pilates for scoliosis focusing on lateral pelvic tilt · diagnosed with scoliosis at the age of 15...
TRANSCRIPT
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PILATES FOR SCOLIOSIS FOCUSING ON LATERAL PELVIC TILT
RAWYA ROTILY MARCH 2020
COMPREHENSIVE GLOBAL 2019 STUDIO RITUEL PARIS
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ABSTRACT
A lateral pelvic tilt is the asymmetric positioning of the pelvis where one
hip is ‘hiked’ up higher than the other due to certain muscle imbalances that
exist in the body. This paper addresses how a lateral pelvic tilt is a common
postural misalignment, which results in a drastic chain effect that reverberates
up and down the body. It will explore how this condition develops, how it’s
treated, and how to improve it.
Our bodies aren’t all perfectly symmetrical and everyone has some
asymmetry to some degree due to how we hold and use our bodies throughout
our lives. This asymmetry is expected and perfectly normal.
However, there can be times where a little too much asymmetry, such as
in the case of a lateral pelvic tilt, can leave us more prone to injury, reduce
mobility and negatively affect our overall physical performance.
The good thing is that in most cases a LPT can be fixed through stretching
and corrective exercises that I have designed using the BASI Comprehensive
Program.
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TABLE OF CONTENTS
TITLE PAGE 1 ABSTRACT 2 TABLE OF CONTENTS 3 ANATOMICAL DESCRIPTION 4 CASE STUDY 7 CONDITIONNING PROGRAM 9 CONCLUSION 12 BIBLIOGRAPHY 13
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ANATOMICAL DESCRIPTION
A lateral pelvic tilt (LPT) is a common postural misalignment characterized by
the tilting of the pelvis to one side. Individuals with this condition will appear to
have unbalanced hips, with one side sitting lower than the other.
There are several known causes of a lateral pelvic tilt, including scoliosis and
leg length discrepancy, but one of the most common culprits of this postural
discrepancy is poor posture. In order to understand how improper posture
contributes to a lateral pelvic tilt, it’s important to consider how the pelvis is
structured.
The pelvic bone sits at the top of the thigh bones (femurs) and is supported
by a network of muscles that help stabilize the hips and allow for a full range of
movement of the legs. The muscles and ligaments include:
° Adductors
° Gluteus medius
° Obliques
° Quadratus lumborum (QL)
° Tensor fascia lata (TFL)
When a muscle imbalance occurs between these muscles, whether due to
injury, tightness, weakness or overuse, a lateral pelvic tilt may develop.
Specifically, a lateral pelvic tilt is the result of the tightening and shortening
of the adductors, gluteus medius, and quadratus lumborum on one side of the
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body, and the simultaneous weakening and lengthening of the same muscles
on the opposite side of the body.
Other than one hip being heigher than the other, the presence of a lateral tilt
can result in a drastic chain effect which reverberates up and down the body. A
few of the structural problems include:
• Uneven hips & gait • Uneven shoulder heights
• Leg length discrepancies • Internal rotation of the leg
While mild to moderate cases of lateral pelvic tilt usually do not produce any
noticeable symptoms, severe or longstanding cases of LPT may cause muscle
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tightness and low back pain. If left untreated, it can lead to more serious
medical conditions such as:
• Disc degeneration • Disk herniation • Sacroiliac joint pain
There are a few things that can cause a lateral pelvic tilt:
• Bad posture habits - holding the body in the same position for hours
each day, every day, for several months or years, the body’s tissues will
adapt to this position.
• Sitting too much with incorrect posture – prolonged sitting not only
places undue stress on the spinal column, but also changes how the
muscles and ligaments of the lower body (specifically those that
support the pelvis) interact. This can lead to a negative feedback loop
of injury, overcompensation, and re-injury of the muscles and ligaments
that stabilize and mobilize the pelvis.
• Injuries and structural issues – hurting oneself on one side of the body is
possible to create a hip hike in order to avoid pain in the injured area.
• Pronated foot – a flat foot or a collapsed arch on one side will cause
the foot to roll inwards, causing the tibia and fibula (muscles of the
shin) to internally rotate and the knee will turn inwards. With the inward
turn of the knee (knee valgus) the femur also internally rotates and the
hip will drop, causing the lateral pelvic tilt.
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CASE STUDY
Introduction: When I was around 13 years old, I used to love carrying my
little sister on my right hip and twist her around. As this was a critical time for
spinal growth and maturation, little did I, or my parents know, that I would be
diagnosed with scoliosis at the age of 15 with a 20 degree lumbar curve and a 5
degree tilt angle in the thoracic spine.
I was told I would have to be fitted for and wear a back brace to prevent
the curve from progressing. I wore the brace for 23 hours a day over 2 years and
did some yoga exercises that were given to me. I am now 31 years old and my
lumbar curve has progressed to 27 degrees. Had I known and discovered pilates
at the time, I would have prevented that increment.
I designed a BASI Comprehensive Block System program to target my
problematic areas which are: adductors, gluteus medius, obliques, quadratus
lumborum (QL) and hamstrings. The goal of this program is to restore symmetry
to the pelvic girdle by strengthening weak and/or elongated muscles while
stretching tight, constricted muscles.
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My current imbalances are seen in the images below:
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CONDITIONING PROGRAM
BLOCK SESSIONS 1-10 SESSIONS 11-20 NOTES
WARM UP
[Mat] Pelvic curl
Spine twist supine Chest lift Leg Lifts
[Mat] Pelvic curl
Spine twist supine Chest Lift
Chest Lift w/ rotation Leg Lifts / Changes
These warm ups help me achieve a neutral pelvis and
wakes up my transversus abdominus.
FOOTWORK
[Reformer] Parallel Heels Parallel Toes
V Position Toes Open V Heels Open V Toes Calf Raises
Prances Prehensile
Single Leg Heels Single Leg Toes
[Cadillac] Parallel Heels Parallel Toes
V Position Toes Open V Heels Open V Toes Calf Raises
Prances Single Leg Heels Single Leg Toes
Hip Opener
These exercises help me strengthen my overpronated
left foot by doing all footwork that require me to
dorsi flex. I work on strengthening my
ankles with calf raises, prances and prehensile.
Hip Opener on the Cadillac is magical. It helps me strengthen hip external
rotators (which are internally rotated on one side)
ABDOMINALS
[Mat] Roll up
Hundred prep Double leg stretch Single leg stretch
Criss cross Teaser prep
[Wunda Chair] Standing pike
Standing pike reverse Full pike
Pike Sitting
Strengthening my abs is essential for me as it helps decrease my lower back pain. In the Wunda chair
exercises, I love the pike ab work as it lengthens the curves of my spine while
strengthening my abdominals and stretching
my tight hamstrings.
BRIDGING / HIP WORK
[Mat] Shoulder bridge prep
Shoulder bridge Back support
Scissors Push up
[Reformer]
Frog Circles [down, up]
Openings Extended frog
[Cadillac]- Basic leg springs:
Frog Down circles
Up circles Walking Bicycle
Strengthening weak adductors and my weak
hamstrings is very important to gain balance when
having a lateral pelvic tilt.
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SPINAL ARTICULATION
[Mat] Rolling like a ball
Spine stretch Roll over
Open leg rocker
[Cadillac] Monkey Original
The Mat work for Spinal
Articulation was extremely difficult to do in the first 3
sessions. With my scoliosis I would fall on one side when attempting (rolling like a ball or open leg rocker) but ive learned that the stronger
your core is, the more control you will have. Spine stretch is
great for opening up that lumbar curve, the arched
back at the end loosens all curvatures and helps elongate the spine.
As for the monkey – it feels great because it gives you this deep hamstring stretch
and the plantar /dorsi flexion helps me stretch out my calf muscle of my right supinated
foot.
STRETCHES [Reformer]
Standing lunge
[Cadillac] Shoulder stretch
Standing lunge on the reformer is my fav! At a
posterior tilt I feel a yummy stretch of the hip flexors and at an anterior tilt I focus more
on my right leg as I have tight hamstrings and hip
extensors. Since I also have a right
hiked shoulder, the shoulder stretch is great for release.
FBI - 1
[Reformer] Elephant
Up stretch 1 Up stretch 2 Long stretch
[Cadillac] Sitting forward
Saw
These all scream hamstring stretch, and ab strength!
Exactly what a scoliosis client needs.
ARMS
[Reformer] Arm sitting series: Chest expansion
Biceps Rhomboids Hug-a-tree
Salute
[Reformer] Rowing series: Rowing Back 1 Rowing Back 2 Rowing Front 1 Rowing Front 2
Reformer arm work helped me sit up right as it was
diffuclt in the beginning. I still use a small pad under my
left sitting bone to balance my pelvis. As for rowing
series, the rowing back 2 + the rowing front 2 are lovely for strengthening the back
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extensors. Scoliosis clients have weak back extensors on one side of their spine, and its important to wake
those muscles
LEGS [Reformer]
Single leg skating
[Leg Weights] Side leg lift
Forward + lift Forward with drops Adductor squeeze
Single leg skating for my weak gluteus medius + hip adductor + knee extensor
strength
All the leg weight exercises are great for hip abductor strength and pelvic lumbar
stability
LATERAL FLEXITION / ROTATION
[Reformer] Mermaid
Side over on box
[Wunda chair] Side stretch
When I lift up and into my concave side, these
exercises straighten up my back and bring me into
neutral spine. For my case, the one side that stretches out my QL is
the same side that straightens my back . Feels
amazing! For the Wunda chair side stretch, not only are you
uncurving the spine but also lengthening the leg that is
stretched out and elongating it,
BACK EXTENSION
[Mat]
Cat stretch Single leg kick
Double leg kick Swimming
[Wunda Chair]
Swan Basic Back extension single arm
Cat stretch is great for breathing into the
compressed rib cage.
Swan basic on wunda chair requires activation of the hip extensors – I do more reps on
the right side to strengthen my glutes that will help with
the lateral pelvic tilt.
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CONCLUSION
I got introduced to Pilates about 2 years ago and it has changed my
entire mindset on the whole mind-body connection / awareness. I started
noticing my imbalances and that made me understand why my left pelvis is in
an anterior tilt, or why my left ribs are externally rotated and protruded, or why
my right foot is supinated and so on. Doing Pilates twice a week, I’ve started
noticing that my alignment, movement and posture have improved.
I know that at this age, I cannot reverse the curve with Pilates exercises
but a targeted program taught me how to release tight areas, improve my
awareness of alignment and strengthen the internal muscles that support and
control my spine. And who best knows your body other than you? That’s when I
decided to dive in and learn Pilates myself to understand my scoliosis, heal my
own body and hopefully help others.
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BIBLIOGRAPHY
Isacowitz, R. (2000-2014). Refomer Movement Analysis Workbook. Body Arts and Science International Isacowitz, R. (2000-2014). Mat Analysis Workbook. Body Arts and Science International Isacowitz, R. (2000-2014) Cadillac Movement Analysis Workbook. Body Arts and Science International Isacowitz, R. (2000-2014), Wunda Chair & Ladder Barrel Movement Analysis Workbook. Body Arts and Science International. “Back muscles” Lose the back pain, [online] Available at: https://losethebackpain.com/back-muscle-pain“Lateral Pelvic Tilt” Lateral Pelvic Tilt: How to Fix Unever Hips and (Apparent) Leg Length Discrepancies, [online] Available at: https://www.drbodygadget.com/lateral-pelvic-tilt/ “Left AIC Pattern” What is the Left AIC Pattern? [online] Available at: https://pritrainer.com/left-aic-pattern/