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How  Can  We  Improve  Female  Client’s  Round  Shoulders  with  

Strengthening  Back  Muscles   through  Pilates?   (Especially   for  

Asian  Female  Clients  Who  Mostly  Have  Round  Shoulders  and  

Weak  Ab/Back  Muscles)  

 

 

 

 

 

 

 

 

Myunghwa  Choi  

CTTC  2014  

O-­‐Pilates,  Seoul,  South  Korea  

April  20,  2015  

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ABSTRACT  

I  started  to  write  my  paper  very  carefully  using  the  phrase,  “Asian  female  client”  in  the  

title.  As  a  military  wife,  I  have  been  switching  my  life  back  and  forth  either  in  the  U.S.  or  

in   South   Korea.   This   made   me   think:   Can   one’s   nationality   or   cultural   differences  

determine  or  have  an  impact  on  people’s  poses   in  different  ways?  To  some  degrees,   it  

may  sound  like  an  assumption  regarding  stereotypes  and  some  people  wouldn’t  agree  

with  me.  However,  this  idea  didn’t  come  to  me  all  of  sudden,  but  slowly  flowed  into  my  

mind  as  I  started  to  teach  Pilates.    

In  my  case  study,  I  chose  as  my  client  Young-­‐bin,  who  can  be  seen  as  a  typical  Korean  

female  client  with  round  shoulders,  weak  back  muscles  and  not  much  confidence  about  

physical  exercise.     I  am  going  to  explain  how  she  transformed  with  the  Pilates  program  

that  I  designed  for  her  here.     Anatomical  explanations  will  follow  as  well.  

 

 

 

 

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TABLE  OF  CONTENTS  

Page  1     TITLE  PAGE  

Page  2     ABSTRACT  

Page  3     TABLE  OF  CONTENTS  

Page  4       BRIEF   ANATOMY   OF   PECTORALIS   MINOR,   RHOMBOIDS   AND  

MULTIFIDUS  MUSCLES  

Page  7     CASE  STUDY  

Page  8     BASI  BLOCK  PROGRAM  

Page  10     CONCLUSION  

Page  12   BIBLIOGRAPHY  

 

 

 

 

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BRIEF  ANATOMY  OF  PECTORALIS  MINOR,  RHOMBOIDS  AND  MULTIFIDUS  

1) Pectoralis  Minor  

 

 

 

 

The   pectoralis   minor   is   a   thin,   triangular  

muscle,  situated  at  the  upper  part  of  the  chest,  

beneath   the   pectoralis   major   in   the   human  

body.   It   arises   from   the   upper   margins   and  

outer   surfaces   of   the   third,   fourth,   and   fifth   ribs,   near   their   cartilages   and   from   the  

aponeuroses  covering  the  intercostalis.  The  pectoralis  minor  depresses  the  point  of  the  

shoulder,   drawing   the   scapula   inferior,   towards   the   thorax,   and   throwing   its   inferior  

angle  posteriorly.  I  found  out  that  quiet,   introverted  women  who  lacks  confidence  and  

rarely  exercise  tend  to  have  tight  pectoralis  minors  mostly  (again,  this   is  based  on  my  

personal  teaching  experience).  My  client  and  I  spent  enough  time  to  stretch  this  muscle  

before  we  started  any  kind  of  arm  work.  When  it  was  too  tight,  I  have  her  brief  massage  

on  the  muscle  areas  with  a  tennis  ball.  

 

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2) Rhomboids    

 

The   rhomboid   muscles,   often   simply   called   the   rhomboids.   There   are   two  

rhomboid  muscles:   Rhomboid  major   and  minor.  The   rhomboid  major   arises   from   the  

spinous   processes   of   the   thoracic   vertebrae   T2   to   T5   as   well   as   the   supraspinous  

ligament.  The  rhomboid  major  helps  to  hold  the  scapula  (and  thus  the  upper  limb)  onto  

the  ribcage.  Other  muscles  that  perform  this  function  include  the  serratus  anterior  and  

pectoralis  minor.  The  rhomboids  work  collectively  with  the  levator  scapulae  muscles  to  

elevate  the  medial  border  of  the  scapula,  downwardly  rotating  the  scapula  with  respect  

to   the   glenohumeral   joint.   Both   rhomboids   (major   and  minor)   also   act   to   retract   the  

scapula,   pulling   it   towards   the   vertebral   column.  Most   of  my   female   clients  who   had  

round  shoulders  with  weak  back  muscles  also  had  protruding  shoulder  blades.    

 

3) Multifidus  

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The  multifidus  muscle  consists  of  a  

number  of  fleshy  and  tendinous  fasciculi,  

which  fill  up  the  groove  on  either  side  of  the  spinous  processes  of  the  vertebrae,  from  

the  sacrum  to  the  axis.  The  multifidus  is  a  very  thin  muscle.  Deep  in  the  spine,  it  spans  

three  joint  segments,  and  works  to  stabilize  the  joints  at  each  segmental  level.  The  

stiffness  and  stability  makes  each  vertebra  work  more  effectively,  and  reduces  the  

degeneration  of  the  joint  structures.  As  it  is  already  stated  in  Study  Guide,  multifidus  

should  be  singled  out  as  an  extremely  important  back  extensor  muscle  with  regards  to  

trunk  stabilization.  Locating  shoulder  blades  in  the  right  position  and  strengthening  

shoulders  cannot  be  accomplished  without  healthy  multifidus.  

 

 

 

 

 

 

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CASE  STUDY  

My   client,   Young-­‐bin,   is   a   24-­‐year-­‐old   female   in   good   general   health,   but   very  weak  

muscular   condition  who   came   to  me  because   she  was   stressed   out   from  her   CrossFit  

personal   trainer.   Despite   working   out   two   to   three   days   a   week   in   the   gym   for   two  

months,  she  seemed  very  tired  and  had  more  shoulder  pain  than  when  she  only  rested  

at  home.  Also,  she  had  a  lack  of  flexibility,  barely  touching  her  toes  when  she  bent  over  

for   roll-­‐down.   She   told   me   that   CrossFit   and   extreme   exercises   gave   her   a   lot   of  

frustration,  and  this  made  her  look  for  Pilates.  She  wanted  to  improve  her  posture  and  

reduce   her   shoulder   and  neck   pain,   also   hoping   to   gain  weight   in   a   healthy  way.  Her  

height   was   166   cm   but   her   weight   was   just   about   48   kg,   which   was   extremely   thin.  

When   I  used  arc  barrel,   I  had  put  a  mat  around   it   to  prevent  her  bones   from  directly  

touching   the  hard   surface.  We   even  had   to   take   a   rest   in   the  middle   of   reformer   foot  

work  with  medium  strength,  because  of  her  dizziness.  For  two  weeks,  we  had  to  take  a  

rest  with  any  kinds  of  foot  work  series.  But  instead  of  urging  her  to  continue,  we  took  a  

break  and  had  conversations  about  her   life,  diet,   jobs,   and   so  on.   She  didn’t   even   talk  

that  much  at  first,  but  as  the  sessions  continued,  she  started  to  smile  and  concentrate  on  

the  movements  and  listening  to  my  directions.  

 

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Basi  Block  Program  

 

This   is   a   summary   of   the   first   eight  weeks   (approximately   twenty   sessions)   of   the  

Pilates   conditioning   program   I   developed   for   Young-­‐bin,   keeping   in   mind   her   goals,  

which  are  improving  her  sway  back  posture  and  reducing  neck  and  shoulder  pain.  I  also  

considered  her  to  be  quiet  and  introverted.  Honestly,  it  took  many  sessions  to  find  out  

how  she  feels  and  to  better  motivate  her.  

 

 

Week  1  -­  2  

Mat:  Pelvic  Curl,  *Spine  Twist  Supine,  Chest  Lift/with  Rotation,  Leg  Lifts/Changes  

Reformer:   The   whole   foot   work   series   (two   reds   and   one   blue),   Hundred   Prep,   Hip  

Work   (Frog,   Down   Circles,   Up   Circles,   and   Opening),   Hamstring   Stretch   Series   –  

Standing  lunge,  Arms  Supine  Series,  Breaststroke  Prep,  Roll  Down.  

  *  We  used  a  big  gym  ball  to  her  Spine  Twist  Supine.  Putting  the  gym  ball  under  her  legs  

really  stabilized  her  spine  on  the  mat.  I  didn’t  force  her  to  follow  the  Basi  Block  system  

strictly  in  the  very  first  week  not  only  because  of  her  weak  physical  condition,  but  also  

not  to  overwhelm  her.  I  actually  spent  most  of  our  session  hours  making  sure  that  she  

kept  her  back  on  the  mat.    

 

 

 

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Week  3-­5  

Mat:   Pelvic   Curl,   Roll-­‐up,   Spine   Twist   Supine,   Double   Leg   Stretch,   Single   Leg   Stretch,  

*Criss  Cross  –  we  had  to  wait  for  a  better  time  for  Young-­‐bin  to  accomplish  criss-­‐cross  

until   5th  week.   She   managed   to   do   Double   Leg   and   Single   Leg   Stretches   but   couldn’t  

stabilize  her  trunk  when  she  rotated.    

Breathing:   I   taught  her  the  importance  of  Breath  this  week.  Her  breathing  patter  was  

partially  wrong  from  the  beginning.  Her  chest  went  up  a  lot  when  she  breathe  in.  Since  

she  could  not  really  understand  how  to  breathe  in  belly  first,  I  made  her  hold  PTB  bar  

with   both   hands   (without   springs)   standing   beside   Cadillac   and   leaning   forward   her  

upper  body.  Not  bending  her  knees  and  keeping  her  back  flat,  she  breathe  in  and  lot  like  

frog’s  belly  (imagery).  In  this  way,  she  slowly  understood  how  to  engage  her  abdominal  

muscles  for  breathing.  

Reformer:  The  whole   foot  work  series   (three  reds),  Hundred,  Coordination,  Short  Box  

Series:   Round   Back,   Flat   Back,   Twist,   Hip   Work   (Extended   Frog   and   Extended   Frog  

Reverse,   Down/Up   Circles),   Hamstring   Stretch   Series   –   Kneeling   Lunge,   Up   Stretch  

Series:  Up  Stretch  1,  Elephant,  Down  Stretch,  Arms  Sitting  Series,  Mermaid,   Side  Over  

Box,  Pulling  Straps  1  &  2,  Roll  Down.  

 

Week  6-­8  

Mat:  Roll-­‐up,  Spine  Twist  Supine,  Double  Leg  Stretch,  Single  Leg  Stretch,  Criss  Cross  

Reformer:   The   whole   foot   work   series   including   Prehensile   (three   reds),   Hundred,  

Coordination,  Short  Box  series  –  Round  Back,  Flat  Back,  Twist,  Hip  Work  (Extended  Frog  

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and  Extended  Frog  Reverse,  Down/Up  Circles),  Bottom  Lift,  Bottom  Lift  with  Extension,  

*Hamstring  Stretch  Series  –  Kneeling  Lunge,  Up  Stretch  Series   (  Elephant,  Up  1,  Up  2,  

Long  Stretch),  Down  Stretch,  Arms  Sitting  Series,  Shoulder  Push,  Arms  Kneeling  Series,  

Hamstring  Curl,   Jumping  Series,  Side  over  Box,  Pulling  Straps  1  &  2,  Breaststroke,  Roll  

Down  

*We   tried   Full   Lunge   for   Hamstring   Stretch   but   my   client   felt   pain   in   her   left   knee  

whenever   she   did   Full   Lunge.   Instead   of   repeating   the   same,   Kneeling   Lunge,   I   kept  

reminding  her  not  to  rotate  her  pelvis  when  she  stretches.  

 

CONCLUSION  

 

When  I  first  met  her,  she  was  extremely  thin  and  weak.  She  couldn’t  even  accomplish  

half  of  the  reformer  foot  work,  and  kept  telling  me  that  she  was  dizzy.  With  this  in  mind,  

I  designed  my  program  with  a  narrow  variety  of  equipment.  This  was  when  I  realized  

Basi’s  block  system  is  very  applicable  while  also  being  unique  for  everyone.  In  this  way,  

having   her   reviewed   what   she   did   from   the   last   session,   we   tried   to   focus   on  

accomplishing   the   right   movement   at   each   time.   This   also   benefitted   her   by  

strengthening   her   muscles   and   helping   her   to   feel   ready   to   move   on   to   different  

machine  with  confidence.    

Media  and  society  has  somehow  created  this  idea  that  being  extremely  thin  is  healthy  

and  beautiful.  Even  my  client  thought  that  she  doesn’t  need  exercises  since  she  was  thin  

enough.   Her   introverted   personality   somehow   contributed   to   her   having   round  

shoulder,  since  she  thought  that  looking  tall  and  opening  her  chest  might  seem  arrogant  

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in  Asian  culture  sometimes  (Again,  this  is  not  a  fixed  idea  all  the  time  nowadays,  but  it  

was  what  she  had  in  her  mind).  That  was  why  she  needed  to  rebalance  both  mentally  

and   physically.   Strengthening   her   abdominals   and   back   extensors   really   helped   her  

lengthen   vertically.   Rhomboid   exercises   in   arm   sitting   series   also   helped   her,  

rebalancing  her  upper  trapezius  scapulae  lavator  and  reducing  her  shoulder  pain.  

Now  it  has  been  about  three  months  since  I  started  to  teach  her.  I  can  see  the  slight  

physical  improvement  in  her  body.  However,  more  than  that,  it  is  her  inner  change  that  

I’m  so  happy  with.  Now  she  can  concentrate  on  herself  more   than  ever  and  enjoy  her  

awareness.  Even  other  Pilates  instructors  who  I  work  with  sometimes  tell  me  how  much  

she   has   changed   when   they   see   her   laugh   and   ask   me   questions.   For   her,   gaining  

confidence   back   and   reducing   shoulder   pain   will   be   the   most   remarkable  

accomplishments.  I  am  very  proud  of  my  client.  

 

 

 

 

 

 

 

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BIBLIOGRAPHY  

Isacowitz,  Rael.  Study  Guide:  Comprehensive  Course.  Costa  Mesa,  California  :  Body  Arts  

and  Science  International,  2013.  

Arnold   G.   Nelson   and   Jouko   J.   Kokkonen.   Stretching   Anatomy.   Prunsol   Publishing   Co.  

through  Danny  Hong  Agency,  Seoul,  2011.  

Pilates  Anatomy.  Rael  Isacowitz  and  Karen  Clippinger.  Human  Kinetics.  2011.  

BASI   Mat   Movement   Analysis   Workbook.   Rael   Isacowitz.   Body   Arts   and   Science  

International.  2000-­‐2012.  

BASI   Reformer  Movement   Analysis  Workbook.   Rael   Isacowitz.   Body  Arts   and   Science  

International.  2000-­‐2012.  

BASI   Study   Guide:   Comprehensive   Course.   Rael   Isacowitz.   Body   Arts   and   Science  

International.  2000-­‐2013.  

소도구를  활용한  필라테스  완전정복,  아침풍경,  2011  

사진으로  보는  촉추와  사지의  검진,  Bruce  Rider,  AB,  MD,  군자출판사   2008  

Rhomboid,  Multifidus,  Pectoralis  Minor  pictures    

from  https://en.wikipedia.org/wiki/Pectoralis_minor_muscle