Case Study - Postural Correction

I decided to start documenting some of my Pilates classes, so that I can share my experience with other instructors, while this kind of written record will also be useful for my clients as reference. *Note: Names used are fictional.

Case Study - Alvin

Background:

Alvin is a 27y/o school teacher who is concerned about his own posture. Initial assessment reveals that he has exaggerated lordotic curves in cervical and lumbar area while too much kyphosis is observed in thoracic spine (hunch-back). He has never been medically diagnosed with any abnormality in the spine before. He is right handed and the right side of his body was generally stronger but also tighter than the left. His right shoulder is higher than the left. He used to play badminton and presently goes to gym regularly, mainly to run on threadmill and perform resistant training on stacked-weight machines (such as Chest-press, Lats Pull Down & Seated Row), after which he did not perform stretching as he was not sure what to stretch. Alvin went through 10-sessions of personal training but had no apparent result in terms of postural correction and weight gain. Movement analysis of upper limbs reveals lack of control and stability in the shoulder joint.

In conclusion, his posture is mainly due to weakness in postural muscles, such as serratus anterior, rhomboids and latissimus dorsi (back muscles), tightness in chest (pectorial major), back of neck (sternocleinomastoid & levator scapulae) and the thigh muscles (hamstrings and hip flexors). Instability & lack of control in shoulder movements (as shown in his pushing and pulling movement patterns) further reinforce the faulty posture.

Session #1 (focusing mainly on upper body):

Education of "correct posture", body awareness and proper neck alignment:

• The spine has two natural curves called the 'double C' or 'S' curves, these are the curves found from the base of head to shoulders and the curve from the upper back to the base of the spine. When standing straight up, weight should be evenly distributed on both feet.
• Using a mirror, align ears, shoulder, and hips. Proper alignment places the ears loosely above the shoulders, above the hips. Again, these points make a straight line, but the spine itself curves in a slight 'S'.
• Hold head in a balanced manner over the trunk in a sitting or standing position. The chin should be horizontal and parallel to the floor, drawn back slightly and centered. Try to stand, walk and sit "tall" at all times.

Reduce tightness and improve flexibility in cervical area.

• Tilt (stretch) head in all four directions over shoulders (forward, back, left, right). Avoid rolling in a circle, as it may cause further strain.

Education of proper movements over the shoulder joint & Improve strength of thoracic postural muscles.

• At quadriped position (on all four, with hips directly above knees and shoulders directly above wrists), find the neutral position by repeatedly curling the back upwards, like a cat, and then the opposite
• Lie facing up on a mat, 1. arms straighten pointing up to ceiling, "peel" shoulders off the mat and return, keeping shoulders away from ears throughout; 2. Arms straighten on the mat overhead, slide them along the mat, drawing shoulders towards ears then away from ears)
• Seated row and Lats Pull down, focusing mainly on engaging shoulders instead of the pulling motion.

By end of Session #1: Alvin's neck is a lot "straighter" (reduced lordosis) and Alvin is supposed to do his "homework" by practicing all the exercises above!