Pilates for an Adolescent Female with...Pilates for an Adolescent Female with Scheuermann’s Syndrome and Lumbar Scoliosis BASI Pilates Student Paper By Caireen du Plessis “A man

Pilates for an Adolescent

Female with Scheuermann’s Syndrome and

Lumbar Scoliosis BASI Pilates Student Paper

By Caireen du Plessis

“A man is as young as his spinal column.” - Joseph Pilates

Caireen du Plessis - BASI Pilates Student Paper June 2019 Melbourne, Australia

1

Abstract

The gradual curves of the spine allow the body to absorb many shocks and stresses thorough out our daily lives. This is a delicate balance and even the smallest deviation can create pain and a reduction in mobility.

Scheuermann’s Syndrome, also known as juvenile osteochondrosis, is a self-limiting developmental derangement of normal thoracic or lumbar vertebral bone growth. It often lead to an increase in thoracic kyphosis and 1:3 patients also develop scoliosis (sideways curvature of the spine).

Symptoms can be seen in early childhood but structural changes and thoracic/lumbar pain levels often peak during the adolescent growth phase. The chronic back pain experienced can also have a significant psychological impact on the patient. Late diagnosis may be due to the symptoms being blamed on poor posture or growing pains.

A personal Pilates program for an adolescent with Scheuermann’s Syndrome should focus on improving overall posture as well flexibility and strength of the posterior chain, transverse abdominus and pelvic floor (i.e. the Pilates ‘core’ muscles). It is important to be mindful that the patient may be in pain and they may even find basic stretches to be quite uncomfortable.


2

Table of Content

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

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

Anatomical Description ........................................................ 3

Introduction ......................................................................... 5

Case Study ........................................................................... 6

Conditioning Program .......................................................... 7

Conclusion .......................................................................... 10

Bibliography ........................................................................ 11


3

Anatomical Description

Scheuermann’s Syndrome:

Spinal Deviations:

Spine-Health (2015)

Highsmith (2019)

Armfield (2017)


4

Pilates Core Muscles:

Case Study Radiographs (‘Emily’):

Chauhan (2016)


5

Introduction

Emily (not her real name) is a 16 y/o adolescent with Scheuermann’s Syndrome and Lumbar Scoliosis. She received treatment for 6 months by a physiotherapist, all with little to no help in reducing her pain. Emily’s physiotherapist then referred her to begin Chiropractic care and to do 2-3 Pilates classes a week. The Chiropractic care provided immediate but only temporary relief to her pain.

The first few weeks of Pilates classes were quite difficult for Emily and she was required to do private beginner classes for 6 weeks before she was ready to join beginner group classes. She attended class twice a week (religiously) and occasionally did a 3rd class when a weekend slot was available.

At 3 months of Pilates classes Emily said she began to feel stronger and more in control of her own body. Her movement felt more ‘free’ and she felt that the Pilates classes helped her ‘hold’ her Chiropractic adjustments for longer.

At 6 months of Pilates classes Emily said her pain levels were notably decreased though still present as expected. The exercises became easier for her to perform and she started feeling comfortable with performing a few intermediate exercises.

By the end of Emily’s first year of Pilates she says that she will forever be grateful to her physiotherapist for referring her to Pilates. She feels that Pilates is now a way of life for her. Emily finds that if she skips Pilates for 5 days or more her pain levels seem to increase and her mood is also effected. Emily has now decided to become a Pilates instructor when she is old enough to enrol.


6

Case Study

Emily, is a 16 y/o female and had recently been diagnosed with Scheuermann’s Syndrome and right convex lumbar scoliosis. A recent MRI and x-ray confirmed the presence of an L5/S1 herniated disc. In her case, an increased thoracic kyphosis was not present.

She has memories of general back pain as early as 6 y/o but her parents put it down to poor posture and ‘growth pains.’ Emily noted a drastic increase in her lower back pain at the age of 14 (2 years ago). She does not currently take part in any sports and cannot run or pick up heavy objects due to her back pain.

If she sits down for more than 30 minutes her legs begin to feel numb and ache until she stands up and goes for a walk. She occasionally gets sharp, painful radiations into her thigh and a tingling feeling in the soles of her feet (due to herniated disc). Standing in the same spot for an extended period of time (e.g. shower, cooking, brush teeth) exacerbated her symptoms. She also found twisting and forward/back bending movements to be quite uncomfortable/painful.

During her Initial Consultation it was noted from Emily’s physiotherapist that she had:

-Reduced flexibility/tightness in: Hamstrings (knee flexion, hip extension), back extensors and flexors, quadratus lumborum (lateral flexion), trapezius (scapula movement and upper body posture), gluteus maximus (extend and laterally rotate leg) and psoas

-Quire notable reduction of strength in: Gluteus medius (important for maintaining posture), transverse abdominus (primary core muscle which is vital for almost all movement)


7

Conditioning Program

The following are specific exercises that, using the BASI BLOCK System, will be incorporated into Emily’s Pilates Program. Progression from beginner into intermediate/advanced exercises will depend on her developing strength and flexibility as well as her pain tolerance.

BASI BLOCK SYSTEM EXERCISE BENEFIT Warm up Roll down

Pelvic Curl Spine Twist Supine Chest Lift (with rotation) Leg Lifts/Leg Changes *Progress to intermediate warm up

Warm ups are important to prevent muscle injury during exercise and to ensure the fundamentals are being performed correctly

Foot Work Parallel heels Parallel toes V-position toes Open V-position Heels Calf raises Prances Single leg heels Single leg toes *Progress to Wunda Chair and Cadillac

Your feet are the base of your body’s structure. Weakness in the ankles and feet can have a great impact on the body’s kinetic chains.

Abdominal Work Hundred (Prep) Roll up Double/Single leg Stretch Criss Cross Standing Pike CAT Stretch Kneeling Tilt (Short Box Group) *Progress to Intermediate exercises

Abdominal stability and bracing is vital for everyday activities. Without correct abdominal control, Pilates exercises cannot be performed correctly.

Hip Work Supine Leg Series (first on reformer then Cadillac) *Progress to Single Leg Supine Series

Hip flexibility and strength. Stability of the lumbopelvic region.


8

Spinal Articulation Spine Stretch Roll Like a Ball Bottom Lift Pelvic Curl *Caution on progression to intermediate exercises

It is vital to include healthy spinal movement and co-ordination into Emily’s program.

Stretches Standing Lunge Side Stretch Side Over Prep Gluteals Hamstrings Hip Flexors Adductors Shoulder stretch 1 and 2 Shoulder Stretch Prone *Progression depends on patient pain tolerance

Stretches are important for Emily as it is common for people with her condition to have reduced flexibility/hypertonic muscles. Recommendation for Emily to do daily stretches at home would be a favourable idea.

Full Body Integration Scooter Up Stretch 1 Elephant Flat Back

All-encompassing body awareness and strengthening.

Arm Work Arm Supine Series Sitting Side (Prep) Ped-a-pul Tricep Press Sit

Correct stabilisation of the scapular and cervicothoracic region during arm work will teach healthy movement patterns for Emily and thus help prevent further injury to her thoracic spine

Leg Work Leg Press Standing Hamstring Curl Hip Opener Frog Front

Leg Strength is important for performing daily activities.

Lateral Flexion/Rotation

Side Lifts Spine Twist Side Kick Mermaid Side Stretch Side over Prep

Flexibility of the quadratus lumborum and strength in the lateral kinetic chain.


9

Back Extension Back Extension Swan Prep Breaststroke (prep) Swimming

Strength and flexibility of the posterior kinetic chain is invaluable to a patient with Scheuermann’s Syndrome


10

Conclusion

Based on the BASI BLOCK System, regular Pilates sessions for an adolescent with Scheuermann’s Syndrome can be invaluable. Correcting the student’s posture, increasing flexibility, improving strength and performing healthy, articulate movement in the spine can greatly relieve the student’s pain levels and reduce the severity of the structural changes in their spine, thus improving their quality of life. The sooner the effected patient begins Pilates classes in conjunction with manual therapies (as required) the better they will be for it.


11

Bibliography

Armfield, S., (2017). Scheuermann's Disease – Physio Works. Retrieved at 25 June 2019 from: https://physioworks.com.au/injuries-conditions-1/scheuermanns-disease

Chauhan, H., (June 2016). Why are core muscles important? Retrieved at 25 June 2019 from: https://www.chiefactive.com/fit/core-muscles/

Highsmith, J.M, MD, (15 February 2019). Retrieved at 25 June 2019 from: https://www.spineuniverse.com/conditions/scoliosis

Isacowitz, R., (2013). Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Sciences International

Isacowitz, R., (2013). Mat Movement Analysis Workbook. Costa Mesa, California: Body Arts and Sciences International

Isacowitz, R., (2013). Reformer: Comprehensive Course. Costa Mesa, California: Body Arts and Sciences International

Isacowitz, R., (2013). Cadillac: Comprehensive Course. Costa Mesa, California: Body Arts and Sciences International

Isacowitz, R., (2013). Wunda Chai/Ladder Barrel: Comprehensive Course. Costa Mesa, California: Body Arts and Sciences International

Spine-Health (2015). Scheuermann's Disease of the Thoracic and Lumbar Spine, Retrieved at 25 June 2019 from: https://www.spine-health.com/conditions/spinal-deformities/scheuermanns-disease-thoracic-and-lumbar-spine

Documents

Pilates for an Adolescent Female with...Pilates for an Adolescent Female with Scheuermann’s Syndrome and Lumbar Scoliosis BASI Pilates Student Paper By Caireen du Plessis “A man