Professional Documents
Culture Documents
a
Pilates
Program
For
A
Client
With
Shoulder
Impingement
Syndrome
July 2013
Paris,
France
Abstract
This paper discusses the structure of shoulder girdle and the spine on a
functional continuum and how BASI Pilates block system, when applied as
a holistic exercise system, can contribute to achieving neck and shoulder
girdle stabilization, and improving functional strength for a client
diagnosed with functional shoulder impingement.
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Table of contents
1. Abstract
2. Shoulder Anatomy
3. Shoulder pathology
4. Rationale for holistic approach
5. Case study
a. Assessment and goal setting
b. Exercise Plan
c. The program
d. Phase 1 - releasing tension and core stabilization
e. Phase 2 - addressing the shoulder mechanism
6. Conclusion
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Figure
1
Bones
of
shoulder
joint
Anatomy of shoulder
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movement.
Shoulder pathology
While rotator cuff muscles are often singled out as being responsible for
shoulder health, shoulder is a complicated structure requiring an
advanced sense of proprioceptive capacity due to its multiple joint
mechanism and the dependence of its stability on the supporting muscles.
These muscles, in turn, have their origins and insertions spanning the
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entire torso, front and back. For example, pectoralis minor connects
upper ribs of chest to coracoid process, and overactive pectoralis minor
draws scapula forward which then pulls the shoulder into forward and
rounded position. In a controlled study, Borstad and Ludewig found that
short pectoralis minor demonstrated scapular kinematics similar to the
kinematics exhibited in earlier studies by subjects with shoulder
impingement, support the theory that an adaptively short pectoralis minor
may influence scapular kinematics and is therefore a potential mechanism
for subacromial impingement.
As such, conditioning
clients with shoulder
pathology must take
more global approach
addressing the whole body
posture and muscular
imbalances, instead of
working locally around the
pain.
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Figure
4
Thoracic
kyphosis
and
scapula
kinematics
demonstrating
reduced
shoulder
ROM
on
thoracic
kyphosis
(source
:
dynamicchiropractice.com)
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Case study
Dominique, 45 years old, is a corporate marketing professional who has
always been tall and slim. He is a long time runner and cyclist, with love
for motorcycle and photography.
He was diagnosed with shoulder impingement in his 30s and has followed
through shoulder re-education in several occasions.
He never changed his life style except during his recurring episodes of
shoulder tendinitis, which would force him to limit his activities.
In the past 2 years, however, he has completely stopped his running and
cycling due to worsening shoulder condition.
His short-term goal is to rectify his shoulder problem, and long-term
goal is to regain strength and improve general health and energy level.
Exercise plan
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Although his ultimate goal is to build back overall strength as quickly as
possible, we came to agree that ignoring his shoulder issue will in the
long run only set him back more than go forward.
During the first phase, the attention will be on improving breathing, and
cervical and thoracic spine alignment and function. While the focus is
working on opening up the rib cage to give more space to the lungs and
other internal organs, the exercise program in phase 1 also introduces
truck and pelvic stabilization as well as foot and knee awareness.
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back (closed chain) to refer to facilitates the mind to focus on
conveying information regarding alignment to the body.
Cadillac basic leg spring series while the leg spring series will
increase mobility of hip joint and strengthen the quadriceps and
hamstrings, the main focus will be on stabilizing the pelvis while legs
are in motion. The client will also work on knee and foot alignment in
relation to femur positioning parallel or external rotation. The client
is gently yet consistently encouraged to let go of the tension in his
neck and shoulder.
Arm series supine on reformer - continue giving the support for back
chain while working to stabilize the shoulder girdle, focus on
lengthening of the movement to work on crowded articulation and to
engage intrinsic muscles of shoulder girdle including serratus anterior
Lateral Flexion and rotation - Side over leaning on to the Step barrel
gives support to pelvis for stabilization and keeping the spine neutral
while oblique muscles go through full ROM
Leg work Gluteals Kneeling series and Adductor Lift are chosen to
activate and strengthen the hip extensors and adductors which are
weakened from holding the sway position for too long. Kneeling with
elbows on the box also reduces the intensity of gravity on upper girdle,
allowing us to work on weakened neck flexors by keeping the head
lifted
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Back extension by focusing on keeping the abdominals engaged and
reaching the arms and the legs towards the back of the room,
Dominique is strengthening his entire posterior chain while
eccentrically working the shoulder depressors including serratus
anterior
and teres major. The adductor muscles are encouraged to stay
active in order to aid in pelvic floor muscle activation
Arm work - Triceps Press sitting, Side Kneeling Arm press, Side
Kneeling stretch on Wunda chair: more movements to combine
stabilization of the trunk, and the activation and strengthening of
shoulder depressor muscles. The movements balances out tight
antagonist muscles, namely the upper trapezius.
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Full body Integration on reformer Up stretches with emphasis on
scapula stabilization. Down stretch with emphasis on mid back
strength and scapula stabilization
Conclusion
The client should be reminded that good habits form the same way bad
habits form. Even after the pain is gone, tight muscles relieved and weak
muscles strengthened, and the general balance is brought back to the
body, in order to maintained the balance and the good posture, the
client should be encouraged to continue Pilates or include some form of
mindful and holistic exercise in her life.
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Bibliography
Borstad J. D., Ludewig P. M. (2005 April). The effect of long versus short
pectoralis minor resting length on scapular kinematics in healthy
individuals. Retrieved 23 July, from
http://www.ncbi.nlm.nih.gov/pubmed/15901124.
Feil, C. & Morgan, W. E. (2010 May 6). The Importance of the Thoracic
Spine in Shoulder Mechanics. Retrieved 20 July 2013, from
http://www.dynamicchiropractic.com/mpacms//dc/article.php?id=54622
From FDA reports: Depression and Kyphosis n.d. Retrieved 20 July 2013,
from http://www.ehealthme.com/cs/depression/kyphosis
Paterson, J. (2009). Teaching Pilates for Postural faults, Illness & Injury.
A practical guide. Kidlington, Oxford:Butterworth-Heinemann Elsevier
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