Lower Back Pain in Dancers
Using Pilates to Support and Strengthen the Lumbar Spine
Sierrah Dietz April 10th, 2014 2013 Aptos, CA
Most sports and activities require repetitive movement in the same range of motion, and without proper form or alignment this can lead to serious injury. Dance training is a great example of high impact movement, that when done incorrectly over time can cause serious muscle and joint damage. Dancers are asked to move their bodies in ways that seem impossible to the average person but with vigorous training it can be accomplished. This is not always safe for one’s body, and requires knowledge of proper body mechanics to avoid injury. Some of the most common injuries related to dance include lower back pain, and hip and knee joint issues. This research paper will be focusing on lower back pain in dancers. By incorporating Pilates into a dancer’s regimen, it can help rehabilitate already vulnerable muscles and joints, while also building the muscles needed to prevent further injury and help overall performance
TABLE OF CONTENTS Title Page Abstract Table of Contents Anatomical Description Introduction Case Study Conclusion Work Cited
The area of the body I have chosen to focus on is the lower back, pelvic floor, and lower abdominals. Specifically the exaggerated "tuck" or posterior tilt emphasized by dance training which can cause a dancer to lose their natural lumbar curve and over stretch the muscles in their low back. Posterior, or backwards tilt, is the opposite of anterior tilt. While lying supine the iliac bones would be on a lower horizontal plain then the pubic bone.
A posterior tilt is usually accompanied by excessive kyphosis of the spine which involves a rounding or slouching of the lower back causing a hump in the lumbar region of the spine. The lumbar spine is the lower back, where the spine curves toward the abdomen. It starts about five or six inches below the shoulder blades, and connects with the thoracic spine at the top and extends downward to the sacral spine. Three of the most important muscles that work to support the low back are Psoas Major, Quadratus Lumborum, and Lattissimus Dorsi. They each have individual functions and work together to provide support for the
lower spine. The psoas major stabilizes the base of the spine, which can lengthen and move forward, and it enables external rotation in the hip. The Quadratus Lumborum or QL stabilizes the bottom rib and helps with side bending, lifting the hip and extending the lumbar spine. The Latissimus Dorsi is the largest muscle of the lower back and originates from the mid-‐thoracic spine to the sacrum and it works to stabilize the back.
INTRODUCTION The human spine naturally has curvatures within it; our body placement with these curvatures is referred to as neutral spine. Many activities often force one’s body to move against or extremely within these curves which can cause serious injury to the muscles and bones in the torso. Dance is a very unique and physically vigorous activity which is known to cause weathering on the body after time. One common movement pattern for dancers is called posterior tilting of the pelvis or "tucking". This posture is encouraged mostly in ballet dancers and it forces the body to try and eliminate the natural curve in the lumbar spine, increasing external rotation of the hips and making it appear as though ones spine is completely straight. This "tuck" of the pelvis over time will cause the iliopsaos muscle to become very short, lower abdominal muscles to be weak, and lower back muscles to be overstretched. The muscular act of posteriorly tilting the pelvis causes the hip flexors, gluets, and quadriceps to engage just to support the position of the hips, over working these muscles. There are any ways Pilates can help to move the pelvis in an anterior direction trying to regain the natural lumbar curve in the spine. By strengthening the lower abdominal muscles, relaxing the lower back muscles and elongating the hamstrings, Pilates can help move to correct the "tuck" in the pelvis often caused by dance conditioning.
CASE STUDY Molly is a 26 years old female who has been dancing for twelve years. She teaches dance and studies it no less than twenty hours a week. She is very physically fit and strong but in the last five years has been experiencing lower back and hip pain. This is alarming to her and threatening the longevity of her career and she has decided to try Pilates in hopes of having a long and pain free dance career. Because of her years of dance training and physical fitness she, Molly is very aware of her body and is a confident mover, with that, it is important to encourage the good habits molly's body has developed while correcting the more physically taxing habits. Molly's limitations include a posterior tilt in the pelvis, extremely tight hip flexors, and short inflexible hamstrings. Dance requires amazing flexibility so these limitations make it difficult for molly to use her full movement potential. She has very strong upper back and quadriceps which makes her movement sometimes stiff and puts some strain on the weaker less dominant muscles suck has her abdominals and lower back. By taking Pilates twice a week for five weeks and utilizing the BASI Block System Molly hopes to even out her body and experience less pain when she dances. Below is the first outline for Molly’s first session, and Molly's tenth session to show her growth in strength and understanding of the Pilates method and movement patterns. Each session will be well balanced for a full body work out while focusing on the areas the need
special attention and strengthening. Hopefully Moly will be able to translate the movement and muscle memory she learns in the Pilates sessions to her dance training and teaching. SESSION ONE:
Mat Work: Pelvic Curl -‐ performed with breathing to warm up the lungs while beginning to move the lumbar spine in a posterior direction, Spine Twist Supine -‐ with feet on the floor to increase stability through the lower back, Chest Lift -‐ isometric movement, focusing on maintaining neural pelvis while flexing the upper back and engaging abdominals Reformer: Parallel Heels, Parallel Toes, V-position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, and Prehensile -‐ getting the body moving and watching for posterior tilting of the pelvis, and gripping of the hip flexors. Try to engage the inner thigh muscles in external rotation Reformer: 100's Prep - using a lighter spring to lessen the arm work and really focus on upper abdominal flexion and natural spine, Coordination - adding the movement of the legs to challenge stability and strength the abdominals Reformer: Frog, Circles Up, Circles Down -‐ not letting the legs lower then she can support with her abdominal muscles, and resisting he springs as she lifts the legs, using a light spring so she can find some ease and movement in the hips and utilize her flexibility positively
SPINAL NOT INTRODUCING THIS YET ARTICULATION Ladder Barrel: Glueteals, Hamstrings, Adductors, Hip Flexors - STRETCH all of these stretches are very important for dancers flexibility, lots of breathing and enough time in each position is crucial FULL BODY I NOT INTRODUCING THIS YET Cadillac: STANDING ARM SERIES - Chest Expansion, Hug-A-Tree, ARM WORK Circles Up, Circles Down, Punches, Biceps - Spinal Stabilization while working the arms FULL BODY II NOT INTRODUCING THIS YET Cadillac: Squats - Lining the body up, resisting the urge to LEG WORK posteriorly tilt the pelvis, encourage a slight anterior tilt to line the hips up over the heels Ladder Barrel: Side Over Prep -‐ Introducing obliques while LATERAL working the abdominals, maintaining pelvic stability throughout FLEXION movement BACK Ladder Barrel: Swan Prep - Try to keep the lumbar spine still while EXTENSION extending the upper back and relaxing the hop flexors into the barrel
SESSION TEN: Mat Work: Pelvic Curl -‐ performed with breathing to warm up the lungs while beginning to move the lumbar spine in a posterior WARM UP direction, Spine Twist Supine -‐ with legs in table top, Chest Lift -‐ legs in table top, Leg Changes -‐ pelvic stability main focus Wunda Chair: Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes -‐ Starting with the arms on the chair FOOT WORK for stability then move them to second position for more of a challenge. No pelvic rocking, lots of lower abdominal support and strength Cadillac: Mini Roll Ups, Mini Roll Up Oblique -‐ Keep the pelvis ABDOMINAL neural while opening up the back and increasing abdominal strength Cadillac: BASIC LEG SPRINGS - Frog, Circles Up, Circles Down, HIP WORK Walking, Bicycle - resisting the springs as the legs lift and maintain neutral spine throughout exercise Reformer: Bottom Lift - working on moving the spine with ease ** SPINAL two sets, one with heavy springs for lower back stability, and one ARTICULATION with lighter springs to challenge and strengthen the hamstrings Reformer: Side Split, watching out for posterior tilt and soft lower STRETCHES abdominals, try to keep a very strong torso while allowing adductors to move and strengthen Reformer: Round Back - working the abdominals in a posterior tilt FULL BODY I (more comfortable), Flat Back - challenge abdominal work in a neutral spine or "flat back" position (sight anterior tilt if needed) Reformer: ARMS SITTING SERIES - Chest Expansion, Biceps, Rhomboids, Hug-A-Tree, Salute - Sitting up away from the ARM WORK shoulder rests and trying to find a slight anterior tilt in pelvis while stretching the hamstrings, focus on arm strength FULL BODY II NOT INTRODUCING THIS YET Wunda Chair: Backward Step Down - keeping the spine very LEG WORK stable while working on the strength, arms crossed for balance LATERAL Wunda Chair: Side Stretch - hip/pelvis stability on chair FLEXION BACK Wunda Chair: Swan Basic - pressing hips into chair stretching the EXTENSION hip flexors while working back extension
CONCLUSION: Pain is something that most people experience and feel that they must live with, especially people who are active. It’s hard to be in peak physical shape and admit to injury or weakness, we are told to "suck it up" or "push through". Pilates allows you to continue to work hard and be strong without having to live with that constant pain, it teaches you to be healthy, while constantly pushing you to and beyond your potential. Molly continues to work hard to stay physically fit and after her ten sessions she has begun to see the benefits Pilates can offer. She feels stronger than ever and knows what muscles to include and work to maintain proper alignment throughout her conditioning. There is always room for growth and improvement and Pilates is such an amazing tool and resource to help you on our way to a more beneficial and pain free life. Molly will continue to do Pilates to support her dance career and hobby and hopes to continue to challenge herself physically in ways she never thought possible.
WORK CITED Pilates Anatomy by Rael Isacowitz and Karen Clippinger Human Kinetics; 1 edition (March 10, 2011) Teaching Pilates: for postural faults, illness, and injury by Jane Patterson RGN Butterworth-‐Heinemann; 1 edition (January 5, 2009) Body Arts and Science International: Study Guide Comprehensive Course Copyright © 2000-‐2013 BASI Pilates livestrong.com "Pelvic Tilt and Back Pain" by Phil Swain, M.S., M.Ed.C (August 16, 2013) Copyright © 2014 Demand Media, Inc. www.spine-health.com "Lumbar Spine Anatomy and Pain" by Eben Davis, DC (January 11, 2013) Copyright © 1999-‐2014 Spine-‐health.com pilatesinteractive.com