Clients with Lumbar Hyperlordosis

Clients with Lumbar Hyperlordosis Andrea Sobke June 10, 2007 1

BASI Costa Mesa 2007 Abstract Lumbar hyperlodosis is a faulty posture in which the curve of the lumbar spine is increased. This can be caused by a variety of behavioral or congenital movement patterns or predisposed anatomical structure; but in all cases of lordosis, the pelvis is always in an anterior tilt. The anterior tilt of the pelvis resonates to the muscles surrounding the pelvic complex, resulting in tight hip flexors and back extensors, and weak abdominals and hamstrings. Tariq has an average case of lumbar hyperlordosis, and exhibits all of its characteristics. The goal of his conditioning program is to reduce and possibly correct his lordosis of the lumbar spine. By targeting certain muscles groups, and varying the emphasis from strengthening to stretching, the proposed conditioning program will be of great assistance in finding better alignment and harmony throughout the body. The Pilates program is designed to help Tariq reach his fitness goals, while keeping his lumbar hyperlordosis the priority in the selection of exercises. 2

Contents Anatomical Description....page 4 Introduction.. page 5 Meet Case Study: Tarik Soliman....page 5 Conditioning Program....page 6 Why this Conditioning Program?...page 10 Closing Statement.... page 12 Bibliography page 13 3

Anatomical Description Lordosis of the lumbar spine is commonly known as Sway Back. The direct areas affected are the lumbar spine (L 1-5), the abdominals, back extensors, hip flexors, and hamstring muscle groups. Although lumbar hyperlordosis often affects other spinal curves and their corresponding muscle groups, this study focuses primarily on the lumbar region of the spine and pelvic complex, and the methods of correcting this faulty posture through the BASI Pilates Block System. When the lumbar spine curve is increased, the placement of the pelvis is changed and therefore the muscles which stabilize the pelvis begin to work in a way that supports the lumbar lordosis. With the pelvis in anterior tilt tightness occurs in the back extensors and hip flexors, and weakness occurs in the abdominals and hamstrings. When the pelvis is in anterior tilt, the abdominals are lengthened and the hip flexors are shortened. Meanwhile, the back extensors are shortened and the hip extensors are lengthened. This position of the pelvis, and its affects on its surrounding muscle groups, causes the lumbar spine to curve excessively forward. The psoas major can be a direct cause of lordosis when tight. It originates from the anterior surfaces of the bases and lower borders of the transverse processes of the lumbar vertebrae, and inserts into the lesser trochanter of the femur. When tight, it pulls the lumbar spine forward toward pelvic insertion. It is important to keep in mind that although the contributing factors may vary, the muscle groups surrounding the pelvis are directly affected by any lordosis of the lumbar spine. 4

Clients with Lumbar Hyperlordosis Lumbar lordosis is a common flawed posture, one that can be found in all body types, even the most fit and talented athletes. The faulty posture can be caused by many different behavioral movement patterns or by congenital disorders. While many of the patterns or health disorders might be involuntary and out of someone s control, Pilates is an effective way of correcting the negative influences lordosis can have on one s body. Hyperlordosis of the lumbar spine resonates throughout the body by resulting in a series of tight and weak muscle groups surrounding the pelvic complex. The position of the pelvis in anterior tilt can change the distribution of weight on the feet, the rotation of the femur when standing and walking, and the overall movement pattern of the gait cycle Meet Case Study: Tariq The individual chosen for this case study has moderate lordosis in the lumbar spine, and all the symptoms of lumbar hyperlordosis. Tariq is a 28 year old male, 5 11 with a medium build. He is slim in his upper and lower extremities, with a slight splay in his ribs and abdominals, followed by an increased curve in the lumbar spine. His weight is shifted forward on his feet, and there is a slight increased curve in the thoracic spine with minor forward head. Tariq has not and currently is not dealing with any injuries or medical conditions. His interest in Pilates is solely to achieve a higher level of fitness, especially in the abdominal region, to gain better mind-body awareness, and to increase his flexibility. The lumbar lordosis of Tariq s spine can be seen clearly from his profile, and is confirmed by the lack of mobility in his lower back and hip flexors, and weakness in his abdominals and hamstrings. The back extensors are extremely tight, causing him difficulty in finding posterior tilt when supine. 5

When he does find his posterior tilt, his hamstrings fatigue and the position becomes strenuous for him to maintain. The tightness resonates in exercises such as the Pelvic Curl and Roll Up. During the Pelvic Curl, the spine immediately goes into lordosis at the top of the movement, partially due to tight hip flexors. Although he can find his posterior tilt when lifting the pelvis, he is so fatigued when lowering the pelvis that he cannot move through posterior tilt at all. The lower back extensor s agonist, the abdominals, are also afflicted with weakness due to the lumbar lordosis. Tarik finds difficulty finding the navel-to-spine position, and once he has found the position, he has trouble maintaining it due to the fatigue in his abdominals. In addition to weakness, the over all contraction of the abdominals lacks the significant integration of the transverse abdominus. The abdominals contract statically; they tighten in place; which is more evident as the session progresses and he has begun to fatigue. As expected, Tariq is very immobile in his hamstrings, illio psoas, gastrocnemius and soleus. With his pelvis in anterior tilt, his weight tends to be forward on his feet, resulting in a gripping of the plantar flexors. His hamstring immobility causes him discomfort when sitting upright with his legs extended in parallel, and affects the execution of many of the exercises of the Fundamental level. Increasing his mobility would greatly assist him in executing his Pilates exercises correctly and with more efficiency. 6

Conditioning Program Warm-Up The exercises below will allow Tariq to focus his attention to his body and the actions necessary to form a connection between the movement and finding the proper muscle recruitment, particularly the Transverse Abdominus. Pelvic Curl Prep Pelvic Curl Supine Spine Twist Chest Lift (w/ Rotation) Single Leg Lifts Roll Up w/ Roll Up Bar Finding the transverse abdominus Focusing on drawing the navel down towards the spine Emphasizing hamstring control and spinal articulation Avoiding anterior tilt of pelvis, in 1 st phase of exercise Yoga ball underneath the legs for support Maintaining navel-to-spine Rib cage stabilization Scapula Stabilization Concentrating on pulling the navel down to the floor in order to the lift the leg Imagery: rope attached to knee from the navel. When the navel lowers, the knee rises and vice versa Concentrating on scooping the belly Feeling the lumbar spine against the mat, while rolling up and down Footwork (on Reformer) Tariq s condition of lumbar hyperlordosis creates or is accompanied by slight external rotation of the femur. His rotation is not the main concern however, it should be addressed and the adductor group should be targeted during the footwork exercises. Emphasis is also put on the ability to maintain a neutral pelvis and spine when extending the legs in both parallel and when in the V stance. Parallel Heels & Toes V Toes Open V Heel & Toes Single Leg Heels & Toes Calf Raises & Prances Prehensile Stretch All footwork exercises emphasizing on hamstring initiation and control Maintaining a neutral pelvis, avoiding anterior tilt Stretch the non-working leg at 90 degrees with a theraband over the sole of the foot during the exercise Maintain neutral pelvis, especially with the non-working leg stretching upwards Stretched leg should be straight at all times Keep neutral pelvis and spine, especially with the legs extended Stabilization of the ribs, focusing on lateral breathing and sinking the navel Stretch the calves on the footbar, with the springs or assist by gently pulling the heels 7

Abdominals (on Cadillac or Mat/Table) The Mini Roll Ups are the perfect opportunity to find the correct flexion in the trunk, and locate the correct position on the lumbar spine on the mat. The Double Leg Stretch, Single Leg Stretch and Criss Cross should be done sequentially without a time to rest in order to target Tarik s endurance. Hundred Prep Mini Rolls Ups Mini Roll Ups Oblique Legs at table-top Keeping the lumbar spine on the carriage during flexion of the trunk Focusing on trunk flexion, while maintaining neutral pelvis Emphasis on contacting the lumbar spine with the mat Maintaining neutral pelvis, while identifying a clear flexion and rotation of the trunk Re-educating the body from doing crunches ON MAT OR TABLE OR CARRIAGE OF REFORMER Double Leg Stretch This exercise will test Tarik s endurance Keeping the lumbar on the mat when the arms and legs are extended Single Leg Stretch Coordination of the hands on the knee and ankle Criss Cross This exercise will test Tarik s endurance Hip Work (on Reformer or Cadillac) It is imperative that he remain out of lordosis when extending the legs. When the legs are extended in a supine position, Tarik loses the abdominal support due to fatigue, and his hip flexors become the sole muscle group supporting his legs. Frog Circles (down & up) Openings (only on Reformer) Hamstring control and initiation Hamstring and adductor control Abdominal stabilization Hamstring and adductor control Abdominal stabilization Spinal Articulation (on Reformer) Because of the difficulty Tariq has with the Pelvic Curl, it depends on the session and his advancement with the exercises as to whether the Bottom Lift should be included in the session. 8

Bottom Lift Short Spine Hamstring strength and control Finding the articulation of the lumbar spine Hamstring stretch and extension strength Articulation and extension of the spine Stretches (on Reformer) The focus should be on the psoas muscle lengthening into the stretch, rather than contracting against it. The session will also close with a series of stretches designed to increase mobility in Tariq s hip flexors, back extensors, and hamstrings. Standing Lunge Posterior tilt during hip flexor stretch Anterior tilt in hamstring stretch Full Body Integration 1 (on Reformer and Cadillac) The Up Stretch exercises are difficult for Tariq to maintain a neutral spine due to the lack of flexibility in his hamstrings. It is likely that these exercises may not be included until Tariq has increased his flexibility and is able to sit upright without his lower back extensors fatiguing into flexion or lordosis. The thigh stretch is an important exercise for Tariq to focus on his posterior tilt, while challenging the quadriceps during the intense stretch accompanied by the movement. Scooter Up Stretch 1 Up Stretch 2 Reverse Knee Stretch Down Stretch ON CADILLAC Keep slight lumbar flexion Isolation of the leg action from the trunk, avoiding slipping into lordosis when the working leg pushes back Working the thoracic spine extensors Hamstring stretch Targeting the abdominals to draw the carriage in Keep an extended spine Abdominals engaged, keeping from slipping into lordosis Maintain correct trunk flexion Focusing on abdominals to bring the knees forward Hip flexors extended While keeping an extended back, avoid sinking into the lumbar spine 9

Sitting Forward Side Reach Thigh Stretch Finding correct flexion of the lumbar spine Using the back extensors (thoracic spine especially) Hamstring stretch Abdominals engaged, supporting a contracted lumbar spine Hip flexor stretch Focusing on posterior tilt Arm Work (on Reformer) Straps will be added to the Rowing Series exercises once Tariq has found the needed contraction of the abdominals to correctly and safely execute these exercises on a mat or table. Sitting Series Rowing Back 1 Rowing Back 2 Keep back extended (not hyper extended) while sitting This sitting position will probably be a stretch for the hamstrings Shoulders adducted for biceps and rhomboids Tarik is capable of the knee and kneeling series, but the sitting series should be accomplished first to achieve hamstring mobility and back extensor strength Abdominal strength Imagery: Shoulders away from the ears Flexion on the lumbar spine while rolling down Sequentially engaging the back extensors to return to starting Additional Leg Work (on Wunda Chair) Hamstring Curl Focusing on pelvic lumbar stabilization Lateral Flexion and Rotation (on Wunda Chair and Step Barrel) The Side Stretch and Side Lift are both challenges for Tariq to do without slipping into his lumbar lordosis. Side Stretch ON STEP BARREL Side Lift Keeping the pelvis still Focusing on the obliques, but also trying to stay out of lordosis Oblique strength, but keeping a straight movement pattern Not arching into lordosis at the top of the lift 10

Back Extension (on Step Barrel, Reformer or Cadillac) Each of the selected exercises below should be done with caution of Tariq s tendency to be in lordosis and use his back extensors without the support of the abdominal wall. The back extension exercises are also selected to work on the extension of the thoracic spine, which tends to curve excessively forward. The pectoralis major should be stretched and lengthened. Swan Prep ON REFORMER Breaststroke Prep ON CADILLAC Prone 1 Stay out of lordosis Lift with the back extensors, not allowing the abdominals to sink forward Keeping abdominals engaged so as not to sink into lumbar spine Imagery: shoulder away from the ears Abdominals engaged and integral to the extension of the back Why this Conditioning Program? The goals set for Tariq to meet through his Pilates program were to strengthen the hamstrings and abdominals, stretch the hip flexors and back extensors, and re-educate the back extensors and abdominals to correctly engage to flex/extend the trunk. At the beginning of the program, Tariq s abdominals and back extensors were contracting incorrectly. His abdominals contracted statically, and his back extensors contracted without the support of his abdominal wall. To effectively address Tariq s goals, a Pilates program was designed for his needs, while still meeting his fitness goals, utilizing the BASI Block System. All of the exercises listed in the conditioning program are not to be addressed in a single session. The exercises listed in the conditioning program are a combination of Fundamental and Intermediate exercises, each chosen specifically for Tariq s needs and abilities, weaknesses and strengths. 11

The exercises were chosen for Tariq as a way to correct or reduce the increased curve in his lumbar spine. They can be done for a variety of individuals facing any faulty posture or sports injury. The focus intended for Tariq per exercise is what personalizes the conditioning program for his needs for a healthier musculature and spine. Closing Statement Lordosis is a painful posture which can be incapacitating for many individuals. Through the exercises and observations used through this Pilates conditioning program, Lumbar Hyperlordosis can be severely corrected or at least reduced by creating a mind-body connection with the muscles integral in attempting to achieve ideal posture. By locating and understanding the role of the transverse abdominus and the hamstrings, anyone with lordosis of the lumbar spine will be able to exercise in correct pelvic and spinal posture. In addition to the strengthening of the abdominals and hip extensors, the stretching of the back extensors and hip flexors plays a similar vital role in eliminating or reducing lordosis. By stretching the two muscle groups, the muscles surrounding the pelvic complex can begin to work symbiotically to improve and work towards neutral pelvis, spine, and eventually work towards the ideal posture. The condition program proposed for Tariq is a series of exercises chosen specifically for his needs, both to create a trimmer waistline and to achieve healthier alignment. 12

Bibliography Eva Hellsing, Thomas Reigo, John McWilliam and Erik Spangfort. Cervical and lumbar lordosis and thoracic kyphosis in 8, 11 and 15-year-old children. European Journal of Orthodics. http://ejo.oxfordjournals.org/cgi/content/abstract/9/1/129. May 24, 2007 Kemp, Simon. Lower back pain Injury Clinic - diagnosis and effective treatments. http:// www.sportsinjurybulletin.com/archive/lower-back-pain.html. May 24, 2007. Randal P. Morris, Kim J. Garges, Milan Mody, Anthony J. Muffoletto, Rita M. Patterson, Jinping Yang, James W. Simmons. The Affect of Lumbar Spine Lordosis on Stability and Injury. http://www.ruf.rice.edu/~preors/morris.pdf. May 24, 2007. Regan, John MD. What is Lordosis? SpineUniverse. http://www.spineuniverse.com/ displayarticle.php/article1438.html. May 24, 2007. Images Kasper Dl, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ: Harrison s Principles of Internal Medicine, 16 th Edition: http://www.accessmedicine.com Psoas Major Muscle. 30 May 2007. Wikipedia, the Free Encyclopedia. http://en.wikipedia.org/ wiki/psoas_major_muscle. 13