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Special Populations
PART II: SPECIFIC INJURIES/ DYSFUNCTIONS AND PILATES
| Question | Answer |
|---|---|
| Lumbar Spine Stabilizers: Local | Transversus abdominis, multifidii, rotatores, interspinales, pelvic floor, diaphragm |
| Lumbar Spine Stabilizers: Global | External + internal obliques, glutes (help stabilize the pelvis and trunk on the femur), adductor brevis and magnus (help stabilize lateral movements of the trunk), tensor fascia latae (assists in stabilizing the pelvis on the femur in standing) |
| Lumbar Spine Stabilizers: Global Mobilizers (multi-joint muscles) | Rectus abdominis, iliocostalis, quadratus lumborum, latissimus dorsi (lateral flexion and extension), rectus femoris, hamstrings |
| Thoracic Stabilizers: Local | Multifidii, intercostals |
| Thoracic Stabilizers: Global | Obliques (predominately internal oblique), semispinalis |
| Thoracic Stabilizers: Global mobilizers (multi-joint muscles) | Rectus abdominis, erector spinae |
| Cervical Stabilizers: Local and Global | Deep cervical flexors (includes longus colli and longus capitis, which act as local and global stabilizers), multifidii, interspinales, suboccipitals, semispinalis |
| Cervical Stabilizers: Global Mobilizers (multi-joint muscles) | Sternocleidomastoid, levator scapulae (with scapula fixed), scalenes, splenius (capitis and cervicis), upper trapezius (with the scapulae fixed), erector spinae |
| Postural Dysfunctions: Swayback Lumbar (Sometimes mistaken for increased lordosis) | posterior tilted pelvis, flattening (flexion) of the lumbar spine, increased kyphosis (flexion) of the thoracic spine, a forward head with slightly extended cervical spine, and hyperextended hip and knee joints. The upper trunk deviates backward. |
| Postural Dysfunctions: Hyperlordosis | anterior tilted pelvis, hyperextended (excessive lordosis) lumbar spine, normal thoracic curve and neutral head position, and mildly hyperextended knees. This is often seen in dancers and can also be associated with LCS. |
| Postural Dysfunctions: Kyphotic-Lordotic | pelvis is anteriorly tilted, the lumbar spine has an excessive lordosis and the knees are mildly hyperextended. The head is forward with a hyperextended cervical spine, a protracted scapula and an excessively kyphotic (flexed) thoracic spine. |
| Postural Dysfunctions: Flat Back | The flat back posture consists of a posteriorly tilted pelvis, flexed (flattened) lumbar spine, upper thoracic increased kyphosis and a forward head with slightly excessive cervical extension. |
| Postural Dysfunctions: Forward Head Posture (FHP) | Extended upper cervical spine + a flexed lower cervical spine and upper thoracic spine w/ protracted scapulae. As the head moves forward, there is increased weight + tension at the base of the cervical spine, with the muscles trying to keep the chin up. |
| Swayback Lumbar Programming | During training sessions, the focus should be on strengthening the deep cervical flexors, upper back extensors and external obliques. Be sure to stretch the hamstrings. |
| Hyperlordosis Programming | Strengthen the abdominals, gluteals and hamstrings. Stretch the low back extensors and hip flexors. |
| Kyphotic-Lordotic Programming | Strengthen deep cervical flexors, thoracic extensors, external obliques, and hamstrings. Stretch neck extensors and hip flexors. While the low back extensors are usually shortened, these muscles can easily lengthen in the seated position. |
| Flat Back Programming | Focus on strengthening the hip flexors and stretching the hamstrings. |
| Forward Head Posture Programming | Chest Expansion, Head Nods, Scapula Isolations, thoracic extension on long box (e.g. Swimming), and modified Roll-Up/Roll-Down on the Spine Corrector, or at the Springboard. |
| Intervertebral Disc Herniation (aka bulging, slipped, ruptured) | The inner nucleus pulposus can bulge out into the annulus. With a rupture, the inner nucleus can push out through the weakened outer annulus fibrosis. This can cause compression on the spinal nerve (causing radiculopathy) as it exits the spinal column. |
| Intervertebral Disc Herniation Causes | Can be related to age-related degeneration of the annulus fibrosis; Wear/tear w/ constant sitting, lifting + squatting; Traumatic lifting/straining; When the spine is flexed and/or flexed + rotated such as w/ forward bending, improper lifting and sitting |
| Lumbar Spine Disc Herniations | Back pain, buttock pain, leg pain (usually unilateral) • Numbness, tingling and/or weakness into leg and foot • Increased pain with sitting, standing, forward bending and walking • Pain may also increase with sneezing, coughing and laughing |
| Cervical Spine Disc Herniations | Pain in the neck and upper scapula; pain, numbness, tingling and/or weakness into the upper extremity (usually unilateral). Surgical opt include diskectomy, laminectomy, fusion + artificial disc replacement. |
| Cervical Spine Disc Herniation Contraindications | Avoid flexion-based exercises, sitting for extended periods of time, posterior tilt and imprinting of pelvis, flexion w/ rotation, caution w/ rot; anterior herniation: avoid extension-based exercises |
| Cervical Spine Disc Herniation Modifications | Utilize extension-based exercises, neutral pelvis/spine to sit, neutral pelvis w/ feet/legs supported, decrease ROM if client can't maintain neutral, use spinal stenosis guidelines to work in pain-free ROM. |
| Cervical Spine Disc Herniation Programming | Posterolateral herniation, extension-based exercises are indicated. If/when flexion is added, start w/ small and controlled ROM. Spinal and pelvic stabilization w/ focus on trans abs, multifidi, pelvic floor. Neutral! Glute strength. Hamstring lengthening |
| Lumbar Radiculopathy | Nerve pain caused by compression or irritation of a spinal nerve as it exits the spinal column. Pain, numbness, tingling, weakness and/or burning can radiate into the lower extremity. Think Sciatica. |
| Sciatica (Causes) | Herniated disc (common); lateral foraminal stenosis; spondylolisthesis, degenerative disc disease, scar tissue from previous surgery, scoliosis, diabetes (can lead to decreased blood flow to spinal nerve), trauma/infection (less common) |
| Sciatica | Most commonly due to involvement of the L5 and/or S1 spinal nerve. Clients may experience pain, burning, numbness, tingling and/or weakness into the buttocks and back of thigh. Can radiate below the knee to the foot. Usually on one side. |
| Sciatica Contraindications/Precautions | Avoid any position or exercises that increase pain or radicular symptoms |
| Sciatica Modifications | Utilize positions that are pain-free; for example, if flexion increases pain and symptoms, use extension-based exercises |
| Sciatica Programming | Avoid any position or exercise that causes and/or increases symptoms. Often same guidelines for herniated discs. |
| Spinal Stenosis | Spinal canal narrowing w/ possible subsequent neural compression of the spinal cord or nerve roots. May be congenital. |
| Spinal Stenosis as a secondary condition | Facet joint arthropathy, ligamentum flavum hypertrophy, posterior longitudinal ligament hypertrophy, vertebral body osteophytes, intervertebral disc herniations, spondylolisthesis, Epidural fat |
| Central Canal Stenosis (cervical and thoracic spine) symptoms | Loss of hand dexterity, severe cases present w/ spastic quadriparesis |
| Central Canal Stenosis (lumbosacral region) symptoms | Radicular nerve pain down bilateral legs, neurogenic numbness in bilateral lower extremities w/ walking, relieved by sitting, pain w/ extension relieved w/ flexion, pain w/ standing, relieved w/ sitting |
| Lateral Canal Stenosis symptoms | unilateral radicular (nerve) pain weakness and numbness along distribution of the affected nerve |
| Spinal Stenosis Contraindications/Precautions | avoid excessive extension (prone and prolonged standing), stop activity if onset of symptoms such as numbness, tingling and/or pain, caution w/ rotation (can close facet joint and increase nerve compression) |
| Spinal Stenosis Modifications | seated, quadruped, side-lying positions; eliminate rotation. |
| Spinal Stenosis Programming | Flexion; facilitate opening of the spinal canals; work in imprint; lateral foraminal can be relieved from lateral side bending to opposite side of stenosis; gluteal strengthening is important for lumbar. |
| Facet Joint Syndrome | Inflammation and/or degeneration of the structures of the structures of the joint and/or hypertrophy of the synovium of the joint. |
| Facet Joint Syndrome Contraindications/Precautions | Avoid extension if it increases symptoms; avoid anterior pelvic tilt; caution w/ rotation |
| Facet Joint Syndrome Modifications | Flexion-based exercises; imprint, working toward ability to maintain neutral pelvis, introduce rotation if pain-free |
| Facet Joint Syndrome Programming | Flexion-based exercises. Core stabilization and strengthening, working to maintain neutral spine and pelvis. Posterior pelvic tilting to neutral. Strengthen gluteal muscles. Stretch hip flexors, lumbar extensors, quads and hamstrings. |
| Spondylolisthesis | displacement (usually anterior/ forward slippage) of one vertebra on another. This condition most commonly occurs at L5/S1. Hyperlordosis is a common postural pattern seen with spondylolisthesis. |
| Spondylolysis | Defect or fracture of the pars interarticularis of the vertebral arch. It can be congenital or acquired. Can lead to spondylolisthesis. |
| Spondylolisthesis Symptoms | local low back pain; pain may also radiate into the buttock, thigh and leg w/ radicular symptoms such as numbness, tingling and/or weakness. Hamstring tightness is common. W/ anterior slip, pain may increase w/ extension and prolonged standing. |
| Spondylolisthesis Contraindications/Precautions | Avoid lumbar extension, anterior pelvic tilt, prolonged standing, caution in hip extension exercises to avoid lumbar hyperextension. |
| Spondylolisthesis Modifications | Work w/ flexion-based exercises; imprint and progress to neutral; utilize side-lying for glute strengthening and/or use cushion/support under pelvis in prone to prevent lumbar extension. |
| Spondylolisthesis Programming | Flexion-based exercises in imprint, progress to neutral. Focus on spinal and core stabilization. Stretch hamstrings and hip flexors, especially when lumbar hyperlordosis is present. Strengthen glutes. |
| Ankylosing Spondylitis | Inherited rheumatic disorder of the spine. Inflammation affects the synovium of the spinal arthrodial joints and the joint ligaments of the spine at their insertion points into the bone. Limited ROM. |
| Ankylosing Spondylitis Programming | Gain spinal mobility, stretch anterior flexor musculature. Prone. Strengthen postural muscles. Emphasize breathing and chest expansion. Maintain and improve hip mobility. |
| Scoliosis | Lateral curvature of the spine. There may also be rotation of the vertebrae. Generally C or S shaped. Can cause long and weak muscles. |
| Structural Scoliosis | structural changes to vertebrae. cannot be fixed by exercise, but muscles and soft tissue structures can improve. |
| Structural Scoliosis: Idiopathic | unknown cause; most common; adolescent onset is common |
| Structural Scoliosis: Congenital | Refers to vertebral anomalies that are present at birth |
| Structural Scoliosis: Neurological | Secondary to conditions such as Marfan syndrome, cerebral palsy and muscular dystrophy |
| Non-structural/functional scoliosis | Structurally normal spine. Lateral curvature may be secondary to posture, leg length discrepancy, pain or nerve irritation. Usually no rib/vertebral body rotation/rib bulge. Reversible by correcting underlying dysfunction. |
| Scoliosis Programming | Strengthen muscles on the convex side of the curve, while stretching the concave side of the curve. Side bending and rotation will be limited in one direction. Work both sides. Elongate spine. Props min curve. Strengthen hips and glutes. Breathwork. |
| Degenerative Disc Disease/Spondylosis | Likely multifactorial. Changes in the intervertebral disc occur w/ age, decreased disc height w/ loss of fluid; injury causes instability at segmental level; nucleus pulposus becomes more fibrocartilaginous, decreased disc height, possible osteophytes. |
| Degenerative Disc Disease Programming | Neutral spine/stabilization exercises. Extension-based exercises help decrease intradiscal pressure. Smaller ROM, short levers. Decreased resistance. Flexibility of hamstrings, hip flexors, lats, pectoralis muscles. |
| Spinal Instability | Abnormal excessive movement of the vertebrae at the segmental level. Can cause mechanical low back pain. Influenced by neural control, passive elements, musculotendinous (global/local) |
| Spinal Instability Programming |
Created by:
barefootnbluejeans89
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