The Role Of Pilates For Proprioception

And Posture Of A Blind Masseur

Lauren Gunawan

Body Art and Science International

Comprehensive Teacher Training Program

September 2014

Svarga Holistic Health Center West Java, Indonesia

i    

Preface

The writer would like to thank to the Almighty God, who has given His blessings so

that she can accomplish this thesis.

This thesis is one of the requirements to accomplish her study at Body Arts and

Science International comprehensive teacher training program.

In this process of doing this thesis, the writer has got guidance, correction and suggestion.

For that purpose, she would like to give big thanks to :

• Mrs. Abigail Meilyawati Angkawijaya as her mentor, who has given lots of guidance

, correction , suggestion and support to the writer so that this thesis can be finished

intime

• Her teachers : Ashley Ritchie , Michelle Lam , Eduard Botha

• Mrs. Ellen Kurniawan , as the owner of Svarga, who has given her spirit to finish this

thesis

• My parents and sister : Mr. Rudy Gunawan , Mrs Lili Setiati , and Shyeren Gunawan

,who have supported me a lot so far

• My collage mates : Mr. Ariston , Ms. Stephanie Lauw , Mrs. Neneng Sasmita , Ms.

Nur , Ms. Anisa , Ms. Mutiara Fernandez , who have given her a lot of assistance and

support

The writer realizes that there are still a lot of weaknesses in this thesis therefore criticism

and suggestion are needed to improve it. Hopefully, this thesis can be useful and helpful for

those who want to learn pilates.

Bandung, September 2014

ii    

Abstract

Mr Herlan is a masseur. Although having his disability of eyesight, he is the one who

likes learning ceaselessly so that I would like to introduce pilates to him for being able to

improve his kyposis posture. He has rounded shoulders, hunched back and excessively

curved forward spine. He is generally has no problem with his body. Everything is in good

function. His problem is about his posture, especially his hunched back due to his job as a

masseur.

Through Mr Herlan’s disability, I am sure to be able to train him pilates. Every

human has an ability of sensing himself called proprioception, which is the sense of

position and movement. My goal of training Mr Herlan is to perform my program which

will start to connect his mind to his body, strengten the thoracic extensors and stretch the

anterior shoulder muscles.

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Table Of Contents : Page

Preface i

Abstract ii

Table Of Contents iii

Kyphosis 1-3

Proprioceptive System 4-6

Case Study : 7-12

- Assesment and Goal Setting

- Excercise Plan

- The Program

Conclusion 13

Bibliography 14

1    

1. Description 1.1 Kyphosis

What is kyphosis?

Kyphosis is a deformity of the spine that results in a segment of it curving (flexing)

more than is normal (Frank 2001). As the vertebrae are no longer stacked properly, the

muscle and nerve functions can be disturbed. Symptoms include pain and impaired nerve

function, which can develop slowly or rapidly and may get worse over a period of time. If

this flexing is excessive excessive, this abnormal curve may result in hunchback.

2    

What causes kyphosis?

Kyphosis is caused by the deformity of the vertebra(Frank 2001). Kyphosis that

occurs in children is usually due to abnormal development (congenital or during adolescent

growth) or poor posture. In adults, kyphosis may be caused by fractures to the spine, injury,

tumors, infection or osteoporosis (deterioration of the bone).

Can kyphosis be prevented?

Not all causes of kyphosis can be prevented, but certain actions may reduce the

possibility of developing it. These actions include good posture, good nutrition, consistent

and sensible exercise, avoiding smoking, proper lifting and accident prevention (Frank

2001).

3    

Head : Forward

Neck : Increase curve

Scapulae : Abducted

Thorax : Increased (kyphosis)

Lower Back : Hyperextended (lordosis)

Hips : Flexed

Pelvis : Forward (Anterior pelvic Tilt)

Knees : Slightly hyperextended

Feet : Slightly plantar flexion

Short and Tight : Neck extensors and

hip flexsor, the low back is tight.

Lengthened and Weak : Neck flexors,

upper back, erector spinae, hamstrings,

possibly abdominal

4    

1.2 Proprioceptive System

Proprioception is the body’s ability to transmit a sense of position, analyze that

information and react (consciously or unconsciously) to the stimulation with the proper

movement (Houglum 2001). Put simply, it is the ability to know where a body part is without

having to look. Proprioception allows you to scratch your head withou t looking in the

mirror or walk up a flight of stairs without having to peer at each stair.

Taken as a whole, proprioception includes balance, coordination and agility because

the body’s proprioceptors control all these factors. Proprioceptors consist of both sensory and

motor nerves that send and receive impulses to and from the central nervous system from

stimuli within the skin, muscles, joints and tendons (Houglum 2001). These impulses

transmit vital information, such as the amount of tension in a given muscle and the relative

position of a body part during a given movement.

By improving their proprioception, clients can gain the balance skills necessary to

maintain stability, hone their agility so they can quickly change direction when necessary,

and fine-tune coordination skills so they can perform physical activities accurately and

consistently. Proprioception exercises reduce the risk of injury by teaching the body to react

appropriately to sudden changes in the environment. A good sense of proprioception is vital

for many fitness activities, especially some of the more advanced core-training classes

currently attracting large numbers of clients.

How to Progress Proprioception Exercises

When planning proprioception exercises for a particular client, it is just as important

to consider the client’s baseline level of skill as it is when designing a flexibility, strength or

5    

endurance program. There is no specific test for proprioception as there is for cardiovascular

endurance or muscle strength. However, there is a proper progression to follow, starting with

static balance activities, progressing to dynamic balance activities and finally advancing to

coordination and agility training.

Contraindications

Although improving proprioception helps reduce the risk of injury, there are instances

when performing some of the activities described here may actually cause more harm than

good. Acute inflammation and postoperative conditions are two common and valid reasons

why certain clients should avoid proprioceptive exercises.

Another potential contraindication is joint instability (Houglum 2001). Before a client

with this condition can begin proprioception exercises, he may need to do resistance and

range-of-motion training to strengthen the structures surrounding the affected joint. Of

course, this will depend on the location of the joint in question. For example, an instability at

the shoulder joint would not prevent him from working on lower-extremity proprioception

training, whereas an ankle instability obviously would.

One must recognize limitations as a fitness professional through proprioception

training. It is also essential to consider the limitations of the particular client that needs

specialized attention that is outside one’s scope of practice. It is recommended that a client

who lacks good proprioception should be advised avoiding group fitness classes like

advanced core training, which requires a high level of skill.

6    

The Pros of Proprioception Training

Starting with simple exercises is considered important to improve proprioception and

increase the complexity by changing variables such as the surface used, the distance covered,

the duration of activity or the weight of the objects so that it can reduce the risk of future

injuries and eventually improve a client’s skill level.

7    

2. Case study

2.1 Client profile

Muhammad Herlan, 47 years old, is a shiatsu masseur who is totally blind. His is 168

cm and 56 kg. In 2003 he had a cataract operation which was successful. Due to the loss

after operation maintenance, his eyesight was getting worse until one day in 2007 when he

was riding a motorcycle, suddenly his eyesight was white and blank. Then he was trying to

have alternative treatment, namely, acupuncture, three times per week. It turns out that his

retine nerves were broken so he has been totally blind since then. He has sense of basically

more sensitive olfactory. His posture has kyphosis and suffer from painful right shoulder

impingement. He unconsciously has such a posture like that, his short term goal is to

“rectify” his kyphosis and painful right shoulder and long term goal is to regain his proper

posture and improve general health.

Kyphosis is a forward rounding of your upper back. Normal rounding can be consider a

normal curve, but the term “kyphosis” as usually refers to an excessive rounding sometimes

called round back or hunch back Kyphosis can occur at any age, its most commonly in

masseur. Mild kyphosis may cause few problems. Whereas severe cases can affect your

lungs, nerves, and other tissues and organs, causing pain and other problems. Treatment for

kyphosis depends on one’s age, the cause of the curvature and its effects. In addition to an

abnormally curved spine, kyphosis can also cause back pain and stiffness in some people.

Mild cases of kyphosis may produce no noticeable signs or symptoms. Kyphosis may cause

the following complications (Loghum 2008) :

-­‐ Body image problems. Adolescents, especially, may develop a poor body image

from having a rounded back or from wearing a brace to correct the condition.

8    

-­‐ Back pain. In some cases, the mis alignment of the spine can lead to pain, which can

become severe and disabling.

-­‐ Breathing difficulties. In severe cases, the curve may cause the rib cage to press

against your lungs, in habit your ability to breathe.

2.2 Posture Assesment and Goal Setting

The entire body from his head slightly forward. He has increases curve neck,

abducted scapulae, increase thorax, hyperextended lowerback, flexed hips, forward pelvic

(anterior pelvic tilt), slightly hyperextended knees , feet slightly plantar flexion. Short and

tight neck extensors and hip flexors. The lowerback is tight. Lengthened and weak neck

flexors, upper back, erector spinae, hamstring, possibly abdominals.

In case study, Mr Herlan is a blind person therefore to improve his kyphosis, the

proprioceptive system is essential to apply. Proprioception is the process by which the body

can vary muscle contraction in immediate response to incoming information regarding

external forces, by utilizing stretch receptors in the muscles to keep track of the joint position

in the body.

Proprioception and kinesthesia, the sensation of joint motion and acceleration, are the

sensory feedback mechanisms for motor control and posture. These mechanisms along with

the vestibular system, a fluid filled network within the inner ear that can feel the pull of

gravity and help the body keep oriented and balanced, are unconsciously utilized by the brain

to provide a constant influx of sensory information. The brain can then send out immediate

and unconscious adjustments to the muscles and joints in order to achieve movement and

balance. Proprioception, also often referred to as the sixth sense, is developed by the nervous

system as a means to keep track of and control the different parts of the body.

9    

2.3 Exercise Plan

First of all, it is important to introduce “what pilates is” to Mr Herlan. In pilates, it is

taught how to breathe properly connect the brain with movements. In pilates, the system of

respiration is different from other excersises. During the first case, the attention will be

focused on improving breathing, and the function of pectoral parts to be opened up and the

position of back to be more up right while focusing on awareness. Yet Mr Herlan was only

provide with mat. He cannot go anywhere he likes due to his condition. So that planned

program and equipment have not been done yet. Therefore, I came to his house as part of my

service. As soon as Mr Herlan can recognize the techniques, the exercise will be continued

focusing on back extension to open the chest. As explained above, proprioception is often

referred to as the body’s ability of transmitting a sense of position, therefore it is essential

that Mr Herlan knows how to control the different parts of his body through the

proprioceptive system.

10    

The Program

Mat

Session 1-10 11-20 21 Onwards

Level Fundamental Intermediate 1 Intermediate 2

Exercise

Pelvic Curl Pelvic Curl Roll up

Spine Twist Supine Spine Twist Supine Spine twist supine

Chest Lift Hundred prep Double leg stretch

Chest Lift with

rotation

Hundred Single leg stretch

Leg Lift/Leg changes Double leg stretch Criss cross

Hundred Prep Single leg stretch Open leg rocker

Roll Up Criss Cross Roll over

Leg Circles Saw Hamstring pull 1

Rolling Spine twist Leg pull front

Spine Stretch Corkscrew Leg pull back

Side Lift Cat Stretch Side kick

Back Extension Front support Swimming

Rest Position Back support Rocking prep

Seal puppy

*Ps : As his mobility is limited, i provide him only the program of a mat. Yet if he can be

more mobile, I will give him equipment program.

11    

Equipment

Session 1-10 11-20 21 Onwards

Warm Up Pelvic Curl Roll Up Roll Up w/ Roll Up Bar

Spine Twist Supine Spine Twist Supine Spine Twist Supine

Chest Lift Double Leg Stretch Mini Roll Up

Chest Lift with Rotation Single Leg Stretch

Mini Roll Up w/Roll Up Bar

Criss Cross Roll Up Top Loaded

Foot Work REFORMER WUNDA CHAIR CADILAC

Parallel Heels Parallel Heels Parallel Heels

Parallel Toes Parallel Toes Parallel Toes

V-Position Toes V-Position Toes V-Position Toes

Open V-Position Heels

Open V-Position Heels Open V-Position Heels

Open V-Position Toes Open V-Position Toes Open V-Position Toes

Calf Raises Single Leg Heel Calf Raises

Prances Single Leg Toes Prances

Prehensile Calf Raises Single Leg Heel

Single Leg Heel Single Leg Toes

Single Leg Toes

12    

 

Abdominal Work SPINE CORECTOR

Hundred Prep Overhead Stretch Breathing with push through bar

Teaser Prep

Hip Work SPINE CORECTOR (Single Leg Supine)

Frog Openings Frog

Circle Down Scissors Circle Down

Circle Up Helicopter Circle Up

Openings Bicycle Hip Extension

Bicycle Reverse Bicycle

Spinal Articulation - REFORMER REFORMER

Bottom Lift Bottom Lift with Extension

Stretches REFORMER

Standing Lunge Kneeling lunge Full lunge

Full Body Integration F/I - CADILAC

Scooter (Push Through Series)

Sitting Foward

Side Reach

13    

Arm Work PED A PULL (Arm Sitting Series) (Arm Standing Series)

Extension Expansion Chest Expansion

Adduction Biceps Hug a-tree

Circle Up Rhomboid Circle Up

Circle Down Hug a tree Circle Down

Triceps Salute Punches

Bicep

Full Body Integration A/M - - REFORMER

Balance Control Back Prep

Leg Work Wunda Chair Single leg skating WUNDA CHAIR

Hamstring Curl Frog Front

Lateral Flextion Rotation Side Stretch Mermaid Side Kneeling Stretch

Back Extension Swan Basic Breastroke prep Swan On Floor

Breastroke

14    

3. Result

3.1 Objective

Looking from the anterior and posterior view (see appendix), after 20 sessions of

pilates his shoulders is more even. Before having the pilates session his body weight was

shifted to the left side due to his work habit as masseur. Many people with low proprioceptive

awarenes and/or continues poor habbit will not be aware of such body weight shift. This 20

sessions of pilates excercise has help him to find his body weight center, which can be seen

on the picture. Also his body has found the more alligned foot placement. The “before”

anterior view shows his left foot is placed slightly behind his right foot whereas the “after”

shows more paralel foot placement

Looking from the lateral view, his “before” shows excessive thoracic curve into

flexion. It may be caused by his job. It result in weakness of his back muscle and thightness

of his pectoralis muscle. At the first 10 sessions he has difficulty doing back extension.

However on the next 10 session he has developed more strength on his back extensor muscle

and more lengthened pectoralis. He can do the back support in the controled way on the end

of 18th session. The postural picture also shows difference in his thoracic curvature is more

flatten and his posture getting better and better.

3.2 Subjective

According to Mr Herlan, after practicing pilates, he feels more upright and his

stomach gets slimmer. Besides, he feels more relieved. While doing his work massage, his

massage is powerful.

15    

Photos Anterior View

Before After

Lateral View

Before After

16    

Posterior View

Before After

17    

Conclusion

Proprioception is the body’s ability to transmit a sense of position, analyze that

information and react to the stimulation with the proper movement (Houglum 2001). Put

simply, it is the ability to know where a body part is without having to look. Therefore it is

very effective and useful for Mr Herlan who is a blind person and has rounded

shoulders, hunched back and excessively curved forward spine to know and learn what

proprioception is.

If given more time for more pilates session, the result would have been more

satisfying. Yet having done the exercises twenty times, Mr Herlan felt that the way he breated

was more relieved and longer besides, his shoulder pain decreased . His body gets more

upright, lighter and more healty. To have the optimum results he has to do the excercises

more often and regularly. Besides, he has no side effect after doing the exercises so far.

18    

Bibliography

Kyphosis of the spine.American Academy of Orthopaedic

Surgeon.http://orthoinfo.aaos.org/topic.cfm?topic=A00423.Accessed April10,2012

Isacowitz, R.(2013).Study Guide. Comprehensive Course. Costa Mesa CA: Body Arts and

Science International

Kinesiology: The Skeletal System and Muscle Function, 2e by Joseph E. Muscolino DC (Oct

5, 2010)

Isacowitz, R.(2013).Reformer . Comprehensive Course. Costa Mesa CA: Body Arts and

Science International

Isacowitz, R.(2013).Mat. Comprehensive Course. Costa Mesa CA: Body Arts and Science

International

Calais-Germain,B.(1991).Anatomy Of Movement. Eastland Press; English Language Ed

edition (October 15, 1993)

Floyd, R.T. Manual of structural kinesiology. 13th ed. 1998

Http://en.wikipedia.org/wiki/proprioception

Http://www.spdaustralia.com.au/the-proprioceptive-system/

Http://sensoryprocessingmadesimple.com/the-proprioceptive-system-and-sensory-

processing-disorder/