BASI Student Paper 2014 - BASI Pilates - Teacher …...5" "...
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1 Pilates for Posterior Tibial Tendonitis as a Result of Overpronation Kara Riddle November 2014 Flow Studios Chicago, Illinois
Transcript of BASI Student Paper 2014 - BASI Pilates - Teacher …...5" "...
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Pilates for Posterior Tibial Tendonitis as a Result of Over-‐pronation
Kara Riddle
November 2014
Flow Studios Chicago, Illinois
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Abstract
Over-‐pronation of the foot can lead to misalignment issues up the chain of the body
with a common resulting injury to the posterior tibial tendon. This occurs as result to excessive
weight and stretching being exerted on the tendon with each step. Correction is therefore
needed at the root of the issue to bring strength and stability back into the arch of the foot
focusing on the muscles of the lower chain and invertor muscles of the feet. With a consistent
and efficient BASI® Pilates repertoire, foot and ankle stability can be achieved to prevent
further tendonitis along with greater alignment and support throughout all the body.
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Table of Contents
Title Page 1
Abstract 2
Anatomy of the Foot and Ankle 4
Case Study 7
BASI® Specialized Program 8
Conclusion 11
Bibliography 12
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Anatomy of the Foot and Ankle
As human beings evolved to become bipedal walkers and runners major shifts resulted
in the functioning and balancing of the entire body. The femur bone lenghthened resulting in
the development of the very tendinous gastrocnemius muscle, the pelvis radically morphed to
allow stability of the trunk upright while still maintaining forward movement, and the foot
became our primary source of all weight bearing and shock absorption.
It is no wonder that the foot and ankle have become a complex and dynamic mechanical
network of 26 bones, 33 joints, and more than 100 muscles, tendons and ligaments. The 52
bones that make up the feet account for a quarter of all the bones of the body.
Image of Foot and Ankle Anatomy
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The ankle joint allows for plantar flexion and dorsiflexion movements. This joint is
located between the talus, the lateral malleolus of the fibula, and the medial malleolus of the
tibia. Inversion, eversion, pronation and supination take place at the midtarsal joint and the
subtalar joint. The calcaneus, or heel bone, is the largest bone of the foot and is connected to
the talus at the subtalar joint. The gastrocnemius and soleus muscles of the lower leg are the
primary plantar flexors. These muscles join to form the calcaneal tendon of the heel and attach
to the calcaneus bone. Shin muscles such as the tibias anterior and extensor digitorum longus
dorsiflex the foot and extend the toes. The tibialis anterior and posterior are the invertors, and
the peroneals and extensor digitorum longus are the evertors.
Images of Over-‐pronation of the Right Foot and Arches of the Foot
When referring to the tibialis posterior specifically, it is the most central of all the leg
muscles, and is located at the inner posterior borders of the tibia and fibula. It is the key
stabilizing muscle of the lower leg. The tendon of the tibialis posterior muscle descends
posterior to the medial malleolus and divides into plantar, main, and recurrent components.
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The plantar portion inserts into the bases of the second, third and fourth metatarsals, the
second and third cuneiforms and the cuboid. The main portion inserts into the tuberosity of the
navicular and the plantar surface of the first cuneiform. The recurrent portion inserts into the
sustentaculum tali of the calcaneus.
The tibialis posterior tendon is a main supporter of the medial longitudinal arch of the
foot. Several factors may affect its efficiency at maintaining an appropriate lifting of the arch
which may include genetics, obesity, trauma to the tendon or muscle, or over exertion of the
lower legs such as in high impact sports without adequate stretching and rest. A common
finding when inflammation is present is tight calf muscles that result in overstretching of the
tendon to the tibial muscle and less shock absorption ability. Over time this can lead to what is
commonly referred to by podiatrists as adult acquired flat foot.
Image of Posterior Tibial Tendon
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Introduction to Case Study
Over-‐pronation of the foot is a common structural abnormality of when the posterior
tibial tendon’s attachment to the medial longitudinal arch is compromised. Inflammation
occurs and pain is felt behind the medial malleolus as a result from unbalanced weight
distribution during the gait cycle along with significant stretching of the tendon over time. High
impact sports such as running and dancing can contribute when the person allows for over
strenuously being on their feet without adequate rest and recuperation. If tibial weakness is
present and large amounts of stress are placed on the tendon, then over time a gradual falling
of the arch will occur along with the first symptoms of pain and inflammation. Focus must be
placed on strengthening the invertors of the foot (tibialis anterior and tibialis posterior) and
stretching of the calf muscles allowing for strength and stability in full range of motion of
dorsiflexion and plantar flexion.
Case Study
I am a 29 year old female who has dealt personally with this affliction in the last year.
As stated previously, over pronation of the foot for me was something that occurred over time.
My job as a Respiratory Therapist working in Pediatric and Neonatal intensive care units
requires me to be fast paced and on my feet for most of my 12 hour shifts . I experienced sore
and tired feet after most work days but did not think much of it; however I didn’t know that
during these years of working my arches were gradually falling until I experienced the
debilitating pain of posterior tibial tendonitis in my left ankle. I am fortunate that with my
condition the tendonitis had not yet progressed to what is called tendinosis; a chronic condition
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of micro tears along the tendon. It is with my personal knowledge and journey to recovery that
I have practiced the BASI® Pilates repertoire to regain ankle strength and stability.
BASI® Conditioning Program
The BASI® approach consists of a block system to ensure functionality, alignment,
strength, flexibility and wellbeing throughout the entire body. In order to lessen the strain
placed on the posterior tibial tendon and strengthen the arch of the foot the BASI® system is an
ideal method to ensuring the attention needed to correct the muscular imbalances and move
toward a natural gait cycle. I started out my study with the Reformer for the first 4 sessions
then added the Cadillac and Wunda Chair for the last 4 sessions. These apparatuses all provide
adjustable resistance and low impact strength building exercises ideal for clients seeking foot
and ankle rehabilitation.
Sessions 1-‐4 on Reformer
Block Exercise *Case Study Specifics(if any)
Warm Up-‐-‐-‐Single Leg Lifts, Leg Changes, Chest Lift, Foot Circles
Foot Work-‐-‐-‐ Parallel Heels/Toes, V Toes, Open V Heels/Toes, Prances, Prehensile
*Emphasizes ankle-‐foot stability and alignment. Cued for pelvic stability, correct muscle recruitment of hip extensors, flexors, adductors, rotators, and knee extensors.
Abdominal Work-‐-‐-‐ Hundred Prep, Hundred, Coordination
Hip Work-‐-‐-‐ Frog, Circles Up/Down, Openings, Extended Frog, Extended Frog Reverse
*Emphasizes pelvic stability, increasing hip range of motion, correct muscle recruitment of hip extensors, flexors, adductors, rotators, and knee extensors.
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Spinal Articulation-‐-‐-‐ Bottom Lifts, Bottom Lifts with Extension, Short Spine
*Emphasizes foot and ankle alignment while in plantar flexion along with hip extensor control. Objective of short spine is hamstring stretch.
Stretches-‐-‐-‐ Kneeling Lunge
*Stretching of the hip flexors and hamstring muscles without placing excessive weight on the feet.
Full Body Integration (Fundamental/Intermediate)-‐-‐-‐ Scooter, Stomach Massage Series (Round, Flat, Reaching)
*Emphasizes ankle plantar strength, knee extensor and hip extensor control and strength along with trunk stabilization.
Arm Work (Supine Series)-‐-‐-‐ Extension, Adduction, Circles Up/Down, Triceps
Lateral Flexion/Rotation-‐-‐-‐ Mermaid
Back Extension-‐-‐-‐ Back Stroke Prep
Sessions 5-‐8 on Cadillac and Wunda Chair
Block Exercises *Case Study Specifics(if any)
Warm Up (Cadillac)-‐-‐-‐ Single Leg Lifts, Leg Changes, Chest Lift, Chest Lift with Rotation, Spine Twist Supine
Foot Work (Wunda Chair)-‐-‐-‐ Parallel Heels/Toes, V Toes, Open V Heels/Toes, Calf Raises, Single Leg Heel/Toes
*Emphasizes ankle-‐foot stability and alignment. Cued for trunk stability, correct muscle recruitment of hip extensors, flexors, adductors, rotators, and knee extensors.
Abdominal Work (Cadillac)-‐-‐-‐ Roll Up with RU bar, Mini Roll Ups, Mini Roll Ups Oblique (Wunda Chair)-‐-‐-‐ Standing Pike Reverse *Provides hamstring stretch.
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Hip Work (Cadillac)-‐-‐-‐ Frog, Circles Up/Down, Walking, Bicycles, Hip Extension Single Leg
* Emphasizes pelvic stability, increasing hip range of motion, correct muscle recruitment of hip extensors, flexors, adductors, rotators, and knee extensors.
Spinal Articulation (Cadillac)-‐-‐-‐ Monkey Original, Tower Prep
*Emphasizes hamstring and calf stretch with plantar and dorsiflexion.
Stretches (Mat)-‐-‐-‐ Rest Position, Kneeling Lunge
Full Body Integration (Fundamental/Intermediate) ( Cadillac)-‐-‐-‐ Push Through Series (Sitting Forward, Side Reach)
*Cueing to maintain contact with feet providing hamstring and calf stretch during exercise.
Arm Work (Cadillac)-‐-‐-‐ Chest Expansion, Hug-‐A-‐Tree, Circle Up/Down, Punches, Biceps
Full Body Integration(Advanced/Master) (Cadillac)-‐-‐-‐ Kneeling Cat Stretch
Leg Work (Wunda Chair)-‐-‐-‐ Leg Press Standing, Backward Step Down, Hamstring Curl, Hip Opener
*Emphasis on knee and hip extensor strength and control, along with hip external rotation control and pelvic lumbar stabilization.
Lateral Flexion/Rotation (Wunda Chair)-‐-‐-‐ Side Stretch
Back Extension (Wunda Chair)-‐-‐-‐ Swan Basic
In addition to the BASI® repertoire, I did subtle stretching at home with a Thera-‐Band for
10 minutes a day. Place the ball of the foot in the band while lying supine in neutral spine,
working leg is perpendicular, resting leg is straight on the ground. Dorsi flex, plantar flex, evert,
and invert the foot while maintaining resistance and holding both ends of the band. This will
provide a stretch throughout the calf, peroneals, and tibial muscles and tendons.
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Conclusion
With a BASI® Pilates approach, total body wellbeing, flexibility, strength, functionality
and stabilization is a realization and way of life. After using the above conditioning program I
have significantly noticed a positive change throughout my body, but especially have noticed no
pain or tendonitis flare ups of my posterior tibial tendon since incorporating Pilates into my
exercise regimen. Emphasis of the foot work while using the Reformer, Cadillac and Wunda
Chair has increased my ankle stability, flexibility and strength throughout a full range of
dorsiflexion, plantar flexion, eversion and inversion with a noticeable improvement in foot and
ankle alignment. This is most noted while doing Calf Raises on the Reformer and Wunda Chair
as this requires a strong posterior tibial muscle to achieve full range of motion against
resistance. Although no pain is present, on visual observation over-‐pronation is still seen in my
left foot. Because of this I will continue with the BASI® program, do my daily stretches with the
elastic Thera-‐band and wear arch supportive footwear as a preventative strategy. I strongly
believe that with the exercises provided by the BASI® program I will continue to be pain free
and enjoy an active healthy life.
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Bibliography
Body Arts and Science International Study Guide, Comprehensive Course. Rael Isacowitz, MA, Founder and Director, Body Arts and Science International. Copyright 2000-‐2014.
Pilates. Rael Isacowitz, MA, Founder and Director, Body Arts and Science International. Copyright 2009.
Principles of Anatomy and Physiology. Gerard J. Tortora and Bryan Derrickson. 11th Edition. Biological Sciences Textbooks Inc. Copyright 2006.
“Facts of the Feet.” Dr. David Jenson. Podiatric Medicine. Jenson Foot and Ankle Specialists. www.profootcenter.com.
“Posterior Tibial Tendonitis.” American Academy of Orthopedic Surgeons. www.orthoinfo.org.
“Theories of Bipedalism.” Russell Howard Tuttle. Encyclopedia Britannica. http://www.britannica.com/EBchecked/topic/275670/human-‐evolution/250597/Theories-‐of-‐bipedalism. Copyright 2014.
“Exercises for Posterior Tibial Tendonitis.” Joshua McCarron August 14th 2013. Livestrong Foundation. http://www.livestrong.com/article/158005-‐exercises-‐for-‐posterior-‐tibial-‐tendonitis Copyright 2014.
Images. www.wikipedia.com, www.hss.edu, www.google.com/footanatomy.
