Download Sacroiliac Joint Dysfunction in Dancers

 Sacroiliac Joint Dysfunction in Dancers Lindsey Arnold November 22, 2015 Toronto, Ontario 1 In today’s day and age, professional athletes’ and artists’ are asked to push their bodies to the limits in order to succeed and surpass their competition. Rigorous training schedules, which are often structured around practicing repetitive movements in the same range of motion due to the athletes specified sport, undoubtedly creates muscle imbalances in the body and places great strain on the muscles, joints and ligaments. With a lack of balance, stability and proper strength in all areas of the body, injury is more susceptible to these highly trained athletes. In order to better protect the body of injury, Pilates will help evenly condition, strengthen and stretch the body, ultimately improving sport performance. Dance is an athletic artistry form that can produce enormous strains on the body due to the levels of high impact movement, repetitive stress and overuse of the muscles and joints. Without an in depth understanding of body mechanics, alignment, balance, and strength to withstand this range, serious issues in muscular balance and alignment will develop, often leading to injuries in the lower back, hips and legs. Among these injuries, studies have found that low back pain is one of the most common occurrences among dancers. More over, health professionals who specialize in dance medicine have discovered that one of the leading causes of low back pain among dancers stems from Sacroiliac joint dysfunction [1]. The culprit of Sacroiliac joint dysfunction is due in part to alterations or abnormalities in the normal joint motion. Due to the extreme physiological demands placed on the SI joint from the dynamics of dance, as well as the biomechanics of the Sacroiliac joint (SI joint), it is very clear why dancers suffer from SI joint dysfunction and pain [1]. In order to provide joint stability, strengthen the vulnerable muscles surrounding the joint and help prevent further injury, Pilates is an ideal solution to add to a dancer’s repertoire and aid in rehabilitating the Sacroiliac Joint. 2 Table of Contents Title page 1 Abstract Page 2 Table of Contents 3 Anatomical Description 4, 5, 6 Introduction 7, 8 Case Study Conditioning Program 10-­‐14 Conclusion 15 Bibliography 16 9 3 The Sacroiliac joint, also referred to as the SI joint, is the area of the body I have chosen to study and research. The SI joint is our linkage system between our lower spine and pelvis, specifically where the sacrum connects on the right and left sides of the ilium [2]. It is the keystone of the pelvis and acts as a transfer station, distributing weight and forces between the upper and lower body, assists with shock absorption during activities and coordinates movement between the spine, pelvis and hip [3]. 4 While previous research claimed that the SI joint was immobile, new studies have documented that a small range of movement and mobility is not only apparent at the joint, but also essential to help relieve some strain on the lumbar spine due to the amount of weight it endures [4]. Due to the joints anatomical structure and design to allow only a small range of motion consequently limiting mobility, any unusual degree of movement, either too little or too much, will allow your Sacroiliac joints to adopt an abnormal or stressed joint position. When the SI joint is not moving in it’s proper range, either due to stiffness (hypomobility), excessive mobility (hypermobility), or becoming locked, it is referred to as Sacroiliac Joint Dysfunction. Common symptoms of Sacroiliac Dysfunction are noted as experiencing pain emanating in the lower back, buttock, groin, hip and legs [2][5][6]. 5 Hypermobility found at the joint, especially common among dancers, is the leading cause of Sacroiliac joint pain and dysfunction. The SI joint is surrounded by strong ligaments and muscles, which aid in stabilization, especially during stressful and vulnerable positions. The large muscle groups surrounding the joint include the erector spinae, psoas, quadratus lumborum, piriformis, transverse abdominus, oblique abdominals, gluteal muscles and hamstrings with the most important emphasis being the deep abdominal core muscles and deep gluteal muscles. Unfortunately, if the surrounding muscles are weak, tight and lack endurance or the surrounding ligaments are overstretched or damaged, the body lacks stability and balance. Moreover, this produces an extremely vulnerable SI joint that is susceptible to small shifts in alignment and incapable of limiting excessive ranges of movement, thus creating hypermobility, instability and pain. [2][4] 6 INTRODUCTION Proper skeletal alignment is the basic building block for a healthy balanced body. For a dancer, proper alignment, especially pelvic alignment, is key to achieving the aesthetic lines that dance requires as well as aid in protecting the body from injury. While many professional and seasoned dancers fully understand the importance behind proper alignment, it is typically overlooked in the early to mid stages of a dancers training. This is usually in relation to poor training and a lack of knowledge from either the teacher or the inability of the student to fully initiate the correct muscles needed when performing specific positions and exercises. Two common postural alignment faults prominently practiced and found in dancers are posterior tilting and anterior tilting of the pelvis. A posterior tilt, also commonly referred to as “tucking” (tailbone under), is a common sustained position held by dancers during ballet repertoire. Teachers will often cue the dancers to “squeeze their glutes” or “tuck their toosh” which is not 7 only incorrect and unnecessary, but creates tightness in the psoas, IT band and anterior hip structures. An anterior tilt, also commonly referred to as “sway back” (tailbone lifted), is a common position found in a dancers “relaxed” or everyday stance and is due in part to weak lower abdominals, hamstrings and gluteal muscles and tight hip flexors [7]. In addition to poor pelvic alignment, dancers also tend to overuse and over stretch muscles. One of the more prominent muscle groups used by dancers are the deep rotators of the hip, especially during ballet training to sustain external rotation. From a young age, dancers constantly overstretch muscles and ligaments attaching to the pelvis to better achieve a deeper degree of mobility and often ignore strength-­‐training exercises to offer balance. Unfortunately, once the ligaments have been stretched beyond a certain point, they are unable to return to their original length nor regain elasticity. While to a young dancer this may not seem alarming, the lax ligaments and weak surrounding muscles will offer little support over the course of their career and can initially cause the SI joint to “lock” in an asymmetrical position, thus resulting in SI joint pain and dysfunction [6]. With the continued practice of Pilates, a dancer who suffers from SI joint pain and dysfunction can benefit immensely to retrain weak muscles and work in correct pelvic and spinal alignment. 8 CASE STUDY Emma is 28 years old and is a professional dancer. She is a member of a contemporary ballet dance company, which requires extensive training and rehearsals. She starts each day with a two hour ballet class, which continues into approximately four to 6 hours of rehearsals, dependant on upcoming performances. While the repertoire is heavily ballet focused, it has a contemporary flair to the movement, requiring larger ranges of movement and rotation through the torso and body. Emma began feeling subtle pain a few months ago in her lower back when dancing, but the pain was not consistent so Emma continued with her regular training schedule. About a month ago during a rehearsal, Emma felt discomfort during a movement sequence that shot a sharp pain starting from her low back and continued all the way down through her hip to her right leg. At the on sight of the injury, she was unable to move her back without an occurring muscle spasm and any trunk or hip flexion would cause an obscene amount of pain in her lower back. After several tests, the doctor confirmed that Emma had SI joint dysfunction and her joint was in fact locked, which better explained her inability to move with ease during forward flexion. The doctor then released her SI joint and referred Emma to a Physical Therapist to help strengthen and balance her body. After weeks of working with a Physical Therapist, Emma’s pain eventually diminished but she knew she needed to continue to strengthen her body and in doing so, Emma added Pilates into her daily regimen. Emma’s main limitations include an anterior tilt of the pelvis, very tight hip flexors and weak lower abdominals. She has very strong and powerful quadriceps, which have been over developed in relation to her hamstring and gluteal strength. She has very open hips due to her years of ballet training, which indicates over stretched muscles and loose ligaments in the hip and pelvis region, causing instability and the sole reason for her SI joint dysfunction. While Emma 9 does have a strong sense of body awareness, she does not always initiate the proper muscles needed when practicing certain exercises, which will be a main focus of our work in addition to strengthening the body as a whole to correct muscular imbalances. Emma will begin adding three BASI Pilates sessions per week for the first five weeks and then add one additional session for the remaining five weeks. By week ten, Emma will have a better understanding of how to initiate the deeper muscles within the body and will have gained strength in the areas that were weak, offering greater stability when dancing and decreasing the chances of reoccurring SI joint pain or locking. Below is the outline of Emma’s first BASI Pilates session. WARM UP FOOTWORK ABDOMINALS 1) Roll Downs: Warming up the spine and allowing myself, as the instructor to see any muscular imbalances, tightness. 2) Pelvic Curl: Start with finding and initiating pelvic floor through breathing and articulation of the pelvis. From there, continue into full pelvic curl with focus of deep abdominal engagement, articulation of pelvis and spine, hamstrings, gluteal muscles and adductors (not allowing knees to open) 3) Spine Twist Supine: Start with feet planted on mat for greater support of SI Joint. If no pain is present, legs will rise to table top. Focus on staying neutral throughout and stabilizing pelvis, pulling in abdominal wall to engage deep abdominals especially when bringing legs back to center 4) Leg Circles: Work in a smaller range of motion to ensure pelvic stability. Emphasis on keeping legs parallel, engaging abdominals and not clenching quadriceps and hip flexors 1) Reformer: Parallel heels, parallel toes, V position, Open V heels, Open V toes, Calf raises, Single Leg heel and toes: Continuing to warm up the body. Emphasis on initiating the push to extension from hamstrings and gluteal muscles. Any position in external rotation, focus on adductors by resisting legs as they close and fully lengthening through muscles. Remain neutral and abdominals fully engaged. 1) Reformer: Hundred Preps into Coordination: Start with about 4 hundred preps and then begin to add extension of legs with movement of open/close (make sure legs aren’t opening past carriage width). Emphasis on remaining neutral and keeping pelvis stable. Legs parallel on leg movement and focus on pulling up pelvic floor and 10 narrowing through abdominals 2) Cadillac: Roll Up Top Loaded: Emphasis on co-­‐contraction of abdominals and back extensors. Keep “c” curve deep by pulling abdominal wall inwards (navel to spine) and then elongate through spine during extension 3) Cadillac: Breathing with Push Through Bar: Deep abdominal focus as well as focusing on articulating through spine and pelvis-­‐ heavy on posterior tilting or imprinting on hip lift. During hip lift, concentrating on activating gluteal muscles and hamstrings 1) Cadillac: Frog, Circles Down, Circles Up, Walking, Bicycle: Frog: Pelvic Stability; Focus on not overly rotating in hips & engaging adductors Circles: Pelvic Stability; fluid movement Walking: Pelvic stability; Initiate hamstrings Bicycle: Pelvic Stability; adductor and hip extensor strength which is essential to strengthen to keep from anterior tilting in derriere positions ** STAY NEUTRAL THROUGH OUT HIP WORK SPINAL ARTICULATION NOT INTROCUCING YET 1) Reformer: Scooter: Abdominal emphasis with pelvic lumbar stabilization & hip extensor strength. Deep focus on staying rounded through spine and in a posterior tilt FULL BODY I 1) Reformer: Arm Supine Series: (Extension, Adduction, Circles Up/Down, Triceps): Focus on staying Neutral & legs in table top stable-­‐ abdominals engaged-­‐ weight resistance light ARM WORK FULL BODY II NOT INTRODUCING YET LEG WORK 1) Reformer: Hamstring Curl: Hamstring, hip extensor and knee extensor strength & control, which are all essential for dance. Dependant on back, chest can be down to eliminate back extension 2) Reformer: Single Leg Skating: Working to strengthen Gluteal muscles. Keep abdominals pulling inward and stabilize pelvis. Standing leg stable & weight over standing 11 LATERAL FLEXION BACK EXTENSION STRETCH leg throughout 1) Ladder Barrel: Side Overs: Pelvis stable throughout. Lift body up with oblique engagement. Trunk lifts in 1 unit; limit flexion/bending through torso 1) Ladder Barrel: Swan Prep: Back Extensor Strength (thoracic) with abdominal focus. Cue to press Pubic Bone into barrel and elongate body during exercise 1) Ladder Barrel: Gluteal muscles, Hamstrings, Adductors, Hip Flexors: Hold for 3-­‐5 breath cycles. All essential muscle groups to stretch for dancers. 2) Roll Down: Provides Client with a back and hamstring stretch as well as allows instructor to watch mobility Below is the outline for Emma’s tenth BASI Pilates session. WARM UP FOOT WORK ABDOMINALS 1) Cadillac: Roll Downs Pelvic Curl: Pelvic floor and abdominal engagement; Hamstring, gluteal muscles and Adductor focus Warm Up Series: Roll Ups with Roll Up Bar/Mini Roll Ups/Mini Roll Ups Oblique/Roll Ups Top Loaded: Focus on staying neutral throughout & increase abdominal strength 1) Wunda Chair: Parallel Heels, Toes, V position, Open V Heels, Open V Toes, Calf Raises: Begin with arms on chair and once comfortable, lift arms open to sides, up to sky or behind head for added stability challenge & lower abdominal strength 1) Wunda Chair: Pike Sitting: Engage Pelvic Floor and maintain slight posterior tilt of pelvis to deepen abdominal work. 12 HIP WORK SPINAL ARTICULATION FULL BODY I ARMS FULL BODY II Cat Stretch Kneeling: Abdominal and back extensor work 1) Reformer: Extended Frog/Extended Frog Reverse: Neutral; Focus on not overly rotating in hips (narrow V position with feet), keep pelvic stable (no rocking), resist against straps for deeper adductor engagement 2) Openings: Neutral; pelvic stability, abdominals; adductors 1) Reformer: Bottom Lift: Start with Heavier Springs and regress resistance to work stabilizers. Focus on articulating spine with ease, pelvic floor and abdominals, strengthening hamstrings, gluteals, adductors and maximizing hip extensor control Bottom Lift with Extension: Added hamstring strength 1) Cadillac: Sitting Forward: abdominal and back extensor control 2) Saw: Abdominal Oblique and Back extensor control * Both exercises assist in stretching Hamstrings 1) Cadillac: Arm Standing Series: Chest Expansion, Hug-­a-­tree, Arm Circles, Punches, Biceps: Trunk stabilization while movement of arms is present. All arm work excellent for dancers shoulder mobility and postural muscles NOT INTRODUCING YET LEG WORK LATERAL FLEXION 1) Cadillac: Scissors: Focus on Lumbar Pelvic Stability: engage throughout abdominals and lift obliques up from underneath. Stretching and controlling hip extensors and hip flexors Circles (forward/back): Maximize hip joint range while keeping pelvis stable during circles. Hip Extensor, Hip Flexor and Adductor stretch and control 1) Wunda Chair: Side Stretch: Abdominal strength with oblique emphasis. Keep pelvis stacked and stable 13 BACK EXTENSION STRETCH 1) Wunda Chair: Back Extension Single Arm: Pelvic Lumbar Stabilization, press pubic bone and hip bones down into chair, abdominals lifted. Focus on thoracic back extension 1) Reformer: Standing Lunge: Hip Flexors and Quadricep Stretch. Keep hips square and don’t allow “splits”. 2) Roll Down: Provides Client with back and hamstring stretch as well as allows instructor to watch mobility 14 Sacroiliac Joint dysfunction and low back pain are extremely common occurrences throughout people’s lives, especially common among dancers where their bodies are their instruments. Repetitive movements and high amount of stress put on dancers joints, heavily influence muscular imbalances throughout the body. In efforts to better align and rebalance the body as a whole, Pilates is the key to success. Pilates vastly improves posture, teaches you how to
properly activate the bodies deep stabilizer muscles, and strengthens the weak muscles, tendons and
ligaments so everyday life is essential easier and injury is less susceptible. All in all, Pilates proves to be a
leading form of cross training and should be practiced and studied by all dancers, both young and seasoned
professionals for improved long term health.
15 BIBLIOGRAPHY [1] DeMann, L.E. Jr. “Sacroiliac dysfunction in dancers with low back pain.” Manual Therapy Journal, Web. February 1997 [2] Miller, John. “Sacroiliac Joint Pain.” Physio Works, Web. March 22, 2015 [3] Watson, Cathy. “Pilates for Sacroilliac Issues.” Vernon Physiotherapy, Web. March 20, 2013 [4] Dionne, Cassie. “Why your SI Joint is such a Pain.” Breaking Muscle, Web. 2015 [5] Adolfs, Jennifer. “Sacroiliac Joint Pain”. Pilates-­‐Back-­‐Joint-­‐Exercise, Web. 2006-­‐2014 [6] “Sacroiliac Joint Dysfunction.” Wikipedia, Web. July 24, 2015 [7] Fischer Gam, Clara. “Dancing with the Pelvis: Alignment, deviations and mobility.” International Associations for Dance Medicine and Science, Web. April 30, 2015 16