Addressing Osteoporosis and Osteopenia through BASI Pilates

Transcription

1 Addressing Osteoporosis and Osteopenia through BASI Pilates Author: Sharalyn Lehman Date: July 2015 Course Location: Bodies in Motion, Tacoma, WA Instructors: Brandon Gamble and Lianne Reimers Case Study Location: The Studio, Friday Harbor, WA

2 Abstract Currently, I am employed at The Studio, located in Friday Harbor, WA. The Studio is co- owned by two BASI graduates, Jennifer Horn and Jacqueline Reiff. At The Studio, we teach BASI Pilates to many of our clients. According to AreaConntect, almost 40% of the population in Friday Harbor is over 60 years of age. As a result, we are finding many of our Pilates clients in this age range. The National Osteoporosis Foundation states that, 1 in 2 women and 1 in 4 men over the age of 50 have low bone density and is at risk for fracture. Because of this, it is key that I create programs that assist in the treatment and maintenance of both Osteopenia and Osteoporosis. In this paper I will define Osteopenia and Osteoporosis, discuss bone health and the anatomy of the spine, explain important modifications for people experiencing these conditions, provide programs for both Osteopenia and Osteoporosis as it relates to two of my clients, and discuss the goals of each program.

3 Table of Contents Title Page.p. 1 Abstract.p. 2 Table of Contents.p. 3 Introduction p. 4 Anatomical Description...p. 6 Programs...p. 7 Conclusion.p. 11 Bibliography.p. 12

4 Introduction BASI Pilates is based on 10 principles - awareness, balance, breath, concentration, center, control, efficiency, flow, precision, and harmony. Many of these principles apply to the management of Osteopenia and Osteoporosis. Osteopenia is defined by Therapilates as a mildly reduced bone mass (about 10% to 20% bone loss). The World Health Organization defines Osteoporosis as a skeletal disorder characterized by compromised bone strength, predisposing one to an increased risk of fracture. The most common fracture sites are the vertebral bodies, the hip, and the wrist. This directly effects what exercises are beneficial to someone experiencing these conditions. As people age, often they lose their proprioception. Structural and functional declines of the somatosensory system occur with aging and potentially contribute to postural instability in older adults (Aging of the Somatosensory System: A Translational Perspective, Scott Schaffer and Anne Harrison). Also, this decline in somatosensory system can lead to loss of balance. BASI s emphasis on awareness, balance, concentration, and precision can help decrease the risk of falls resulting in a broken wrist, hip, and/or vertebrae. Not only does exercise help to maintain and build strong bones, but it can improve balance and reflexes and thereby prevent falls, the most dangerous threat to those with fragile bones (Osteoporosis and Pilates, Rebekah Rotstein, Finally, the requirement of precision and emphasis on alignment during a Pilates session assists in decreasing unneeded stress on the spine. This leads to better posture. Alignment refers to the relationship of the head, shoulders, spine and hips to each other. Proper alignment of the body puts less stress on the spine and ensures good posture, thereby decreasing risk of fractures (How to do Pilates Safely while managing Osteoporosis, Stephen Featherhuff, to- do- pilates- while- safely- managing- osteoporosis/#.vaglc5nviko). The focus on alignment and posture addresses an issue relating to Osteopenia and Osteoporosis. Hyperkyphosis is defined as excess anterior

5 curvature of the thoracic spine caused by changes in the vertebral bodies and vertebral discs (TheraPilates for Osteoporosis). According to TheraPilates, Kyphosis increases with age and hyperkyphosis is associated with underlying vertebral fractures and increase risk for future fractures. A wonderful way to address this condition is through the movements outlined in the below Programs. More specifically, loading up the springs on the footwork on the reformer increases the strength of the hip extensors, plantar flexors, and knee extensors. Adding balance control front, long stretch, and other movements that place load on the wrist may help to increase bone building in this area. Including exercises such as leg press standing and other balance challenging exercises may better the balance of a person. And finally, the jump board prepares clients for jumping with gravity, a motion proven to build bone mass in the hip. 10 jumps 3x per week could increase BMD in the hip 4%, (TheraPilates for Osteoporosis). The Jump Board is a fantastic tool to safely introduce someone to jumping with correct form and alignment so that they can eventually jump or faux jump against gravity. Jumping on the Reformer might also help to increase leg strength to help clients tolerate the impact on their hip, knee and ankle joints. (Osteoporosis and Exercise Activities, Guidelines, Research, and Insights from Physical Therapist and Polestar Pilates Educator Sherri Betz). With all these wonderful movements in mind, it is important to know that spinal flexion is contraindicated for those with Osteopenia and Osteoporosis. A 1984 Mayo Clinic study determined that flexing the spine (forward bending) can result in vertebral fractures, the type that lead to loss of height and eventually even to a "dowager's hump (Osteoporosis and Pilates, Rebekah Rotstein, Modifications to exercises involving spinal flexion are key and maintaining the muscle focus and the objective of the exercise is doable.

6 Anatomical Description The following diagrams are taken from the website, OrthoInfo. They show a spine with normal curvature and progress to severe curvature. This is followed by a series of vertebrae - healthy vertebrae to vertebrae with severe osteoporosis. Finally, the last picture depicts the full spine of a healthy body to a body suffering from Osteoporosis and hyperkyphosis. Figure 1

7 Figure 2 Vertebrae showing signs of osteoporosis. Normal vertebrae (left), vertebrae with mild osteoporosis (center), and vertebrae with severe osteoporosis (right).

8 Figure 3 As osteoporosis progresses, the vertebrae weaken and narrow, which can make the patient shorter and cause a severely rounded upper back ("dowager's hump"). Programs Osteopenia This client is a 58 year old female who has group equipment sessions twice a week. While she has practiced Pilates for two years, she took a 6 month hiatus due to a back injury. She re-entered her practice 1 month ago. The below client with Osteoperosis is her mother. Warm Up (on Mat) Pelvic Curl Spine Twist Supine Leg Changes Double Leg Stretch with Upper Body on mat Footwork (Reformer, spring setting = fully loaded) Parallel Heels Parallel Toes V Position Toes Open V Heals Open V Toes Calf Raises Prances Single Leg Heel (drop 1 red spring) Single Leg Toes (drop 1 red spring) Abdominals (1 Red) Hundred with the upper body on the carriage Coordination with the upper body on the carriage

9 Hip Work (1 Red + 1 Blue) Extended Frog Extended Frog Reverse Spinal Articulation (2 Red + 1 Blue) Bottom Lift with Extension (placing a ball between the legs to facilitate inner thighs) Stretches (1 R) Standing Lunge Full Body Integration Fundamental/Intermediate (1 R) Upstretch 1 Long Stretch Arm Work Seated Arms Series (Reformer) Chest Expansion 1R Biceps 1 R Rhomboids 1 R Hug- A- Tree 1 R Triceps 1 B OR Frog Back (Chair) Note: For flow purposes, if we perform Frog Back we would continue on the chair and mat in the following blocks to complete the session (color coded in purple). Full Body Integration Advanced/Master (1R +1B) None Leg Work (2 Red) Jump Board Parallel Position Feet V Position Feet Single Leg Changes OR Leg Press Standing (Chair) Lateral Flexion (Cadillac) Side Lift (1 Blue) Or Side Kick Back Extension (Cadillac)

10 Prone 1 (1 Blue) Swimming Or Swimming and Swan (mat) Osteoporosis This client is an 85 year old female with Osteoporosis. She has practiced Pilates for 6 years and has private sessions twice a week. This client has hyperkyphosis. In order to make her comfortable, I place towels under her head when lying supine and remove them during articulation - making sure her ears are in line with her shoulders. Warm Up (on reformer, springs fully loaded to stabilize carriage) Pelvic Curl Spine Twist Supine (holding onto the shoulder rests) Leg Changes Double Leg Stretch with Upper Body on Carriage Note: This client is not able to move to the floor and get back up. As a result, I warm her up on the reformer or the tower/cadillac. Foot Work (3 Reds) Parallel Heels Parallel Toes V Position Toes Open V Heals Open V Toes Calf Raises Prances Single Leg Heel (drop 1 red spring and add 1 yellow) Single Leg Toes (drop 1 red spring and add 1 yellow) Abdominals (1 Blue) Hundred Prep Coordination Note: Both these exercises are done with no spinal flexion, upper body remains on the carriage) Hip Work (1 red + 1 yellow) Frog Circles Down Circles Up Openings Spinal Articulation (fully load the carriage to ensure no carriage movement) Pelvic Curl with feet parallel on wood

11 Stretches Pole Series sitting on side of reformer with springs fully loaded and foot bar down Full Body Integration Fundamental/Intermediate Thigh stretch with roll up bar (Tower/Cadillac) Arms (Short Yellow) Standing Arms Extension Circles up Circles Down Hug a tree Punches Biceps No Butterfly Full Body Integration Advanced/Master None Legs (1 Red) Jump Board Parallel Position Feet V Position Feet Single Leg Changes Lateral Flexion Twist on short box series Note: While twist is in the short box series, due to physical limitations this exercise is the most appropriate one for lateral flexion for this client. Highlighting extension and lift is a key component in cueing this movement. Back Extension Back Extension Prep Swan Basic Prep Conclusion There are a plethora of exercises in the BASI Pilates repertoire that apply to both osteopenia and osteoporosis management. With the knowledge regarding Osteopenia and Osteoperosis, one can assist a client in decreasing their risk of injury

12 and increase their overall strength and mind/body connection. While all principles are important, focusing on the BASI Pilates principles of awareness, balance, concentration, and precision and marrying this with a proper program could slow the progression of Osteopenia to Osteoporosis. The increased load during the footwork will strengthen the legs decreasing the risk of falling. The abdominal work, which focuses on strengthening and controlling the core or power house, will help stabilize the body during movement and support the skeleton while standing. The hip work strengthens the hip extensors and adductors and maintains the neurological pathways required to efficiently fire these muscles. The spinal articulation during the pelvic curl on the chair or bottom lift on the reformer helps elongate the spine. Finding full body integration work that loads the wrists such as Long Stretch, Balance Control Front, and Cat (with no spinal flexion), helps strengthen that joint. Finally, the back extension work assists in decreasing the compression that may occur on the spine throughout daily movement. These clients, and many others, are finding positive results with this work. As a result, The Studio not only is performing successful private equipment sessions, but also considering a mat class for these clients who can easily move up and down from floor. Bibliography Betz, Sherri. Rehab Programs for Osteoperosis Fit and Frail with Pilates Emphasis. Santa Cruz, CA. Therapilates. 2014

13 Featherhuff, Stephen. How to do Pilates Safely while managing Osteoporosis. HSS on the Move. 8, February to- do- pilates- while- safely- managing- osteoporosis/#.vaqmbpnvikp Rotstein, Rebekah, Osteoporosis and Pilates. Dr. Weil. 13, July w.drweil.com/drw/u/id/art02834 Schaffer, Scott and Harrison, Anne. Aging of the Somatosensory System: A Translational Perspective. Journal of the American Physical Therapy Association. 23, January AreaConnect OrthoInfo. What is Osteoporosis.