Pilates and Posture: Kyphosis-Lordisis

One of the classic postural types is called Kyphosis-Lordosis. Characteristically, Kyphosis-Lordosis is a posture in which all the natural curves of the spine are exaggerated.

As seen above, the figure on the left side has increased the curve in the neck (hyper-extension), displacing his head into a forward position; notice the figure’s chin on the left is forward of his sternum, unlike the figure on the right where the head is erect and the chin is in-line with the sternum. In addition, the curve of the upper back (thoracic spine) on the left is more pronounced (increased kyphosis) and the shoulders are rounded forward. Likewise, the curve of the lower back (lumbar spine) is also exaggerated (hyper-lordodic). The exaggerated curve of the lumbar spine is accompanied by a tipped pelvis (anteriorly tipped).

In this set of pictures below, you can see the shape of the bones more clearly. Although the figures are facing the other direction from the figures above, you can compare the curves of the spine and position of the head and pelvis more clearly here. The figure on the right displays the ideal curves while the figure on the left displays Kyphois-Lordosis

So, what can be done in pilates to help offset this particular postural alignment?

First, you must understand what muscular imbalances are associated with this posture.

Because of the position of the head and neck, a small pad or other prop may need to be place behind his or her head during all exercises that are conducted on their back (supine). This will help to keep the head and neck in a more ideal posture. In addition, the individual may need to work in an imprinted position more frequently than in neutral. He or she may be able to eventually work in a neutral position as they become stronger.

Take a look, again, at the curve in the lower back. Notice how the muscles of the lower spine are shortened and the muscles on the front side (the abdominals are lengthened.) This individual will need exercises that encourage he or she to lengthen the tight lower back muscles and recruit the weak abdominals.

It is imperative that a student with lordosis of the lumbar spine, learn to use their abdominals to support their back instead of their hip flexors or hip extensors. In other words, often new students with a lordodic tendency (hyper-extension of the lumbar spine) try to use gluts (bum) or muscles in the front the hip to control their back. Because of this tendency to recruit the wrong muscles, they tend to remain unable to control their back even after years of trying to do “abdominal specific” work.

Here are a few exercises you can do to promote good balance of the abdominals, hip flexors and gluts and lengthen the lumbar spine.

First, Practice lengthening the lumbar spine correctly. Here the student is lying on their back with her legs relaxed over a pillow. She is gently elongating her back into the mat (you can slightly see how the purple waist band is tipped toward her belly button in the second photo), so that the curve in her lower back diminishes (i.e more of her low back touches the mat) . It is important to make sure that your abdominals are moving your back instead of your legs. Any gripping in your back muscles or legs indicates that you may not be finding your core muscles correctly.

sit-up:

Now, try to go into a sit-up position without gripping your legs and back. You are trying to keep your back from moving into a bigger curve (i.e. arch away from the floor.) Your movement may be very small. It is important that you train you abdominal muscles to bring your upper body off the floor instead of changing your lower back or using your legs.

Dead Bug:

Finally, see if you can keep your lower back lengthened on the mat (using your abdominals, like you did in the first exercise) and pick one foot of the ground without arching your back away from the floor. If this is too hard, imprint. Alternate legs.

It is also important to teach the upper back muscles (erector spinae) to learn how to extend the upper back. Take a look at the picture of the skeleton above. Notice how the upper back is rounded, this prolonged posture makes the upper back muscles very weak and the muscles on the front side of the chest very tight (the pecs). So, it is important that this individual learns how to move their back out of this curve, open their chest and work the weak upper back muscles.

Here are a few exercises you can do to promote extension of the upper back without creating unwanted hyperextension of lumbar spine:

Turtle:

Finally, because of the way the pelvis tips, the muscles in the front of the hip can become really short and tight. Conversely, the muscles on the opposite side (the bum and hamstrings) are really weak. Take a look at the little girl’s stance below. Because of the angle of her pelvis, you can see the distance between the front of her hip bone and thigh is very short.

Here is a good exercise to open the hip and, simultaneously, use the gluts and hamstrings:

Bridge

All of these exercises are best done under the supervision of a certified pilates expert.

Scoliosis and scapula

My name is Brigitte and I’m a certified STOTT PILATES instructor and massage therapist in Montreal. I have watched you over many hours while editing the rehab DVD series that you did (I edit from English to French). I find you very knowledgeable, inspiring and motivating and if I could, would love to just spend a few months with you to learn even more (something that right now is not possible but who knows what the future holds!). I’m writing to you because I’d like to have your opinion on someone I’m working with. I realize that you cannot make any diagnosis or give me the absolute answer regarding this client, however perhaps you could shed some light.

I’ve been working with a woman for over a year now, she has spondilolithesis (so she’s obviously quite kyphotic in thoracic and hyperextended in cervical), fused lumbar, with a slight scoliosis, winging right scapula. She has a lot less stability in right shoulder and scapula. I have been focusing on spinal extension and scapular stabilization. I also work her in seated, kneeling and standing positions to encourage recruitment of the spinal and pelvic stabilizers in a neutral position. My one issue that I have is this terribly winging right scapula. I make her do lots of rotator cuff work, I also do lots of protractions against resistance to work her serratus anterior. I work on the cadillac, doing mid, lower and upper trap work, often unilaterally. The upper fibers of her rhomboids and mid traps seem to be firing well. However her mid to lower area of her scapula is always winging at a certain degree, usually when her elbows are bent (ex: when they’re bent and at elbow height, or while side-lying and doing ext. rotations with ball – although this has improved greatly). I make her do certain things and think, wow, her scapula is flush and moving smoothly. Then I make her do something else and it totally pops right off. I’ve been trying to help by placing her against a wall, with elbows bent at 90 degrees, in line with her shoulders. I then get her to do external rotations, bringing her forearms to the wall. She has a much smaller range with her right side and sometimes cringes while attempting this (she has improved but still not to full range).

Is there anything else I could do, it’s just boggling my mind and I really want to help this woman. I know I already have but I’m stumped. I started to think that she has quite a few active trigger points which may be preventing her from getting that full range. Either way, anything insight you could give would be much appreciated. I hope to one day attend one of your workshops, perhaps when you’re a little closer to Montreal!

Thanks so much and have a great day!

Sincerely,
Brigitte

From Brigitte to Pacific NW Pilates