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Pilates for ScoliosisAzusa Miyake December 20th,2020Course year 2020Physio Logic Pilates & Movement NYAbstract This paper will address a general overview of Scoliosis and how Pilates helps an individual’s body and their condition with Scoliosis. Treatments for Scoliosis vary from bracing, surgery, pain management, physical therapy, and exercise depending on the severity of the condition. Most Scoliosis cases are mild to moderate which doesn’t require a surgery and a common treatment option is exercise. Pilates is known to be helpful in reducing chronic pain caused by Scoliosis. It is beneficial in counteracting the muscle misalignment, useful as a tool for assessing progress, and increases awareness of one’s body. In this paper, I would like to focus on how Pilates exercises are beneficial in reeducating one’s body to correct negative movements, increase flexibility and mobility for people with mild to moderate Scoliosis. This paper will conclude with a case study as well as my view on how Pilates can improve quality of life for people with Scoliosis.Table of ContentsAbstract Table of Contents Overview of ScoliosisCase Study BASI Block SystemConclusionBibliography Overview of Scoliosis3663950177800What is Scoliosis 42926001718945 Figure SEQ Figure \* ARABIC 1:Examples of different types of Scoliosis (Webmaster,TOCA.) 00 Figure SEQ Figure \* ARABIC 1:Examples of different types of Scoliosis (Webmaster,TOCA.) Scoliosis is a medical condition that involves an abnormal sideways curvature of the spine and it can affect any age group, from adolescents to adults. As seen in Figure 1, the sideways curvature is usually denoted as C or S and the degree of curvature is different for each condition. (Webmaster,TOCA)right1777365 Figure2: types of scoliosis (Scoliosis and Chiropractic Care) 0 Figure2: types of scoliosis (Scoliosis and Chiropractic Care) There are several types of curvature for Scoliosis that depend on the location of the curve. As seen in Figure 2, there are five different types of Scoliosis. When a curve is seen in the lower spine area, it is called Lumbar scoliosis. Additionally, when the curve is seen in the middle of spine, it is called Thoracic Scoliosis and it is the most common right0condition. When a patient has an abnormal curve in lower thoracic and upper lumbar spine, it is called Thoraco-lumbar Scoliosis or Combined Scoliosis.(Scoliosis and Chiropractic Care)The cause of Scoliosis: If the cause of Scoliosis is unknown, then it is called Idiopathic Scoliosis. However, it is generally believed that the main causes of Scoliosis are either genetic or environmental. Although, most Scoliosis cases are Idiopathic, some cases are congenital, caused at birth, in which a bone in the spine grows abnormally. If Scoliosis is caused due to other diseases, then it is categorized as neuromuscular Scoliosis. Signs and Symptoms: The symptoms of Scoliosis differ depending on the severity of the condition, but the most common symptom is an abnormal curvature of the spine. Other noticeable symptoms include an uneven shoulder, uneven waist, or one hip higher than the other as well as a limitation in mobility around spinal area. Scoliosis can cause chronic pain in different parts of the body and it affects the way an individual walks and stands as well as other functional movements depending on the severity of the condition. In some severe cases, the curvature of the spine affects the vital organs and may lead to other health problems such as heart and respiratory related issues. If the curvature of the spine is not severe and it is relatively small, symptoms can be mild enough to not require treatments. Again, signs and symptoms can be vastly different depending on people.43878502857500 Figure 3: measurement of the cobb angle(An Integrative Framework for 3D Cobb Angle Measurement on CT Images)0 Figure 3: measurement of the cobb angle(An Integrative Framework for 3D Cobb Angle Measurement on CT Images)Diagnosis 4476750617855: Scoliosis is diagnosed through a Spinal X-ray. X-rays will show the severity and the progression of the Scoliosis by measuring the Cobb angle. The Cobb angle is the most common way of measuring Scoliosis. As seen in Figure 3, the Cobb angle is a quantitative measure of the curvature between the two most titled vertebrae— depicting the extent in which the spine is not straight. If the Cobb angle is greater than 10 degrees, then it is diagnosed as mild Scoliosis. Conditions with the Cobb angles greater than 30-45 degrees are considered as moderate. If the angle is over 45 degrees, it is diagnosed as a severe Scoliosis and generally requires a surgery. People with the Cobb angles more than 60 degrees typically have respiratory issues and visible physical symptoms such as deformities. Depending on the severity, further examination such as an MRI or CT scan can be conducted for potential disc degeneration.Treatment: Treatment options are determined by a doctor depending on the curvature of the spine, type of Scoliosis, and other medical conditions. Some forms of mild Scoliosis might require no treatment, but the potential progression of the curvature must be monitored closely. The following three options are the most common treatments for Scoliosis: bracing, surgery, and exercise such as Pilates.Bracing: Bracing is not effective for adults since they are at full skeletal maturity. Conversely, bracing is normally recommended for adolescents who have yet to reach their skeletal maturity and have a Scoliosis condition that might get worse as they grow or is already rapidly progressing. Normally, bracing is suggested if the Cobb angle is greater than 10 degrees and less than 25 degrees. Scoliosis curvature may not be fixed through back bracing but bracing helps to keep the Cobb angle small and prevent having to undergo surgery in the future. The aim of bracing is to slow down and stop the progression of the spinal curvature. Surgery: Severe cases with a large Cobb angle over 45 degrees usually require surgery. In these cases, bracing is not feasible, and the spinal curve will most probably get worse. In order to stop progression of the curve and reduce spinal deformity, surgery is the most efficient way to treat the condition. Depending on the case, more than one surgical procedure might be needed. There are different types of surgery such as spinal fusion surgery, fusionless surgery, and thoracoscopic surgery. The approach and surgery type are determined by a doctor.Exercise such as Pilates: Pilates will be a great aid in the treatment of Scoliosis if exercised correctly and regularly. Mild Scoliosis typically does not require any treatments but if a patient is experiencing pain or discomfort due to their Scoliosis condition, Pilates may help to reduce pain and minimize symptoms. There is no scientific evidence that Pilates cures Scoliosis, however it is praised for being effective in strengthening the core muscles, promoting postural reeducation, and increasing one’s flexibility which are all helpful for people with Scoliosis. The key is continuous exercise that focuses on specific muscle groups specified for their Scoliosis condition and avoiding contradicting movements that place too much pressure on one’s spine and neck. For example, any spinal articulation exercise must be performed very carefully. Learning effective breathing techniques such as lateral breathing during exercise can also assist a person with Scoliosis.?Modification of one’s exercise might be made depending on its personal conditions as well. (Scoliosis Treatment, Causes, Symptoms & Surgery.)Case StudyChihiro Miyake, age 27, Female with functional Scoliosis (Pilates experience 3 years)Her Symptoms?and Scoliosis condition: She has chronic shoulder pain and migraines from her stiff neck that is a result of her mild Scoliosis. Within her trunk area, her left side muscles are weaker than her right side, and, due to her imbalanced muscles, the difference of curvature around her torso is visually noticeable. Additionally, her uneven hips and shoulders are also recognizable if observed carefully, and her right hip socket pops occasionally. Her left shoulder is higher and she has a habit of slouching due to her occupation requiring long hours of desk work. Based on her X-Ray results conducted by a chiropractor, she has functional Scoliosis. The recommended treatment plan was getting a physical therapy massage to release her tense muscle as well as daily exercise such as Pilates. Her goal:?Her goal is to work on her muscle imbalance caused by her condition and increase the mobility of her lumbar spine. When working on her abdominals, she needs to target her left core strength. Deepening her understanding of her own muscle structure and work on her muscular imbalance caused by Scoliosis also helps her to observe her condition and progress. Her results after 6 months of continuous practice:Chihiro worked through the BASI Block system given in this thesis for 6 months. When performing Side lift and Side kick, Side kick kneeling series on mat, it was obvious that she was struggling with her left side more and had less general stability, so we focused on her left side more and worked on increasing strength of abdominals. Once we strengthened her non-dominant side, her dominant side also improved. As we focused on using her muscles equally and worked extra hard on the core strength of her left side, her muscle imbalance around her trunk area was reduced and the curvature of her torso was more even. Additionally, she needed to work on increasing her limited flexibility of her spine. This could be observed in her struggles to perform exercises such as Rolling like a ball, Open leg locker, and Seal Puppy which require abdominal strength and spinal flexibility. I could see that she needed to work on flexibility on her lumber spine area in order to hold herself stable and maintain stable C curve. With a tactile que that reminds her to focus on squeezing her abdominal and keeping C curve, her balance and stabilization improved. After 6 months of consistent practice, she had less pain in her neck and shoulder. More importantly, she was pleased to see improvements in her muscle usage and flexibility. She also experienced subtle changes in her body which encouraged her to continue practicing Pilates. Besides practicing Pilates, she paid attention to work on her habits and functional movements. She stopped crossing her legs with right leg over left, standing on one leg, carrying a bag on her right shoulder. Pilates worked as a great tool to assess her own body.BASI Block SystemBASI BLOCK SYSTEMEXERCISEEXPLANATION ASSESMENTRoll downThis roll down is used to assess alignment and posture. Instructors can view Plumb line from the side, front, back to check a client's body. WARM UPMat: -Pelvic Curl -Spine Twist Supine-Chest Lift-Chest Lift with Rotation-Leg changes Warm up exercise that is perfect to work on neutral pelvis and neutral spine. Feeling both sides of pelvis being even on the floor helps to bring awareness of Scoliosis condition as well. FOOT WORKReformer:-Parallel Heels, Toes-V position Toes-Open V Heels, Toes-Calf Raises -Prances-Prehensile-Single Leg Heel, ToeSince foot work requires lying supine in a neutral position throughout the exercise, clients need to maintain trunk and pelvis stability which helps in correcting Scoliosis condition. Medium to heavy springs are recommended. ABDOMINAL WORKReformer:-Hundred Prep-Hundred-CoordinationCadillac:-Roll up with RUB-Mini roll upsAbdominal work is essential to correcting muscle imbalances around the trunk area. This will reveal which side of one’s oblique is weaker and needs more strength. Building better core strength helps to maintain pelvic lumbar stability as well. Better abdominal strength means better pelvic lumbar stabilization. HIP WORKReformer:-Frog-Circles up and down-OpeningsCadillac:-Hip Extensions-BicycleThe key for Hip work exercise is to keep both sides of body working evenly. During hip works on the reformer, a client needs to maintain both pelvic stability and avoid hip disassociation. Movements do not need to be big. SPINAL ARTICULATIONMat:-Rolling like a ball-Spine stretch Cadillac:-Tower Prep-TowerClients with Scoliosis need to be careful with any spinal articulation work. Avoid putting too much weight on one’s neck and shoulder and modify the exercise if needed. Clients with Scoliosis tend to have tight hip extensor so Tower -prep and Tower exercise will allow hip extensor to stretch and helps with spinal articulation. STRETCHESPoles:-Shoulder Stretch -Overhead Stretch-Side Stretch-Spine Twist These Pole series are for clients of any level and they can be performed either standing and sitting. This will allow clients with Scoliosis to stretch and lengthen their spines.FULL BODY INTEGRATION 1Reformer:-Elephant-Scooter-Reverse Knee Stretch These full body exercises are great for clients with Scoliosis as they can work each side of their body while using abdominal as one. Clients need to also focus on hip disassociation.ARM WORKReformer:-Chest Expansion-Biceps-Rhomboids-Hug-A-Tree-SaluteArms sitting series are a great assessment to observe which arm is stronger. This sitting series especially reveal a client's muscle imbalance. Instructors can check if the rib remains stable and not shifting one side. FULL BODY INTEGRATION 2Not addressed at this time N/ALEG WORKWunda Chair:-Leg Press Standing -Hamstring Curl -Frog FrontThis leg work is all about stabilization, control, and balance. Maintaining a stable pelvic position and trunk can be challenging for clients with Scoliosis. However, it is also a great way of building better balance and stabilization. LATERRAL FLEXION/ROTATIONWunda Chair:- Side stretch - Side kneeling stretch This side exercise is beneficial for strengthening each side of one’s obliques independently. BACK EXTENSION Mat:-Back extensionCadillac:-Prone 1-Prone 2Back extension on a Cadillac helps a client to keep correct alignment of the spine by using the PT bar. It is also helpful to observe which side of back muscle is stronger than the other. ASSESMENT Roll downThis roll down allows students to feel how their body changed and focus on alignment as they end a session. Conclusion Pilates is neither a cure for Scoliosis nor a quick fix exercise. However, it does help in reducing chronic pain, improving muscle recruitment, decelerating the progression of the curve, and, more importantly, bringing awareness to one’s body. Once you are aware of your posture and habitual movement patterns, it will also change the way you move and function in daily life. In order to maintain better health including a healthy spine, muscles, and joints, constant Pilates practice is the key. Pilates has great benefits as it deals with the whole body. Approaching “whole” body is important as it brings general balance to the body. Lastly, better alignment and greater range of motion as well as less pain and injury will lead you to a better life. Pilates will bring not just physical improvements but mental improvements as Joseph Pilates says, “Mind, Body, Spirits”.BibliographyWebsite:Webmaster, TOCA. “What Is Scoliosis, Causes and Treatment Options.” TOCA (The Orthopedic Clinic Association), 13 June 2017, . Scoliosis and Chiropractic Care | Tuckahoe Family Chiropractic. . Accessed 20 Dec. 2020.Huo, Xing, et al. “An Integrative Framework for 3D Cobb Angle Measurement on CT Images.” Computers in Biology and Medicine, vol. 82, Mar. 2017, pp. 111–18, doi:10.1016/pbiomed.2017.01.007.Scoliosis Treatment, Causes, Symptoms & Surgery. . Accessed 20 Dec. 2020.Books:Rael Isacowitz, Karen Clippinger. Pilates Anatomy. Human Kinetics 1, 2010 ................
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