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Pilates Case Study

History

A previously healthy, active 27-year-old female suffered a concussion after falling backward and hitting her head on a concrete wall.  Subsequently, she developed a throbbing headache and was bedridden for a few days. The patient saw multiple doctors for her persistent symptoms and received various diagnoses. Eventually, she was referred to our clinic for her persistent headaches and severe jaw, neck pain. Throughout her rehabilitation, the patient made progress reporting reduced pain and headaches. However, the patient had not returned to her previous level of activity. She continued to have persistent functional deficits (I.e., sitting for extended periods of time, difficulty carrying light objects, and wearing heels). To help the patient return to her previous level of function, her Physical Therapist recommended expanding the scope of her care. As a PT and a certified Pilates instructor, the patient was referred to me.

Patient’s Goals

Sit at a desk for work, return to social activities, and restore overall quality of life.

Evaluation

Upon evaluation, the patient held herself in a very rigid upright position, anxious when changing positions or with natural head, shoulder movements. Her evaluation revealed winging scapulae, limited active shoulder movement, and weakness of the rotator cuff and shoulder blade muscles. My assessment indicated that the patient had developed a high-level of post-injury anxiety prompting her to severely restrict her overall movement repertoire. Of course, this led to very restricted everyday movement patterns.

Treatment

My evaluation indicated this patient was a perfect candidate for my Wellness Pilates program. With Wellness Pilates I focus on gradually improving postural alignment, target specific muscle weakness, and graduate to full body strengthening and mobility.  To address this patient’s high-degree of anxiety we began by focusing on a basic component of Pilates, breathing.  I used the breath to teach her how to relax muscles and address her holding patterns.  Simultaneously we used the Pilates breath as the impetus to activate the deep abdominal muscles, essential for core strength.

After establishing core strength tied to the Pilates breathing we introduced the CADILLAC further expanding the patient’s ability to control her breathing and engage her core. To eliminate her narrow movement patterns, we initiated gentle ROM exercises for her shoulder and shoulder blades. To address her anxiety, we worked in a controlled and supportive environment. But it was important to simultaneously restore her confidence in and joy of movement. From the beginning, we also incorporated more vigorous exercises on the REFORMER, such as footwork, side-lying leg press, bridging, etc. As she became less fearful of moving, we were able to add resistance and incorporate more exercises in various positions using all of the Pilates equipment.

My original evaluation had indicated both physical issues and areas of patient anxiety. The Pilates program was designed with these concerns in mind. I paid special attention to her head, neck and shoulder alignment ensuring that the patient didn’t experience any relapse of symptoms.

Outcome

The patient is now fully re-integrated into her normal daily and social life. She has returned to her full-time job without pain (I.e., able to sit at a computer for 8 hours), socially active, wears her favorite heels and goes shopping with her friends. She continues her Pilates Wellness program for core and general strengthening, mobility, posture and tolerates more advanced exercises.