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Pilates COREterly

Spring 2011

Rehab Corner

Scolio-Pilates: Working in Multiple Dimensions

by Karena Thek Lineback

Scoliosis is one of the most common spinal aberrations. Working with scoliosis clients has benefits that extend beyond working with just that type of client. Because of the positioning of the scoliosis spine in multiple dimensions, you can tackle almost any variation that wily 24 vertebrae can throw your way. Working with scoliosis clients can better your understanding of how to work with spine pathologies including hypertrophies, atrophies, bony remodeling and disc issues.

Getting Started

You can not continue to train muscles in the position they are already in if you want to create change. You must correct the position, first, and only then can you apply strengthen and endurance exercises to hold the change.

Your first task will be to determine what corrections must be made to bring the spine towards neutral. To do that, you’ll first need to know where the spine is curving and rotating. With scoliosis, the primary curve tends to be fairly obvious. It is usually seen as a thoracic convexity, a lumbar convexity or a protruding hip. Once you find it, find the other two or three compensating curves. They may be more subtle but are apparent through hypertrophy of the tissues, rotations of the vertebrae, ribcage, shoulders and cervical spine. Also look for areas of the spinal musculature that appear atrophied.

Planes of Scoliosis: Coronal, Sagittal and Transverse

Scoliosis curves happen in all three planes of movement. Most scoliosis MRIs that we see look at the coronal plane, or side-to-side plane. Much of the corrective exercise for scoliosis focuses solely on this plane. But lasting change needs to speak to the sagittal and transverse planes as well. The rotations of the spine in the transverse plane can be seen using a scoliometer, a level that looks at the difference in height of one side of the spine to the other. The sagittal plane changes can be seen in standing, where you’ll generally see an anterior tilt in the pelvis as well as changes in the thorax, shoulders and cervical spine.

Corrections:

Every exercise/position will have a different list of corrections to follow, so for our purposes here, let’s just talk about what you can do with your client in supine.

Because these movements can be very subtle, it’s important to go step-by-step and take your time. Once you understand these corrections the other positions will be easier to grasp.

(continued above)

1. Elongate:
Begin by elongating the spine. In supine imagine you have little shoes on the tips of your scapula (shoulder blades) and take a walk in the direction of your head. Now put those little shoes on your butt cheeks, walk the little shoes towards your feet. Anatomically, you are providing traction to elongate axially.

2. Correct Alignment to Center:
As much as possible, bring the legs, torso, arms, neck, and head into perfect alignment.

3. Propping: De-Rotating the Pelvis, Spine and Shoulder Girdle
First, you’ll want to know the reason for propping up the spine. You are not using the props to fill in the gaps between the floor and the spine. Instead, you are using the props to de-rotate the convexities to bring the spine closer to neutral. When you bring the spine closer to neutral you lengthen the short and tight muscles and you shorten the long and stretched muscles. You are placing both groups into a position where they can activate effectively. It may be first time in a long time that they are able to do this. You will need to find props to help you lift the rotations of the spine towards neutral. I use Scolio-Wedges and ‘Angles but you can be creative and find some things around the studio that will work. For instance, try cutting up an old mat that you were thinking of ditching anyway.

  1. Place a large Scolio-Wedge across the iliac crest and lumbar convexity.
  2. Place a small Scolio-Wedge under the ribcage convexity.
  3. Place Scolio-Triangles (2 or more) under kyphotic shoulder. You are trying to bring the shoulder to neutral, so use however many it takes. In supine, the kyphotic shoulder will be the shoulder that is dropping into the mat.
  4. Place a ball under the hand on the side of the shoulder kyphosis and press into it. This will correct the kyphotic shoulder as well as aid in lengthening the lumbar convexity musculature allowing it to contract more effectively.
  5. Laterally flex the cervical spine in the direction of the curve referred to in Figure 2. See how the right side of the neck appears shorter than the left? That indicates that the curve is pushing to the left, dropping the right ear down.
  6. Continue to elongate the cervical spine towards the mat by pressing the occiput towards the mat. Bring the chin straight back as if you are trying to push the chin inside the mouth.

4. Didn’t Prop it? Drop it.
The areas of the spine that are propped are the ones that are moving too far back or dorsally, so we brought them forward (ventrally). The parts that are not propped? They need to be cued dorsally.

  1. Cue the un-propped side of the ribcage and pelvis to drop towards the mat.
  2. The shoulder on the side of the thoracic convexity will usually pop forward of the mat. Correct it by placing the hand on the shoulder and opening the elbow to the side.

5. Gliding
To finish up, we will glide the spine in the coronal plane.

  1. Isometrically squeeze the muscles on the side of the protruding hip as you glide the pelvis towards the body’s center.
  2. Glide the ribcage convexity towards center. Do not allow the ribcage to dive down towards the hip as you glide.

In conclusion I’ll offer you the most common comment that I hear from Pilates instructors learning these corrections for the first time: “Really? I don’t think my clients will put up with all this propping, rotating, hand on the shoulder complicated stuff.” And here’s my answer... Your clients will feel so good in this position that after the first session working this way, you won’t have any issue getting them to put in the work. And the corrections become natural very quickly because they do feel good. All those corrections take about 30 seconds (at most) once you and your client know what to do.