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Posted by on Jun 2, 2016 in Anatomy & Physiology, Featured, Pilates, Workshops | 0 comments

Scoliosis – How can Pilates help?

Scoliosis – How can Pilates help?

 

by Mary Thornton BSc Hons MCSP HCPC

When you get a new enquiry from a client with scoliosis, does it fill you with dread or excitement? Personally, I love the thought of assessing a new client with a scoliosis. As with many other conditions, you never know how the individual will present and what challenges lie ahead.

A scoliosis is a side ways curve of the spine with rotation of the vertebral bodies. It can occur anywhere along the spine and even present as two specific curves. There are many reasons why someone might present with a curvature of the spine: a difference in leg length, a hemi-pelvis to spinal degeneration or even a neuromuscular condition, but the most common curve you will probably see in the studio is a idiopathic scoliosis. This means the cause of the curve is unknown. It generally first appears during puberty and can progress rapidly during this period then generally slows down as the body reaches skeletal maturity.

The medical profession determines the severity of a curve using what is referred to as a Cobb angle. The Cobb angle is measured by looking at the end points of the curve and the angle formed from the intersection of these two lines and a curve greater then 10 degrees is deemed a scoliosis.

On physical examination the client may present with:

  • Rib hump
  • Elevated / winging scapula
  • Pelvic or torso shift
  • Decreased lung expansion
  • Leg length discrepancy

The management of a scoliosis varies depending on the severity of curve, pain and probably location in which they live. Generally surgeons do not intervene unless the curve is greater then 45 – 50 degrees and in the first instance they are generally referred for Physiotherapy, or fitted with a back brace. Traditional fixed braces like the Boston are rigid restrictive devices that are difficult for the client to use but there is a new wave of dynamic braces that are proving very effective and more user friendly.theclinicalpilatesstudio

As a movement therapist, there are many things we can do to help manage the scoliotic spine. While we must not be under the illusion that we can make a curved spine straight, we can certainly help manage the muscular imbalances that occur.

We must also be very aware of the psychological effect of the scoliosis on the client. Though outwardly they may seem ok with their diagnosis, their self esteem and body image can be effected. Avoid the use of negative words and limit the use of mirrors during sessions. Although mirrors give feedback about where the client is in space and can aid the develop of new motor patterns, be sensitive to their reaction. With a little sensitivity, we cannot only help the individual develop a better understanding of balance within their bodies, but also enhance self esteem.

As a teacher, it is easy to get to bogged down by terminology, but with a few basic assessment rules, it can be easy to devise a safe and beneficial exercise regime. However, like all pathologies, to really benefit from Pilates the client initially needs to be seen on an individual basis to determine their specific needs and teach them how to adapt in a group situation.

So the next time someone mentions they have a scoliosis, start to be inspired by the challenges that lay ahead. With a little research and insight, you can make big changes to their life.

To learn more about how to plan a Pilates programme for scoliosis come along to one of Mary’s workshops, advertised on Facebook or contact directly at info@theclinicalpilatesstudio.co.uk

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Posted by on Feb 17, 2015 in Anatomy & Physiology, Body & Mind, Featured, Pilates | 0 comments

Hypermobility – Keeping It In The Box!

Hypermobility – Keeping It In The Box!

Hypermobility syndrome or HMS as it is sometimes known covers a large spectrum of symptoms. Hypermobility comes in many forms from someone being able to place their hands flat on the floor and hyperextending their elbows and knees with ease to a more severe presentation effecting the vascular system, digestive tract, heart valves, bladder and many other soft tissues of the body.

Many people walk around most of their lives unaware that they have this pathology as to them having excessive joint range of movement is normal and in some circumstances (as in dancing) it can be an asset. It isn’t until they start to experience muscular skeletal pain that they may seek help and are finally diagnosed, however the condition is still not fully understood and its symptoms can sometimes be dismissed by the medical profession and mismanaged.

Compared to other pathologies hypermobility is a relatively new one as far as diagnosis is concerned. Most clinicians initially use the Beighton criteria to diagnose. This test looks at the flexibility of the spine, elbows, fingers, wrist and knees to determine their range of movement. They use these measures of joint range along with levels of joint pain, recurrent subluxation, levels of fatigue, bruising etc to lead to a diagnosis of a hypermobility syndrome. HMS can be separated into two forms; joint hypermobility syndrome (JHS) or Ehlers Danlos syndrome (EDS) this terminology is often interchangeable with clinicians.

Symptoms can include:

  • general joint hypermobility
  • recurrent subluxation
  • joint pain
  • family history
  • skin involvement/fragility
  • arterial/ heart involvement
  • intestinal problems
  • fatigue
  • congenital hip dislocation • increased spinal curvature • excessive bruising
  • bladder problems

As you can see from the above list the symptoms can be vast and complex depending of the severity of the condition.

As Pilates teachers we have all had a client who never feels the end range of a stretch, presents with excessive joint range and never seem to be able to stabilise. Some of these clients are just hypermobile with no other symptoms, but others may report pain and problems with daily function. As teachers the type of muscular skeletal symptoms that we may see with a hypermobile client are:

  • laxity in joints
  • poor proprioception
  • fatigues quickly
  • subluxation – fingers, elbows, shoulders, patella
  • effusion following trauma
  • fibromyalgia
  • trigger points

When devising a safe and effective Pilates programme for these clients it is important to be aware of any of these symptoms to prevent over working or over stressing the joints as this can cause repetitive micro trauma to these type of tissues. Remembering that if this client has poor proprioception and a decreased awareness of joint position then you have to reeducate their sense of joint position by what I refer to as “keeping it in the box”! This basically means keeping the range of movement small and working where possible with a closed chain pattern to help reeducate this awareness and gain effective control of their movement patterns.

The emphasis of controlling range of movement and postural reeducation can be the key factors when devising a Pilates programme for this type of client. Of course they can also present with tightness, especially in the thorax. This area can get particularly locked up and breathing can be shallow and apical, as they may hold them selves from this region due to the general lack of stability elsewhere, In this instance breath work can be invaluable.

With a more extreme presentation of the condition the client may well fatigue quickly which could mean that a shorter session is required. Often they may not show this during the session as the fatigue could be a delayed reaction, so its alway best to start with a shorter session, then check how they where 48 hours later. Ideally seeing the clients for a couple of shorter sessions a week is best with some basic home exercises to follow through even if its just postural awareness.

Working with this type of client can be extremely rewarding as it can help manage their condition long term, but teachers do need to be aware of adapting and keeping movements basic. Remember, keep it in the box!

To learn more about how to adapt Pilates for HMS Mary will be presenting her workshop “Hypermobility: Keeping it in the box!” later this year.  To find out more contact mary@theclinicalpilatesstudio.co.uk.

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Posted by on Aug 22, 2014 in Anatomy & Physiology, Featured, Health, Pilates | 0 comments

Pilates For Total Hip Replacement: What We Need To Know?

Pilates For Total Hip Replacement: What We Need To Know?

Due to changes in our NHS service more & more Pilates teachers are being referred clients following hip replacement surgery. Once, patients would have been on a hospital ward for at least a week receiving Physiotherapy daily. This ensured that they could confidently perform their post op exercise regime and climb stairs safely. However, these patients are now discharged after 2 – 3 days with an exercise booklet and a quick mobility check.

As a result many patients turn to Pilates looking for an alternative rehab programme to enable them to restore normal hip function and mobility. So what does the Pilates teacher need to know? There are shutterstock_94626565-e1368042178741several hip replacement procedures, the most common of which is the total hip replacement (THR).This involves the removal & replacement of the femoral head with a prosthesis and the acetabulum is deepened and resurfaced. These prosthesis’s are commonly made from metals such as titanium, stainless steel & polyethylene.

During surgery the hip is dislocated to enable the prosthesis to be fitted and as a result post operatively the hip joint will be more unstable. Therefore the main objective is to strengthen the muscles around the posterior & lateral region of the hip to help regain stability. As the muscles start to gain strength the clients balance and mobility also need to be restored.

Due to the invasive nature of this surgery you often find post op that the gluteas maximus & medius as well as the external rotators and abductors will be weak, and that you will also be presented with a protective shortening pattern of the anterior element of the hip around the TFL, rectus femoris and even the psoas. This tends to gives the impression of the ilium hitching and the head of femur sitting forward of the joint. This can often be observed if the client is lying supine with knees flexed, feet on floor & you will also be able to palpate this shortening.

Therefore, as well as strengthening the effected posterior and lateral element of the hip we also need to rebalance the pelvic and femur placement by careful positioning and cueing.

The biggest fear that many patients have is will their hip will dislocate after surgery. This is very rare and with the correct rehabilitation exercises over 6 – 9 months the hip will be as strong as it was before. However, like any recovery process it must be paced. Initially there will be vast improvements but then the pace will slow down as it reaches its potential. So it is important that the client be guided to reach progressive goals.

There are a few contraindications that need to be given attention initially after surgery to prevent dislocation, they are:

• Hip flexion > 90 degrees • Leg adduction
• Hip rotation
• Crossing legs

As a Pilates teacher it is necessary to be aware of these contraindications during the early stages of rehab. However, due to our deep understanding of movement, we are well equipped to take the client through a gradual rehab programme that will address the weaknesses that have arisen during surgery.

As I mentioned earlier the THR is the most common hip replacement available but in the instance of trauma or congenital abnormalities the procedure and contraindications may differ. It is extremely important in this instance that the Pilates teacher liaises with the patients Physiotherapist to check the safely precautions with that specific situation.

To learn more about the steps to follow after hip & knee surgery see Maryʼs workshop; hip & knee post op workshop. www.theclinicalpilatesstudio.co.uk

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Posted by on Nov 10, 2013 in Anatomy & Physiology, Featured, Pilates | 0 comments

Stretching

Stretching

Stretching is a subject that evokes much debate, when to stretch, for how long and how are questions that often arise. There are three main types of stretching commonly used static/passive, pre contraction and dynamic. What type of stretching is best is dependent on many variables.

Static stretching is when a muscle is put into a position of stretch and then held. If this type of stretch is performed by a third party taking the weight of the limb and placing the muscle on stretch then this is referred to as a passive stretch, the type that might be performed by a clinician. Some research has suggested that if a static stretch is held for greater then 30 seconds no greater range of movement will be accomplished? Regardless of how long a static stretch is held, I personally would be more concerned about how the stretch was performed. During all stretching it is imperative that attention is paid to the position of the origin and insertion of the muscle as well as any compensatory movements elsewhere in the body and that if necessary props or supports are used to allow the body to settle into the desired stretch.

Over the last decade research has told us that static stretching prior to a dynamic movement like sprinting can be detrimental to an individuals performance as it has been found to reduce explosive muscular power, with some studies indicating that static stretching prior to such an activity is more detrimental then not stretching at all. The general advice for sports is to warm up the body using gentle dynamic movements mimicking the activity that is about to take place.

Pre contraction stretching is when a muscle is contracted prior to the stretch being applied. This is also sometimes referred to as proprioceptive neuromuscular facilitation (PNF) or hold relax. Like all stretching techniques there are varying suggestions of what works best, you can hold the contraction for anything between 3 – 10 seconds at a maximal voluntary contraction (MVC) of 20 – 100%. Personally, if I use this type of stretching as part of a rehab programme I tend to steer towards the lower MVC range of about 25% at 6 -10 seconds hold with up to 3 repetitions.

Dynamic stretching can come in two forms active and ballistic. Active dynamic stretching involves taking the muscle through its full range gradually, taking into consideration the dynamic forces through the rest of the body. Ballistic involves rapid movements often with end of range bouncing, this is generally considered a high risk type of stretch open to high injury rates due to the sudden aggressive nature of the stretch.

My preferred mode of stretch is the active dynamic approach encouraging the awareness of the base of support and the line of movement to its end point, gradually increasing the range as the body naturally gives to the resistance encouraging stability in the movement as well as length. Many of the movements that we perform in pilates could be deemed as dynamic stretching.

So should we stretch after physical activity? As a Physiotherapist & Pilates teacher I see first hand the results of what repetitive movements can do to a bodies function. For example if an individual sits all day at work all day and then runs regularly during the week, you may see a gradual shortening of the pectorals and hip flexors as both activities favour a flexion bias of movement. To prevent these imbalances developing its imperative that the joints and soft tissues are moved in a variety of different movement patterns at different times during the day.

Most people would probably agree that some form of stretching in our daily routines definitely helps to prevent muscle imbalances and joint stiffness from occurring, but ultimately educating the individual to be more mindful and postural aware of their daily movements should be our first priority. This to me this is where Pilates fits in perfectly as the movement education link between functional daily movements, leisure activities and injury prevention.

How to use stretching and its benefits can be validated by research but ultimately we need to look at the individual and consider their body type, daily activities, medical history, age and much more. So keep an open mind do some independent research and find the best method that suits you and your specific client, not one size fits all!

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Posted by on Jul 24, 2013 in Anatomy & Physiology, Featured, Health, Pilates | 0 comments

The Role Of Pilates In Helping People With MS

The Role Of Pilates In Helping People With MS

Multiple sclerosis (MS) is a neurological condition that affects the central nervous system. The nerves of the body are coated with a covering called the myelin sheath, in MS this sheath starts to break down effecting the messages carried from the brain. As a result symptoms can present in any part of the body.

shutterstock_93206032-e1374650845209-300x300More than 100,000 people in the UK have MS and it is most prevalent in women. It can be hard to initially diagnose as symptoms can be as minimal as a flicking eye

There are many symptoms of MS and no two people present the same. Therefore when using Pilates with MS clients it is essential that they are treated individually so a specific programme can be devised for them to get the best care.

Symptoms of MS can be:

  • decreased balance & problems walking
  • dizziness
  • fatigue
  • spasm & stiffness in muscles
  • altered sensation
  • difficultly with speech & swallowing
  • tremor
  • pain
  • difficultly with memory recall , planning etc
  • bladder & bowel problems
  • visual problems

The majority of people are diagnosed in their 20ʼs & 30ʼs after being refereed to a Neurologist. There are 4 main groups of MS:

  • Relapsing remitting MS – this is the most common form, where symptoms flare up aggressively then settle down again, this is known as a relapse.
  • Secondary progressive MS – after a relapse the presenting symptoms worsen and the disabilities can increase.
  • Primary progressive MS – disability with this form develops very quickly from onset of diagnosis.
  • Benign MS – infrequent mild attacks that are interspersed by long periods with no symptoms.

There is no cure for MS but there are a number of drugs that are prescribed to help manage the condition. It is also important for the individual with MS to have a holistic treatment plan combining diet, Physiotherapy, exercise and alternative therapies that can help manage their symptoms.

I have personally found that a Pilates based exercise programme introduced early on in the condition can help to reduce contractures in the muscles and help with balance and pelvic floor control. As the symptoms of MS are different from person to person it is essential that the client is assessed on an individual basis to begin with so all symptoms and function problems can be noted and a plan to address them is devised.

One of common presentations of MS is muscle hypertonia in which there is increased muscle tension, or tone as it is often known, which reduces the muscles ability to stretch.

This is the result of damage to the motor pathways in the central nervous system, which over time can result in a joints inability to function through range and cause joint pain.

In the early stages of MS increased muscle tone may not be present, if a Pilates based exercise programme is introduced at this stage it could help maintain muscle length & joint range. Often in Pilates we are encouraged to use touch to help stimulate a muscles function. However, with MS touch of a high tone muscle group would produce negative results. It is more affective to stimulate length in a tight muscle group from a distal point. For example if you were trying to open the hip flexors focusing on grounding the clients heel and creating a sense of space in the hip would be of more beneficial. Also passive positioning and using the breath to aid relaxation would be helpful.

On the other extreme is hypotonia where the tone of the muscle is reduced. In this case the muscle would benefit from tactile stimulus to help facilitate activation of the muscle group. stroking of the low-toned muscle from the insertion to origin is advised. This is where a strong understanding of functional anatomy is required to get the desired results.

If an MS client has an altered gait due to hypertonia or hypotonia they may benefit from a walking aid to prevent falls but also to reduce imbalances occurring. However, if they do have altered gait sometimes our role is to help them undo these imbalances during their session by positioning to prevent contractures occurring. In the lying position we can help place their limbs in a more symmetrical alignment that will assist with the rebalancing of the muscular skeletal system.

Challenging posture in different postural sets is also advised to help maintain balance perception. Getting the clients to work outside their base of support i.e. reaching forward and to the side while sitting is a very basic but functional exercise. The general education of postural positioning that we use in Pilates in different postural sets plays an important role in helping to maintain the MS clients proprioception & body awareness.

People with MS experience relapses which means that the disease is going through a period of flare up. It is important the Pilates teacher does not push their clients through these periods, but instead encouraged them to rest. After the relapse the client may present with worsening symptoms, its is therefore very important to review your exercise plan at this stage and to adapt accordingly. Working with this condition is challenging but also very rewarding.

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