Misty Myler June 8, 2019

The Pilates Center, Forth Worth, TX 2019

Pilates for Postural Costochondritis EMPHASIS ON POSTPARTUM WOMEN

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Abstract:

Costochondritis is the inflammation of the cartilage that connects a rib to the breastbone

(MayoClinic.org). This condition may result from impact-specific injuries, infection, illness, or

be most commonly found among individuals comporting improper posture within the upper

thoracic spine.

Similarly, this increased curvature of the upper thoracic spine (referred to as Kyphosis) is also a

common and typical deviation found in postpartum women.

The focus of this research paper explores the potential link between kyphotic posture found in

postpartum women who also feel symptoms of or have been diagnosed with Costochondritis.

In my personal experience, and in working with postpartum clients, family members, and

friends, these symptoms seem to be strikingly common, yet undermentioned.

A well-designed Pilates program has the ability to correct postural deviations and imbalances

which could result in healing this condition.

Because symptoms of Costochondritis can mimic chest pain, it is imperative to consult with a

physician to rule out any heart conditions, or other life-threatening illness before proceeding with

a Pilates regimen.

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Table of Contents: Abstract……………………………………………………………………………1 Table of Contents……………………………………………………………….....2 Anatomical Description…………………………………………………………3-6 Case Study………………………………………………………………………7-8 Pilates Block System………………………………………………………………9 Conclusion………………………………………………………………………..10 Bibliography..…………………………………………………………………….11

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Anatomical Description of Costochondritis

Costochondritits.com provides the following definition:

“Costochondritis is the medical term for inflammation of the cartilage that joins your ribs to

your breastbone (sternum). This area is known as the costochondral joint. Cartilage is tough but

flexible connective tissue found throughout the body, including in the joints between bones. It

acts as a shock absorber, cushioning the joints.”

Image Reference: https://www.rehabmypatient.com/thoracic-spine/costochondritis

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Posture involved in causing Costochondritis

Kyphosis, as defined in the BASI Comprehensive Course Study Guide (2000-2014), “...involves

an increased thoracic curve of the spine (p. 44).”

Thoracic vertebrae are the twelve vertebral segments that make up the thoracic spine. “These

structures have very little motion because they are firmly attached to the ribs and sternum

(breastbone) (Scioscia, 2017).”

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Typical Post-Partum Posture:

According to Robinson (2016), during pregnancy, the growing baby becomes too large to remain

solely in the pelvis. To counterbalance the extra load the pelvis tips forward, thus increasing the

lumbar curve resulting in what is commonly referred and shown below as Lordosis.

Meanwhile, further up the spine, the increased weight of the growing breasts pulls the upper

spine into a greater curvature resulting in a more rounded upper back.

Due to the rounded upper back, shoulder joins are now out of alignment as well. This results in

tightness throughout the chest.

This posture continues postpartum as the abdominals have been stretched and weakened.

Breastfeeding also encourages further rounding in the upper body (Robinson, Duchars, &

Fernyhough, 2016, pp. 19-20).

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Thoracic Extensors

The thoracic extensors must be strengthened to correct rounding of the upper back.

Additionally, gently stretching the chest and anterior shoulder muscles is recommended to

correct posture and alleviate Costochondritis.

Above image referenced from https://learnmuscles.com/blog/2017/06/16/causes-muscle-spasming-neck/

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Client: Misty Myler Age: 30 My name is Misty Myler. I’m the proud mother of four children, and I’ve spent around seven

out of the last ten years either pregnant and/or breastfeeding!

I’ve always lived an active lifestyle, and frequently practiced Pilates during my first two

pregnancies. My last two children were born much closer together in age, however, and I found

it increasingly difficult to continue in any consistent Pilates exercise regimen as a result of the

ensuing responsibilities of Motherhood.

About a year ago, I started noticing pain in my sternum after performing high-impact activities

such as running and playing tag with my children. This pain was sporadic in nature, and even

recurred during and after stretching and while doing basic exercises.

After visiting with and thoroughly mentioning these symptoms to my doctor, he determined

that any potential heart conditions could be ruled out of the equation, and I was diagnosed

generally with “Costochondritis.”

I was informed that the cause of this condition is unknown, but not dangerous, and thereafter

advised to take (over-the-counter) pain/anti-inflammatory medication as needed.

Months later, I was jumping on the trampoline with my children, and was again hit with an

intense episode of aching around my sternum which lasted multiple days, and nearly had me

demobilized.

I decided to contact my immediate friends (post-partum Mothers) and likewise other family

members and acquaintances to see if they too had ever experienced similar symptoms of pain

or had been diagnosed with this condition. The results were astoundingly in the affirmative,

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and I was so intrigued by the commonality of these occurrences that I resolved to undertake

extensive research to find more answers on this topic.

According to Costochondritits.org, “...this condition is most often a result of poor posture in the

upper thoracic spine causing a misalignment of the vertebrae resulting in inflamed cartilage

between the ribs connecting to the breastbone.”

This made sense as I was already aware of the fact I had typical post pregnancy posture

(increased rounding of the shoulders and upper thoracic spine as well as a slight Lumbar Hyper

lordosis.)

I started practicing a Pilates routine designed to strengthen the thoracic extensors and gently

stretch the shoulder and chest muscles, and it has proved to be the perfect way for me to treat

and heal my condition based on the aforementioned diagnosis (due to post-partum).

Page 9 includes the Pilates exercises used to address this condition.

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Pilates Blocks:

Pilates Exercise Session 1-10 Session 11-20 21+ Comments

Warm Up Fundamental Warm-Up

Intermediate Warm Up Cadillac Warm-up

Foot Work Reformer Series Reformer Series Cadillac Series Encourage use of

hamstrings

Abdominal Work Hundred Prep Hundred

Coordination Roll-up Bottom

Loaded Breathing

Focus on correct recruitment of deep core and pelvic floor

muscles

Hip Work Hip Series Hip Series Single Leg Basic Springs

Emphasize Placement and

stability of Pelvis

Spinal Articulation N/A Short Spine Monkey

Work to release tightness in the

low back

Stretches Standing Lunge Kneeling Lunge Kneeling Lunge

Release Hip Flexor / Stretch

hamstrings Full Body

Integration F/I N/A Up Stretch 1 and 2

Kneeling Cat Stretch

Observe and cue back extensors

Arm Work Supine arm Series Sitting Arm Series

Arms Standing Series

Avoid rolling forward in shoulders /

stabilize scapula

Full Body Integration A/M N/A N/A Balance Control

Back

Stabilize scapula and encourage opening chest

Leg Work Gluteal Side lying with ankle weights

Gluteal Kneeling

ankle weights Squats

Watch placement / Strengthen

pelvic stability

Lateral Flexion/Rotation

Shoulder stretch lying side

Side lift (SC)

Shoulder Stretch lying

side Side lift (SC)

Side Lift Push through Series

Utilize Spine Corrector and Stretch chest

gently

Back Extension Swan Prep (SC)

Hamstring/Shoulder Stretches on LB

Swan Prep (SC)

Prone1 Hamstring/Shoulder

Stretches on LB

Focus on correct recruitment of back extensors

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Conclusion

After implementing these Pilates exercises, I have noticed a greater sense of awareness

throughout the day. I often catch and fix myself from slouching forward as I am working at a

desk or rocking my babies to sleep. I have regained abdominal strength and stability in the pelvis

allowing me to broaden my range of activities and exercises.

My posture has improved immensely through proper stretching of my chest, and at the same time

has proven to release both emotional and physical tension from within. I am slowly gaining more

mobility throughout my thoracic spine.

I have not suffered any additional pain episodes or symptoms of Costochondritis in months.

Staying consistent in my Pilates practice is vital for me to continue to keep up with my family,

children and clients.

I feel this condition is very common among postpartum women, yet extremely misunderstood

and understated. Oftentimes mothers are more focused on taking care of their children and don’t

have the time, energy or resources to help themselves.

During this time, I reached out to other moms on Social Media to inquire about this topic. Within

24 hours I received over 60 comments from mothers stating they have this condition or

symptoms of this condition. I am grateful for the opportunity I had to explore this topic and

know I will be able to utilize this as I work with future clients.

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Bibliography Body Arts and Science International (2000-2014). Study guide: Comprehensive course. Costa Mesa, CA: BASI Pilates.

Everything you need to know about costochondritis. (n.d.). Retrieved from https://costochondritis.org/

Kei. (2017, August 20). What are the causes of muscle spasming in the neck? Retrieved from https://learnmuscles.com/blog/2017/06/16/causes-muscle-spasming-neck/

Isacowitz, R. (2006). Pilates. Champaign, IL: Human Kinetics.

Isacowitz, R., & Clippinger, K. (2011). Pilates anatomy. Champaign, IL: Human Kinetics.

Patient, R. M. (n.d.). Costochondritis | Rehab My Patient. Retrieved from https://www.rehabmypatient.com/thoracic-spine/costochondritis

Robinson, L., Duchars, D., & Fernyhough, K. (2016). Pilates for pregnancy: The ultimate exercise guide to see you through pregnancy and beyond. Kyle Books.

Scioscia, T. (n.d.). Vertebrae in the Vertebral Column. Retrieved from https://www.spine-health.com/conditions/spine-anatomy/vertebrae-vertebral-column

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