhilegettingastretchacrossthechest.
FBI2 WundaChair:• TendonStretch
Havingfocusedmostlyonworkingtheupperbacktowardsanextensionandaneutralposition,Ibelieveitwouldbenecessarytoworkonhowtostabilizetheshoulderswhiletheupperbodyisinflexion.Itisalsoimportanttomentionthatwewanttotargettheserratusanteriorhere,themusclewhichisresponsibleforstabilizingscapulaeduringapushuptypemovementandwhichrotatesscapulaefromabductingandraisingarm.(Bandhayoga.com)
LEGSWundaChair:
• FrogFront
Again,herewewanttofocusonmaintainingtrunkstabilization,bykeepingmoreofanuprightpositionwiththeupperbody;wealsofocusonscapulaestabilizationasthelegswork.
LATFLEX/ROTATION
WundaChair:• SideKneeling
Stretch
Focusingoncemoreonmaintainingstablescapulaeinaneutralposition,whilethebodythistimeisworkinglaterallytostrengthenobliqueabdominals.
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BACKEXTENSION
WundaChair:• SwanBasic• Swanonthefloor
Usingthesupportofthepedaltostrengthenbackextensorsisaverysafewaytodoso,especiallywhenthespecificareaofthebodyisalreadyintraumatized.Theclientalsogetsabetterfeelingofwhetherscapulaearebeingstablethroughoutthemovement(fromneutralspinetobackextension).Comingon“Swanonthefloor”wedemandfromtheclientabitmoreofaneffort;toengageherbackextensorsevenmoretoenhancetheirstrengthandalittlebitmoreefforttostabilizeherscapulaeandasnowthepedalisworkinglikeanextrachallengeinhermovement.Also,thisexerciseishelpingtheclienttoincreaseshoulderextensorcontrol!
Weeks5-8
BASIBlockSystem Exercise ReasonsandPurpose
WARMUP
Intermediate:• RollUp• SpineTwistSupine• DoubleLegStretch• SingleLegStretch• CrissCross
Theclienthasbeenreadytomoveintoamoredynamicandintermediatewarmup.Withthe‘rollup’,theclientwilllearnhowtofeelandcontrolthescapulaethroughthearticulationofthespine,fromneutralallthewaytoaCcurve.Thisisalsoaverynicewaytolearnhowtokeeptheheadinalignmentwiththespinethroughoutthemovement,soshestopsputtingexcessivetensioninherneckmuscles.Sheisgettinganicethoracicstretchwith“SpineTwistSupine’.Andfinally,sheworksonthetrunkstabilizationwiththethreeabdominalexercises.Shealsoworksonkeepingtheheadalignedwiththespineinflexionandtofocusontheabdominalengagementratherthanputtingtensionintheneckmuscles.
FOOTWORK
Cadillac:• ParallelHeels• ParallelToes• VPositionToes• OpenVHeels• OpenVToes• CalfRaises• Prances• SingleLegHeel• SingleLegToes• HipOpener
AveryactiveandsportypersonlikeSophianeedsaverygoodstretchinherhamstrings.IbelievefootworkintheCadillacisoneofthemosteffectivewaystodothat.Inaddition,withherbacksupportedontheCadillac,shecanlearntofeelherscapulaewideandflatonthe‘mat’,keepingshouldersformroundingforward,herchestopen,andtheneckmusclesarewithouttension,astheheadisalignedwiththespineandsupportedbytheCadillac.
ABDOMINAL
Reformer:ShortBoxSeries:
• RoundBack• FlatBack
RoundBack:isaveryniceexercisetomaketheclientunderstandhowtheCcurveishappeningbypullingdeeplyintotheabdominalsandtheupperbackisroundingasanaturalresponsetothatdeeplumbarflexionratherthancurvingjustthethorax.
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• Tilt• Twist• RoundAbout• Climb-A-Tree
Then,wegettheopportunityherewiththerestoftheseries,toworkontheabdominalsandthebackextensorsatthesametimebyco-contractingthemequallytomaintainmovementwithaflatback.Also,thisisagreatchancefortheclienttoworkonkeepingtheheadinalignmentwhilesupportingitslightlybygivinghertheoptiontopositionherhandswithinterlacedfingersbehindthehead(likein“Tilt”)untilthe“Roundabout”.Andfinally,agreatbenefitforSophia,isthatbackextensionduring“Climb-A-Tree”asshewillfeelthechestmusclesopeningandstretchingwhilethearmscircleoverhead!
HIPS
Reformer:• Frog• CirclesDown• CirclesUp• Openings
Whiletheclientisstrengtheningandstretchingherhipadductors,theclientcanworkonmaintainingherchestniceandopenkeepingherarmsactiveandlongbyhersidetomaintainslightactivityintheupperbackthere.
SPINALART Reformer:• Semi-Circle
Thewiderangeofspinemobilityandarticulationofthisexercise,allowstheclienttostretchoncemoretheupperbackandthechestinauniqueway!Again,shecanworkonkeepingallweightonhershouldergirdle,avoidingtensionontheneckmusclesandthebodypositioningwillhelphertokeeparmsstretchedwhilebeingoverhead;pushingintotheshoulderrestscanhelphertocontroltheshouldersfromexcessiveelevating.
STRECHES Cadillac:• ShoulderStretch
Onethebestwaystomobilizeandstretchtheshouldersespeciallywhentheysufferfromtensionandtautness.Thisexercisecouldbeconsideredtherapeuticinourcase.
FBI1
Cadillac:• SideReach• KneelingCat
Stretch
Agreatexerciseformobility,stretchingatthesametimetheshouldersadductors,focusingonopeningthechestandstretchingthebackasthethoracicspinehastoremainisolatedfromthelumbarspine(whichhastoremaininflexion).With“CatstretchKneeling”,whilemobilizingthewholespine,wearestrengtheningthebackextensors,workingonscapularstabilizationandwealsoofferatremendousshoulderstretch!Maintargetsforourclient.
ARMS
Cadillac:• ShoulderAdduction
SingleArm• ShoulderAdduction
DoubleArmOrAlternatively,
• SittingSidePrep• SittingSide
AneffectivewaytomakeourclientunderstandhowtofocusonactivelyengagingtheLatissimusdorsi,withoutlettingthe‘wrongmuscles’totakeoverallthework.It’salsogreatforimprovingtheclient’spostureashershoulders(whichareroundingforward)havetoremainexternallyrotated.Withouralternativeexercise,wecanimprovetheclient’sscapulaadductionandabductioncontrolcreatingatthesametimemorescapularmobility,whichwillfreetheclientfromalotoftensionandperhapssomepain.Itisalsoaniceopportunityfortheclienttounderstandandcontrolscapula
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unnecessaryelevation,whichhasbeenoneofhermostcommondysfunctions.
FBI2 Cadillac:• SittingBack
Wealreadyofferedshoulderstretchesfortheclient(with‘shoulderstretch’,KneelingCatStretch)butwhatismakingthisonemoreintense,andperhapsmoreeffective,isthatinthisexerciseastheshouldersrotateexternallyforthestretchthethoracicspineisflexingquitedeeply.
LEGS Cadillac:• Squats
Whileworkingonthelegstheclientoncemorehastocontrolspinalalignmentandworkonmaintainingthetrunkinanuprightposition.Atthesametime,shewillneedtocontroltheshouldersfromrollingforwardasthesprings’tensionwillbeanextrachallengethereforher.Keepingtheheadinalignmentwiththespinewillbealsooneofourmaintargets.
LATFLEX/ROTATION
Cadillac:• Butterfly
Awonderfulexerciseforourclienttoworkonherabdominalobliqueswhileshewillalsobenefitfromlearninghowtocontroltheunnecessaryelevationoftheuppershoulderduringtherotationofthebodyandwhilethearmsareswingingaround.Thestarting/finishingpositionofthisexerciseuntilthelateralflexion,canencouragetheclienttofeelastrongneutralspinewiththeheadinabsolutealignmentandtheopeninginherthoracicspine(incontrastwithherkyphoticposture).
BACKEXTENSION
Cadillac:• Prone1• Prone2
Nowthebody,iswellpreparedforamorefocusedbackextensorstrengtheningandshoulderstretch!Theclientwilloncemorehavetothinkofscapularstabilization,toachievemaximumstretchintheshouldersandwillstrengthenthebackextensorsbylearningtoarticulatethespineinordertoliftandlowerthetrunk.
It would be naïve for someone to believe that the chosen exercises above for Sophia’s
ConditioningProgram,aretheonlyexercisesthatwillavailheroranybodydealingwiththe
sameproblemof pain. I strongly feel that every single exerciseof thewholeBASI Pilates
repertoire can be a benefit for someone suffering fromMyofascial Pain Syndrome in the
upperbackoranyotherareaofthebody.
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Conclusion
Inconclusion,IwouldlikeoncemoretorefertoIsacowitz,R.andKlippingerK.(2011)and
emphasizethatthegoaloftheconditioningprogram,“isnottoovercorrectandremovethe
naturalcurvesofthespine”;“thegoalisnottoholdthescapulaeexcessivelydownwardorin
placebutrathertohelpestablishaneutralpositionofthescapulaeastheynaturallyrotate
upward”.AsRaelstated,“it’sjustlikewefindneutralpositionofthepelvisweneedtofind
neutralpositionofthescapula;thescapulaislikethepelvisoftheupperbody,isthepower
houseoftheuppergirdleandweaddressthescapulathesamewayweaddressthepelvis;
weneedtofindneutralpositionofthescapula”.(https://youtu.be/IcZ6jKhwzqA).
Hopefully, in this way we can probably assure that the right muscles will work for the
appropriatemovement.Themovementcanthenbeperformedmoreaccurately,toprovide
a more balanced work on the muscles. This will make it possible for almost any spinal
alignmentdeviationtobecorrected,avoidingmusclefatigueandtraumaandthustreating
MyofascialPainSyndrome!
I can happily note down that Sophia has already felt a significant relief of pain and her
scapulaearemoremobileandherbodyfeelsstrongerandlesstensed.However,herbiggest
achievementandmybiggestsatisfactionisthatSophiahasdeeplyunderstoodhowherpoor
postureaffectsherbodyandshehasnowrealizedwhat/whenandhowtocorrectitbyherself
inhersportsactivitiesbuthereverydaylife! Icanfeelhermorecontent,trouble-freeand
moreconfident,fullofenergytokeepgoingon!
21
Bibliography
Books
Isacowitz,R.andClippinger,K.2011.PilatesAnatomy,IllustratedGuidetoMatWorkandCore
StabilityandBalance.
Butler,D.andMosely,L.2013.ExplainPain.
Oscar,E.andBussaed,M.2015.FunctionalAnatomyofthePilatesCore.
Online
Asher, A.Myofascial pain syndrome and spasm cycle. Verywell health, January 21, 2018.
(https://www.verywellhealth.com/what-is-myofascial-pain-syndrome-296534).
Myers,T.W.Facial fitness: training in theneuromyofascialweb. IDEA fitness journalApril.
2011.(www.ideafit.com).
Osborn, C.What isMyofacial Pain Syndrome?Medically Reviewed byMorrison,W.MD,
August22,2017.(www.healthline.com/health/myofascial-pain#home-remedies).
Salyer,J.Howto`WorkyourUpperBacktoIncreaseDefinition,Livestrong.com,September
11, 2017. (https://www.livestrong.com/article/557405-how-to-work-out-your-upper-back-
to-get-the-muscle-line/)
Sports InjuryClinic:Kyphosis. (http://www.sportsinjuryclinic.net/sport-injuries/upper-back-
neck/kyphosis).
22
Consultation
Dr.SherifGamil,SpecialistOrthopedicSurgery,SymbiosisMedicalCenterDubai,2018.
Videos
BASI Pilates Mat Exercises | Shoulders, the Second Powerhouse, by Isacowitz, R.
(https://youtu.be/IcZ6jKhwzqA)
Figures/Images
Figure1:Fasciaisaweb:www.laurachancelmt.blogspot.com
Figure 2: Figure 2: (a) Ideal standing alignment, (b) kyphotic posture: Isacowitz, R. and
Clippinger,K.2011.PilatesAnatomy,IllustratedGuidetoMatWorkandCoreStabilityand
Balance,page22.
Figure3:Commonposturaldeviations:Marshal,J.4Simpledesk-basedstretchesforeffective
lower back pain relief. (https://www.lifehack.org/492069/4-simple-desk-based-stretches-
for-effective-lower-back-pain-relief).
Figure 4: Trigger points: Prakasa. J. 2012. Myofasical Pain Syndrome, Pain Sensation
(www.painsensation.blog.ae).
Figure5:(a)Upwardanddownwardrotation,(b)useofscapulardepressorstoavoidexcessive
elevationofeachscapulaasthearmsareraisedoverhead: Isacowitz,R.andClippinger,K.
2011.PilatesAnatomy,IllustratedGuidetoMatWorkandCoreStabilityandBalance,page
24.