a Pilates program designed to alleviate pain while undertaking common household chores, particularly for those with scoliosis

By: Catherine Skilliter Date: June-5-2018

Course year: 2018 Location: The Pilates Clinic, London, UK

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Abstract

An overabundance of muscles are involved in the 8 commonly surveyed household chores

performed by my client. A unique approach that combines an evaluation of my observations of

her posture, an understanding of the clients limitations, her flexibility and movement patterns,

along with a survey of the frequency and intensity and locations of her pain are reviewed to

determine how to deal with the complex pain syndrome that she develops in several parts of

the client’s body while doing these chores. This, along with the muscles that are likely used,

and overused, in 8 of these surveyed common household chores has been provided, and

collectively used to create an introductory, intermediate, and advanced Pilates conditioning

program using the BASI Block method to help alleviate pain while conducting common

household chores. This program is particularly designed for those with scoliosis, but others

may benefit from the program.

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Table of Contents

Abstract ........................................................................................................................................................ 1

Table of Contents ......................................................................................................................................... 2

Anatomical Description of the area of the Body .......................................................................................... 3

Introduction ................................................................................................................................................. 4

Case Study .................................................................................................................................................... 4

Limitations ................................................................................................................................................. 5

Postural Evaluation ................................................................................................................................... 5

An Evaluation of Flexibility and Movement .............................................................................................. 7

Current Rehabilitation Treatments ........................................................................................................... 8

A Unique Approach to Designing a Conditioning Program ........................................................................... 9

Conditioning Program ................................................................................................................................. 11

Introductory Program 1 – Sessions 1-10 ................................................................................................. 11

Intermediate Program 2 – Sessions 11-20 .............................................................................................. 12

Advanced Program 3 – Sessions 21+ ...................................................................................................... 12

Conclusion ................................................................................................................................................... 16

Bibliography ................................................................................................................................................ 17

Appendix 1 ............................................................................................................................................. 18-20

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Anatomical Description of the area of the body

In a survey that was conducted with the client of 8 common household chores undertaken, 5

regions of pain were noted – the right wrist/forearm, the lumbar region, the right shoulder,

right neck and right heel (Figures and Charts 1a and 1b). It should be noted that the client

experiences significant right-sided pain, which is her dominant side. When evaluating pain

intensity in the survey of household chores, pain was most intense in the right wrist/forearm

region and lumbar region (Figure 1a), whereas pain is felt more often (frequency was higher) in

the right wrist/forearm and the right neck region (Figure 1b). This survey was useful as it

provided an approach on how to decide what area to focus on as there are more than one

location of pain in the body.

Figure 1a: pain locations and pain intensity that often flare up when the client conducts 8 household tasks. See Chart 1a below for scales and legend. Source: modified from

https://www.pinterest.com/pin/50658465806

6246779

Figure 1b: locations of pain, based on the number of occurrences of pain that flare up when the client conducts 8 household tasks. See Chart 1b below for scales and legend. Source: modified from

https://www.pinterest.com/pin/5065846580

66246779

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Introduction

This pilates routine is designed to reduce pain associated with the common routine household

tasks. These described household chores can be challenging for many people, but exacerbated

for clients with scoliosis, leg-length discrepancies, rotated pelvis’s and chronic pain.

Case Study

Charlie is a 44 year old female patient, who has come for advice to see if pIlates can help to

reduce her pain in several household chores that she is doing. The household chores are listed

below (Figure 2) and ranked from most difficult to least difficult in a survey by my client. She

has a lot of difficulty with chores such as hand stirring in a bowl, sweeping and raking,

vacuuming/hoovering, and less difficulty with other tasks such as cutting and chopping

Chart 1a: locations of pain and pain intensity that often flare up when the client conducts 8 household tasks. See Figure 1a above for locations.

Chart 1b: locations of pain, based on the number of occurrences of pain that flare up when the client conducts 8 household tasks. See Figure 1b above for locations.

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vegetables.

Limitations

I evaluated the client’s limitations by

conducting a postural evaluation

(Chart 2) as well as by conducting an

evaluation of her flexibility and

movement (Chart 3). Several

deviations from the ideal posture

were noted, but the primary issue

causing the deviations is that she has

scoliosis, likely due to a leg length

discrepancy in her right leg.

Postural evaluation

The client has a kyphosis-lardosis posture, and this is a deviation from the ideal posture in

Figure 3, and from a photograph of her in Figure 4 and the client would benefit from the simple

suggestions and adaptations to the equipment provided in Chart 2, many of them related to

related to correcting her posture within reason considering she has scoliosis., but many of these

adaptations should be considered when working with someone with deviations such as

scoliosis, leg length discrepancy as they commonly need props to help them with support.

Many more images, including X-ray images of her torso and pelvis are included in Appendix 1

(Figures 2-8) and I would encourage you to look at those images for a more in-depth analysis of her

scoliotic traits.

Figure 2: The client’s ranking of 8 household activities from highest difficulty (red) to lowest difficulty (green) using a pain scale from 1- 5 in five different body areas that commonly experience pain – the lower lumbar region, right shoulder, right forearm/wrist, right neck, right heel.

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Postural Evaluation Corrections, Suggestions & Adaptations

Kyphosis-Lardosis posture (Appendix 1, Figures 2 and 3)

work on encouraging plumb line, ideal alignment posture

leg length discrepancy - right leg shorter than left by 13 mm

put wedge under foot, allow for wearing of heel lift or orthotics in shoes in class

right hip crest lower than left hip (Appendix 1, Figure 4)

put wedge under foot, allow for wearing of heel lift or orthotics in shoes in class

scoliotic (Appendix 1, Figure 5) curvature in thoracic region of the spine to the right

right shoulder elevated (Appendix 1, Figure 5) strengthen lower traps, serratus anterior

head forward position (Appendix 1, Figure 6)

put towel or foam block under head, use head rest when not doing spinal articulation exercises. Encourage plumb line.

Anterior tilt of the pelvis (Appendix 1, Figure 7)

Encourage pelvic tilt and bias to the posterior at all times, and the use of a towel or rolled-up sticky mat on either side of the spine in the coccyx region will help alleviate pain on coccyx.

Externally rotated right foot and pronation (Appendix 1, Figure 8)

work on encouraging internal rotation of foot, foot work on chair/reformer. Work on magic circle sitting series to strengthen adductors

forward rounding of shoulders, particularly right (Appendix 1, Figure 8)

stretch tight upper traps, stretch tite pectoralis, strengthen lower traps, rhomboids, serratus anterior, work on depression of scapula

Figure 3 (left): Ideal alignment posture (A) and common deviations from ideal, including the Kyphosis-Lardosis posture (B), the posture observed in the client. Source : https://www.quora.com/Is-it-true-that-correcting-a-bad-posture-can-add-up-to-2-inches-to-your-height. Figure 4 (right): photograph of client’s right side, showing Kyphosis-Lardosis posture.

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slight winging of right shoulder blade

strengthen serratus anterior, scapular protraction/abduction

An Evaluation of Flexibility and Movement

An evaluation of flexibility and movement of the client was also conducted, and the results are

in Chart 3. The client has significant tightness in the upper torso, including tight pectoralis,

scalenes, upper trapezius muscles, as well as limited thoracic extension. She has difficulty

lifting her arms over her head, likely due to weakness or tightness in her shoulder flexors. She

also complains about left-sided waist “tightness”, as well as left-glute tightness. More details

can be found in Chart 3 where I have listed some of her issues and suggestions to consider

when constructing a BASI pilates beginner, intermediate and advanced stage program. I have

attempted to incorporate these exercises and suggestions into the conditioning program

detailed later in this paper.

Evaluation Of Flexibility And

Movement

Suggestions beginning phase

Suggestions mid phase

Suggestions late phase

tight pectoralis shoulder stretch lying side, overhead stretch (with pole) back support

sitting back, balance control back

tight scalenes and upper trapezius muscles

encourage shoulders down and back, plumb line posture, ears in line with shoulders, strengthening lower traps, serratus

shoulder stretch cadillac, shoulder stretch 1 back support

tight left glute stretch glutes on ladder barrel

stretch glutes on ladder barrel

stretch glutes on ladder barrel

limited thoracic extension

swan on floor, back extension prone 1 prone 2

Chart 2: A description of some of the important posture traits of my client, and suggestions,

on how to address these concerns when constructing a BASI pilates conditioning program.

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difficulty rotating to the right, limited right axial rotation spine twist (with pole) spine twist (mat) Twist

difficulty lifting arms overhead, limited shoulder flexion shoulder stretch 2, Elephant

overhead stretch (with pole)

overhead stretch (ladder barrel)

difficulty bending and lifting objects repeatedly, flexing at waist roll downs roll downs roll downs

left sided tightness/shortened distance between waist and ribs

side lifts, side stretch (with pole), mermaids

shoulder stretch lying side

side over prep, side over

Current Rehabilitation treatments

The client has attempted many traditional and alternative therapies to help alleviate pain while

doing chores, but finds that many of these therapies focus on one area of pain at a time (Chart

4), and that a combination of these therapies can help to alleviate pain to some extent.

Although the client takes part in regular group pilates mat and reformer classes, I believe that a

Current and prior rehab treatments

Client wears a 9 mm heel lift in right shoe Biweekly group Pilates reformer and mat classes

Client wears professionally made orthotics Osteopath appointments

Monthly Chiropractic adjustments Shockwave therapy

Monthly Physiotherapy treatments Graston technique

Occasional Massage Therapy sessions Prolotherapy

Chart 4: A list of current and prior rehabilitation treatments that the client has undergone.

gram.

conditioning program.

Chart 3: A description of the flexibility and movement traits in my client, and some

suggestions and BASI exercises to consider when constructing a BASI pilates conditioning

program.

conditioning program.

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dedicated, well-constructed pilates program, taught in one-to-one sessions will be beneficial for

the client, as it is functional – many of the movements mimic the actions done in the household

tasks, it is efficient - in that a single exercise often targets more than one muscle at a time,

using the BASI block system ensures that there is focus on the areas of concern (areas of

weakness, tightness and pain), and that there can also an emphasis on a comprehensive and

progressive strengthening, stretching, and lengthening program.

A Unique Approach to Designing a Conditioning Program

As my client had a complex pain syndrome when conducting household chores, it was difficult

to decide how to construct a program, like where to begin and what body part to focus on. I

considered the following when tailoring this program. 1) her postural deviations, 2) her

flexibility and movement traits, 3) the locations of her pain (Charts and Figures 1a, 1b), 4)

results of a survey of her pain intensity and frequency in these locations, as well as 5) what

muscles were likely used, and overused, in these household chores (Chart 5).

A quick survey of the pain intensity of the client reveals that the right forearm feels the most

pain while conducting these household chores, followed by the lower lumbar region, thirdly the

right shoulder, fourthly the right neck and lastly the right heel (Figure 1a and Chart 1a).

A quick survey of the frequency of pain in the client in 8 household tasks reveals the following:

that right forearm and right neck pain show up in all 8 surveyed household tasks, right heel

pain in 7 of the tasks, lower lumbar pain in 6 of the tasks, and right shoulder in 5 tasks (Figure

1b and Chart 1b). Looking at it from a task (household chore) approach and proposing what

muscles are used most frequently in those 8 surveyed household tasks, (Charts 5 and 6) it is

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revealed that the stabilizers, back

extensors, and biceps are likely used most

extensively in these 8 household tasks,

followed by triceps, shoulder flexors,

obliques, upper abdominals, and knee

flexors (hamstrings). Muscles used less

frequently include shoulder adductors and

abductors, hip extensors (glute max), knee

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Chart 6: Frequency of muscle use when conducting the 8 household chores that cause pain for the client. This frequency chart was built from data collected in Chart 5.

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Lowest down on the list includes hip adductors and abductors, shoulder extensors and hip

flexors.

Conditioning Program

The client currently attends weekly group mat and reformer pilates classes, and has a good

foundation. It’s my recommendation that she would benefit from tailored, one-on-one

sessions or private classes, with an instructor with skills in working with scoliotic patients, and

in working with a progressive conditioning program as the one detailed below.

Introductory Program 1 – Sessions 1-10

The focus in the introductory program (Chart 7) should be stretching of the thoracic region and

working on getting a full range of motion in shoulders prior to strengthening these areas. The

warm-up is to focus on correcting her posture within reason, as well as stabilization and spinal

articulation to allow for easier forward flexion. Emphasis is also on strengthening back

extensors (most frequent muscle used in 8 household chores), abdominals for core stability

used in most chores, and biceps for lifting objects, pulling the vacuum, cutting vegetables and

hand stirring/mixing in a bowl. Some minor shoulder strengthening and stabilization should

begin with the arms series supine exercises. Oblique muscles, which are used extensively in 6

of the 8 chores will also begin to be worked on, mainly in the lateral flexion/rotation block.

Also, any adaptations to equipment, such as wedges under right foot, props under her head

should be considered early in the program (suggestions in Chart 2).

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Intermediate Program 2 - Sessions 11-20

Some shoulder and thoracic extension has likely developed in sessions 1-10, so this

intermediate program (Chart 8) continues to develop flexibility in the thoracic and shoulder

region, and begins to add in some strengthening exercises for this region (FBI 1 block). The

warm-up continues working on flexion exercises and engagement of stabilizers, along with

correct patterning or sequencing of muscle engagement. Arm work will focus on strengthening

triceps, rotator cuff muscles, and shoulder flexors in the arms kneeling and arms sitting series

of exercises. Leg work focuses on knee extensor (quads) and flexor (hamstrings) exercises, the

two biggest groups of leg muscles used in 4-5 of the 8 chores such as lifting, bending,

vacuuming, sweeping/raking as well as changing beds. Hip extensors (eg., glute max) exercises

are also required in 4 of the 8 chores, so this is a focus as well.

Advanced Program 3 – Sessions 21+

This is the part of the program (Chart 9) where the client and instructor start to fine tune some

of the earlier exercises, and working on more complex, advanced and highly choreographed

exercises in the BASI repertoire, beginning with an intermediate warm-up rather than a

fundamental warm-up, and exercises such as the rowing series. Stretching continues to be a

focus, and this isn’t just done in the stretching block but will also be worked on in FBI 1 and 2

blocks. Stretching will include more intense/advanced stretches for the shoulder and thoracic

region. Hip adductors will be worked in the hip block with the supine leg series of exercises.

Lateral flexion and rotation exercises will be more challenging, to help strengthen the weaker

left side of the body.

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Chart 7: Introductory Program 1 – Sessions 1-10

SESSIONS 1-10 Exercises Reasons/specifics

WARM-UP

many roll downs, pelvic curls, spine twist supine, chest lift and chest lift with rotation

against wall for support and articulation on wall. difficulty bending, work on flexion. Really learn how to properly engage TA, stabilizers

FOOT WORK foot work series on reformer

work on articulation of feet - paying particular attn. to right foot - tight/pain, also works glutes at the same time

ABDOMINAL WORK

hundred prep, leg changes - mat, cat stretch kneeling TA - need to strengthen core gradually

HIP WORK (STRAP WORK)

possible magic circle sitting series

need some minor hip abductor and adductor work for chores - vacuum/sweep/rake

STRETCHES shoulder stretch lying side, pole series, stretch glutes

lots of thoracic and shoulder stretching (focus on increasing ROM before strengthening), rotations, openers for left side

ARM WORK arms series supine

focus on strengthening biceps - muscles used second most frequently in 8 household chores - pulling, lifting, sweeping/raking

LEG WORK glute side lying series - mats/weights, chair foot series

need some minor glute work for chores, need quad work

LATERAL FLEXION ROTATION

side lifts, spine twist, side over prep

left sided shortness/weakness - also difficult to rotate for client, lateral flexor strength

BACK EXTENSION swan basic, swan on floor

erector spinae, need to focus on this - predominant muscles for chores, also need to stretch thoracic and shoulders

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SESSIONS 11-20 Exercises Reasons/specifics

WARM-UP continue with many roll downs on wall, fundamental warm up

against wall for support and articulation on wall. difficulty bending, work on flexion. Really focus on how to properly engage TA, stabilizers

FOOT WORK foot work series on reformer addresses some foot pain in right foot

ABDOMINAL WORK

hundred prep, hundreds - reformer, hamstring pull 1, overhead stretch (step barrel)

more intermediate work on abs, shoulder mobility with overhead stretch on step barrel

HIP WORK (STRAP WORK)

supine leg series ref (particularly 1, 4)

need some minor hip adductor work for chores - vacuum/sweep/rake

SPINAL ARTICULATION bottom lift

may help with difficulty bending and lifting objects repeatedly in chores, and flexing at waist

STRETCHES shoulder stretch lying side, pole series, stretch glutes

tight pectoralis, difficulty rotating right, tight left glute

FULL BODY INTEGRATION - FUND/INT upstretch 1

work shoulder extensors, shoulder stretch

ARM WORK alternate between arms sitting and arms kneeling series

focus on strengthening biceps - muscles used second most frequently in 8 household chores - pulling, lifting, sweeping/raking, as well as triceps, and rotator cuff, and shoulder exten

LEG WORK side split, skating single leg, reformer jumping series

need some minor glute work for chores, more advanced leg work for quad strength

LATERAL FLEXION ROTATION mermaid, side over prep

left sided shortness/weakness - also difficult to rotate for client, lateral flexor strength

BACK EXTENSION swan on floor, prone 1

erector spinae, need to focus on this - predominant muscles for chores, also need to stretch thoracic and shoulders

Chart 8: Intermediate Program 2 – Sessions 11-20

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SESSIONS 21+ exercises Reasons/specifics

WARM-UP intermediate warm up abs/stabilizers need to be worked the most out of any muscle for 8 chores

FOOT WORK foot work series on cadillac addresses some foot pain in right foot

ABDOMINAL WORK

hamstring pull 1, 2, 3, full pike (shoulder extensors too)

more advanced exercises, focus on more than one muscle

HIP WORK (STRAP WORK)

supine leg series ref (particularly 1, 4), add extended frog, extended frog reverse

need some minor hip adductor and abductor work for chores - vacuum/sweep/rake

SPINAL ARTICULATION

bottom lift with extensions

may help with difficulty bending and lifting objects repeatedly in chores, and flexing at waist

STRETCHES shoulder stretch cadillac, shoulder stretch 1

may address tight scalenes, and upper trapezius, shoulder flexors

FULL BODY INTEGRATION - FUND/INT

upstretch 1 and upstretch 2 work shoulder extensors, shoulder stretch

ARM WORK

alternate between rowing series, avalon arms sitting series, arms kneeling side

focus on strengthening biceps - muscles used second most frequently in 8 household chores - pulling, lifting, sweeping/raking, followed by triceps, and rotator cuff. More advanced exercises than in sessions 1-10

FULL BODY INTEGRATION - ADV/MAS

balance control back prep, balance control front, sitting back add in - advanced, need shoulder work

LEG WORK forward lunge, frog front

need some minor glute work for chores, more complex exercise (balance), need quad work for chores

LATERAL FLEXION ROTATION

side over extended arms, side over prep, side overs

left sided shortness/weakness - also difficult to rotate for client, lateral flexor strength and stretch

BACK EXTENSION swan on floor, prone 2

erector spinae, need to focus on this - predominant muscles for chores, also need to stretch thoracic and shoulders

Chart 9: Advanced Program 3 – Sessions 21+

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Conclusion

A unique approach was created to help in dealing with my client’s complex pain syndrome

when conducting common household chores that considers 1) her posture, 2) an understanding

of the client’s limitations, her flexibility and movement patterns, 3) her pain patterns, and 4) a

survey of the frequency and intensity and locations of her pain when developing the program.

From this study, I’ve created a long-term, overall, body conditioning pilates program that I

believe the client will benefit from that addresses and focuses:

1) correct posture, and strengthening postural weaknesses,

2) on locations with the most intense and most frequent pain first (lower lumbar, right

forearm and right shoulder first), without ignoring all other minor locations of pain,

3) her right-sided pain likely due to scoliosis,

4) her left-sided tightness and corresponding weakness in the area between the ribs and

iliac crest,

5) her limited thoracic extension and shoulder mobility,

6) and allows for modifications and adaptations to the equipment to compensate for

her structural deviations (e.g., such as wearing a wedge under heel and/or orthotics, and

shoes in class to compensate for short right leg).

Clients with scoliosis may also benefit from modifications and adaptations such as the

use of props and towels to prop the head into proper alignment, for example.

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Bibliography

1) Figures 1a, 1b, Website: https://www.pinterest.com/pin/506584658066246779

2) Figure 3, Website: https://www.quora.com/Is-it-true-that-correcting-a-bad-posture-can-add-up-to-2-inches-to-your-height. Ivan Hoe, Apr. 27, 2016

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Appendix 1

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