Ideas for working with a spinal fusion

This question was emailed to us, and we thought others might be interested!

Hi Leslie,

I have a client who is 25 and has two metal rods in her back, one on each side of her spine because of terrible scoliosis. She is not very mobile because of the rods, she can manage imprint and neutral but can only do extremely limited flexion and extension. The muscles in her lower back are obviously imbalanced, very strong on her right side and almost non existent on the left. What would you suggest for helping balance out her core strength considering her lack of mobility? Thanks so much!
Erin Whipp

Answer from Leslie Braverman:

Hi Erin:
Nice to hear from you. I hope things are going well!
 
Oooh, I have worked with a few clients that have had metal rods put in their back, and there is a lot you can still do.
 
My suggestion is to continue moving her spine only gently through ranges- mostly keep her neutral, but try to do as many things that challenge her torso strength as you can. Contralateral arm and leg work will be excellent, as well as doing things that challenge weight distribution and proprioceptive awareness. Here are some ideas:
 
1.) Sitting back and front rowing (on a box or platform if necessary to sit in neutral). Do one arm backrowing work preps to get the weaker side stronger. You could even sit her on am unstable surface (ie. a wobble cushion) to build spinal control and learn to control rotation.
 
2.) Side lying work will be excellent. One leg kick, side leg lift series- prop her hip on a small ball to build more strength on an unstable surface as she progresses. Make sure to keep her spine in neutral and avoid rotation or lateral flexion. Do more reps on the side that is weaker.
 
3.) Plank position exercises – push up, leg pull front- add things on a ball.
You can also do plank based exercises against a wall too- standing on a BOSU and/or with two small balls under her hands- again to challenge spinal control and build awareness of body in space. Add contralateral arm or leg work to build strength on one side of the back more than the other.
 
4.) Waiters bow- elephant position- (on or off reformer- use ligher weight) with one arm on the bar instead of two. or just practice going into waiters bow while standing on the floor and reaching one arm up by her ear- standing up with that arm by her ear will work her erectors and deep paraspinals on that one side, as well as challenge rotation and build glut strength.
 
5.) Contralateral prone work without extension- ie. swimming preps
 
6.) Standing on one leg while doing arm work, while high level, will help her build up strenth on one side more than the other.
 
Hope this helps and gives you more ideas. Let me know if you have questions. I can leave out your name if you like too.
 
Thanks Erin! Good luck.

Happy hamstrings: What is the best way to stretch?

Having good hamstring length is important for all athletic endeavors and to comfortably do regular every day activities; to bend over to tie your shoes you will need elongated hamstrings. Without lengthened hamstrings, undue stress and strain may occur in the back, hips and knees.

Commonly, people know static stretches to build passive hamstring length. An example of static hamstring stretching would include lying your back while your instructor holds your leg in the air.

 

This photo illustrates a static stretch for the hamstrings using a wall to support the leg rather than a person

 

Static stretching will encourage the muscles to relax in order to create elongation, however, because the stretch is done passively, it may create an imbalance with the opposing muscle groups, make the muscle less sensitive to neural messages sent to the it by the brain, which diminishes its’ ability to generate force, and reduce blood flow in the stretched muscle. Therefore, static stretching is not considered a wise way to stretch prior to strenuous activity; a static stretch should only be held for 6-30 seconds, and should be done only preceding a gentle activity.

 

A dynamic hamstring stretch, conversely, involves actively taking the muscle in and out of a stretch. Since good flexibility is specific to body position and speed, a dynamic hamstring stretch will lengthen the muscle, but also prepare it for quick, ballistic and/or explosive activity. Consider when a soccer player kicks a ball or a martial artist kicks an opponent, he or she requires long muscles that can respond quickly in a variety of positions. In addition, since dynamic stretching increases blood flow to the muscles, it is an ideal way of stretching to prepare the muscles to be able to lengthen during a variety of situations- from playing sports and to doing other daily activities as gardening or picking up heavy objects. Training your hamstrings to stretch dynamically can greatly diminish the risk of tears and other injuries.

There are numerous exercises on the pilates reformer that can be used to dynamically lengthen the hamstrings. Here are three great exercises that can help you create long, strong and responsive hamstrings.

Feet in straps:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The back is stable against the carriage using the abdominal muscles, and all the muscles of the legs are active (gluts, hamstrings and quadriceps) to maintain the extension of the knees and to create resistance against the straps. When the legs are brought towards the body, the hamstrings are elongated, but the opposing muscle groups are active and the spine and pelvis are stable. This exercise begins slowly and can progress to a faster pace (still with control), 8-10 times.

Elephant:

During elephant, the gluts and hamstrings actively work to press the carriage out, simultaneously, the spine is supported in a neutral position. Then, the carriage is pulled in by using the hip flexor muscles. Notice that the upper body remains completely stable while the movement occurs at the hip joint, as if it were a hinge. This exercise begins slowly and may progress to a quicker pace (still with control), 8-10 times.

Front Splits standing on the floor:

 

 

 

 

 

 

 

In this exercise, the front leg is straightening to push the carriage out and bending to pull the carriage back in. The quadriceps are working to straighten the knee creating a hamstring stretch, then the hamstrings are working to pull the carriage back in. This exercise begins slowly and can progress to a quicker pace (still with control), 5-8 times.

All of these pilates exercises should be executed under the guidance of a certified pilates instructor.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to do quality pilates when you’re on a budget

Given the current economic climate, it is not surprising that people are having to cut back on their pilates lessons. It’s also not surprising that gyms with pilates programs are having to cut back on their programming. So, what can you do to keep in pilates shape and watch your wallet?

You could select a DVD or find a workout online that you like, but the problem with that is you don’t receive any feedback about how you are doing the exercises and with pilates, feedback is paramount!

Instead, find a reputable instructor in your area (see my recent blog about finding a good pilates intructor) and ask he or she to select a Pilates DVD that is appropriate for your fitness level. Then purchase a small package of private lessons with that instructor in order to work on the exercises highlighted int he DVD. Especially if you have an injury or other special condition, it may be really important to make sure that your pilates technique is being evaluated; in some cases, your instructor may suggest that you omit certain exercises that are taught on the DVD.

Over the last several months, some of my students have chosen this option when they didn’t have the financial means to come to the studio every week. This method has also worked well for students that travel alot. In some cases, these students have continued to supplement their training with group classes while others have simply worked at home and then come in once a month to get their routine changed and their technique reassessed.

This solution requires discipline, but it can be an excellent alternative to getting out of shape or losing interest in your workouts when money is tight. Ask your instructor to provide challenges for you to meet and things for you to work on by the next appointment.

Another idea is to look for studios in your area that offer lessons with Pilates apprentices. These are pilates teachers-in-training that have completed all their course hours but have not completed their examination. In many cases, these students will teach you privately at a highly discounted rate, and they are often observed by a seasoned professional. Check out pilates centers in your area that train students to become certified instructors and offer this as an option.

Here is a link to STOTT PILATES Licensing Centers located throughout the world:

http://www.stottpilates.com/education/centers.html

Each of these locations has an Instructor Trainer available. Licensing centers train students to become STOTT PILATES teachers, so these are some of the most elite studios in the industry, and many of them offer discounted lessons with apprentices.

If none of these locations are convenient for you, check out the Instructor Finder search for other certified STOTT PILATES instructors that are near your area at:

http://www.stottpilates.com/finder/infosearch/infocustomerconfirm.lasso

Good luck!

What, exactly, is “the core?”

It’s surprising to me how common the term, “the core”, has become. I hear people talk about it all the time. “I’m going to pilates to work on my core,” or “I think my core is really weak.” But, what exactly is “the core?”

Specifically, “the core” is describing the joints (articulation of two bones), ligaments and muscles that stabilize the rib cage, middle and lower spine, sacrum and pelvic region. When we exercise, “the core” refers primarily to the muscles that control or stabilize this region.

Imagine your trunk, specifically the region from your ribcage to your pubic bone, as a three-dimensional cylinder. If you wrap a large sheet of paper around your trunk, you would have the sides of the cylinder. Then imagine, if you could put a top on the cylinder just under your rib cage and a bottom on the cylinder underneath your sit bones and pubic bone (as if you were sitting on it.) This is the area that is your core.

The core muscles around this region need to co-activiate in order to create and maintain intra-abdominal pressure. That’s seems technical, but mostly what it is saying is that all the muscles in this region that are close to the bones need to work together to create the right amount of pressure to create stability in the trunk. This stability is important because without it your joints and discs are allowed to move too much. Too much movement at any particular joint will create unwanted sheering and will not allow the loads of weight bearing and movement to be transferred between the trunk, pelvis and legs effectively.

Now, imagine you are a long distance runner and every time you move your legs to take a stride, one or two parts of your spine move more than the other parts. In essence, you “give” too much at one or two joints thus creating a lot of friction and sheering at these regions. Over time, these joints will begin to break down, and you may end up with spinal degeneration (i.e. facet syndrome, spinal stenosis, degenerative disc disease).

The primary muscles of your core (that make up the imaginary cylinder) are the pelvic floor (the bottom of the cylinder), the transversus abdominis (the front and sides of the cylinder), the diaphragm (the top of the cylinder), the multifidis (the back of the cylinder) and some of the deep fibers of the psoas muscle.

Learning how to use these muscles correctly during exercise will help develop your core strength and minimize injuries to your spine and pelvis. Cool, huh?

Stay tuned for more information about core stabilization and exercises that help you strengthen it most effectively!

Your expert opinion is requested

This question was sent and responded to through email, but we thought others might be interested!

Hi All-Knowing Pilates Instructors-

Hi Lulu!
How are you doing? Snowed- in? This is just WRONG in Portland.

Anyhow…as you know the new V2 Max Plus™ is awesome! The all- in- one unit is definitely great for a small space. That said, the STOTT PILATES® cadillac is a great piece of equipment too. Here are a few things to consider:

The V2 Max Plus, overall, is a little bit bigger than the Cadillac. (30 in. wide x 97 in long x 16 tall- from the floor) versus the cadillac (36 inches wide x 89 in long x 25.5 tall-from the floor).

You gain many new exercise options with the V2 Max Plus that you couldn’t, otherwise, do with just the Cadillac and STOTT PILATES Reformer. Also, I believe, many of these exercises are more functional then the Cadillac exercises that you will be missing.

You can do the majority of the Cadillac exercises on the V2 Max Plus minus the hanging exercises and the trapeze work. Keep in mind, the hanging exercises (walkover, for example) cannot be executed without high ceilings. Overall, I think you would find that you can do many more V2 Max exercises with ALL your clients then the Cadillac exercises that use the hanging bars.

So, I guess if it were me, I would purchase the V2 Max Plus and another Reformer instead of 2 Reformer and a cadillac.

Hope that helps. Let us know when you are purchasing equipment, we may be able to get you a better price. Carole can help you with the order. Also, let me know if you would mind if I posted your question to our blog- I think others might find it helpful- thanks.

Response from Lulu Blake:

Leslie,

How do I work with someone with scoliosis?

From Melanie Byford-Young

Hi Jeff,
Great questions about your client.

How to work with prenatal clients

• This question was sent and responded to through email, but we thought others might be interested!

Hello ladies!

I am beginning to teach both mat and reformer to a woman 6 weeks pregnant. With her last child she did not do any physical exercise because she was afraid of miscarrying. However, she would like to try Pilates once a week throughout this pregnancy. Can you give me some tips to use when working with her? Also, she hasn’t done Pilates for the last month and is worried that since she has been “out of practice”, starting up again will be like starting a new exercise program–which is not recommended in prenatal books. I assured her that this would not be a problem, but she would like the official word from the experts at PNWP.

Thanks so much!

Answer from Jean Leavenworth:

Hi there-
I am curious why she stopped exercising completely during her first pregnancy. Was she at risk for miscarrying? That is something to find out as it could still be an issue, and I would highly recommend that she is released by her physician to work with you during this pregnancy and that she is given permission to work with you through each trimester; the first trimester has the highest risk of miscarriage, so it is important that she has been cleared for exercise.

General contraindications during pregancy:

1.) no inverted exercises e.g. rollovers, short spine, etc

2.) no extreme stretching due to lax ligaments, especially side splits!

3.) Prone exercises may be uncomfortable due to breast tenderness and after the first trimester will need to be replaced by a quadruped position.
after 20 weeks, work in an inclined plane instead of supine (use arc barrel, spine supporter or similar device to keep upper body elevated)
be cautious about over-exertion or letting the body get over heated. Strengthening the core muscles will be very helpful to prevent excess lordosis during the pregnancy and it may help during the delivery process too.

4.) Pelvic floor exercises are great, but emphasis should also be placed on learning how to relax and release the pelvic floor too.

5.) side lying leg work is great to strengthen the abductors–use a pillow under belly as pregnancy progresses.

6.) arm work and upper body strength is important to prepare the new mom for carrying the baby around and all the other heavy baby stuff!

7.) Check for any changes in the diastus recti. If it separates during pregnancy, then extra care will need to be taken post-partum to avoid increasing separation of the rectus muscle. Flexion should be avoided or any other exercise that causes the diastus to increase. Strengthening the TA while keeping the spine neutral is optimal for healing the herniation.

Let me know if that makes sense!
Best wishes-
Jean

Pilates and Lymphedema

This question was sent and responded to through email, but we thought others might be interested!

Hello,
I am a Peak Pilates Certified Trainer in Bradenton, Florida. I have a client that has severe lymphedema and I would like to train her. Her arm is always swolen and she generally has 2-3 infections per year. I am not able to attend you Breast Cancer class but would be interested in purchasing the materials, perhaps. I look forward to hearing from you.

Patty McIntosh

Answer from Melanie Byford-Young:

Hi Patty!
Pilates can be an excellent approach to help her general health and lymphedema. There are several main things that you need to know and keep in mind.
1) Make sure you get clearance from your client’s physician before beginning any exercise program.

2.) wearing her compression garment is a great idea, especially at the beginning, or until you know how she is going to react to the activity.
3.) Diaphragmatic breathing can help stimulates the pumping of the lymphatic system, which will hopefully help with her swelling. Adding lymph massage throughout the session can be very useful if she or you know how to do that.
4.) You do NOT want to overwork the arm! It is suggested that you begin with breathing and some abdominal work to help stimulate the lymph system, then do some leg work; then start some arm work moving the proximal muscles/ joints first, then progressing to the more distal muscles and joints, and then to return to the proximal/ shoulder muscles to help get blood and lymph moving and clearing from the arm. Follow this up with more abdominal and breath work. You can repeat these steps throughout the workout. Minimally, start with the trunk, and then alternate between leg and arm work so as to not overtax the affected arm.
5.) In the past, women with lymphedema were told to never lift anything heavier than 10 pounds. This advice has changed recently, and experts suggest beginning with very light resistance and progressing very slowly. There is a great website www.lymphnotes.com where you can do some more reading on the topic.
6.) You always must consider whether your client has osteoporosis because of her treatments. If there is any concern that she may have decreased bone density, avoid all inverted positions, avoid thoracic flexion and avoid combined flexion and rotation. If she has osteoporosis in her hips, avoid full compression of the hip in a flexed position. If her wrists are involved, then avoid weight bearing through the wrists. Make sure that you include balance work to help prevent falls and fall related fractures. Again, make sure her physician has given her approval and that there are no special exercise modifications to take into consideration.
I cannot take the credit for putting together the STOTT PILATES® Breast Cancer workshops and DVDs, another team created them. The mat and equipment DVDs are excellent and provide a very good introductory preamble,as well as a well balanced exercise program. You can order them on line at www.stottpilates.com or call 1-800-910-0001.
I hope this helps you out. Good luck to you !

See a pelvic rotation? Check out the tensor fascia latae.

Hello all!

I have made an interesting discovery lately with two of my students. I thought others might have had similar experiences, and I would love to hear more about what you think!

I work with one gal that has a clockwise pelvic rotation. She has a history of left knee pain and burning along the peroneal nerve on the same side. In addition, her left femur is medially rotated. She believes that some or all of this may be attributed to a ski accident over 20 years ago.

At any rate, over the last month, we (she and I) have made an interesting discovery. It seems that most of the rotation and pain in that leg is due to the fact that she constantly grips her left TFL (tensor fascia latae) and possibly iliacus.

So, we discovered that whilst pushing out in from the bar in footwork she grips in her hip (thus medially rotating her hip and causing the clockwise rotation) instead of using her adductors or quadriceps on that leg. It is really interesting. Even when lying supine with her knees bent and a fitness circle or ball between her knees, she uses these muscles instead of her adductors! As soon as she stops doing it, her pelvis looks symmetrical.

Then, I realized that I had another student that was doing the same thing, and believe it or not, the same results occured. It is really exciting.

I would love to hear if anyone else has had a similar experience.

Leslie

STOTT PILATES® Intensive Reformer in Sun Valley

I just got back from a lovely two weeks in Hailey, ID teaching a STOTT PILATES® Intensive Reformer course at Lisa Jenner’s Pilates Studio. I drove to Idaho from Portland with my two dogs and my camping gear, and while it was a long drive, I am so glad I decided to camp. Not only did my dogs have a great time, but I got to discover just how beautiful the wilderness is around Hailey and Sun Valley. Here are a few photos of my time in Idaho.

Lisa has a beautiful studio in Hailey in the Gateway Building. It was fun working in such a beautiful space with such great students too. Everyone worked really hard, but also had a lot of fun!

Osteoporosis & Pilates

This question was sent and responded to through email, but we thought others might be interested!

Hi Pacific Northwest,
This is Christi Tuck from the YMCA in Colorado Springs. I thought I would run this question by your studio since over the years we have had your instructors come out to the Springs to do our CEC’s. Anyways, I have a client that was recently diagnosed with osteoporosis of the spine and osteopenia of the hip. I have done quite a bit of research regarding safe exercises for her, however I am still not sure about backward flexion, e.g. backrowing roll-down on the reformer … I know to avoid all forward flexion and lateral flexion. Her doctor said minimal spinal rotation with no resistance would be okay. Any thoughts on the backward flexion??
Thanks for any information you can provide. Have a great holiday weekend.

Sincerely,

Christi Tuck

Answer from Leslie Braverman:

Hi Christi:

This is a great question!

The conservative approach is to omit all flexion and rotation from a client’s workout. Unfortunately, most normal people have to conduct some flexion and rotation in their daily lives, so, in my opinion, it is a good idea that they know how to do these movements appropriately and without alot of loaded compression. Practically speaking, an individual will have to do these movements but should be educated to know what is appropriate for the overall health of their bones.

The thing I try to do is to make sure that the flexion and rotation is never in a loaded position and is done minimally during a workout (i.e. with lots of exercises that include extension and neutral spine spaced between.) Loaded flexion includes ANY inverted work. I would make certain never to do any roll over, short spine type of exercises. Especially because the thoracic spine can fracture easily, you want to make very sure that you omit these kinds of exercises—easily done. This is, of course, something to keep in mind when working in a group setting, also, when you don’t know all the students or their history very well.

In addition, you may need to be cautious with other types of loaded rotation or flexion that uses alot of spring tension or sends a great amount of loaded compression through the spine (I would be careful with things like stomach massage and elephant in a round back position). Also, exercises that combine flexion and rotation in one should, generally, be omitted (i.e. saw, stomach massage with twist etc.)

Do your best to keep your client working in neutral positions as much as possible. As an important aside, loading the bones in other ways would be great and makes Pilates a safe and effective tool for bone building! (i.e. footwork, jumping on the STOTT PILATES® jumpboard, armwork with the spine in a neutral position) all of these types of exercises are going to help your client to build bone without stressing one particular area of the spine too much. Good for you…. being a smart and inquisitive instructor!

I also hope that Melanie and Jean will put in their two (or three) cents!

I hope you are well…all my best to everyone in Colorado Springs.

Leslie

Reply from Christi:

Hi Leslie,
Thank you so much for your quick reply. Your information was invaluable and it also helped confirm the changes I have made to her workout. We had a private session on Friday with omitting the exercises you have mentioned with a main focus on staying neutral. She attended my reformer class yesterday so I was able to ask her how her body responded with the changes we made and I am pleased to say she felt great. Fortunately, she has been doing pilates for a while so her mind/body focus is wonderful. I am happy to hear that you think the jumpboard is a good option because she enjoys it. Thanks again for all your information.

Sincerely,

Christi Tuck

Flat abs without back pain

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Melanie:

What are some good ab exercises that I can do without hurting my back? Do you have research to support these ideas?

Hello,

The most beneficial way to strengthen your abs, flatten your stomach and not hurt your back is to do abdominal exercises that encourage proper recruitment of the spinal and pelvis stabilizing muscles: the pelvic floor and transversus abdominis muscles. To do this, you need to understand how to “recruit” these muscles (in lieu of using other muscles, which is common) and how to tell if they are staying “on” (instead of using those other muscles) while you complete abdominal exercises.
The transversus abdominis is the deepest layer of abdominals. It does not, by design, create movement. Instead, it creates stability for the spine and flattens the abdominals. It is important to make sure that while exercising the transversus abdominis, it is pulling in and flattening sideways (the fibers run horizontally around the trunk like a corset).
These muscles work best when the pelvis and lumbar spine are placed with the natural curve in the lumbar spine (i.e. when the back is not flattened into the mat) and the back muscles are not gripping.

There are several basic exercises one can practice to find the pelvic floor muscles. Since the pelvic floor muscles attach to the underneath side of the pelvis (these are the same muscles that control urination) they are felt easiest by sitting on a ball and gently bouncing up and down or by folding up a small wash cloth and sitting on it. These devices give some feedback for the individual.

To strengthen these muscles, gently connect these muscles by thinking of lifting them upward slightly. (It should feel like the same muscles that work to keep you from urninating.) It is important to be able to gently lift them for a count of 5, hold them on for a count of 5 and release them for a count of 5. They should not be working at 100% but closer to a 25% level.

Transversus should become active just prior to incorporating other muscles. When the transversus abdominis is recruited properly, you see a flattening or drawing in of the lower abdomen without any noticeable movement of the spine or hips.
To get the look of a flat, strong abdomen, you need a variety of different exercises in your routine. Some include:
1) Challenging the spine in neutral (plank, head and shoulders on the ground) ensuring the spine remains as it starts throughout the exercise
a. Toe taps
b. Dead bug series
c. Scissors with head down
d. One leg circle
e. Push ups
f. Leg pull front
2) Flexion routine- ensure that lower abdominals are set prior to and throughout the motion
a. Roll up
b. Obliques with single leg stretch
3) Extension based exercises- keep abdominals lifting up
a. Swan dive
b. Swimming
More info about the transversus abdominis:
1) acts as a corset, drawing in circumferentially as it protects the spine
2) stabilizer of the lumbar spine by virtue of:
- insertion into the thoraco-lumbar fascia, which inserts into the vertebrae,
- its neurological firing pattern (fires before movement begins so that the spine is protected and prepared
- coordinated work with the other stabilizers including the pelvic floor muscles, diaphragm, deep psoas, and multifidus
3) creates motion around the proper axis of motion, and prevents unwanted shearing or translation of the vertebra which can lead to irritation and degeneration of the discs and facet joints
4) provides compression (in a good way) so that the larger muscles have a stable base to pull from
REFERENCES:
1. Lee, Diane: The pelvic Girdle, Third Ed. Edinburgh, Churchill Livingstone, 2004
2. Richardson C, Hodges P, Hides J: Therapeutic Exercise For Lumbopelvic Stabilization: Motor Control Approach to the Treatment and Prevention of Low Back Pain, 2nd edition, Edinburgh, Churchill Livingstone, 2004
3. Vleeming A et al: Movement, Stability and Low Back Pain- The Essential Role of the Pelvis 2nd edition, at press, 2006
Articles
3. Lee, Diane (1998) Stress Urinary Incontinence: A consequence of Failed Load Transfer Through the Pelvis? Proceedings from the Third Interdisciplinary World Congress on low Back and Pelvic Pain. Vienna, Austria www.dianelee.ca <http://www.dianelee.ca>
4. Lee, Diane (2005) Recent Advances in the Assessment and Treatment of the Sacroiliac Joint- Stability & the Role of Motor Control. www.dianelee.ca <http://www.dianelee.ca>
5. Richardson C A, Snijders C J, Hides J A, Pas M S (2002) The Relationship between the Transversely Oriented Abdominal Muscles, SIJ Mechanics and Low Back Pain. Spine 27(4): 399-405
7. Vleeming,A Stoeckart, R, Volkers A C W, Snijders CJ (1990a) Relation between Form and Function in the Sacroiliac Joint, 1: Clinical Anatomical Aspects. Spine 15(2): 130-132
8. Vleeming,A Stoeckart, R, Volkers A C W, Snijders CJ (1990b) Relation between Form and Function in the Sacroiliac Joint, 2:Biomechanical Aspects. Spine 15(2): 133-136

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