Pilates - Dealing with a Moderate

Structural Scoliosis Condition

BASI Comprehensive Course

Maria del Carme Farré Carbonell

April 7, 2016

Studio Carme, London, U.K.

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Abstract

The purpose of using Pilates to help alleviate the negative effects of structural scoliosis, is to

balance the physical asymmetry resulting from the condition by working on flexibility, posture,

lengthening and muscle strengthening. Pilates can help create awareness by the client of

proper posture and reeducate their body to improve functional and positive movement patterns

during daily life.

My case study focuses on structural scoliosis, which involves a spinal curvature and twisting of

the spine that is always present. This condition has a physical impact on the torso, making it

appear uneven. In addition, the body’s muscles are overdeveloped on one side of the spine and

underdeveloped on the curved side. Over time the bossy or stronger muscle group will become

even stronger and more dominant vs. the underemployed, which will become weaker with lack

of use.

The purpose of my paper is to provide a practical Pilates guide based on the BASI block system

to partly rectify the negative effects on the body of scoliosis.

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Table of Content

A Look at Structural Scoliosis ______________________________________ Page 4

Dunia Oriol – My Case Study ______________________________________ Page 6

BASI Block System Conditioning Program ______________________________Page 8

Conclusion _________________________________________________Page 12

Biography __________________________________________________Page 12

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A Look at Structural Scoliosis Scoliosis occurs when the spine curves sideways and the individual vertebrae also twist and

rotate around the vertical axis of the spinal column. Because the ribs are attached to the

vertebrae, this rotation of the vertebrae may create a ‘hump’ or prominence on one side of the

back.

Source: http://patient.info/health/scoliosis-curvature-of-the-spine-and-kyphosis

We distinguish between structural scoliosis which is always present when taking an x-ray and

non-structural scoliosis where the curve disappears when and x-ray is taken lying down or

bending sideways. The best way to assess which type of scoliosis a client has is by doing a roll

down, If the rib cage and/or lower back are asymmetrical then it is the second, or structural

type.

Source: http://www2.massgeneral.org/ortho/scoliosis.htm

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Scoliosis can occur in either the upper back (thoracic area), lower back (lumbar area), or more

rarely, in the neck (cervical area). Depending on the type and severity of the curvature of the

spine, scoliosis may be unnoticed early on but eventually symptoms such as the shoulder or the

hip being uneven become more noticeable, Other symptoms include protrusion of the shoulder

blade,a, tendency to lean to one side or a bulging on one side.. Most cases of scoliosis occur

during adolescence and have no known cause. Scoliosis occurs in approximately 2-3% of

children between the ages of 10 and 16.

The curvature may be acute, such as that seen in the case of a fracture (the type for my case

study as discussed on page 6). More often, it is smooth as shown below.

Source: http://rad.washington.edu

The Cobb technique for measuring the degree of the

curvature uses the vertebrae at the upper and lower end of

the curve that are most severely tilted towards the curve, to

measure the degree of scoliosis. Mild cases have between

10 to 25 degrees of curvature. Moderate cases are between

25 and 40 degrees and can be helped with bracing of some

sort. Severe cases are those in which the angle is greater

than 40 degrees and are likely to require surgical treatment.

Source: http://www.boneandjointburden.org/2013-report/iii-spine-deformity-and-related-conditions/iii

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Dunia Oriol – My Case Study Dunia Oriol is a forty-two year old economist who was diagnosed with s-curve scoliosis at the

age of 12 years old. When she was 10 years old she suffered a motor accident as a result of a

collision with a car, which left her in a coma for three days. The accident left her with multiple

broken bones and the recuperation was lengthy.

Two years later, Dunia was diagnosed with a double major curve with the thoracic curve to the

right and lumbar to the left as seen in the photo below.

On the left we have a photo of Dunia’s back and on the right an x-ray of a similar condition showing the bone structure. X-ray source:

http://www.coreconcepts.com.sg/wp-content/uploads/2010/07/S-shape-Bistol-Chiropractic.gif

As a teenager she travelled to the USA to assess her condition and they explored the possibility

of having a surgical intervention, or to wear a brace for two years to improve her spine.

However, she opted for Lateral Electrical Surface Stimulation {“LESS”}. LESS treatment is a

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neuromuscular stimulation treatment for idiopathic scoliosis. Dunia followed this therapy for

four years, throughout her teen years. This helped her condition from becoming worse.

However, throughout the years, Dunia has always complained about back pain and started

exercising with a personal trainer, to strengthen her body, combining PT with high intensity

interval training to improve her cardiovascular capacity.

One year ago, Dunia came to my studio to try Pilates. We started working with the

fundamentals to be sure she understood basic concepts like neural pelvis, neural spine and how

to activate her abdominals muscles. Because of scoliosis, her body awareness is limited and

finding her neutral spine and keeping her body in line has been a difficult process.

In our Pilates sessions I have observed the following that her muscles are stronger, tighter and

well-developed on the right side of the spine, but weak and sunken on the left side. The

stronger side will do all the work so we need to switch it off. I have tried to make Dunia aware of

this so she would use the weaker side more consciously.

I have worked with her to do the following as corrective measures:

• Lengthening and stretching the collapsed side

• Strengthening the muscles of the collapsed side so they are more active

• Achieving pelvic stability awareness

• Improving flexibility of the spine

• Rotation and lateral work to mobilize the facet joints and vertebrae so as to counteract

any further spinal rotation

• Used visual awareness with mirrors to teach her to reeducate her habits and to start to

become more aware of weight bearing thoughout her body

• In some exercises I have made her work one side and stabilize the opposite to become

more aware of her dominant side.

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BASI Block System Conditioning Program Block Apparatus Exercise Objective

Warm up Mat Roll down

Pelvic curl

Spine twist supine

Chest lift

Chest lift with rotation

Fundamental is perfect for her to

start her session. PC helps Dunia

to connect with her body and

sets her up for spine mobility

throughout the session.

Footwork Reformer Parallel heels

Parallel toes

Open V heels

Open V toes

Calf raises

Prances

*Single leg heels

*Single leg toes

I put her in the reformer so she

can have straight shoulders and

a well -aligned body while

working the hamstrings and

feet. I make her do extra reps on

the single leg to encourage

pelvic stability.

Abdominal work Reformer Hundred prep

Coordination

The reformer makes it easier to

align her body. She found

difficult the coordination

because of her body awareness,

so it took a few sessions to

achieve.

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Block Apparatus Exercise Objective

Hip Work Reformer Frog

Circles (down, up)

Openings

*Single leg frog

*Single leg openings

Her range is small so she could

keep pelvic stability. I make her

work on single leg frog and

openings to make her aware of

the weaker side and to feel each

leg getting equal amounts of

work.

Spinal Articulation Reformer Bottom lift

Semi-circle

These exercises were excellent

for her to improve spinal

mobility. Particularly helpful has

been the semi-circle, her body

alignment from the first rep to

the eight has improved

dramatically. She was able to

feel her body flow.

Stretches Reformer Kneeling lunge

Side split

Easy to maintain her alignment

with the right cues and to help

Dunia to stretch her hip flexors

and hamstrings. She needs to

improve her flexibility so the side

split allowed her to work on the

adductor stretch and strength.

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Block Apparatus Exercise Objective

Full Body Integration

– F/I

Cadillac Sitting forward

Side Reach

Thigh stretch with roll

up bar

The Cadillac is fantastic to give

that feeling of length and with

Dunia she benefits from having

her hips stable and then moving

through the exercises to gain

abdominal control,

Hamstring/oblique stretch and

spine mobility.

Arm Work Reformer Arm supine series:

Extension

Adduction

Up Circles

Down Circles

Triceps

*Single arm extension

*Single arm adduction

Dunia could feel the positioning

of her shoulders while working

on the scapula, trunk and legs

stability as well as shoulder

mobility. It is safe for her

alignment and she is able to

maintain pelvic stability while

increasing the weight gradually.

Leg Work Mat Gluteal side lying series:

Side leg lifts

Forward and lift

Forward and drop

Dunia was able to work on each

leg individually as well as to work

on the pelvic lumbar stability, rib

cage awareness and alignment.

She found it difficult to lie on her

side straight.

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Block Apparatus Exercise Objective

Lateral Flexion and

Rotation

Wanda

Chair

Side stretch

*work twice reps on the

collapsed side to

strengthen and stretch

the oblique.

Having a long leaver as a

reference (her foot) allowed her

to work through out her full side

keeping pelvic stability.

Step

Barrel

Side lift

*work twice reps on the

collapsed side to

strengthen and stretch

the oblique.

The step barrel helped her to

stretch each lateral flexor

individually, so important to

improving side mobility and to

strengthen each oblique

individually.

Back Extension Step

Barrel

Swan Prep She was able to keep trunk

stability. Her spine curves were

visible and she had to work to

extend her back evenly.

Finish with back stretch and roll down.

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Conclusion Dunia has benefitted from the program as she has been able to work precisely in the different

areas of her body and to understand how to reeducate her imbalances. Pilates has established

the foundation for her to do other physical activities more efficiently. Her back pain has

disappeared after attending regular Pilates classes. After each class, Dunia feels that her body

has lost its rigid structure and feels loser, more flexible and straighter.

Her bone structure can not change, but the BASI Block System is giving my client a clear path

and steps to a more flexible and more balanced body

Biography

BOOKS Annette Wellings and Alan Herdman. ‘Curves, Twists and Bends’ - A practical guide to Pilates for Scoliosis, 2010. Jane Paterson. ‘Teaching Pilates for Postural Faults, Illnesses & Injuries’ – A practical guide, 2009. Rael Isacowitz, Karen S. Clippinger. ‘Pilates Anatomy’, 2011.

Websites http://patient.info/health/scoliosis-curvature-of-the-spine-and-kyphosis http://www2.massgeneral.org/ortho/scoliosis.htm http://rad.washington.edu http:// www.boneandjointburden.org/2013-resport/iii-spine-deformity-and-related-conditions/iii http://www.coreconcepts.com.sg/wp-content/uploads/2010/07/S-shape-Bistol-Chiropractic.gif