PilatesforPectusExcavatum

(SunkenChestSyndrome)

JulieLavoriniJuly2018

GreenwoodVillage,CO2017-2018

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Abstract

PectusExcavatumisacongenitalconditioninwhichaperson’sbreastboneissunkenintothe

chest.Mostoftennoticeableatbirth,pectusexcavatumtypicallyworsensduringthe

adolescentgrowthspurt.Itismorecommoninboysthangirls.Inseverecases,thesunken

breastbonecancompressthelungsandheart,causingchestpain,wheezingorcoughing,and

rapidheartbeat,aswellasothercomplications.Inmildcases,pectusexcavatumcanmakethe

personfeelself-consciousabouttheirappearance,oftenexhibitingakyphoticposturetohide

thedeformity.Whilesurgerymightbenecessaryinseverepectusexcavatumcases,proper

exerciseandconditioningcanlessenthenoticeableeffectsinthemildcases.Thispaper

examinestheuseoftheBASIBlockSysteminordertocorrectfaultyposturalalignmentdueto

pectusexcavatumcompensation.

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TableofContents

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

AnatomicalDescription ...............................................................................................................................4

Introduction .................................................................................................................................................8

ConditioningProgram ..................................................................................................................................9

Conclusion ..................................................................................................................................................13

Bibliography ...............................................................................................................................................14

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AnatomicalDescription

TheThoracicCavityandPectusExcavatum

Thethoraciccavityismadeupofthespine,ribcageandsternumthatenclosesandprotectsthe

heart,lungs,arteriesandothervessels.Anormalthoraciccavityprovidesenoughroomforthe

lungstoexpandandhearttofunctionproperly.Pectusexcavatumcanpreventfullexpansionof

thelungsandcompresstheheart.

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MusclesoftheShouldersandUpperBack

Thekyphosis,asasymptomofpectusexcavtum,istheresultoftightshoulderandchest

musclesandweakupperbackmuscles.Theshoulderandchestmusclesforthefocusof

stretchesincludetheanteriorandmiddledeltoids,pectusmajorandminor,andsubscapularis.

Themusclestofocusonforstrengtheningtheupperbackincludestheupper,middle,and

lowertrapezius,latissimusdorsi,posteriordeltoid,andrhomboids,teresmajorandminor,

supraspinatusandinfraspinatus.

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IntercostalMuscles

WhileintercostalbreathingisimportantforanyonepracticingPilates,itiskeyforanindividual

withpectusexcavatum.Intercostalbreathingtrainstheindividualtobringthebreathintothe

chestcavityinsteadoftheabdomen.Thishelpstoexpandtheribcage,takinganypressureoff

ofthelungsandheart,andstrengthentheintercostalmuscles.Intercostalbreathingutilizesthe

externalandinternalintercostalmuscles,foundbetweentheribs,andthediaphragm.

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Introduction

Robert,a49-year-oldmale,wasbornwithamildcaseof

pectusexcavatum.Hedidnothavecorrectivesurgeryasa

child,andthushaddevelopedakyphoticpostureoverhis

lifetime.Thekyphosiswasalsoaccompaniedbyforwardhead

posture,acommonresultofkyphosis.

Inadditiontothekyphosisandforwardheadposture,Robert

alsohadaweakcorewithanunstablepelvic-lumbarregion,

overstretchedquads,andaninternallyrotatedrighthip.

WhenIstartedworkingwithRobert,hehadnobodyawarenessandcomplainedofpaininthe

shouldersasaresultofthetightshouldergirdle.Heisabrewer,aphysicallydemandingjob,

andaPilatesprogramwillalsohelphimsafelyperformhisjobduties–thisincludeslifting

heavysacksofgrainandequipmentandstandingforlongperiodsoftime.Hisonlyotherform

ofphysicalactivityisaweeklyyogaclass.

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ConditioningProgram

ForRobert’sPilatesprogram,Iwantedtofocusonstrengtheningthebackextensors,stretching

thechestandshoulders,strengtheningthequadsandpelvic-lumbarregion,andworktogetthe

rightlegclosertoparallelfromtheinternallyrotatedposition.

Sessions1-10

Block Exercises Notes

Warm-Up FundamentalWarmUpPelvicCurlSpineTwistSupineChestLiftChestLiftwithRotation

Focusonbodyawarenessandabdominalstrengthandcontrol.

Footwork ReformerFootworkSeriesParallelHeelsParallelToesV-PositionToesOpen-VHeelsOpen-VToesCalfRaisesPrancesPrehensileSingleLegHeelSingleLegToe

FocusonkeepingRobert’srighthipparallelintheparallelexercisesandexternallyrotatedfortheV-positionexercises.

Abdominals HundredPrepHundred

Whenhebegantheprogram,Roberthadverylittleabdominalstrength.Ashegainedendurance,IaddedtheHundred.

HipWork SupineLegSeriesFrog

Thefocusforthisseriesispelvic-lumbarstabilizationand

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Block Exercises Notes

DownCirclesUpCirclesOpenings

strengtheningthehipadductors.TheexternalrotationofthehipsworkstocorrectRobert’sinternallyrotatedrightleg.

SpinalArticulation BottomLiftBottomLiftwithextension

WhenRobertstarteddoingPelvicCurls,hewasverywobblyonthearticulations.Ichosethesetwoexercisessothathecouldcontinuetoworkonthestability.

Stretches ShoulderStretch1ShoulderStretch2

ThesetwoshoulderstretchesaregentleandprovideawayforRoberttograduallydeepenthestretchesashefeelscomfortable.

FullBodyIntegrationF/I

ElephantUpStretch1

Iaddedthesetwoexercisesafterafewsessions.Theybothstretchthehamstringsandshouldersandstrengthentheabdominalsandbackextensors.

ArmWork ArmsSittingSeriesChestExpansionRhomboidsBicepsHug-A-TreeSalute

BoththeChestexpansionandRhomboidsexercisesstrengthenthebackandstretchthechest.TheseatedpositionoftheseriesrequiresRoberttokeephisabsandbackextensorsengagedinordertosittallandnothunchforward.

FullBodyIntegrationA/M

N/A

LegWork LegPressStanding Focusonbalanceandkneeextensorcontrol.

LateralExtension/Rotation

SideStretch Focusonthestretchofthelateralflexorsandstrengthentheabdominalobliques.

BackExtension DoubleLegKick

Strengthenbackextensorsandstretchchest.

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Sessions11-20

Block Exercises Notes

Warm-Up IntermediateWarm-UpRoll-upSpineTwistSupineDoubleLegStretchSingleLegStretchCrissCross

AsRobert’senduranceandabdominalstrengthincreased,IaddedtheintermediateWarm-Upseries.

Footwork ChairFootworkSeriesParallelHeelsParallelToesV-PositionToesOpen-VHeelsOpen-VToesCalfRaisesSingleLegHeelSingleLegToe

Thisseriesworksthequadsandhamstrings,butalsorequiresabdominalandbackextensorstrengthandcontrolinordertositwithoutslouching.

Abdominals BreathingwiththePush-ThroughBar

IintroducedthisexerciseasRobertgainedmorebodyawarenessandcoordination.

HipWork SupineLegSeries-AvalonFrogOpeningsScissorsHelicopter

Bythistimeintheprogram,Roberthasthestrengthandthecoordinationtoperformtheseexercises.Thisseriesisparticularlyhelpfultocorrecttheinternalrotationofhisrightleg.

SpinalArticulation ShortSpineLongSpine

Theseexercisesrequirealotofstrengthandcontroloftheabdominalsandbackextensors.

Stretches ShoulderStretch(Prone) Thisexerciseprovidesagreatershoulderstretchaswellasafocusonshouldermobility.

FullBodyIntegrationF/I

UpStretch2LongStretchUpStretch3

IchosetheseexercisestochallengeRobertashegainedabdominalandbackextensorstrength.Allthreeoftheseexercisesrequirehimtofocus

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Block Exercises Notes

onstabilizinghistrunk.

ArmWork ArmsStandingSeriesChestExpansionHug-A-TreeUpCirclesDownCirclePunchesBiceps

Inadditiontotheindividualmusclefocusandobjectivesoftheexercises,thisseriesrequirestrunkstabilizationwithabdominalengagement.

FullBodyIntegrationA/M

BalanceControlFront IaddedthisexercisetochallengeRobertandfocusonhisabdominalstrengthandtrunkstabilization.

LegWork SingleLegSkateSquats

SingleLegSkateworksthegluteusmediusaswellasfocusesonpelvic-lumbarstability.Squatsstrengthenthequadriceps.

LateralExtension/Rotation

SideOveronBox Thisexerciserequiresgreatabdominalobliquestrengthandtrunkstabilization.

BackExtension Breaststroke ThisexerciseshowcasesRobert’sbackextensorstrengthandmobilityofhisshoulders.

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Conclusion

IworkedwithRobertonceaweekfor10months.Hisoverallpostureandbodyawarenessimproved.He

wouldcatchhimselfslouchingandcorrecthimself.Hehadresignedhisachesandpainstoaging,but

withPilateshefoundthatheisholdinghimselfdifferentlyandthathavingastrongercoreallowshimto

putmoreofamusclefocusinotherareastobalancetheexertion,especiallywhileworkinginthe

brewery.WhilePilatescannotcorrectastructuralproblemsuchaspectusexcavatum,itcanhelpto

correctthesideeffects–kyphosisandforwardheadposture.Robert’sposturegreatlyimprovedandhe

sayshenowhasasenseofconfidence.Thevisualresultsspeakforthemselves!

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Bibliography

Isacowitz,Rael,andKarenClippinger.PilatesAnatomy.HumanKinetics,2011.“PectusExcavatum.”MayoClinic.MayoFoundationforMedicalEducationandResearch,09March2018.Web.07June,2018Isacowitz,Rael.StudyGuide:ComprehensiveCourse.CostaMesa,California:BodyArtsandScienceInternational,2013Isacowitz,Rael.StudyGuide:FundamentalCourse.CostaMesa,California:BodyArtsandScienceInternational,2013