OsteoPilates by Karena Lineback

Spine Pathologies in the Pilates Fitness Setting

by Karena Thek Lineback

 It is public knowledge that Pilates is great for ailing spines.  That knowledge puts quite a responsibility on we Pilates instructors to be able to manage an endless variety of spinal pathologies.  But we handle it well, because we excel in finding, then correcting imbalance. Imbalance is rampant within spine pathologies, landing them squarely in the dominion of the Pilates Instructor.  Within hundreds of possible imbalances, let’s review The Protruding Ribcage, The Sympathetic Head Tilt, and The Un-Centered Pant Seam.

The Protruding Ribcage.

We see this almost daily.  A client lies on the mat and all we see are ribs poking out.  A protruding ribcage indicates that the external obliques are weak and in a stretched position (long).  If the external obliques are long then so are the internal obliques and rectus abdominis.  On the posterior side of the torso, you’ll find that the latissimus dorsi and the erector spinae are tight, short and weak.  These posterior muscles are in a ‘holding pattern’.  They are winched down to lock the torso into position to prevent an imbalance that could only result in the individual falling forward on her nose. 

 Short or long, both groups of muscles are weak.  Begin strengthening by simply restoring neutral alignment. This way the shortened spine muscles are immediately lengthened and the anterior muscles are shortened.  Now, both groups are in a position to be able to fire adequately.  Make sense?

 Think of a clenched fist. The muscles on the inside of the fist are tight and short, so short that the muscles cannot contract any further.  The muscles on the outside of the fist cannot contract because they are too stretched. So the best way to put both muscles into a position where they can adequately fire is to simply un-clench the fist.  Same with the spine. Put the spine in a position where all groups of muscles have the best opportunity to engage. Now, any exercise will reinforce the stabilizers of the spine around this new corrected position.

The Sympathetic Head Tilt.

This shows up as someone who has an ear dropping towards the shoulder. To correct this imbalance you generally end up making two corrections  Here’s why...

 When any part of the spine takes a detour in the coronal plane (the side-to-side plane) it will also begin to travel in the transverse plane (rotating or twisting plane). Why? Once the spine reaches a certain point in the coronal plane, the transverse processes begin to get in the way. So if rotation is added then the mis-alignment is ‘permitted’ to travel further. The natural progression would be to have the cervical spine laterally flex in one direction (say, the right) but to twist in the opposite (the left). 

 To correct this you are first going to look at the lower levels of the spine to see if this person has a scoliosis, since this sort of ‘sympathetic head’ is common in scoliosis.  If the answer is yes, then the corrections start in the lumbar spine or pelvis. Don’t fix just the neck. That would be like trimming the pinecones off a tree that is uprooting your sidewalk.  But once the lower levels are deemed fine or corrected, you are going to simply reverse the cervical lateral flexion and rotation.  If the neck is laterally flexed right, tilt it left. Follow this up with a rotation to the opposite side. In this example, you will rotate the neck to the right.  It will create an over-correction but that’s okay. Over-correction in this case will spring the neck back towards neutral once corrections are made.

The Un-Centered Pant Seam.

 The back seam in our pants is supposed to ride directly over the gluteal crease (where the butt cheeks meet).  So when it takes a detour, moving right or left, we know there’s an imbalance. The direction that the seam has shifted matches the direction the ilium has rotated anteriorly in the transverse plane. In other words, if the pant seam has shifted right then the right hip has moved forward. In addition, when you lie this person in supine on the reformer with the feet on the footbar, you may also notice that the forward hip is also elevated in the coronal plane (a hiked hip).  You are going to correct this imbalance by moving the right ASIS posteriorly and dropping the right ischial tuberosity caudally (towards the feet).  Just like we had to unwind the cervical spine to correct the imbalance, you have to do the same with the pelvis.  First, unwind. Then strengthen.

 Finding imbalances in our clients means that we have found the beginning of a solution.  Correct, or diminish the imbalance and you are on your way to successfully managing any spine pathology. Good luck and let me know if you have any questions!

Karena, owner of Pilates Teck in Southern California, is the author of ‘OsteoPilates’ (2003) and ‘Scolio-Pilates’ (2011).  She is a Pilates continuing education provider, focusing on managing pathologies in the Pilates fitness setting.  Her next workshop is in Spain on May 7-8.  She can be reached at Karena@OsteoPilates.com