TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT Pilates for Low Back Pain Let’s call it CONTROLOGY!! TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic 920 41st Avenue ©Copyright TheraPilates 2019 920 41st Avenue with Dr. Sherri Betz, PT,Santa DPT Cruz, CA 95062GCS, CEEAA, PMA®-CPT Santa Cruz, CA 95062 www.TheraPilates.com 888-229-5334 ©Copyright TheraPilates 2019 Main Causes for Low Back Pain: ♦ Declining activity level ♦ Prolonged Sitting ♦ Poor Postural Alignment/Asymmetry ♦ Muscular Imbalances ♦ Poor Core Muscle Strength ♦ Habitual Faulty Movement Patterns ♦ Genetic Predisposition TheraPilates® Physical Therapy Clinic ♦ Skeletal Anomalies 920 41st Avenue Santa Cruz, CA 95062 Copyright © 2019 TheraPilates® 1 TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT TheraPilates® Physical Therapy Clinic TheraPilates® Physical Therapy Clinic 920 41st Avenue 920 41st Avenue Santa Cruz, CA 95062 Santa Cruz, CA 95062 “Stability is optimal when muscle activity is controlled with sufficient finesse to maintain controlled movement and postures in a manner that is matched to the demands of the task.” Paul Hodges www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 9 ©Copyright TheraPilates 2019 920 41st Avenue Santa Cruz, CA 95062 Santa Cruz, CA 95062 Also “Box” coined by Bob Liekens Muscolino JE, Cipriani S. Pilates and the “Powerhouse”: I. J Bodyw www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue Mov Ther. 2004;8:15-24. Santa Cruz, CA 95062 Copyright © 2019 TheraPilates® 2 TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT vs. www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 ©Copyright TheraPilates 2019 920 41st Avenue 920 41st Avenue ©Copyright TheraPilates 2019 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Beighton Score for Hypermobility Syndrome TheraPilates® Physical Therapy Clinic TheraPilates® Physical Therapy Clinic 920 41st Avenue 920 41st Avenue Santa Cruz, CA 95062 Santa Cruz, CA 95062 3. Pelvic Asymmetry www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue ©Copyright TheraPilates 2019 920 41st Avenue 18 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Copyright © 2019 TheraPilates® 3 TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT ♦ Palpation of Transversus Abdominus medial to ASIS in Supine Prone Instability Test: ♦ Cough/Sneeze https://www.physio-pedia.com/ Prone_Instability_Test ♦ Forced Expiration ♦ Sidelying ♦ Pregnant Cat in Quadruped ♦ Prone Lift of Transversus Abdominus ♦ Rollup without Rectus Bulge (No Loaf of Bread!!) www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue ©Copyright TheraPilates 2019 920 41st Avenue 20 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Aberrant Movement: Avoid cueing “neutral spine” in supine or Rapid superficial contraction prone. The client will often over arch and accentuate lumbar lordosis which Global contraction with ES and OE will recruit superficial erector spinae Posterior Pelvic Tilt muscles. Subtle Anterior Pelvic Tilt www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 21 ©Copyright TheraPilates 2019 920 41st Avenue 22 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Cheap and Effective! Good evidence for PF Training… Is it tight or weak? Neumann, et al 2006 www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 23 ©Copyright TheraPilates 2019 920 41st Avenue 24 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Copyright © 2019 TheraPilates® 4 TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT Can you stop the flow of urine midstream? (Avoid doing this regularly) Sitting is different than standing posture (Avoid doing first thing in the morning) Do you have difficulty initiating micturition? Most people think that good posture is to extend everything! (May suggest hyperactivity or hypertonicity) Women have more lordosis than men Does your stream stop and start? in sitting. Do you have pain or discomfort? Lumbar spine is generally flat in sitting Do you hover? Do you lose control when coughing or sneezing? www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 25 ©Copyright TheraPilates 2019 920 41st Avenue 26 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Sacral slope Forward Head-Shuts off the abdominals. Correction is not just a straight retraction, and it’s a scoop and lift. When done relationship correctly, the abdominals will fire. to femoral Thoraco-lumbar junction extended: heads connect distance from bottom of sternum predicts to belly button. Breathe into hands at TL junction curves of Bring rib cage over the back of the pelvis spine *Corrections feel weird but comfortable www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 27 ©Copyright TheraPilates 2019 920 41st Avenue 28 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Axial Elongation helps to distribute • Encourage “release” into optimal curve… and minimize shear forces at each not forced. vertebral segment, facet joints and • Shift weight forward and back on feet, sacroiliac joints. feel abdominals fire. Decreases dependence on inert or • Rock pelvis forward and backward to dissociate pelvic from thoracic motion passive (ligamentous, bony, and with weight over IT’s capsular structures) for stability • Post Tilt: Weight behind each IT Minimizes wear and tear of • Ant Tilt: Weight in front of each IT cartilaginous surfaces of joints www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 29 ©Copyright TheraPilates 2019 920 41st Avenue 30 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Copyright © 2019 TheraPilates® 5 TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT Neutral or Optimal Alignment Relaxed Posture Forced Correction Best Correction www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 31 ©Copyright TheraPilates 2019 920 41st Avenue 32 Santa Cruz, CA 95062 Santa Cruz, CA 95062 67 year old woman with 4 Vertebral compression fractures after doing Yoga Shoulder Stand with Osteoporosis. 1 month post- Vertebroplasty x 4. C/O Low Back Pain. Very flat and almost kyphotic Lumbar Spine. www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 33 ©Copyright TheraPilates 2019 920 41st Avenue 34 Santa Cruz, CA 95062 Santa Cruz, CA 95062 •Optimal spine & pelvic position ♦ Everyone should learn to HIP HINGE !! •Most stable posture-not natural! Squat with Dowel on Head, Mid Back, Position is slightly different for everyone Sacrum •General cervical lordosis, thoracic kyphosis ♦ Chair Pose Hip Hinge with Dowel and lumbar lordosis •All segments: disc spaces, facet joints, ♦ Quadruped with Dowel foraminal openings, sacro-iliac joints and ♦ Transfer to and from Floor in Neutral pubic symphysis bear an equal distribution of forces. www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 35 ©Copyright TheraPilates 2019 920 41st Avenue 36 Santa Cruz, CA 95062 Santa Cruz, CA 95062 Copyright © 2019 TheraPilates® 6 TheraPilates ® for Low Back Pain Sherri R. Betz, PT, DPT, PMA®-CPT www.TheraPilates.com 888-229-5334 TheraPilatesTheraPilates® Physical® Physical Therapy Therapy & Gyrotonic® Clinic www.TheraPilates.com 888-229-5334 TheraPilatesTheraPilates® Physical® Physical Therapy Therapy & Gyrotonic® Clinic ©Copyright TheraPilates 2009 920 41st Avenue 37 ©Copyright TheraPilates 2009 920 41st Avenue 38 Santa Cruz, CA 95062 Santa Cruz, CA 95062 We teach people to activate muscles in isolation to provide a training stimulus to make the system modify. Contraction of only TrAb: get pushing up of the diaphragm and descent of the PF Lot of studies where people are asked just to contract the transversus….they have completely missed the point. Paul Hodges www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic www.TheraPilates.com 888-229-5334 TheraPilates® Physical Therapy Clinic ©Copyright TheraPilates 2019 920 41st Avenue 39 ©Copyright TheraPilates 2019 920 41st Avenue 40 Santa Cruz, CA 95062 Santa Cruz, CA 95062 With “bracing” you get descent of the Be careful not to over recruit the TA,