Pilates for the Seated Musician: Muscular Imbalances and

Injury Prevention

Veronica Fulton 10/09/2016

The Pilates Clinic, Wimbledon 2015-16

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Joseph Pilates’ method has appealed to physical performers from the day he

opened his studio doors. Athletes, dancers and musicians have used the Pilates

method when experiencing overuse injuries to help with functional muscle

imbalances and postural deviations.

This paper will focus on a guitarist’s posture, spending their working day in

prolonged hours of flexion, neglecting posture, which can lead to imbalances and

injuries resulting in neck and back pain. This is likely due to recruitment of incorrect

muscles to hold their position, accompanied by poor posture and asymmetry.

I will evaluate the posture and muscular imbalances of a healthy guitarist and using

the BASI Block System, create a program to prevent injury to the shoulder girdle.

Making a specific program will correct imbalances and focus on strength and

endurance as well as improving their mind-body connection, performance and

minimising pain.

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Table of Contents

Page 1: Cover Page Page 2: Abstract Page 3: Table of Contents Page 4 and 5: Anatomical Description of the Shoulder Girdle Page 6 and 7: Anatomical Description of the Spine and Postural Deviations Page 8, 9, 10, 11: Case Study Page 12: Bibliography

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Anatomy of the Shoulder Girdle

The shoulder girdle is comprised of paired clavicles and scapulae. The only

bony attachment to the axial skeleton is via the clavicle at the sternoclavicular joint.

Laterally, the scapulae create a shallow indentation called the glenoid fossa for

articulation with the upper arm bone, the humerus. As the shoulder joint is a ball

and socket joint, it allows a wide range of movement, however there is a lack of

stability in this joint due to the size of the glenoid fossa and very little bony or

ligamentous support.

Scapula movement contributes to the fine tuning of the upper extremity kinetic

chain permitting the glenoid fossa to move in synergy with the humeral head. The

small muscles surrounding the scapulae are otherwise known as the rotator cuff

muscles, they include the supraspinitus, infraspinatus, teres minor and

subscapularis. These muscles connect the scapulae to the proximal humerus and

provide shoulder stability and facilitate subtle desired mechanics of the shoulder.

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Scapula balancing muscles, serratus anterior and trapezius, assist scapular

movement around the thorax. The rhomboids, levator scapulae and pectoralis

minor are the group of muscles which connect the scapulae to the surrounding

bones, but do not have direct connection with the humerus. Finally the largest

muscles which produce gross movements of the arm include the pectoralis major,

deltoids, latissimus dorsi and teres major.

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Postural deviations found in the thoracic and cervical spine can affect the normal

function of the glenohumeral joint. Scapular balancing muscles can also be

adversely affected. It is important to ensure the scapular is in the correct position

and then begin scapular stabilization exercises to strengthen the joint and prevent

injuries such as scapula disassociation, where the misaligned position of the

scapula and repetitive activities e.g. playing guitar, can affect the biomechanics of

the shoulder and can result in abnormal posturing.

Anatomy of the Spine

The spine is made up of 33 individual bones called vertebrae. The spinal column,

which is protected deep inside the bones provides the main support for your body.

Between each vertebrate is an intervetebral disc, a cushion to stop the bones from

rubbing against each other. The cervical spine (neck) is made up of 7 vertebrae

which support the weight of the head, the thoracic (mid-spine) has 12 vertebrae

and holds the rib cage in place. The lumbar spine (lower back) has 5 vertebrae and

holds the main weight of the body. The 5 sacral vertebrae attaches the spine to the

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pelvis and the 4 fused bones of the coccyx provide attachment for ligaments and

muscles.

When viewed from the side, the adult spine has an S-shape curve. The cervical

and lumbar regions have a slight concave curve and the thoracic and sacral

regions have a slight convex curve. The curves act as shock absorbers, help

maintain balance and allow a range of motion for the body. Faulty alignment can

occur when a postural deviation is present resulting in undue stress or strain on

bones, joints, ligaments and muscles. I will determine if there is a postural

deviation (structural or functional).

The most important muscles to develop for good posture and core control

are the multifidus and Transverse Abdominus. These deep muscles help to protect

the spine and pelvis, I will ensure these muscles are strong in order for functional

daily life.

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Case Study

Oliver is a 26 year old, male professional guitarist. He practices in a flexed, seated

position for up to 6 hours a day. To play the guitar, his left arm is in external

rotation and his right arm is in internal rotation. His upper body is rotated around

the longitudinal axis to the left. Naturally, his spine is slightly lordotic with his

shoulders rolling slightly forward of the plumb line. He has tight pectorals, his

shoulder joints have a limited range of movement and he has a weakness in the

thoracic spine. He also has extremely tight hamstrings and hip flexors, no doubt

from his days spent sitting. He aims to do exercise once a week but it is not a

priority. He has experienced lower back pain and for therapies, Oliver has received

treatment from physiotherapy, chiropractors and osteopaths and studied the

Alexander technique to help his posture.

The goals for this conditioning program using the BASI block system will enable

him to strengthen his deep abdominal and back muscles, especially in the thoracic

region. Stretch out his pectorals and increase the range of movement of the

shoulder joint without pain. Lengthen and strengthen the hip flexors and

hamstrings. I will also focus on exercises to strengthen the rotator cuff muscles in

the shoulder to allow him to practice safely. Ultimately, I will help him to become

more self-aware and help improve his posture.

Initial Programme Progressions

Warm Up Roll Down

Pelvic Curl

Spine Twist Supine

Single leg lifts

Chest Lift on the Step Barrel

Chest Lift on Mat

Foot Work Reformer

Parallel Heels

Parallel Toes

V-Position Toes

Open V Heels

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Open V Toes

Calf Raises

Prances

Single leg heels

Abdominal Work Reformer – Short Box Group

Round Back

Flat Back

Tilt

Twist

Cadillac

Mini Roll Ups

Hip Work Reformer

Frog

Down Circles

Up Circles

Openings

Spinal Articulation Reformer

Bottom Lift

Bottom Lift with Extension

Stretches Reformer

Standing Lunge

Pole

Shoulder Stretch

Overhead stretch

Ladder Barrel

Gluteals

FBI (Fund) Reformer

Up Stretch1

Cadillac

Thigh Stretch w/ RU bar

Reformer

Down Stretch

Cadillac

Kneeling Cat Stretch

Arm Work Reformer

(Arm Supine Series)

Extension

Adduction

Up Circles

Down Circles

Triceps

Ped-A-Pul

Adduction

Extension

Up Circles

Down Circles

Triceps

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Leg Work Wunda Chair

Leg Press Standing

Ankle Weights

Adductor Lift

Hip Abduction Bent Knee

Hip Extension Bent Knee

Hip Extension Straight Leg

Ankle Weights

Side Leg Lift

Forward and Lift

Forward with Drops

Lateral/Flexion Step Barrel

Side Lift

Back Extension Mat

Cat Stretch

Wunda Chair

Swan Basic

Mat

Swan Basic

Additional Exercises On Foam Roller

Remedial Shoulder Stretch

or Circles

Magic Circle

Arms Bent

Arms Straight

Arms Overhead

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Conclusion

This program was specifically designed to target Oliver’s goals, giving him

an increased understanding and awareness of his body and adhering to the ten

Pilates Principles.

Having followed this program for 3 months, Oliver has now become aware

of which muscles to recruit to help posture correction including significantly

strengthened abdominals and has taken steps to improve his practise ‘pose’. He

has demonstrated improved flexibility of the pectorals and an increased range of

movement in the shoulder joint. He has improved his understanding of the upper

back muscles, particularly rhomboids and scapula stabilisation.

An important part of his Pilates classes have been focused on stretching of

the glutes and hamstrings and remedial work to the shoulders, preventing injuries

to the shoulder and addressing his lower back pain. In addition, his increase in

stamina and strength will help him during his hours of practise and performance.

Oliver has been able to use his new knowledge and self-awareness learnt in

the studio and incorporates them into his practise and daily life, preventing himself

from injury and leading him to a pain free life.

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Bibliography

Isacowitz, Rael, Body Arts and Science International, 2000-2013, Study Guide: Comprehensive Course Isacowitz, Rael, Body Arts and Science International, 2000-2012, Auxiliary Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Cadillac Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Mat Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Reformer Movement Analysis Workbook Isacowitz, Rael, Body Arts and Science International, 2000-2012, Wunda Chair Movement Analysis Workbook Pilates, Joseph, Pilates’ Return To Life Through Contrology, Revised Edition for the 21st Century, 1998 Brownstein, Bruce and Bronner, Shaw, Functional Movement in Orthopaedic and Sports Physical Therapy: Evaluation Treatment and Outcomes,1997 Berque, Patrice, n.d., Musculoskeletal Disorders Affecting Musicians And Considerations For Prevention, http://www.musicianshealth.co.uk/musiciansmusculoskeletaldisorders.pdf