Low Back Health

Low Back Health The Benefits of Pilates in Corporate America Laura Ann Piini BASI Teacher Comprehensive Training Course December 16, 2012 Oceanside 1 Abstract The purpose of this research paper and case study is to explore the benefit of a consistent Pilates practice in the lives of businessmen and businesswomen as it relates to back health. Low back pain is estimated to affect nearly 80% percent of the adult population at some point in their life (BASI, 51). Research also shows a strong correlation of low back pain to extended periods of sitting (NASM, 5). This is cause for concern considering the average 8 hour business day for most is spent at a desk. In addition to proper sitting mechanics, an effective and consistent Pilates practice may be an effective measure to protect against back pain occurring or recurring. If you are currently experiencing back pain, it is important to check with your doctor before beginning a Pilates program to discuss any possible contraindications. Renee Beason is a 28 year old female who is the subject of this case study. Renee works in human resources for a corporate company that requires extended periods of sitting throughout the day. She has had no back injuries but experiences occasional periods of low back pain that have been diminished through the implementation of a Pilates program. She has been cleared to engage in Pilates and given no restrictions. 2 TABLE OF CONTENTS Title Page…………………………………………………………………...………………………………………..1 Abstract…………………………………………………………………...……………...…………………………..2 Table of Contents…………………………………………………………………...………………...…………..3 Anatomical Description………………………………….……………...……………………………………..4 Low Back Pain in Corporate America………………….…………..……………………………………..7 Case Study…………………………………………………………………...………………………..……………..9 Conclusion……………………………………………………………...……………………………...…...……..13 Bibliography…………………………………………………………………...…………………………………14 3 ANATOMICAL DESCRIPTION The spine is comprised of 33 vertebrae that form a column from the neck down to the pelvis (Isacowitz, 9). The vertebrae are arranged into regions of the cervical(7 vertebrae), thoracic(12 vertebrae), lumbar(5 vertebrae), sacral(5 vertebrae) and coccyx(4-­‐5 vertebrae) (Kapit/Lawrence, 27). The vertebrae of the cervical, thoracic and lumbar permit movement while the 9-­‐10 vertebrae of the sacral and coccyx are fused (Isacowitz, 15). The number of vertebrae in the sacral and coccyx region can vary slightly in number with each individual (Isacowitz, 15). Although each individual vertebrae offers very little movement, working together, they are highly mobile (Isacowitz, 15). When muscles around the spine are tight and/or weak, it can inhibit movement of the spine and prevent the distribution of work throughout the entire vertebral column. When the whole spinal column is not functioning collectively to distribute the forces placed upon it, the stress loads onto only a few vertebrae with shearing force(Isacowitz, 15). The Pelvis acts as a suspension bridge between the upper and lower body (Isacowitz, 16). The bones of the pelvis are the ischium, ilium, and pubis 4 (Isacowitz, 16). The alignment of the pelvis affects the surrounding joints and alignment of the body as a whole. In Pilates, we strive to maintain a “neutral pelvis” through much of the practice which is a certain position of the pelvis where the anterior superior iliac spine on either side of the pelvis and the pubic symphysis are in the same horizontal plane when lying on one’s back (BASI, 8).When the pelvis is in neutral, the resulting spinal position is referred to as “neutral” and implies that the natural curves of the spine are present (BASI, 8). It if important to note that although we strive to maintain a neutral pelvis throughout much of the practice, there will be movements that benefit from deviating away from a neutral position. Working from a neutral pelvis teaches efficient posture and ideal alignment which encourages balanced muscular development and correct muscle recruitment(BASI, 8) The abdominals are made up of the rectus abdominis, external oblique, internal oblique, and transversus abdominis (Clippinger/Isacowitz, 14). “The most important of the abdominal muscles in terms of stabilization is the transversus abdominis.” (BASI, 51) The transversus abdominis is a deep interior muscle that wraps around the spine and acts as a natural weight lifting belt to protect the spine from unwanted movement. Intra-­‐abdominal pressure is the co-­‐
contraction of the transversus abdominis and the obliques which surround and 5 compress the abdomen to protect the spine from pressure (BASI, 51; Jarmey, 55). When these muscles are weak, the spine is left vulnerable to stress which can eventually result in injury. The spinal extensors are located on the back of the trunk and include three muscle groups: the erector spinae, semispinalis and the deep posterior spinal group (Clippinger/Isacowitz, 15). The deep posterior spinal group, includes the multifidis which is comparable to the transversus abdominis in terms of stabilization (Clippinger/Isacowitz, 15). The multifidis lies deep along the spinal column and spans from the cervical region of the spine down to the base of the lumbar (Jarmey, 48). The multifidis and transverse abdominis offer support and stabilization and are recognized as having a profound affect on the prevention of back pain (BASI, 45). The Pelvic Floor muscles must be included when discussing spinal stabilization and health. Actively working the pelvic floor muscles, particularly the coccygeus, can influence the position of the sacrum and can help relieve or prevent lower back pain(Isacowitz, 16). When the transversus abdominis contracts, as it does during Pilates, the pelvic floor muscles will contract as well (Isacowitz, 16). 6 LOW BACK PAIN IN CORPORATE AMERICA In the United States, it is estimated that 80% of the adult population will experience low back pain at some point in their life(BASI, 51 ). The annual costs attributed to low back pain are estimated to be over $26 billion each year (NASM Corrective Exercise, 44). What causes this problem and how can it be prevented? There are many factors that can lead to low back pain but research shows a strong correlation of low back pain to people who sit for periods greater than three hours in a day(NASM, 5). This is cause for concern considering the average eight hour business day is spent at a desk. Sitting leaves the pelvis as the base of support for the spinal column and eliminates the supporting role of the legs (Meyers, 211). Individuals with chronic back pain have been shown to have decreased activation of certain muscles. In particular, these muscles are the transverse abdominis, internal obliques, pelvic floor muscles, multifidus, diaphragm, and deep erector spinae (NASM, 200). These muscles comprise what many refer to as the “core,” Joseph Pilates called the “powerhouse,” and Rael Isacowitz calls the “Internal Support System”(Isacowitz, 18). The transversus abdominis, internal obliques, pelvic floor muscles, multifidus, diaphragm and deep erector spinae are muscles that are at the foundation or “core” of a sound Pilates practice. “Joseph Pilates placed great 7 emphasis on the powerhouse, considering it a physical center of the body from which all Pilates movements should proceed” (Clippinger/Isacowitz, 17). The deep muscles of the core work as a natural protective belt to shield the spinal column from unwanted movement. Rael Isacowitz explains, “As with a tree, the deeper layers, not the bark, provide the support to stand upright and the flexibility to bend with the wind” (Isacowitz, 17). The transversus abdominis and internal/external obliques of the abdominal musculature are often the focus of a back care program as the abdominals support the back and alleviate pressure on the spine (BASI, 51). The structure of the spinal column allows for the abdominals to offer support to the lower spine and the mid and upper back extensors to support the upper spine(BASI, 51). The abdominals cannot be targeted alone as the spinal extensors and pelvic floor also come into play in terms of spinal stabilization. “Actively working the pelvic floor, particularly the coccygeus, influences positioning of the sacrum and may help relieve or prevent lower back pain”(BASI, 16). Together, the musculature of the abdominals, spinal extensors and pelvic floor work together to protect the spine from pain and injury. A carefully crafted and comprehensive Pilates program has the potential to prevent injury as well as to restore health to the low back. An effective Pilates back care program will pay careful attention to the muscles of the abdominals, back extensors and pelvic floor while also considering the body as a whole. The body is an interconnected chain and compensation or dysfunction in the lumbo pelvic hip complex will lead to dysfunction in other areas of the body (NASM/Corrective Exercise, 191). A complete program will provide special attention to varying ranges 8 of motion, sufficient intensity, sufficient overload, correct mechanics, correct muscle recruitment as well as utilizing intra-­‐abdominal pressure (BASI, 52). CASE STUDY Renee Beason is 28 years old female who is the subject of this case study. Renee works in human resources for a large company that requires extended periods of sitting throughout the day. She has had no injuries but experiences occasional periods of low back pain. She has been cleared for physical activity with no restrictions. The objective of the program that I have designed for her targets back care but with the encompassing purpose of overall balance in mind, body and spirit. The following is a sample session from her program. SAMPLE SESSION ROLL DOWN TRAINING OBERVATIONS AND NOTES: Observing the Roll Down from different angles allows me to see movement patterns and compensations. The muscles of Renee’s lumbar have a tendency to move as a solid unit with a slight anterior tilt of the pelvis. Her shoulders also have a tendency to round forward as well as hike upwards towards her ears. Articulation is improving with each session. BLOCK: • Warm Up EXERCISES: • Pelvic Curl • Spine Twist Supine • Chest Lift • Chest Lift with Rotation TRAINING NOTES: The deep muscles of the core are activated throughout these exercises and prepare the body for the more advanced movements to follow. Special care must be taken when performing the Chest Lift to avoid tension in the neck. I also cue her to release 9 her shoulders and relax through the clavicle as this area has a tendency to tighten and draw forward and towards her ears during the Pelvic Curl and Spine Twist Supine. I love this warm-­‐up for her due to the emphasis on the pelvic and lumbar stabilization. BLOCK: • Foot Work APPARATUS: • Wunda Chair EXERCISES: • Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Single Leg Heel, Single Leg Toes TRAINING NOTES: I chose the Wunda Chair for her footwork to challenge the stabilization of her trunk. She previously did very well on the Reformer and Cadillac so this apparatus added a degree of difficulty due to the lack of trunk assisted support. It is important to maintain good posture throughout the footwork without leaning forward or backwards. BLOCK: • Abdominal Work APPARATUS: • Reformer EXERCISES: • Short Box Series: Round Back, Flat Back, Tilt, Twist, Round About, and Climb a Tree TRAINING NOTES: I chose the short box series not only because of the challenge to the entire trunk stabilization with the co-­‐contraction of the abdominals and spinal extensors but because of the more “opening” nature of the movements through the chest. BLOCK: • Hip Work APPARATUS: • Reformer EXERCISES: • Frog • Up Circles • Down Circles • Openings TRAINING NOTES: I pay careful attention to cue pelvis stability during the hip work on the reformer. No wiggling through the hips. BLOCK: 10 • Stretches APPARATUS: • Reformer EXERCISES: • Standing Lunge TRAINING NOTES: I like how the Standing Lunge stretches the hip flexors. Renee’s hip flexors are in a perpetual state of flexion throughout the day at her desk hence my goal was to move the hip in the opposite direction. BLOCK: • Spinal Articulation APPARATUS: • Reformer EXERCISES: • Bottom Lift TRAINING NOTES: Very much like the Pelvic Curl, the Bottom Lift targets the deep abdominals as well as encourages articulation throughout the entire spinal column. I particularly like how the Bottom Lift releases the Hip Flexors at the top point by targeting the Hip Extensors. BLOCK: • Full Body Integration I APPARATUS: • Reformer EXERCISES: • Down Stretch TRAINING NOTES: I love this exercise for Renee because it opens up the chest while also emphasizing the abdominals and hip extensor control. BLOCK: • Arm Work APPARATUS: • Reformer EXERCISES: • Supine Arm Series: Extension, Adduction, Up Circles, Down Circles and Triceps TRAINING NOTES: The arm series strengthens and stabilizes the shoulder girdle. I like this series because she is supine throughout allowing me to cue her to open up her through her chest and shoulders. BLOCK: 11 •
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Full Body Integration II N/A BLOCK: • Leg Work APPARATUS: • Reformer EXERCISES: • Jumping Series: Parallel Position, V Position, Sing Leg Parallel, Leg Changes TRAINING NOTES: I chose the Jumping Series for Renee because it provides not only a challenge to the legs and trunk stabilization but also the degree of cardiovascular movement. This is also more dynamic and playful  It is good to see the client smile. BLOCK: • Lateral Flexion and Rotation APPARATUS: • Wunda Chair EXERCISES: • Side Stretch TRAINING NOTES: The muscle focus of this exercise is on the abdominal oblique with the purpose being a lateral flexor stretch and abdominal oblique strength. She does very little movement throughout the day so this one is great to challenge trunk stabilization while moving her body in a lateral direction. BLOCK: • Back Extension APPARATUS: • Wunda Chair EXERCISES: • Swan Basic TRAINING NOTES: I love this exercise for Renee because of the co-­‐contraction of the abdominals and back extensors while also opening through the chest. ROLL DOWN TRAINING NOTES: The articulation down through the spine continues to improve after each session and with time. Taking a deep breath here at the end of the session serves to calm and ground her as well. 12 CONCLUSION In America, 80% of the adult population has been shown to experience low back pain at some point in their lives. The connection with Corporate America is the correlation of low back pain with extended periods of sitting. The muscles weakened and/or tight from sitting include the transversus abdominis, internal obliques, multifidis and pelvic floor muscles. These very same muscles that are considered weak in individuals experiencing low back pain are at the very heart of a solid Pilates program. Pilates offers a possible solution for businessmen and women to counteract the damage done from extensive sitting and protect again back pain occurring or recurring. My case study, Renee Beason, has experienced fewer and fewer episodes of low back pain since beginning a Pilates program. The articulation through her spine has improved as has her posture. The additional benefit it the decrease in stress with a restored sense of harmony in her body, mind and spirit. “The Pilates Method of Body Conditioning develops the body uniformly, corrects posture, restores vitality, invigorates the mind and elevates the spirit.” Joseph Pilates. 13 BIBLIOGRAPHY Isacowitz, Rael. Pilates. Human Kinetics, 2006 BASI. Study Guide Comprehensive Course. BASI, 2000-­‐2008 Chris Jarmey. The Concise Book of Muscles. Lotus Publishing and North Atlantic Books, 2003. National Academy of Sports Medicine. Corrective Exercise. NASM, 2007. Myers, Thomas. Anatomy Trains. Churchill Livingstone, 2009. Isacowitz, Rael. Clippinger, Karen. Pilates Anatomy. Human Kinetics, 2011. Wynn Kapit/Lawrence M. Elson. The Anatomy Coloring Book. Benjamin Cummings, 2002. National Academy of Sports Medicine. Personal Fitness Training. Wolters Kluwer, Lippncott Williams and Wilkins, 2008. ] Lee, Diane. The Pelvic Girdle. Churchill Livingstone, 2011. Internet Sites: http://www.livestrong.com/article/422836-­‐how-­‐does-­‐exercise-­‐improve-­‐
work-­‐productivity/ http://www.bodymindbalance-­‐ma.com/CorporatePilates.html http://www.centerworks.com/joseph-­‐pilates-­‐quotes/ photo credits: http://positivelypregnant-­‐mummytrainer.blogspot.com http://sportsandchiropractic.net http://tweakfit.com/pelvic-­‐floor-­‐exercises http://www.mbexec.net Myers, Thomas. Anatomy Trains. Churchill Livingstone, 2009. 14