Download kyphosis/ dowager`s hump

KYPHOSIS/ DOWAGER’S HUMP:
A CASE STUDY IN SPONTANEOUS SPINAL
CURVATURE
Debra Rapoport
June 4, 2014
Basi Teacher Training
Brooklyn, NY
TABLE OF CONTENTS
Abstract............................................................................................................................. 1
Kyphotic Postural Analysis............................................................................................. 2
A Case Study .................................................................................................................... 4
Susan’s Program .............................................................................................................. 7
Conclusion ...................................................................................................................... 10
Bibliography ................................................................................................................... 11
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ABSTRACT
Susan is a 36-year-old stay-at-home mom to three kids. She has been fairly active
throughout her life, yet now finds herself in chronic back pain. In childhood, her spine
spontaneous fractured in a single thoracic vertebrae.
The frontal collapse of these
vertebrae caused Susan to acquire a condition known as Kyphosis or Dowager’s hump.
Kyphosis is a forward head and forward rounding of the upper back posture. This
rounding is often called hunchback. Because the condition was most often occurring in
older woman, the term “Dowager’s Hump” became a term for Kyphosis. The word
Dowager means elderly or older woman.
Kyphosis is often age-related due to weakened spinal bones. However, poor
postural alignment and genetic or congenital deformities can cause the condition to
present in much younger people, such as in Susan’s case. As her condition has worsened,
she has incorporated Pilates into her lifestyle and this study will reveal the findings of her
condition and progress.
For Susan’s condition, we have developed a short term and long- term plan.
Incrementally, assessing her abilities and progress to be sure we are on target.
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Kyphotic Postural Analysis
An intervertebral collapse occurs at the disc and causes a loss of normal height. The
collapse in the spine does not always produce symptoms, however, compression on a
nerve root or spinal cord, may produce pain.
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Kyphosis will continue to as the “hump” begins to worsen with ages.
Characteristics of a Kyphotic posture are: head forward, hyperextended cervical spine,
abducted (protracted) scapula, increased flexion in thoracic spine. Areas of focus:
thoracic extension, lumbar flexion, upper back extensors and scapular stabilization.
Areas to strengthen: hamstrings, glutes, obliques and abdominals. Areas in need of
stretching, hip flexors, rectus femoris, pecs and lower back. Possible modifications
when doing Pilates, pads under head when supine, knees slightly bent during seated work.
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A Case Study
Susan Smith, 36, Kyphosis (Dowager’s hump).
Susan Smith has a 65 degree curve in her thoracic spinal column. Susan’s Kyphosis
appeared in early adolescence and was described as spontaneous fracture due to a
damaged bone in a single vertebrae. Her spinal column is un-diseased, however she is
now suffering from her pain in the upper back and sometimes her lower back. Susan’s
pain has been exacerbated by pregnancies and daily activities of caring for her three
children. Susan’s day consists of constant movement and she has a habit of bending from
the spine instead of her waist. Susan has not been doing any specific exercises aside
from walking the dog. Her kyphosis has become a source of chronic musculoskeletal
pain in her thoracic spine, tension headaches and occasionally she experiences shortness
of breath.
Medical Diagnosis: Susan’s Doctor has diagnosed her through x-ray as mildly kyphotic,
and has determined that her condition is congenital. Because her condition is mild,
Susan’s doctor believes that through specific therapeutic exercise and strengthening the
muscles of the spine, she will experience greater functionality in her daily activities.
Limitations
Determining the status of Susan’s postural mechanics is essential to prescribe an effective
exercise routine. Her limitations and challenges must be taken into account in terms of
posture and biomechanics, and structure and balance.
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Posture and Biomechanics:
Susan’s gross postural distortion makes it critical for the design of exercise progressions
to reflect her limited ability to safely load the musculoskeletal system to minimize
negative consequences.
During movement, her abnormal posture alters the weight
bearing effect. We have designed movements, which balance her restricted spinal
mobility. Attention to postural alignment and articulation of the spine are paramount in
creating the lengthening. We will achieve this with an emphasis on extension exercises.
Structure and Balance
In order to improve posture and optimize sagittal balance, we must take into
consideration Susan’s forward head posture and how it creates a distortion of the torso’s
ability to bear loads. We can enlist the gravitational pull of the springs.
Conditioning Program
Susan had done Pilates in a group reformer format in the past. When she came to me, she
had made the decision to begin private sessions. She wanted a program designed to
target her specific needs and issues with regard to her kyphosis and chronic pain. With
her previous experience doing Pilates, a conditioning program will be easier to
implement.
Our short term goal is to get Susan acclimated to using her spine and
controlling her muscles consciously.
We will help her to move through flexion and
extension. This is an important step in her plan to achieve balance in her body.
Our mid-term goals and long-term goals are to have Susan strong in her spine and torso.
With consistent workouts and her commitment to achieving these goals, our hope is to
maintain a pain free daily existence. We will intensify each exercise when she has
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reached her personal best. We will assess her plume line after 2 months and analyze her
range of motion. This will give us a clear picture of our long term plan.
Her program will be formatted to lay the foundation of exercise critical for recovery and
rehabilitation. For each exercise in the program, we will utilize the components of the
Basi block system, specifically, muscle focus and objectives. Susan must begin to make
changes in her movement patterns to develop balance and symmetry in her body. An
important conditioning program sequence will be using several Pilates apparatus
including reformer, ladder barrel and Wunda chair. The reformer will provide stability,
mobility and breath control. The ladder barrel will be an essential apparatus we will use
to stretch Susan’s spine.
The Wunda chair, adds another component to the work,
necessary for her trunk stabilization. In addition, range of motion, multi-dimensional and
multi-planar exercises will be included with attention to muscle focus and control within
each movement.
One of the most important tools in teaching Susan in her recovery and conditioning, and a
staple in the Basi system, is imagery.
connections.
Susan must begin to make neuromuscular
She will be taught to lengthen her spine and support herself through
specific words and phrases. Research strategies have proven as an effective tool for
motor learning. Developing the mind-body connection is the key to her success.
Susan will do a comprehensive, private, Pilates exercise routine three times a week for 45
minutes. Three separate routines will be developed. Each will include: Basi Block series,
groups, and stand alone exercises.
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SUSAN’S PROGRAM
Basi Block Warm- up
1:
Exercise:
Pelvic curl
Muscle Focus: Abdominal and hamstring
Objective: Spinal articulation, hamstring control, pelvic-lumbar stabilization
2:
Exercise:
Leg Lift/ Changes
Muscle Focus: Abdominal
Objective: Hip Disassociation, pelvic-lumbar stabilization
Basi Block
1:
Exercise:
Footwork: Parallel Heels, Parallel Toes, V position Toes, Open V
Heels, Open V Toes, Calf raises, Prances, Prehensile, Single leg heel and toes
Muscle Focus: Hamstrings and quadriceps
Objective: Hip extensor strength, and knee extensor strength
2:
Exercise:
Abdominal work; Short Box series: Flat back
Muscle Focus: Abdominal and back extensors
Objective: Abdominal strength, trunk stabilization
3:
Exercise:
Abdominal work; Short Box series: Tilt
Muscle Focus: Abdominal with oblique emphasis
Objective: Abdominal oblique control and abdominal oblique stretch
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4:
Exercise:
Hip Work - Circles Down, Circles up
Muscle Focus: Hip Adductor and Hamstrings
Objective: Hip adductor strength, Hip extensor control, Pelvic –lumbar
stabilization.
5:
Exercise:
Hip Work Openings
Muscle Focus: Hip adductor
Objective: Hip Adductor stretch and strength, Pelvic –lumbar stabilization.
AFTER 2 Months and 10 sessions:
1:
Exercise: Spinal Articulation: Bottom Lift with extension
Muscle Focus: Abdominals and hamstrings
Objective: Spinal articulation and hip extensor control
Stretches
A:
Exercise:
Ladder Barrel- Shoulder Stretch 1
Muscle Focus: Shoulder Extensors
Objective: Shoulder extensor strength
B:
Exercise:
Ladder Barrel- Hamstrings
Muscle Focus: Hamstring
Objective: Hamstrings
AFTER 2 Months and 10 sessions Exercise:
1:
Exercise: Full Body Integration –Flat Back (knee stretch series)
Muscle Focus: Abdominals and back extensors
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Objective: Trunk stabilization, Shoulder stabilization, Hip and Knee Extensor
control strength (depending on resistance)
2:
Exercise:
Arms Sitting Series: Chest expansion, Biceps, Rhomboids, Hug-a
tree, Salute
Muscle Focus: Latissimus dorsi, Pectoral major, biceps, posterior deltoid, triceps
Objective: Trunk stabilization is the key to all of these exercises, along with
Shoulder extensor, adductor and abductor, elbow extensor and flexor strength,
and scapular adductor strength
3:
Exercise:
Wunda Chair – Triceps Prone
Muscle Focus: Triceps
Objective: Elbow extensor strength, Trunk stabilization, Scapular stabilization
4:
Exercise:
Wunda Chair – Triceps Prone
Muscle Focus: Triceps
Objective: Elbow extensor strength, Trunk stabilization, Scapular stabilization
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Conclusion
This comprehensive, full-body program designed for improving Susan’s form,
alignment, balance, and muscle recruitment all of which focused on her specific issues
relation to her Kyphosis, aka Dowager’s hump.
The warm-up was designed to have Susan move through spinal articulation while
stretching her hamstrings. The Hip Disassociation allows her to maintain a neutral pelvis
and engage her abdominals. These warm-up exercises serve as a bridge between her
upper and lower body.
During her block work, we focus on Thoracic extension, lumbar flexion, upper back
extensors and scapular stabilization.
Because she has such a significant postural
deviation, we need to focus on creating alignment while strengthening and stretching the
upper trunk area. In addition, during hip work we are focused on stretching, lengthening
and strengthening the hamstring and hip flexors. The final two stretches provide essential
positions for maximum benefit for Susan’s two critical areas.
All these movement patterns target the areas we need to strengthen and stretch with
relation to the Kyphosis. The complexity of this exercise regime will lead to long-term
rehabilitation and overall well- being.
Susan has already experienced less fatigue and pain since starting this routine two
months ago. After the first 10 sessions, Susan progressed from the fundamental level.
We have added full body integration, and spinal articulation to our layering of the block
system. We expect her progress will continue within our long- term plan.
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Bibliography
BASI Pilates. Study Guide Comprehensive Course, (Body Arts and
Science International, 2000-2012).
Briggs, Andrew; van Dieen, Jaap H; Wrigley, Tim V; Grieg,
Alison M; et al. Thoracic Kyphosis Affects Spinal Loads and Trunk
Muscle Force. Physical Therapy 87.5 (May 2007) 595-607.
J. Ricker Polsdorfer, MD. “Kyphosis” The Gale Encyclopedia of
Medicine .Ed. Laurie . Fundukian. 4th Ed. Detroit: Gale, 2011.
6Vol.
Ryan SD, Fried LP. The Impact of Kyphosis on Daily
Functioning. J AM Geriatric Soc. 1997;45: 1479-1486
http://www.ideafit.com/fitness-library/corrective-exercisescoming-full-circle-new
http://www.webmd.com
http://www.Kyphosis.com
http://www.pilatesinteractive.com
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