TeresaDelano April8,2017

June2016-October2016ThePilatesBodyMovementStudio,GigHarbor,WA

PILATESANDPOSTURALKYPHOSIS

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ABSTRACT

This paper looks at postural kyphosis (PK), an exaggerated posterior thoracic curve resulting

from poormuscle function based on the way we are using our bodies (e.g., poor posture).

Although the primary impact of PK is weak back extensors and tight pectoral muscles, the

whole body is impacted. PK is becoming more and more prevalent and, as such, ways to

intervene appear to be necessary. One type of intervention that can positively impact the

issuesassociatedwithPKisthePilatesMethod(Pilates).NotonlydoPilatesexercisesimprove

theproblemsrelatedtoPK,themind-bodyapproachofPilatesalsoprovidesanincreasedbody

awareness that can translate into more functional, ideal movement and alignment in an

individual’sdailylife.

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TABLEOFCONTENTS

TitlePage Page1

Abstract Page2

TableofContents Page3

AnatomicalDescription Page4

Introduction Page9

CaseStudy Page10

ConditioningProgramOverview Page10

FiveWeekFundamentalConditioningProgram(Sessions1-10) Page11

Conclusion Page13

Bibliography Page14

Figures:

Figure1.IdealStandingAlignmentversusCervicalLordosisandKyphosis Page4

Figure2.MusclesoftheShoulderandArm-AnteriorView Page5

Figure3.MusclesoftheShoulder,Back,andArm-PosteriorView Page6

Figure4.ErectorSpinaeGroup-PosteriorViewofRightSide Page7

Figure5.TransversospinalisGroup-PosteriorView Page8

Tables:

Table1.Sessions1-10 Page12

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ANATOMICALDESCRIPTION

Thevertebralcolumnhasfournaturalcurvatures(Figure1a),withthethoracicspinehavinga

“normal” amount of posterior curvature when viewed from the side (normal kyphosis).

Kyphosis (akahyperkyphosis) in a clinical settingdescribes an exaggeratedposterior thoracic

spinal curvature when viewed from the side (Figure 1b)1. Kyphosis can be postural or

structural.Thefocusofthispaperisposturalkyphosis(PK).

Figure1.IdealStandingAlignment(a)versusCervicalLordosisandKyphosis(b)2

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Theexaggerated thoraciccurve inkyphosiswillalter thebalanceof thewholebodyover the

lower limbs and feet and affect spine mobility and function1. Further, impaired scapula

alignment resulting in compromised shoulder joint function and cervical spine problems

associatedwithforwardheadpositionarealsoissuesassociatedwithkyphosis1.

Although kyphosis effects the entire body as described above, the primarymuscles affected

includethefollowing1,3,4:

• Pectoralis Major, Pectoralis Minor, Serratus Anterior, Rectus Abdominus, Obliques

(Figure2):Thepectoralismajorandpectoralisminorareshortenedandtightenedwith

kyphosis.Correctionwillfocusonstretching.Theserratusanteriorarelengthenedand

weakened.Correctionwillfocusonstrengthening.Therectusabdominusandobliques

arepossiblyshortenedwithkyphosis.Correction,ifneeded,willfocusonstretching.

Figure2.MusclesoftheShoulderandArm-AnteriorView5

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• Trapezius,Rhomboids,LatissimusDorsi,TeresMajor(Figure3):Themiddletrapezius,

lower trapezius, rhomboids, latissimus dorsi, and teres major are lengthened and

weakenedwithkyphosis.Correctionwillfocusonstrengthening.

Figure3.MusclesoftheShoulder,Back,andArm-PosteriorView5

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• Erector SpinaeGroup: spinalis, longissimus, and iliocostalis (Figure 4): The erector

spinae group are weakened and tightened with kyphosis. Correction will focus on

strengtheningandstretching.

Figure4.ErectorSpinaeGroup-PosteriorViewofRightSide5

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• Transversospinalis group: multifidi, rotatores, semispinalis capitis (Figure 5): The

transversospinalismuscle group are deep to the erector spinaemuscle group. These

thoracic spineextensorsare lengthenedandweakenedwithkyphosis. Correctionwill

focusonstrengtheningthesemuscles.

Figure5.TransversospinalisGroup-PosteriorView5

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INTRODUCTION

Wearelivinginasocietywhereposturalkyphosis(PK)isbecomingmoreandmoreprevalent.

Wearedevelopingpoormusclefunctionbasedonthewayweareusingourbodies. Weare

moving lessandsittingmore. And,whenwedomove,wearedisconnectedfromourbodies

andhowwearemoving. “Our lackofmovement input is slowly suffocatingusona cellular

level. Motions thatused tobe incidental to living (read: occurringallday long)andcellular

loadsthatusedtobebuiltintoeverydaylifehavebeendoledout-tocomputers,machines,and

otherpeoplemovingonourbehalf…People[You]havebeendoingthemovementequivalentof

under-eatingandunder-breathing,whichishavinganimpactonyourwholebody..."6

This is a disturbing trend as PK is a risk factor for back pain, shoulder impingement,

osteoporosis, future spinal fractures, impaired pulmonary function, impaired digestion, and

decreasedphysicalfunction7.Basedonthistrend, itappearstherewillbeagrowingneedfor

“corrective”intervention.ThePilatesMethod(Pilates)isonewaythiscanbeachieved.Pilates

can be utilized to work on the primary areas that need special attention as listed in the

AnatomicalDescriptionSection,but,atthesametime, italsoutilizesawhole-bodyapproach.

Thisisextremelyimportantaskyphosisaltersthebalanceofthewholebody1.Also,themind-

bodyapproachwillbehelpful inbringingbodyawarenessto individualsutilizingPilates. This

awarenesswilladdvaluetotheirdaily lifesothattheynoticemoreandmorewhentheyare

notmovingorholdingthemselvesinafunctionallyidealway.

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FurtherindicationthatPilatescanbeaneffectivetreatmentforPKwasobservedinonestudy8

spanning a 30-weekperiodwhere twogroups (Pilates intervention groupand control group)

hadvariousmeasurementstakenbeforeandafterthestudy.Atthebeginningofthestudythe

Pilates interventionandcontrolgroupsdidnotdiffer. However,afterthestudy“asignificant

benefitwith theutilizationofPilateswasobserved,witha reduction inkyphosisangleanda

small height gain” in thePilates intervention group. The intervention group receivedPilates

trainingtwiceaweekin60-minutessessions. BasiclevelPilatesexerciseswereused,andthe

degree of difficulty was gradually increased. Focus on neutral posture in different gravity

orientationswasmade.”8.

CaseStudy

John is32yearsold,anengineer,andmarriedwith twochildren. Hishobbies includemodel

making(i.e.,cars,etc.)andhomebrewing.Hehasbeencommuting(round-trip25miles)tohis

job via his bicycle with mountain bike handle bars for a couple of years. His job requires

extensive computer time and frequent international travel. His wife complains that he is

hunchedoverandneedstoimprovehisposture.Johncomplainsofneck,shoulder,andupper

backtightness.Hepresentswithahyperkyphoticcurve,forwardhead,androundedshoulders.

Hiskyphosisappearstobeposturalinnature.

ConditioningProgramOverview:

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John isnew toPilates. As such,his conditioningprogramwill startat themost fundamental

level andprogress basedonhis abilities. Hewill startwith two, 1-hour private sessions per

week over a five-week period. Additionally, hewill be given “homework” exercises that he

shouldperformathomeatleasttwotimesperweek.

WhilethefocusoftheConditioningProgramwillbetostrengthenand/orstretchtheprimarily

affectedmusclesaffectedby thePKasdiscussed in theAnatomicalDescriptionSection (e.g.,

strengthenthoracicbackextensors,stretchpectoralismuscles),awhole-bodyapproachwillbe

utilized(TheBASIBlockSystem3)forstructuringtheexerciseprogram.Inadditiontoimproving

strengthandflexibility,thefollowingConditioningProgramfocusesondevelopingJohn’sbody

awareness; teaching breathing techniques to improve mobility and flexibility of the ribs,

sternum,and thoracic spineand to improve the strengthandperformanceof thediaphragm

andabdominalmuscles;developingawarenessofproperalignment;anddevelopingawareness

ofandstrengtheningthe internalsupportsystem(ISS). Modificationsusingpropssuchasan

overballortherabandwillbeutilizedasnecessarytoachieveproperexecutionoftheexercises.

FiveWeekFundamentalConditioningProgram(Sessions1-10):

John’s five-week conditioning program will focus on fundamental exercises. The spinal

articulation,fullbodyintegrationF/I,andFullBodyIntegrationA/Mblockshavebeenexcluded

per the Progressive Layering of the Block System Table in the BASI Study Guide3. Exercises

recommendedforhomeworkaremarkedwithanasterisk(*).

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Table1.Sessions1-10

BLOCK APPARATUS EXERCISE(S) COMMENTSWarmUp Mat RollDown*

LateralBreathing*PelvicCurl*SpineTwistSupine*ChestLift*ChestLiftw/Rotation*

Focusonbreathing,alignment,&bodyawareness.Usepropsormodifyasnecessarytoachieveproperexecutionandworksafely.

FootWork Reformer FootworkSeries Primaryfocusonneutralpelvisandneutralspineandcorrecttracking.

AbdominalWork StepBarrel ChestLiftReach

Stretchesabdominals,thoracicspine,andshoulderswhilestillworkingtheabdominals.Developabdominalcontrolplusstretchabdominals&shouldermuscles

HipWork Reformer FrogCircles(Down,Up)Openings

Strengthenadductorsandhamstringswithfocusonpelvicstability.

Stretches PoleSeries ShoulderStretch*OverheadStretch*SideStretch*SpineTwist*

ShoulderStretch,ChestStretch,ScapulaeStabilization,Obliquestretch,trunkcontrol

ArmWork Reformer ArmsSupineSeries

Strengthenandincreasemobilityofshoulderswhileinasupportedsupineposition.Developtrunkandscapularstabilization.

LegWork ReformerORMat

SingleLegSkatingSideLyingGlutealSeries*

Worktostrengthentheglutemedius,whichisimportantineverydaymovements.Workstostrengthentheglutemedius.

LateralFlexion/Rotation WundaChairORMat

SideStretchSideLifts*

Lateralflexorstretch,abdominalcontrol(obliqueemphasis),greatexercisetoprepareformorechallengingsideoverexercises.Lateralflexorstrength&trunkstabilization.

BackExtension WundaChair

SwanBasic

Strengthensbackextensorsanddevelops

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ORMat

BackExtension*

abdominalandscapularcontrol.

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Conclusion

Attheendof the5-weekprogram,John’sprogresswillbeevaluated. Basedontheresearch

informationreviewedinthispaper,itisexpectedthatJohnwillnoticesomepositivechangesin

hisbody. However,significantchangestohisPKandassociated issueswill requirecontinued

work,and,assuch,continuedprivatesessionsand“homework”willbesuggested.Additional

sessionswillbedevelopedbasedonJohn’sprogress,withthegoalofaddingmorechallenging

exercises, more variety, and adding exercises from the Spinal Articulation and Full Body

IntegrationBlocks.SessionswillcontinuetobedevelopedutilizingBASI’sBlockSystem3.

Poor postural habits carried throughout life and physical inactivity allowed by modern

amenitiesleadtheindividualtogrowaccustomedtousingthebodyinthewrongwayandthis

can lead to subsequent changes (e.g., kyphosis). 9 Pilates is anapproach that canbeused to

promotemusclerecoveryandimprovebodyawareness.9 Improvedmusclefunctionandbody

awarenessobtainedwithPilatescancarryoverintodailylife.Assuch,Pilatesappearstobea

promisingmodalityforaddressingtheproblemsassociatedwithPK.

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Bibliography

1. Patterson,Jane. TeachingPilatesforPosturalFaults, Illnessand Injury: APracticalGuide.China:Elsevier.2009.Print.

2.Isacowitz,RaelandKarenClippinger.PilatesAnatomy.Champaign,Illinois:HumanKinetics.2011.Print.

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

4.Clippinger,Karen.SpineAnatomy&CoreBasicsOnlineWorkshop#2801.January13,2017.https://www.pilatesanytime.com.

5. Biel,AndrewR.TrailGuidetotheBody:Ahands-onguidetolocatingmuscles,bonesandmore.Boulder,Colorado:BooksofDiscovery.2014.FifthPrinting.

6. Bowman, Katy,M.S.Move Your DNA: Restore Your Health Through NaturalMovement.PropriometricsPress,2014.SecondPrinting.

7. Bowman, Katy, M.S. World Massage Conference Presents: Hidden Kyphosis with KatyBowman.March6,2012.https://nutritiousmovement.com

8.Junges,S,etal.Effectivenessofpilatesmethodforthepostureandflexibilityofwomenwithhyperkyphosis.RevistaBrasileiradeCiênciaeMovimento.2012;20(1):21-33.

9.AlvesdeAraujo,M.E.,etal.,TheeffectivenessofthePilatesmethod:Reducingthedegreeofnon-structural scoliosis,and improving flexibility inpain in femalecollegestudents. JournalofBodywork&MovementTherapies(2011),doi:10.1016/j.jbmt.2011.04.002.