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Upper Crossed Syndrome: How Pilates Can Help Today’s Office
Worker With a Common Dilemma
Mila Zenarosa Sharaf 11 September 2014
CTTC, Indianapolis, Indiana
Abstract:
Today, with the proliferation of laptops, tablets and smart phones enabling us to
be more mobile, it is becoming more common for us to be hunched over with our
necks hanging down towards our small screens. Margaux is seemingly suffering
from such a phenomenon. Some daily adjustments addressing her mechanics
should help build her body awareness. But the true corrective involves
rebalancing key muscles via Pilates. She is very interested in Reformer work
first, so her plan will take her stepwise through a reformer repertoire to stretch
and strengthen her upper body. We will also focus on stretching and
strengthening so she can realign her back and pelvis to a more neutral position.
Table of Contents: Anatomical illustration 4
Background 4
Medical Restrictions 6
Fitness Level 7
Goal 7
Assessment / Recommendation 7
Program Framework 8
BASI Program 10
Conclusion 12
Bibliography 13
relatively typical of an office worker today. She spends several minutes getting
ready in the morning, leaning over a bathroom sink. She has a 45-minute
commute in the car, at least 6 to 8 hours in front of her laptop, and then another
45 minute commute home. She seals the deal with another 2 hours online in the
evening tying up lose ends, answering personal emails or watching some show
via online streaming. She works out about 1 hour 3 times a week but still feels
beaten down by the daily grind. Her aches and pains have driven her to try 3
mattresses and toppers in the last several years; she has gone through at least 4
different pillow types, various orthotics, arch supports and shoe styles. She
comes in wishing for some help to pull her up structurally since she is hitting that
time in life where things are taking their toll. Her neck, back and shoulders hurt.
She tries to stay active and exercise and has had physical therapy on her
shoulders but the problems persist. At her initial assessment I noticed a fatigue
type posture, with predominant upper crossed syndrome.
To put Margaux’s syndrome in context, the average American adult spends eight
and a half hours a day in front of a screen, whether it’s on a computer, TV,
mobile phone or other gadget. Users who spend the most time in front of a
screen are in the 45 to 54 age group, dedicating nine and a half hours to this per
day.
The average adult spends 50-70% of their time sitting which may have far
reaching implications. Dr. Emma Wilmot, a research fellow in the Diabetes
Research Group at the University of Leicester in the UK combined the results of
18 studies and included a total of 794,577 participants. The results showed that
sitting for 6 or more hours a day increases your risk of cardiovascular disease
and diabetes significantly.
Today, activities that corrupt our posture and create havoc on our muscle
balance compete with the amount of time we spend sleeping. The Bureau of
Labor Statistics released the results of their time use survey for 2011:
So now that we understand the broader context, let us get back to Margaux.
Medical restrictions:
None
Fitness Level:
She works out regularly so has an intermediate level of fitness. Historically she
has been very athletic but currently she walks, does yoga and hot yoga, has
dabbled in Pilates on the mat in mostly group settings. She was not a huge fan
of Pilates in the past because of the venue and structure, but a close friend
recommended she try again with a more personalized approach to the practice
on the reformer.
Goal:
She wishes to feel vital and free, unencumbered by posture, soreness, and daily
fatigue. She feels slumping also impacts her overall mood.
Assessment/Recommendation:
I did an initial assessment with a roll down for postural assessment. She over
tucked her chin to her chest, seems scrunched in the shoulders, tight through the
thoracic and lumbar spine as well as the hamstrings. Her hips were posteriorly
tilted. She slightly supinates.
I recommend she practice Pilates to correct imbalances, but supplement this with
daily triggers to remind her to stretch and recruit correct muscles for proper
ergonomics. Specifically, she should be in Pilates 3 times a week with daily
stretches and posture check-ins to reinforce habits (stretches, kitchen sink
movements, posture while driving, etc.).
I feel strengthening her abdominals, back extensors, and hamstrings should help
her lengthen vertically, mitigating her hypolordosis. Opening her through the
chest, strengthening her Rhomboids and Serratus should help as well. Also
rebalancing her Upper trapezius and Levator scapulae should alleviate her
shoulder pain and instability.
Below is a general approach, keeping in mind Margaux’s enthusiasm is highly
valued and her feedback to the repertoire will be incorporated to tailor her plan as
she progresses. The approach consists of a BASI program within a broader
framework.
Program Framework
Week 1-10
• Session 1, I will take a baseline picture of Margaux from back, front and
side as a baseline visual for her reference. Additional photos (front, back,
side) taken at weeks 4 and 8 for visual reinforcement of progress
• At regular intervals during the day, she should practice:
o Chest Stretch in Sitting: Extend arms behind you with elbows
straight. Interlock fingers if possible. Gently lift elbows upward. You
should feel a stretch in your chest.
o Shoulder Door Stretches for Pectoralis: Abduct shoulder to 90
degrees or less. Place hand on the door jamb and lean forward.
Hold for 10-15 seconds and repeat 3-4 times.
• While driving, she should adjust her seat so she is within arms distance,
not over reaching forward, sitting erect, shoulders down with Scapulae
tucked in pockets (right to left bottom pocket, left to right bottom pocket)
• Margaux’s BASI program for Weeks 1-10
• Margaux’s feedback of how she is feeling, making any adjustments
needed
Week 11-20
• Margaux’s BASI Program for Weeks 11-20
• Additional photos (front, back, side) taken at weeks 12, 16, 20
• Continued daily stretches and postural adjustments made while driving the
car
Margaux's BASI Program: Reformer
1-3 4-10 11-20
Warm Up: • Pelvic Curl • Spine Twist
Supine • Chest Lift • Chest Lift with
Rotation • Single Leg Lifts
• Pelvic Curl • Roll-up • Spine Twist
Supine • Double Leg
Stretch • Single Leg Stretch • Criss Cross
• Pelvic Curl • Roll-up • Spine Twist
Supine • Double Leg
Stretch • Single Leg Stretch • Criss Cross
Footwork • 3 reds • Parallel heels • Parallel toes • V position toes • Open V heels • Open V toes • Calf raises • Prances • Prehensile • Single leg heel
and toes
• 3 reds • Parallel heels • Parallel toes • V position toes • Open V heels • Open V toes • Calf raises • Prances • Prehensile • Single leg heel
and toes
• 3 reds/1 blue • Parallel heels • Parallel toes • V position toes • Open V heels • Open V toes • Calf raises • Prances • Prehensile • Single leg heel
and toes
Abdominal • Hundred Prep • Coordination
• Hundred • Coordination • Short Box Series:
Round Back, Flat
• Hundred • Coordination • Short Box Series:
Round Back, Flat
Back, Twist, • Teaser Prep
Back, Twist, • Teaser Prep
Hip • Frog • Extended Frog • Extended Frog
Reverse • Down Circles/Up
Circles
• Frog • Extended Frog • Extended Frog
Reverse • Down Circles/Up
Circles
• Frog • Extended Frog • Extended Frog
Reverse • Down Circles/Up
Circles
Spinal Articulation
• Bottom Lift • Bottom Lift with
Extension • Short Spine
Stretches • Hamstring
Stretch Series:
Standing lunge
• Hamstring Stretch
Series: Kneeling
Lunge
• Hamstring Stretch
Series: Full Lunge
Full Body Integration 1
• Up Stretch Series:
Up Stretch 1,
Elephant • Down Stretch
• Up Stretch Series:
Elephant, Up
Stretch 1, Up
Stretch 2, Long
Stretch • Down Stretch
Arms • Arms Supine
Series:
Extension,
Adduction,
Up/Down Circles
• Arms Sitting
Series: Chest
Expansion,
Biceps,
Rhomboids, • Arms Kneeling
Series: Up/Down
• Arms Sitting
Series: Chest
Expansion,
Biceps,
Rhomboids, • Arms Kneeling
Series: Up/Down
Circles, Triceps • Shoulder Push • Shoulder Push
Single Arm
Circles, Triceps • Shoulder Push • Shoulder Push
Single Arm
Legs • Long Box Series:
Hamstring Curl
Lateral
Flexion/ Rotation
• Mermaid • Short Box Series:
Side Over Box
(modification of
arms crossed
across chest, not
raised overhead)
• Short Box Series:
Side Over Box
(modification of
arms crossed
across chest, not
raised overhead)
Back Extension
• Breaststroke
Prep
• Long Box Series:
Pulling Straps 1,
Pulling Straps 2
• Long Box Series:
Pulling Straps 1,
Pulling Straps 2,
Breaststroke
Close • Roll Down • Roll Down • Roll Down
Conclusion:
Margaux’s ailments are common in today’s society. Created and reinforced by
improper ergonomics from activities pervasive in our daily living. Since she is
active and interested in her physical health, a solid regimen of Pilates and
changes in some basic habits should help her improve her body awareness,
recruit the proper muscles and ultimately improve her posture and muscle
balance. Helping her understand what has happened over time and caused the
imbalance will help her understand how good form will undo it. It will be
important for her to feel and see the benefits from her hard work, since this will
help anchor the discipline for the rest of her life.
Bibliography:
1) Modification of Darwin cartoon on a T-shirt,
http://www.kleargear.com/1409.html
2) Reproduction of Upper crossed Syndrome of Vladimir Janda,M.D, by Erik
Dalton, PhD,
http://erikdalton.com/dalton-dirty-dozen/
3) Council for Research Excellence (CRE) and Ball State University’s Center
for Media Design (CMD), Nielsen-funded
4) Emma Wilmot, M.D., Diabetes Research Group, University of Leicester,
UK, Diabetologia, October 2012
5) The Bureau of Labor Statistics, American Time Use Survey - 2011
Results, Table 1. Time spent in primary activities
6) http://www.crossfitinvictus.com
7) Pilates Anatomy, Rael Isacowitz and Karen Clippinger, 2001
8) BASI Study Guide, Comprehensive Course