Pilates and Osteoarthritis of the Knee Linnea Rothenmaier October 2015 Olympia, WA
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Abstract. Osteoarthritis (OA) is the most common type of arthritis, affecting about 25 million people; with low impact forms of exercise being one of the primary recommendations to alleviate pain. Pilates can have immense strengthening and toning benefits, bringing muscle balance to affected joints along with increased flexibility and weight loss when needed. This paper will look specifically at arthritis of the knee with a sample client. 15 onehour sessions are outlined using the BASI Block system, along with potential goals for where to take the client after 15 sessions.
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Table of Contents l. Abstract……………………………………………….…………………...…..1 ll. Visual Diagram of Osteoarthritis………………………….………....……...3 III. The Role of Exercise in Osteoarthritis……………………...……………..4 lll. Case Study. Meet Eliza…………………………………..………….……..5 lV. Eliza’s 15 week conditioning program……………….………….…..…….6 V. Desired Outcomes and Program Intentions………….…………...……....7 VI. Conclusion…………………………………………………………………..9 VII. Bibliography………………………………………….…………………….10
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Comparison of a healthy knee with one affected by Osteoarthritis.
In a healthy joint (shown on the left) the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissues.1 With Osteoarthritis, (shown on right) the cartilage becomes worn away. Spurs grow out from the edge of the bone (Osteophytes) and synovial fluid increases. Altogether, the joint feels stiff and sore.
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Bounce Podiatry Osteoarthritis: Knee
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The Role of Exercise in Osteoarthritis Osteoarthritis (OA) is the most common type of arthritis, affecting about 25 million people over the age of 252 . Osteoarthritis affects the cartilage surrounding the articulating bones of a joint. As the cartilage breaks down the joint loses its elastic strength and becomes stiff, inflamed, and painful. As the condition worsens the joint can deform and parts of bone or cartilage can break off and float in the joint capsule, causing further pain and discomfort. Joint replacement is often suggested as the condition deteriorates further.
Exercise is one of the best treatments for Osteoarthritis3 . Low impact
activities that avoid stress on the affected joints are the most beneficial. In many cases weight loss is needed and will help reduce stress on weight bearing joints. Pilates can have immense strengthening and toning benefits, even with a moderate program. The use of controlled, progressive resistance allows for an incredibly tailored program, giving the client exactly the amount of challenge appropriate. These low impact motions will optimize joint range of motion, while still building strength and coordination. The OA Client will benefit further from the supervision of an experienced practitioner to monitor their progress and individualize their sessions.
Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum. 2008 Jan;58(1):2635. 3 Handouts on Health; Osteoarthritis. National institute on Arthritis and Skin and Musculoskeletal disease 2
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Case Study Meet Eliza. (This is a fictional client and the below information is based on what an average arthritic client may need and the condition that you could reasonably assume to find this type of client in when you start working with them.)
Eliza is a 59 year old female who has increased pain from Osteoarthritis. She started experiencing stiffness, swelling and pain in her right knee starting about 4 years prior and she has gone in and out of exercise programs to varying degrees of success. The condition has progressively worsened. She’s experienced a decline in general fitness and an increase in pain over the past few years and her previous forms of activity are no longer working for her.
Eliza currently suffers from chronic pain and stiffness in the right knee which
is worse in the morning or after long periods of sitting. The condition can become inflamed for days if she is overactive and does too much. She complains of inactivity, mild weight gain, and loss of motivation. Once a very active person, Eliza is used to spending long hours gardening, hiking, playing with grandchildren, and going about regular activities without limitations. She now has trouble walking long distances and has occasional discomfort going up stairs. Eliza’s doctor suggested she try more low impact forms of exercise and encouraged her to keep moving as much as she could. She is hopeful that pilates can help.
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Eliza’s Conditioning Program
Sessions 15
Session 610
Sessions 1115
Potential Goals
Warm Up Pelvic Curl Spine twist Supine (Modified) Chest Lift Chest lift with rotation (Modified)
Warm Up Pelvic Curl Spine twist Supine (Modified) Chest Lift Chest lift with rotation (Modified)
Warm Up Pelvic Curl Spine twist Supine Chest Lift Chest lift with rotation (likely still modified)
Keep it basic for a long time, use this as a measure for how she feels that day and challenge her with increased spinal flexion and perfection of the movement. Goal is to perfect rotation with hands behind the head
FootworkReformer.
Footwork Reformer. With Prehensile for ROM in Feet.
Footwork Reformer.
Footwork Build efficiency, alignment, and resistance.
Abs 100 prep
Abs Abs 100 prep, possibly progressing 100 and/or Coordination. OR Chest lift on Step Barrel for to the 100. thoracic stretch.
Abs Short Box Series
Arms Arms Supine Series (possibly lower reps)
Arms Arms Supine Series (building to 10 reps each, or adding spring)
Hips Supine Leg Series 10 Reps, more spring if performing well.
Hips Basic Legs Springs, Cad.
Hips Supine Leg Series First 3 sessions won’t expect to complete the full series, just frog and possibly circles.
Hips Supine Leg Series Building to full series and 10 reps each
SA Introduce Bottom Lift
SA Bottom Lift with Extension
Stretch Standing Lunge
Legs Kneeling Gluteals, with short box placed on reformer for flow of session
Stretch Standing Lunge (combine with scooter for session flow)
Stretch Continue to target the tightest muscles in the Leg to aid in the knee alignment and function
Legs Side Lying Gluteals
Stretch Adductors and Gluteals, Ladder Barrel
FBI Scooter
FBI Knee stretches, Sitting Forward, Side Reach, Saw,
LFR Side Lift
LFR Arms ARMS Side Over Prep, Ladder Barrel Shrugs and Triceps on Wunda Seated Arms Chair
BX Basic Back Extension
BX Swan Prep, Ladder Barrel
Legs Hamstring Pull and Hip Opener
Legs Leg Press Standing
LFR Side Kneeling Stretch
LFR Side Stretch WC,
BX Basic Swan Wunda Chair, (Modified with feet on floor if needed)
BX Basic Swan WC, Breaststroke Prep, Pulling straps 1 and 2.
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Goals and Intentions with Eliza’s Program
My most immediate goal for Eliza is to get her moving in a way that feels
good and gives her confidence. Footwork will be a valuable place to work with her and allow the instructor to assess her alignment through the hip, knee, and foot. The value of footwork should be highlighted and will continue to serve as a very strong core to her program as she progresses. If she is feeling very stiff one morning we might start with a stretch before footwork. Over time, as she progresses and becomes very confident with footwork I would challenge her with variations, and change of apparatus. The desired results with this block are hip, knee, and ankle alignment, muscle balance, and pelvic stability. I chose the 100 prep followed by Supine Arms Series for the flow of the session and the immense value of the supine arms series. This will be a good level and it will challenge her with abdominal control as she strengthens the shoulder girdle. The spine is supported by the carriage, so it is especially valuable as she regains strength. 100 prep is valuable here mainly for its efficiency with the rest of the session and focused work on the abdominals. Chest lift on the Step Barrel will be nice for opening the thoracic spine. As she becomes more efficient with the other blocks we can introduce the short box series. Shrugs and Tricep Press Sit on the wunda chair will be a good fundamental level for arm work that will give time for other blocks when needed. Hip work will be another area of focus for Eliza as she strengthens the lower body and gains muscular balance. The assumption will be that she is very weak to start and will have a challenge to simply complete the entire Supine Leg Series on the reformer. Our first goal will be to perfect the series and complete the entire series with 10 repetitions each.
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Stretching will help alleviate the stiffness that is associated with OA, and is not a block to be missed. At first I will use this block to assess her range of motion and tailor her stretches for the stiffest parts of her body. The first session I will do standing lunge to better assess her hip flexor and hamstring flexibility, and for efficiency in the session. The second session I would like to see how her glutes and adductors look while stretching on the Ladder Barrel. From there we will continue to work on her flexibility where she needs it the most. Spinal Articulation and Full Body Integration are two blocks that might take some time to work up to. I would not rush their integration, but rather, leave time for the fundamental blocks and ensure that Eliza has learned the essential elements of the work. Rolling like a ball, Bottom lift, Scooter, Sitting forward, Side reach, and Saw will all be nice exercises for her as she progresses. The Knee Stretch Group will be effective as long as kneeling is ok for the knee. Side Lying Glutes will be an exceptional exercise for Eliza and will help to improve misalignments in the knee if her glutes were previously weak. I would likely suggest this exercise as a series she memorizes for ‘homework’ which will also keep the work fresh as we repeat it each session and challenge her to remember the movements. Progressing to the kneeling version will challenge her stability and upper body just enough to add variety and challenge as she gets stronger. This series can be tailored to remain a challenge as the client progresses and will greatly increase her strength without much impact to the knee. For Lateral Flexion and Rotation Side Lift is an immensely beneficial exercise that can take some time to perfect. This will greatly improve her obliques and give her stability and control in all the other exercises as she gets stronger. It is a nice place to teach alignment and proper recruitment of the obliques and transverse. As
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she progresses we can introduce side kneeling stretch, side over prep on the Ladder Barrel and side stretch on the wunda chair. Back Extension, also from the mat work, will finish our first five sessions and will be a good place to asses how her body moves in extension. From there we can progress to the Ladder Barrel to finish the sessions with Swan Prep and also basic swan on the wunda chair, likely with a modification to start by keeping the feet on the floor. I choose these three exercises primarily because they focus on alignment and proper recruitment of the back extensors. Conclusion: Pilates has so many benefits for an osteoarthritic client. In addition to the inherent benefits to all practitioners of Pilates, the OA client will benefit particularly from the culture of non competition and focus found in most studios. The key take home point here should be to focus on range of motion and low impact strengthening for the area affected while working the body as a whole. Potentially the greatest benefit that Pilates can offer the OA client is to help them feel successful and confident in their ability to stay active, even with their limitations.
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Bibliography: 1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum. 2008 Jan;58(1):2635 2. Handouts on Health; Osteoarthritis. National institute on Arthritis and Skin and Musculoskeletal disease 3. Bounce Podiatry. Osteoarthritis: Knee 4. Website: “American Family Physician” Osteoarthritis: Diagnosis and Treatment. 5. BASI Pilates, Study Guide Comprehensive Course: Module 8 P.79
