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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 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 May 8, 2013 in Anatomy & Physiology, Featured, Pilates | 0 comments

Pilates & Total Hip Replacement

Pilates & Total Hip Replacement

A total hip replacement (THR) is a common orthopaedic surgical procedure. It is generally necessary when a hip is diagnosed with osteoarthritis by X-ray or MRI and the individual experiences persistent pain. The client will probably complain of pain in the groin radiating down the anterior aspect of the thigh sometimes also effecting the knee especially when weight bearing & gait. They also present with limited movement of the hip with rotation abduction & adduction.THR can also be performed following trauma to the hip resulting in fracture to the neck of femur or also with congenital hip formation.

Reason for THR:

  • Pain relief
  • Improved function & hip movement
  • Improved quality of life

Ideally it is preferable to assess a client pre operatively to gage their hip range of movement and general physical ability, however this may not always be possible.

Pre operatively the client could be taught posture, basic pelvic tilts, spinal curls, breathing and ankle mobility in sitting or lying.

Before the client is discharged from hospital – normally within 48 hours of surgery – a physiotherapist will ensure that they can walk with a walking aid and climb the stairs. They will also be given basic lower limb circulatory & breathing exercises to prevent clots, as well as quadriceps, abductor and gluteal exercises. Your client should have a booklet outlining these exercises for you to clarify the aims of rehab for the next 6 – 8 weeks post surgery. At 6 weeks the client will be reassessed by the orthopaedic team to determine if the scar and hip movement is healing sufficiently.

There are several movements the individual will initially be told to avoidto prevent dislocation of the new joint these are:

  • Hip flexion above 90 degrees
  • Leg adduction
  • Hip rotation

The aims of the pilates teacher is to continue to follow the rehabilitation guidelines by gradually progressing these movements to strengthen not only the operative leg but to create balance in the bodies function.

Aims: 

  • Strengthen hip abductors & extensors, quads.
  • Balance & agility
  • Gently increase hip flexion
  • Disassociate hip & lumbar movement
  • Create balance in lower limbs
  • Improve posture & gait

The hip will continue to improve over 6 -9 months after surgery but recovery is also dependent on the clients medical history, age etc.

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Posted by on Apr 7, 2013 in Anatomy & Physiology, Pilates | 0 comments

Common Sports Injuries – Part 3 – Shin Splints

Common Sports Injuries – Part 3 – Shin Splints

Common sports injuries – 3 parts by Mary Thornton BSc Hons MCSP HPC

Shin splints is a common term used to describe pain at the front of the distal part of the leg. True shin splints occurs on the medial aspect of the tibia (shin bone) and can occur due to many reasons such as poor mechanics of the foot or lower limb such as over pronation (flat feet), change of running surface or even undiagnosed stress fractures in the foot. These conditions can result in inflammation of the of soft tissues that connect the muscles to the tibia. Traction forces on these structures can then result in shin pain and inflammation.
It is a common complaint amongst runners and dancers and its symptoms can include:

  • Pain in the shin which can start with exercise but then eases or develops after stopping exercise.
  • swelling in the shin muscle.
  • bumpy sensation on the inside of the shin bone.
  • Pain on ankle movement.If you think you are suffering from shin splints rest and ice therapy will help to reduce the inflammation but also consult a podiatrist or physiotherapist who specializes in sports injuries to help determine the cause of the problem and address any biomechanics imbalances to prevent future episodes of the problem occurring.
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