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Archive for the ‘Case Studies’ Category

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Back Pain? Throw on a Back Pack

Monday, August 22nd, 2011 by Karena

This post could have been titled: How to heal back pain with a back pack. And no, I’m

My back was crying today but I had a 6-mile hike planned. Hence, the 12-pound back pack

My back was crying today but I had a 6-mile hike planned. Hence, the 12-pound back pack

not talking about filling it with muscle relaxants to get you through the day. I’m talking about the work of Stuart McGill, PhD. He is a kinesiologist out of the Univeristy of Waterloo and has done extensive research on the best ways to heal back pain.

One of this methods includes wearing a back pack with 15-25 pounds in it. Sounds crazy, huh? The theory behind it is that if the weight is placed low in the back pack, it aids the spine extension muscles, so it helps to keep you upright. If you are bent over your spine muscles aren’t really working they are in a holding pattern; it is more like they are holding on for dear life to keep you from going nose-first into the dirt instead of acting to give strength and mobility to the spine.

Dr. McGill’s recommendation is that you wear the pack and walk on uneven terrain. Hiking a dirt path would be great. The small subtle changes in the terrain force your spine to accommodate forward and back, side to side twisting and side to side bending.

I had a chance to test his advice three years ago after back surgery. I stayed at about 10 pounds in a fanny back and it worked really well. I was able to go about 30% farther with the pack then without it. I had another “opportunity” to test it today. My back decided to get super-angry after mountain biking this morning and my friend and I still had a 6 mile hike planned for the afternoon. I was hurting. Big-time.

So I let my friend wrangle both dogs, I threw a lot of water bottles in the bottom of a pack and gingerly started making my way along the trail. Ow. Ouch. Holy be-geezus… But it got better. It loosened up. And I did the 6 miles. Tonight, I can feel my back. I iced and I’m getting ready to take some Aleve but it’s good. We are planning another hike tomorrow and my back pack is ready.

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How to do Pilates exercise for Multiple Sclerosis and Muscular Dystrophy

Monday, August 22nd, 2011 by Karena

It’s funny how certain types of problems show up in the studio in waves.  My most recent wave has been severe muscular degeneration in the form of multiple sclerosis and muscular dystrophy.  With both scenarios it was, first,  important for me to explain to my clients that exercise is not going to return strength to the muscles that have been affected by the disease.  What we can do is strengthen the muscles that are not affected and increase coordination in those muscles as well.

And the coordination will be key.  Coordination in the small musculature so that the body’s muscles can work together synergistically and effectively is a component that is lost whenever there is an injury.  To return coordination to some of those small muscles in the case of severe muscular degeneration will be even more valuable.

Here’s the video with one of my favorite exercises for muscle loss.  Let me know if you have any questions.  Karena

How to do Pilates exercise for Multiple Sclerosis and Muscular Dystrophy

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Exercise Reduces Scoliosis Pain and Curvature

Friday, December 10th, 2010 by Karena

Exercise reduces scoliosis pain and curvature. That’s the good news.  The really good news is that we have studies published in peer-reviewed medical journals to back up those claims. I chose three for you to look at.  If you go to PubMed and search ’scoliosis exercise’ you’ll find a few hundred more.  These are the studies that are the basis of the exercises in my book, Scolio-Pilates.

1. In 2003, a study of adolescents with scoliosis showed a significant reduction in the degree of curvature over the course of one year using exercise alone. The Cobb angle, used to measure the degree of a scoliosis curve, was reduced on average from 26.1 degrees to 17.85 degrees with exercise alone. The type of exercise used in the study is referred to as the Schroth Method, designed by Katharina Schroth in the early 20th century. Her exercise program for correcting scoliosis is the building block that all modern day therapeutic exercise programs stand on and is described in the book, Three Dimensional Scoliosis.  Her exercise program relies on lengthening and de-rotating the spine, used since the time of Ancient Greece to correct scoliosis, along with a strengthening program.

Read the entire study at PubMed: The efficacy of Schroth 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Med J. 2005 Sep;26(9):1429-35.

2. A 2010 study  shows that asymmetrical exercises were effective in engaging the muscles on the concave side of the scoliosis. The concave muscles, or muscles on the non-hump side of the scoliosis, are generally in a state of severe atrophy. The weaker these muscles become the more the scoliosis is allowed to progress. The study concluded “that these exercises may advance care of patients with scoliosis.”

Source: Schmid AB, Dyer L, Böni T, Held U, Brunner F., Paraspinal muscle activity during symmetrical and asymmetrical weight training in idiopathic scoliosis.Journal of Sport Rehabilitation, 2010 Aug;19(3):315-27. Read the complete study here.

3. With scoliosis, there is a concern surrounding pulmonary (lung) function because of the mis-shapen and rigid ribcage housing the lungs. A rigid ribcage will make it harder for the patient to breathe normally and lung disease becomes a concern.  This study shows that exercise increased mobility in a rigid ribcage and greatly increased vital capacity, measured by the amount of air exhaled, in scoliosis patients.

Source: Weiss, Hans-Rudolf, M.D., “The effect of an exercise program on vital capacity and rib mobility in patients with idiopathic scoliosis.” Spine, Vol. 16 (1/1991). Read the complete study here.

As a result of these studies and also my own scoliosis getting much worse after a discectomy surgery three years ago, I started employing the three-dimensional techniques from the Schroth Method and applying it to my Pilates work.  And even though I was certain I was headed back to surgery, the pain in my spine subsided.  I used the method so successfully with other scoliosis clients that I decided to put the exercises into a book: Scolio-Pilates.  If you are interested, there is more information here about the book. Good luck!!

Posted in Case Studies, For Professionals, Heal Your Back Pain | No Comments »

Finding a Hamstring Imbalance: Osgood Schlatter Disease continued

Monday, November 1st, 2010 by Karena

zac lowYou’ll see the last post was on Osgood Schlatter as well.  Because of the imbalance in the vastus medialis (see last post) I wanted to check the hamstrings a little more closely today when this client came in.  This is how I did it:

  1. I put Zac (our 15 year old client with Osgood Schlatter) prone on the long box facing the foot of the reformer.
  2. I sprung the reformer with one each of the red, blue and yellow springs.
  3. I put the foot loops over the arches of his feet.
  4. I had Zac bend the knees to pull out most of the slack out of the cords. (about 120-115 degrees)
  5. Zac performed hamstring curls in parallel, external rotation and internal rotation. He did 5 of each with both legs (grooving the motion) and then 5 of each with one leg only (dropped the blue and  yellow springs)
  6. This exercise showed a weakness in the hamstring that creates knee flexion with hip extension in internal rotation.  Or in simpler terms: His right leg was much weaker than the left when the knees were together and feet dropped open while trying to perform a hamstring curl.

Homework: I added to Zac’s homework with the exercise in the pic.  He is in internal rotation and he is pulling against the weight of the theraband.  I am having him do all positions on both legs, double-leg and single leg with the theraband and the help of his very amazing mom.  I am also having him do extra work on the position that is most weak (see #6 above).

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Exercises for Osgood-Schlatter in Teen Athlete

Thursday, October 28th, 2010 by Karena

This is my second teenage athlete in three weeks that has come to me for knee pain.  This young man is still in

Exercise can change the muscular imbalances that affect Osgood-Schlatter Disease

Exercise can change the muscular imbalances that affect Osgood-Schlatter Disease

high school and has a really busy schedule of basketball practice and conditioning. His chiropractor diagnosed Osgood-Schlatter Disease, often considered a ‘growing pain’,  which is knee pain affecting children where the bony protrusion below the knee (the tibial tuberosity) becomes inflamed. You can usually recognize it by the bump that begins to form on that bone below the knee, a bump that lasts throughout adulthood.  You can see from the photo that that bump has not really protruded very much yet on the right knee that is affected but if you look closely you can almost see it.

So what can be done about Osgood-Schlatter? This young man does not want to stop his busy practice schedule for fear of being side-lined during the season.  So the normal answer of resting to alleviate pain is not an option. Plan B, then, is to find the muscular imbalances and work hard on those and hope for a big change in the pain levels as the muscles become more balanced.

These are the imbalances that I have found so far:

  1. A weak vastus medialis (the muscle that sits above the knee and to the inside) on the right leg. You can see in the pic that the v.m. is not as developed as it is on the left knee.
  2. A tendency for internal rotation of the right hip which leads to improper tracking of the hip, knee. Or in other words when the knee bends it points at the other knee instead of where it should be pointing: right over the big toe.
  3. And this is the big one: very weak gluteal medius and minimus (the muscles at the side of the hip).  VERY weak.

The exercises to fix the imbalances:

  1. Glut Med, Min Stregthener. Side-lying leg series: Lying on one side, bend the bottom leg while keeping the top leg straight.  Lift the top leg to hip height and back down ten times.  Then lift the leg and hold for 10 seconds.  Lastly, circle the leg ten times in each direction. Once this exercise gets easier start adding ankle weights. Build up to 5 pounds.
  2. Tracking of the knee.  While seated, lift the leg off the floor in parallel position (or knee straight to the ceiling). Bend and straighten the knee and watch the tracking. The knee needs to continually point over the big toe.  Small variations not acceptable; this is your chance to really focus the movement and groove a healthy pattern. Do it perfectly.
  3. Strengthening of the Vastus Medialis. Do the same as exercise #2 with this small change: Instead of the knee facing the ceiling, turn the knee to the outside.  Bend and straighten. Continue tracking the knee as well. As you bend and straighten the knee will still be pointing over the toes.

Good luck. Let me know if you have any questions. K
p.s. Yes, I know it would be better if the pic were turned 45 degrees right. I have the picture on my computer vertically and when I upload it turns it. If you happen to know how I can fix that, Please! Let me know!

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Posted in Case Studies, For Fitness Fanatics, For Professionals, Uncategorized | 1 Comment »

Exercise for Hip Bursitis Pain Relief

Sunday, August 29th, 2010 by Karena

As I was lying on the couch, acutely aware of where my trochanter inserts into

Hip burisitis occurs when the cushion between the hip bone and thigh bone gets inflamed

Hip burisitis occurs when the cushion between the hip bone and thigh bone gets inflamed

my acetabulum, I thought: ‘I should write my little friends (you!) a note about bursitis’.  I have had some flare ups with the ol’ ‘B’ word but I can generally keep the pain pretty short-lived because I know what to stay away from.  And if you have bursitis, I think you should know, too!

Acute episodes of bursitis need never become chronic. Just stop pushing on the bursa!  The bursa is a soft little pillow that cushions the connection between your thigh bone and your pelvis and if your thigh bone continues to squish the bursa, it becomes inflamed; hence the ‘-itis’ that gets suffixed onto the backside of bursa…

How do you squish the bursa? The bursa is squished when you externally rotate the thigh. External rotation crams the greater trochanter into the acetabulum squeezing the life out of the bursa. That’s fine when the bursa is happy but when it’s not happy you need to avoid squishing, smushing and otherwise irritating the bursa.

Here are some things you can do to avoid externally rotating the thigh.

  1. Don’t cross your legs with one ankle dropped over the opposite knee.
  2. Do sit with the legs together, knees touching. If you can cross the legs and smush the inner thighs together you will still be avoiding external rotation and you could be internally rotating which will pull the thigh bone away from the bursa–aaahhhh, sweet relief…. (think piriformis stretch for the professionals out there)
  3. Walk with your feet pointed straight ahead: no duck feet. Duck feet externally rotate the hip and smush the bursa
  4. Perform exercises that internally rotate the hip.  Lie on your back, feet hip-width apart and push the knees towards each other.  You can do an isometric push here.
  5. Another exercise: Lie on your side, bottom leg bent, top leg straight. Now lift the top leg to just below hip height.  Then bring the entire inside of the foot back down to touch the floor (heel to big toe knuckle)
  6. Sleep on your back with your ankles crossed and knees rotated inward.  Okay, so you might not last the entire night that way but it is a great way to get off that bursa!
  7. Do not move the leg to the side of your body past the hip bone.  (No hip abduction for the professionals…) You will have to adopt a demur lady-like position in everything you do until the pain subsides.
  8. Do not sit cross-legged.

Does this make sense? Each and every time you externally rotate the thigh or carry the thigh to the outside of the body you ’smush’ the bursa.  Since the bursa is inflamed that kind of motion is only going to tick it off further.   So…you’ll get relief extremely quickly if you can just remember to STOP SMUSHING THE BURSA.

Good luck and let me know if you have any questions! K

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New Favorite Exercise for Stabilization

Monday, May 10th, 2010 by Karena

Hey, Everyone! Just a quickie today and I don’t even have a pic so we’ll all have to tune into the same Pilates Psychic channel so you can ’see’ what I’m talking about here.  I have been using this exercise for the last three weeks for:

  1. Hip Extensor Strength
  2. Quadricep eccentric contraction
  3. Glut med, min, endurance
  4. Soleus and tibialis anterior endurance
  5. Spine stability
  6. Pelvic stability

Here’s how it goes:

  1. Stand on the side of the reformer facing the footbar with the right leg next to the reformer. The heel of the right foot is about 4″ forward of the shoulder rest (4″ towards the footbar but on the floor).
  2. The left foot goes on the shoulder rest with the toes in extension and the ball and heel of the foot on the actual shoulder pad.
  3. With, of course, perfect alignment, press the left hip into extension.
  4. I give my client a six foot dowel to hold for balance. Watch for hyper-extension of the right knee and accommodations in the low back

Notes: Upon extension, if your client has little hip extension or tight hip flexors the left knee may meet the line of the right knee but may not extend beyond that point.  As the left hip extends be sure that your client is not ‘dumping’ into the low back.

I’ve been giving this exercise to my low back pain clients for increasing pelvic and spine stability. I’ve also used it for a client with a hip replacement to really zero in on the hip extension process without a whole lot of extraneous ’stuff’ going on.  And most recently I’ve used the exercise with a knee pathology.

If you have a variation on this that you love, let me know! I’m always looking for new things.  K

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