BASI Pilates for the Older Person (Osteoporosis) · older person to complete the activities of...

BASI Pilates for the

Older Person

(Osteoporosis)

Theresa Lombard

18 September 2015

Course intake: Feb 2015

EdB Pilates, Cape Town

BASI Pilates for the Older Person

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Abstract

Pilates helps the mind to focus as it connects with the body to bring better awareness. Pilates

exercises helps to correct muscle imbalances and can greatly improve the quality of life for

especially the older population.

Pilates exercises can be taught in different levels to ensure that everyone benefit. Through

empathetic and supportive instruction and guidance, older clients can achieve goals which in

itself will improve their self confidence and bring a sense of wellbeing.

Proprioceptors are stimulated through Pilates exercises and that brings better balance and

stability, proper gait cycle and good posture. As strength and flexibility increases with regular

Pilates sessions, the risk of an injury or fall lowers dramatically. It becomes possible for the

older person to complete the activities of daily living and enjoy a sense of well-being.

Other benefits include improved bone density and muscle strength, healthy cardiovascular

system, healthier blood cholesterol through oxygen in the heart muscle, reduced systolic and

diastolic blood pressure, better breathing as a kyphotic posture improves.


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Table of Contents

Page number

1. Physical fitness and Osteoporosis 1

2. What happens with ageing? 3

3. Joseph Pilates’ opinion 5

4. Case Study 7

5. Conclusion – Pilates is Versatile and Functional 11

6. Bibliography 13


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1. Physical fitness and Osteoporosis

(Information gathered from Training the Over 50’s by Sue Griffen)

Spirduso (1995) divided physical function into five levels:

1. Physically elite

2. Physically fit

3. Physically independent

4. Physically frail

5. Physically dependent

By determining in which level the older client fits, a functional Pilates program can be

beneficial into improving the physical strength and capacity into a highly functional, healthy

lifestyle.

The Pilates principles being awareness, breathing, co-ordination, core strength,

concentration, relaxation, flowing movements, stamina, harmony and precision, makes

movement achievable for the older population in any of the abovementioned levels.

Quote from BASI Study Guide: “The benefits of incorporating Pilates into regular sessions are

largely unexplored as they pertain to the maturing client. However, a typical Pilates studio

setting offers a trusting, caring, non-competitive setting, where exercises are non-impact,

relatively safe and easily adaptable to the unique requirements associated with the aged.

While aging is an inevitable part of living, physical fitness may offer the key to successfully

fighting the negative effects that may be part of this process. Pilates provides a valuable


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method to maintain maximum health and vitality with improved posture, balance, flexibility,

joint range of motion and even reduction in stress.”

In this case study specific focus will be on osteoporosis of the spine. Osteoporosis is the

process of reduction in bone mass due to depletion of calcium and bone protein. Someone

with osteoporosis could easily endure fractures which are often slow to heal. It is more

common in older adults, particularly post-menopausal women; in patients on steroids; and in

those who take steroidal drugs. Osteoporosis will cause changes in posture, physical

abnormality (hunched back), and decreased mobility, therefore it is vital to strengthen the

muscles and bone.

The picture below shows Osteoporosis in the spine:

(picture with thanks to Medicinenet.com)


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1. What happens with ageing?

(Information gathered from The Complete Guide To Teaching Exercise to Special Populations by

Morc Coulson)

Loss of muscle mass

As a loss of muscle mass occurs with age (known as sarcopenia), people are less active and

become weaker. If the older person don’t stay active, the loss of muscle mass and strength

occurs faster than it does during youth and middle age, which could then increase the risk of

osteoporosis and falls.

Less flexible

Flexibility is affected by the cartilage surrounding joints calcifying, which leads to a decrease

in the range of motion at the joint. People then tend to be less active because of the loss of

flexibility and muscle strength which could lead to a higher fat percentage.

Bone strength decrease

Osteoporosis can increase the risk of fractures from falls. As bone mineral density decreases,

disorders like spondylosis and postural problems occur. Bone density is influenced by genetic

factors but can also be affected by environmental factors and medications. According to

www.medicinenet.com, bone density accumulates during childhood and reaches a peak by

the age of 25. While bone density is then maintained for about 10 years, it starts decreasing

again after age 35. Both men and women will normally lose 0.3%-0.5% of their bone density

per year as part of the ageing process.

On the next page follow an illustration showing the progressive stages of osteoporosis (from

www.medicinenet.com):

http://www.medicinenet.com/


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Image Source: MedicineNet, Inc.

Brain cells deteriorate

The 5 senses can deteriorate about 10% while brain cells die faster than they get replaced,

increasing the risk of conditions like dementia and Alzheimer’s disease.

Decreased lung function

The forced expiratory volume decrease due to breathing muscles becoming weaker and

alveoli in the lungs losing elasticity.

Heart rate slower

After the age of 40-50 years, the heart rate slows down which reduces the oxygen carrying

capacity. The heart muscle can also deteriorate which means less blood are pumped and less

oxygen carried to the muscles.

Blood pressure can increase

As the arteries harden, the blood pressure can rise.


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2. Joseph Pilates’ opinion

(Information gathered from 2 of Joseph Pilates’ books: Return to Life Through Contrology and

Your Health)

Joseph Pilates believed that the proper carriage of the spine is the only natural way to prevent

abdominal obesity, shortness of breath, asthma, high and low blood pressure and various

forms of heart disease.

The first lesson he would teach was that of correct breathing. If we could be taught as

children to take long, deep breaths, sufficient to expand the chest to capacity, drawing the

abdomen in and out and fully deflate the lungs with exhalation, there would be a good

foundation for breathing later in life too.

A sound mind would compliment a sound body but if only half is achieved, the perfect

harmony (balance as he called it), would be disturbed. “The mind and body need to be

coordinated in order to accomplish the minimum expenditure of mental and physical energy,

but also to live as long as possible in normal health and enjoy the benefits of a useful and

happy life.”

Joseph Pilates believed that the mistreated body will eventually decrease in health – he used

business men as example – that they would learn that happiness depends on normal health

and not on social position or wealth.


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It is so true that we often treat the symptoms instead of correcting the cause. With Contrology

(nowadays Pilates) we can achieve correct posture, flexibility, strength, coordination, stamina

and most importantly - a healthy spine.

Pilates was a wise man for the era he lived in. In his book “Your Health” which was published

in 1934, he mentioned that money should be spent towards restoring the population to normal

health in a natural way.

“Our interpretation of physical fitness is the attainment and maintenance of a uniformly

developed body with a sound mind, fully capable of naturally, easily, and satisfactorily

performing our varied daily tasks with spontaneous zest and pleasure. To achieve the highest

accomplishments within the scope of our capabilities in all walks of life, we must constantly

strive to acquire strong, healthy bodies and develop our minds to the limit of our ability.”

Pilates believed that heart control follows correct breathing which simultaneously reduces

heart strain, purifies the blood and develops the lungs. All of this will of course benefit

everyone, but specifically aids in slowing down the ageing process.


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3. Case Study

Wendy is a 62 year old healthy woman who came to see me as she often suffered from back

pain and was diagnosed with osteoporosis. She used to do yoga but stopped a few years

back and mostly enjoyed swimming to stay fit nowadays. She has an office job which means

a lot of sitting every day. She is in overall good health and determined to get stronger. After 3

thoracic rolldowns, I assessed that she tends to have a swayback posture with slightly

rounded shoulders. Most of the following exercises were included in the first 10 sessions:

BASI Block Exercises Modifications Reasons

Warm Up Thoracic rolldown

Pelvic Lift

Chest lift over Step Barrel, BOSU or Arc

Not a full rolldown

Not a Pelvic Curl

Using an assist to prevent too much flexion

Her upper body might be too heavy for the weakened spine to hold.

Strengthening the Transverse Abdominus and Multifidus in conjunction with hamstring control. No flexion for osteo-porosis.

Her lower back remained straight. Thoracic flexion and extension using abdominals, head is supported in hands.

Footwork Reformer Not single leg I excluded single leg in the first 10 sessions to gradually build up strength with closed chain exercises.

Abdominals Hundred Reformer

No chest lift, legs in table top

Pumping the arms and learning the breathing to activate the TA.

Hip Work Reformer Basic 1st session 1 red, thereafter 1 red and 1 blue

Frog, Circles Down/Up, Openings were done carefully and controlled.

Spinal Articulation

None No spinal articulation in first 10 sessions. Also not a good idea to encourage flexion in lumbar spine because of osteoporosis.


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Stretches Standing Lunge Reformer

Shoulder Stretch Lying Side (SB)

Encouraging hip flexor stretch as she sits most of the day. Her hamstrings are quite flexible, possibly due to the years of yoga.

Working the range of movement for the shoulder while stretching the thoracic and shoulder area.

Full Body Integration (Beginner/ Intermediate)

None Not for first 10 sessions.

Arm Work Magic Circle: Arms Bent, Arms Straight, Arms Overhead, Single Arm Side, Single Arm Bicep

Focus on correct body mechanics (neck and scapular stabilization) while executing the exercises.

After 3rd session:

Arms Supine Reformer

Additional focus on abdominals as she had to hold her legs in table top during this series.

FBI (Intermediate / Advanced)

None

Leg Work Gluteals Kneeling Series

Focus on absolute precision, pelvic lumbar stability and gluteals squeeze

After 5th session:

Gluteals Sidelying (mat) and Hip Opener (WC) and Hamstring Curl (Wunda Chair)

Encouraging Gluteus Medius strength along with other hip external rotators.

For the Hamstring Curl, focus fell on hamstring control, knee flexor strength and pelvic lumbar stabilization.

Lateral Flexion/Rotation

Side Lift on Step Barrel

Abdominal oblique strength and stretch while the lumbar spine is supported.

Back extension Swan Basic on Wunda Chair

Focus on lengthening with little extension, cue sides of body,


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wide collarbones.

The movement definitely improved her overall well-being and confidence as she showed up

with a smile and talked about how good it felt to move. While she still has stiffness in the

morning, she enjoys a better quality of life, feeling stronger and walking taller. To improve her

balance, we tried Standing Leg Press (Wunda Chair) while she held on to a pole to close the

chain. The first time was uncontrolled and unstable but by the second time progress was

already noticeable. It was amazing to see her improvement after a few sessions.

This is what her Pilates hour looked like by session 15:

BASI Block Exercises Modifications Reasons

Warm Up Thoracic rolldown

Pelvic Lift

Chest lift over Step Barrel, BOSU or Arc

Not a full rolldown

Not a Pelvic Curl

Add Magic Circle above knee joints

Focus on breath and length, engaging the TA, connecting body and mind

Strengthening the TA and Multifidus in conjunction with hamstring control – no flexion for osteoporosis

Thoracic flexion and extension using the abdominals. Head is supported in hands. Circle adds hip adductor control.

Footwork Wunda Chair Adding Single leg work as well.

Additional challenge in keeping the back straight and pelvis stable.

Abdominals Flat Back and Tilt (Short Box Series Reformer)

Or Bottom Lift with RUB

Only these 2 as no flexion is needed

No spinal articulation, just lifting the hips

Abdominal strength and trunk stability improves.

Avoiding spinal articulation by just lifting the hips while still strengthening the abdominals and latissimus dorsi.

Hip Work Basic on Cadillac Frog, Circles Down/Up, Walking and Bicycles were done carefully and controlled.


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Spinal Articulation

Bottom Lift Reformer

Avoiding spinal articulation by just focusing on the hip hinge up.

Strengthening abdominals and hamstrings, working on hip extensor strength and knee strength while maintaining a flat back (no flexion in lumbar spine because of osteoporosis).

Stretches Kneeling Lunge Reformer or SB

Encouraging hip flexor stretch as she sits most of the day.

Full Body Integration (Beginner/ Intermediate)

Long Stretch Reformer

Scapular stabilization to improve her upper back strength and posture. Only 5 reps due to wrist strength.

Arm Work Ped A Pul Arms Standing Series

Or

Arms Sitting Series

Working the arms below shoulder height to build up strength while still focusing on correct scapulae movement.

Cues for open collarbones, wide shoulders, active abdominals and straight back to encourage good posture.

FBI (Intermediate / Advanced)

Flat Back (Knee stretch group: Reformer)

Encouraging hip hinge while maintaining a straight upper body. We focused on abs, back and scapular stabilization.

Leg Work Single Leg Skating

And

Hamstring Curl Reformer

Hip abductor strength, pelvic lumbar stabilization and knee extensor strength.

Bit of thoracic extension while working on knee flexor strength and hip extensor strength.

Lateral Flexion/Rotation

Mermaid Pelvis and lumbar is stable as she flexes to the side. Working abdominal oblique strength and stretch.

Back Extension Prone 1 Cadillac Focus on length through the crown as the head as she gently presses into the PTB


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4. Conclusion – Pilates is Versatile and Functional

(information gathered from Body Arts and Science International Study Guide as well as Return to

Life Through Contrology by Joseph Pilates)

After the first 10 session there was a noticeable improvement on overall strength and

confidence. She has almost completed 20 sessions by now. I include Squats at the Cadillac

and Backward Stepdown at the Wunda Chair to build more gluteal strength. She does

Scooter and Reverse Knee stretch from the Knee Stretch Group (done with a flat back) and

Downstretch to strengthen back extensors and abdominals. She testifies that everyday

activities are easier as she can reach for the cupboards, squat safely and move painfree.

Joseph Pilates believed that his system, Contrology, will bring suppleness, natural grace as

well as skill in the way you walk, play and work. The deduction can be made that through

Contrology exercises (Pilates) the body moves functionally in order to complete everyday

activities naturally and easy.

As osteoporosis, arthritis, Parkinson’s, hypertension and other disabling illnesses develop in

the ageing body, there is great hope with Pilates as it offers a healthy way of movement to

everybody. Exercises can be modified to accommodate the specific body, thereby slightly

altering the choreography of the exercise to meet certain goals (e.g. Reverse Knee Stretch

with a flat back to still enjoy the benefit of the exercise without placing the lumbar spine in a

flexed position). An assist (apparatus) can also be handy to achieve specific goals. The Step

Barrel or Arc is great for her Chest Lifts as it minimises lumbar flexion while she gets to open


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up the thoracic area. Modifications and assists are used to make exercises easier, although it

can also added to create a bigger challenge.

The benefits of Pilates can be enjoyed at any age and the wonderful thing about regular

exercise, is that the mood will lift as well and the client will have a sense of accomplishment, a

sense of well-being and even a social connection when attending a group class.

At times a client might feel the journey to a better posture is too long. Or a person with an

auto-immune disorder like Multiple Sclerosis or Lupus might feel too tired on some days. The

key lies in continuing regular exercise, lightening the load if necessary but persisting with

focus and determination. Joseph Pilates said: “Patience and persistence are vital qualities in

the ultimate successful accomplishment of any worthwhile endeavour.”

It is therefore clear that Pilates is a great way of improving strength, breathing, posture, a

sound mind and physical fitness even though the body goes through an ageing process.


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5. Bibliography

1. Training the Over 50’s. Griffen, Sue. 2013. Copyright 2006, 2013 by Sue Griffen.

2. Study Guide Comprehensive Course, Body Arts and Science International.

3. The Complete Guide to Teaching exercise to Special Populations. Courson, Morc. 2011.

Copyright 2011 by Morc Olsen.

4. Your Health. Pilates, Joseph. 1934. Copyright 1998-2008 Presentation Dynamics Inc.

5. Return to Life Through Contrology. Pilates, Joseph. 1945. Copyright 1998-2010

Presentation Dynamics.

6. www.medicinenet.com for picture of osteoporosis in spine as well as progressive stages

of Osteoporosis

http://www.medicinenet.com/

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