Pilates for Overpronation

Transcription

1 Pilates for Overpronation Karina Ward September 2014 Santa Barbara BASI Pilates 1

2 Abstract The feet face unique biomechanical demands in support of dynamically stabilizing the body. Forming our foundation, the feet are called upon to serve simultaneously as both flexible and stable shock absorption tools, allowing us to propel forward over uneven surfaces while supporting the weight of the body and maintaining balance. Overpronation of the foot is a common condition stemming from numerous factors. Also referred to as flat feet or fallen arches, the overpronated foot collapses during the gait cycle at the medial arch beyond the functional threshold. This places excessive demands on the continuation of the musculoskeletal chain, and creates a biomechanical disadvantage that over time is likely to result in injury. 2

3 Table Of Contents I. The arches of the feet and their supporting musculature. p. 4 II. A brief introduction to the intricate functions of the feet and exploring the known causes of overpronation. p.5 III. Case Study: Michelle Lee p. 6 IV. Pilates Prescriptive Exercises and Conclusion p. 7-9 V. Bibliography p. 10 3

4 The medial arch of the foot is relevant in examining excessive pronation in this case study. What overpronation presents like: Key muscles of the lower leg that support the arch: 4

5 Pronation is a phase of the normal gait cycle during which weight transfers from the heel to the forefoot. The movement assists with shock absorption and occurs at the subtalar joint, the meeting of the talus and the calcaneus or heel bone. Pronation is the cumulative effect of eversion (moving medial to lateral), dorsiflexion, and abduction. Hyperpronation occurs when too much weight is placed on the medial arch of the foot during gait and when standing. It develops gradually as the result of numerous factors including muscular weakness, improper footwear, poor ankle mobility, knock knees (genu valgum), excessive pounding repeatedly on hard surfaces, pregnancy, anterior pelvic tilt, poor gluteus strength/control, and obesity. Hyperpronation of the foot can manifest in many forms including plantar fasciitis, shin splints, bunions, metatarsalgia, tendonitis, medial knee pain, and lower back pain. Pilates exercises aimed at strengthening the medial arches of the foot and key muscles of the lower body can help prevent and correct this debilitating condition. The stabilizing muscles responsible for supporting the bridge of the foot are the abductor halluces, flexor hallucis brevis, and adductor hallucis; along with the tibialis posterior which originates in the lower leg. When tibialis posterior contracts it produces inversion and plantar flexion, both of which add support and stability to the arch. Strengthening the plantar flexors in conjunction with the gluteus muscles will enhance the ability of the arches to pull away from the ground, providing a more stable support system for the body. 5

6 Michelle Lee hails from Hawaii and is an avid outdoor enthusiast and photographer, confined to the restraints of her desk during most of the daylight hours. A competitive soccer player, surfer, hiker, and overall fitness buff; she has found herself sidelined recently by nagging plantar fasciitis and medial knee pain. Michelle grew up wearing flimsy flip- flops and has not yet kicked the habit. In addition, she is very flexible and mobile in the joints, which poses a threat to her overall strength and stability. Due to long hours spent working Michelle s hip flexors are extremely tight and uncomfortable to fully extend. As a result, the hip extensors are rarely engaged and underdeveloped. Although fit, Michelle presents the tell tale signs of overpronated feet including visibly fallen arches when standing upright, as well as a bend in the Achilles tendon toward the midline when viewed posteriorly. The focus will be on strengthening the muscles of the foot in plantar flexion, incorporating tibialis anterior; as well as a concerted effort to activate and develop the hip extensors. Michelle is not entirely new to Pilates, thus her program will reflect a combination of exercises at levels appropriate to her current fitness abilities. 6

7 Pilates Conditioning Program Warm Up: Three standing roll downs to begin. Basic BASI warm up performed on reformer carriage. All springs attached. Pelvic Curl / Supine Twist / Chest Lift / Chest Lift with Rotation Foot Work Reformer: Parallel heels / Parallel toes/ Open V heels/ Open V toes / Prehensile / Prances / Calf Raises/ Single leg Toes. Abdominal Work - Reformer: Hundred Prep / Hundreds / Reverse Knee Stretch Hip Work Reformer: Frog / Circles Down and Up / Openings / Extended Frog Reverse Spinal Articulation Cadillac: Monkey Original / Tower Prep/ Tower Stretches Reformer: Kneeling Lunge/ Side Split Full Body Integration - Reformer: Up Stretch 1 / Elephant / Stomach Massage Flat Back Arm Work Reformer: Arms Kneeling Series: Chest Expansion / Up Circles / Down Circles / Triceps/ Biceps Leg Work Reformer: Jumping Series: Parallel / V position / 1 leg / Leg Changes 7

8 Lateral Flexion and Rotation Reformer: Mermaid Back Extension Reformer: Breast stroke Prep / Breast stroke / Pulling Straps 1 and 2 Shell Stretch on long box. Three Standing roll downs to finish session. The exercises were selected within the BASI block system of programming in order to emphasize strength work for the plantar flexors, hip extensors, adductors, hamstrings, and quadriceps; balanced with flexibility work for Michelle s chronically tight hip flexors, adductors, and lower leg muscles. Utilization of the plantar flexors is required during the Full Body Integration exercises listed above, and the kneeling arm series provides an opportunity to stretch the bottom of the feet against the shoulder rests while working arms, trunk, and pelvis stabilizers. Jumping exercises are ideal for challenging the quadriceps and plantar flexors while emphasizing hip extensor control and pelvic lumbar stabilization. While Michelle is quite flexible and has good back extension, special measures must be taken to counter the long- term detrimental effects of working at a desk all day. Rotations with lateral flexion like the mermaid on the reformer provide for spinal mobility as well as the opportunity to stabilize in the shoulders. For Michelle specifically, additional emphasis would be placed on engaging the upper extensors and learning to relax the lumbar extensors during back extension exercises. With regular practice two to four times per week over time Michelle is expected to create greater strength in the medial arches of her 8

9 feet, lower legs, hip extensors, quadriceps, adductors, and hamstrings, sufficient to support and relieve the stress placed on foot and knee joints. The BASI Pilates system is effective in appropriating both rehabilitative and general conditioning exercises within a single efficient, balanced session. The equipment is ideally suited to safely address the common concern of overpronated arches, allowing the participant to strengthen the legs, hip extensors, and plantar flexors in a variety of supported positions. More importantly, the Pilates method and BASI system will provide the framework for creating a properly integrated musculoskeletal chain in which muscle tension can come into balance and work harmoniously to the benefit of any body. 9

10 Bibliography Understanding Overpronation. Whitney Lowe, LMT Arch Strengthening to Control Overpronation. James Speck, Somastruck.com, 2012 Overpronation Aetrex Worldwide Inc injuries/foot- heel- pain/overpronation Overpronation Copyright Sportsinjuryclinic.net 2014 BASI Pilates Study Guide, Reformer Workbook, Cadillac Workbook 10