RCCB1 Support Material Sample
SUPPORT MATERIAL THE MH&F DIFFERENCE Our team of experts strives to provide fitness and rehab professionals with access to thorough, scientifically-based programming, wide-ranging education options, quality equipment, and the ongoing opportunities and support that are important to your success and to the success of your clients, members and patients. Thanks to our uniquely integrated operation, STOTT PILATES Certified Instructors enjoy numerous benefits, including strong post-graduate support and preferred equipment rates, while our equipment customers have access to comprehensive training, instructional videos and manuals, and business solutions. At Merrithew Health & Fitness, our engineers and talented Instructors work together to refine and evolve our equipment so it continuously exceeds and challenges. RCCB1—SPINAL, PELVIC & SCAPULAR STABILIZATION: CADILLAC, STABILITY CHAIR & BARRELS This course shows how to incorporate the different levels of resistance and support provided by the Cadillac Trapeze Table, Stability Chair™ and Barrels to improve mobilization and stabilization of the lumbo-pelvic region and shoulder girdle with a scientific approach to Pilates. This support material guide is designed as a reference for exercises taught in the course along with the Comprehensive Matwork, Essential Cadillac, Complete Stability Chair, Complete Arc Barrel, Complete Spine Corrector and Complete Ladder Barrel technical manuals that list the full exercise repertoire. This manual is intended for those training at a Licensed Training Center, Corporate Training Center or host site offering STOTT PILATES branded programming, under the instruction of representatives of Merrithew Health & Fitness. STOTT PILATES MANUALS The following manuals are available from Merrithew Health & Fitness: ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ ◗ RMR1 SUPPORT MATERIAL 3 RMR2 SUPPORT MATERIAL RCCB1 SUPPORT MATERIAL RCCB2 SUPPORT MATERIAL COMPREHENSIVE MATWORK ESSENTIAL REFORMER INTERMEDIATE REFORMER ADVANCED REFORMER ESSENTIAL CADILLAC INTERMEDIATE & ADVANCED CADILLAC STABILITY CHAIR LADDER BARREL ARC BARREL SPINE CORRECTOR INJURIES & SPECIAL POPULATIONS ADDITIONAL SUPPORT MATERIALS To complement our technical manuals, Merrithew Health & Fitness also provides the following helpful support materials: ◗ WALL CHARTS Outlining the STOTT PILATES repertoire for each piece of equipment CLIENT WORKOUT SHEETS Our repertoire in handy pads of 100 tear-off pages WORKOUT VIDEOS Unparalleled instruction from beginner to advanced level ALL AVAILABLE at merrithew.com ◗ ◗ ◗ RCCB1 Objectives 1. Learn how to apply the STOTT PILATES Five Basic Principles to exercises on the Cadillac Trapeze Table, Stability Chair & Barrels. 2. Learn the choreography, modifications, indications and contraindications for exercises on the Cadillac, Stability Chair & Barrels 3. Develop the ability to teach, modify, correct and progress each exercise. 4. Learn how to integrate the Cadillac, Stability Chair & Barrels into clinical practice through Case Studies and Clinical Reasoning Challenges. 5. Develop an understanding of how Matwork, Reformer, Cadillac, Stability Chair & Barrel exercises can be integrated together. 6 1705E-1 SUPPORT MATERIAL: RCCB1 SPINAL, PELVIC & SCAPULAR STABILIZATION: CADILLAC, CHAIR & BARRELS Table of Contents Introduction 2 Feet on Ladder Side Bend Obliques with Flexion 14 14 14 14 Leg Springs Bend & Stretch Lift & Lower Leg Circles Walks 23 23 24 24 Arc Barrel & Spine Corrector Exercises Seated Breathing Forward Breathing Side 8 8 Rotation Prone Swan Dive Supine Incline Scapula Isolation Arm Scissors Arm Circles 8 8 9 Cadillac Exercises Roll-Down Bar Scapula Isolations Roll-Down Breathing 9 Airplane Prep 15 15 15 16 Side-Lying Leg Springs Bend & Stretch Lift & Lower Side Kick Top Leg Circles 24 25 25 25 Supine Hip Rolls Stability Chair Exercises Leg Work Footwork Hamstrings Press Hips Down Supine Hip Extension Foot Press on Long Box Standing Leg Press 26 26 27 27 27 Seated Port de Bras Rotation with Port de Bras 9 9 Push-Thru Barâ€”Springs From Above Scapula Isolation Pull Down Push-Thru on Back 10 Push-Thru on Back with Roll Up Forward Push-Thru 10 10 10 11 Push-Thru with Feet Swan Dive Lat Pull Side Arm Pull Mermaid 11 11 11 12 Standing Push-Thru 16 16 16 16 17 17 17 18 18 18 18 Supported Supine Flexion Single Leg Stretch Prone Breast Stroke Prep Leg Extension Spinal Extension Rotation Prone Arm Work Scapula Isolation Prone One Arm Push Prone One Arm Prep Hand on Floor 28 28 28 7 Inverted Shoulder Bridge Prep Single Leg Stretch Lower & Lift Obliques Can-Can Torso Rotation Rotation Prone 29 Arm Springs Sitting Back Rowing Preps Front Rowing Preps Mermaid 19 19 19 Torso Extension Swan Dive Prep 29 Torso Flexion Ab Press Sitting 29 Spine Corrector Exercises Side-Lying Side Bend 12 Arm Springs Midback Series Midback Series in Prone Arm Work in Quadruped 12 12 13 13 20 20 21 Torso Lateral Flexion Mermaid Kneeling Mermaid 30 30 31 33 Ladder Barrel Exercises Standing Outside Of Barrel Scapula Isolations Push Up Prep Breast Stroke Prep Single Leg Extension Case Study Clinical Reasoning Challenge Appendices Arm Springs Standing Upper, Middle & Lower Trap Strengthener Chest Expansion Snow Angels 21 22 22 A Spine Corrector & Arc Barrel Exercises B Ladder Barrel Exercises C Cadillac Exercises 34 38 40 44 46 Short Box Series Round Back Straight Back 13 13 Roll-Down Bar Standing Lat Press Press Down Triceps Lunge 22 23 23 D Stability Chair Exercises References Selected Pages from Intermediate & Advanced Cadillac Manual Triceps Lunge Push-Thru with Feet  49  51 Cadillac Exercises Roll-Down Bar 1. Scapula Isolations with Roll-Down Bar attached to Vertically Sliding Bar Refer to Appendix C a. Protraction / Retraction with springs from behind or in front b. Three arm positions: above shoulder height, in line with shoulder height, below shoulder height i. Kneeling ii. Standing ◗ ◗ ◗ Bar can provide more support to joints of hand and wrist than Flex-Band Spring resistance is greater than Flex-Band so can challenge strength of scapula stabilizer for a more simulated weightbearing experience Vertically sliding bar allows greater variation of lines of pull 2. Roll-Down Refer to page 22 of the Essential Cadillac manual a. Regular b. Omit flexion / extension of elbows c. Flex / extend elbows three times d. One arm i. Spring tension options, vertical bar options ii. Adjust start position – use Padded Platform Extender, Reformer Box, Arc Barrel e. Half Roll Back ◗ ◗ ◗ ◗ ◗ ◗ Can change ROM to focus on one area of articulation or control of the spine if required Focus on scapula stabilization with spinal motion and scapula loading with resistance Easier for abdominals but more challenging to scapular stability Do not allow pelvic posterior rotation (flick) as torso lifts off bed during roll up phase Lumbar spinous processes do not necessarily have to contact bed; this could be over-flexing for some clients Clients with tight hips may adjust starting position and sit on Padded Platform Extender, Reformer Box, Arc Barrel (for all, ensure two in a row lengthwise to accommodate torso) 15 3. Breathing Refer to page 34 of the Essential Cadillac manual a. b. c. d. e. f. g. ◗ ◗ ◗ Regular Four breath Omit arms Omit roll Start with knees flexed and legs laterally rotated Start with knees flexed and legs parallel Staccato breath Helps many clients feel spinal articulation Challenges global muscles and posterior slings Contraindications: thoracic osteoporosis 3. Supine Hip Extension Refer to Appendix D ◗ ◗ Spring tension: 2 heavy-low Place Chair at end of Cadillac, or two Chairs together to support upper body – inner-range hip extension work to gain length through anterior hip a. Pedal together – bilateral, unilateral b. Split pedal – bilateral, unilateral, reciprocal i. Alternative foot positions – dorsiflexed, plantar flexed ii. Thomas stretch leg position to bias pelvis into flexion for flexion bias syndromes iii. Legs abducted to take tension off IT band iv. Flex-Band or Mini Stability Ball around or between legs to facilitate adductors or abductors ◗ ◗ ◗ ◗ ◗ ◗ Monitor closely for excess lumbar extension and anterior femoral head translation Cue deep proximal hip extensors to pull femur down Ensure client is off the end with the vertically sliding bar Tabletop leg easier to stabilize pelvis, unilateral with foot on pedal challenges pelvis Lighter springs to emphasize psoas (e.g. two springs) Indications: promote length through anterior hip muscles, facilitate deep hip extensors, weak psoas (when using light springs), SI joint dysfunction, lumbar spine dysfunction 4. Foot Press on Long Box Refer to page 38 of the Complete Stability Chair manual and Appendix D a. Box Leg Flexing i. Parallel ii. Laterally rotated iii. Medially rotated b. Pedal Leg Flexing i. Parallel ii. Laterally rotated iii. Medially rotated c. Gluteus Medius Targeter d. Staggered leg position i. Alternative arm positions ◗ ◗ ◗ ◗ 27 Challenges abductor system which has functional implications for gait Stability and proprioceptive challenge Watch for sacral and pelvic tucking instead of hip flexion Can do pelvic lateral tilt and rise for lateral hip challenge (both legs stay straight, client depresses pedal by lowering the pelvis, then raises back up) 5. Standing Leg Press Refer to page 42 of the Complete Stability Chair manual and Appendix D a. Front b. Side c. Facing side of Chair i. Varied spring resistance ii. Single Knee Lift iii. Single Leg Squat iv. Use Flex-Band around handles ◗ ◗ Balance and proprioception challenge Ensure roll of hip in socket Case Study Assignment For each of the following case studies, write out: a. Factors contributing to the client’ s complaint b. Your goals with STOTT PILATES c. Ten to 15 exercises including appropriate props and modifications d. Five progressions 1. Savana with Seven Small Children, Scoliosis, and Supraspinatus Tendonitis ◗ ◗ ◗ ◗ ◗ ◗ ◗ Savana is always carrying at least one child on her hip, or groceries to feed all nine in the family Spinal S curve – right thoracic, left lumbar Right handed Left supraspinatus tendonitis Painful arc of motion left shoulder Anterior left humeral head – 70% anterior to acromion Pain with combined extension and right rotation on lumbar spine Contributing Factors Goals Exercises Progressions a. b. c. d. 2. Paulina with an Unstable Pubic Symphysis 31 ◗ ◗ ◗ Paulina was in a car accident six years ago; she was rear ended when her foot was on the brake Torn ligaments and disc of her pubic symphysis Functional for all activities of daily living, but has experienced clicking with asymmetrical activities since the accident (e.g. getting in and out of cars) ◗ ◗ Six weeks pregnant and comes to you for assistance getting through her pregnancy Will work with you weekly until she delivers Contributing Factors Goals Exercises Progressions a. b. c. d. 3. Henrietta with Horrible Headaches and a Head Forward Posture ◗ ◗ ◗ ◗ ◗ ◗ Henrietta is a telephone operator who spends her days on the phone and at the computer Presents with a two-year history of tension type headaches Has seen numerous medical professionals (including your well-qualified boss) but has never found any lasting relief All imaging blood work has come back negative Very straight and restricted thoracic spine, and a shallow breath pattern Head forward posture, chin poke, and tilts her head to the left Contributing Factors Goals Exercises Progressions a. b. c. d. Clinical Reasoning Challenge 1. List two STOTT PILATES exercises per piece of equipment to mobilize the thoracic spine into rotation. 2. a. Describe the postural type of a client with a lengthened and weak psoas major. b. What activities might be difficult for them? c. List six exercises that can help develop strength in the psoas major and what you will have to monitor with each. 3. a. List three exercises per piece of equipment to help develop lumbar extension. b. How would you modify each exercise for a client with symptomatic L4 facet degeneration? 4. List six exercises that can address both lumbar and ankle stability issues at the same time. 5. a. List three exercises which can be done on both the Stability Chair and Cadillac. b. Indicate when or with which conditions you would choose one piece over the other. 6. List six Cadillac, Stability Chair & Barrel exercises to help develop abdominal strength with a client who had a recent whiplash and cannot tolerate lifting head off Mat from supine. 7. a. What issues and symptoms may result from gripping the left posterior pelvic muscles? b. What exercises help to correct gripping of the left posterior pelvic muscles? 8. a. List six exercises to help correct a right anterior innominate. b. Why might a client have recurrence of this problem if they do not do stabilization exercises? 9. a. When would you choose to use an Arc Barrel under a client for prone work? b. When would you avoid using an Arc Barrel? 10. a. In what way is Footwork on the Reformer different from Footwork on the Stability Chair? b. With whom would you choose to use the Stability Chair? 11. In order of increasing difficulty, list a series of exercises to develop cervical spine extensor strength on the Cadillac, Stability Chair and Barrels. 12. List six Cadillac, Stability Chair & Barrel exercises you could do on Day 1 with a client who presents with acute posterolateral L4 disc lesion to help reduce the pain. 13. 14. List six exercises you could do following manual therapy to stabilize a C2 lateral shift. What exercises could you do to progress a client with a lumbar facet problem toward being able to do rotation prone on the Spine Corrector? 15. What exercises can you have a pregnant woman in her third trimester do to help overcome an unstable sacroiliac joint which is partially managed by a sacroiliac joint belt? 33 Appendix A Spine Corrector & Arc Barrel Exercises WARM UP ARM SCISSORS 1. POSITION 1 Flex-Band exerciser behind back and scapulae, arms toward ceiling holding Band, palms facing in, head near apex of Barrel, pelvis and spine neutral on incline, lumbar spine may not be in contact with Mat or Barrel, knees flexed, abducted hip-distance apart 2. POSITION 2 Flex-Band behind back and scapulae, arms toward ceiling holding Band, palms facing in, head and shoulders on Barrel with thoracic and cervical spine extended, knees flexed, abducted hip-distance apart a. FLEX-BAND AROUND BACK in: prepare, ex: flex one shoulder toward head and extend other shoulder by hip, in: reach both arms to the ceiling, ex: flex and extend opposite shoulder b. UNILATERAL in: prepare, ex: maintain stabilization of scapulae and rib cage, flex one shoulder toward head, in: reach arm to the ceiling, ex: extend shoulder toward floor. Repeat on other side NOTE: May need to use pads under head to ensure to prevent excessive extension in cervical spine HIP ROLLS 1. FLEX-BAND UNDER PELVIS supine, pelvis and spine neutral, knees flexed, feet abducted hip-distance apart on top of Barrel, arms long by sides, palms down or in, Flex-Band under pelvis, instructor or client holding ends of Band for assistance, scapulae stabilized in: prepare, ex: pull up on Flex-Band and sequentially articulate spine off Mat from tail to upper thoracic, in: stay, ex: initiate from thoracic and sequentially articulate spine through flexion down to Mat with or without assistance NOTE: Flex-Band can assist during the concentric phase of movement or throughout exercise 2. FLEX-BAND ACROSS HIPS OR FRONT OF KNEES supine, pelvis and spine neutral, knees flexed, feet abducted hip-distance apart on top of Barrel, arms long by sides, palms down or in, Flex-Band across ASIS or tibia, holding ends of Band against floor, scapulae stabilized in: prepare, ex: sequentially articulate spine off the Mat from tail to upper thoracic, in: stay, ex: initiate from thoracic and sequentially articulate spine through flexion down to Mat 34 SEATED PORT DE BRAS ARM CIRCLES 1. POSITION 1 Flex-Band behind back and scapulae, arms toward ceiling holding Band, palms facing in, head near apex of Barrel, pelvis and spine neutral on incline, lumbar spine may not be in contact with Mat or Barrel, knees flexed, abducted hip-distance apart 2. POSITION 2 Flex-Band behind back and scapulae, arms toward ceiling holding Band, palms facing in, head and shoulders on Barrel with thoracic and cervical spine extended, knees flexed, abducted hip-distance apart a. UNILATERAL in: reach one arm toward ceiling and overhead, ex: circle out to the side and around to hip Reverse sequence NOTE: Can be done bilaterally seated on step facing away from Barrel, feet hip-distance apart, pelvis vertical, spine flexed forward over legs, arms reaching forward at shoulder height, palms facing in, scapulae stabilized 1. OMIT EXTENSION WITH HEAD AND CERVICAL SUPPORTED on Barrel (use floor side when working with Spine Corrector) in: initiate by rolling ASIS away from front of femurs and roll upper thoracic and head onto Barrel finding a neutral spine, reaching arms overhead, ex: circle arms out to sides, then forward, initiate from top of head and flex spine, bringing pelvis to vertical and weight on sit-bones 2. OMIT EXTENSION WITH THORACIC SPINE SUPPORTED on Barrel in: initiate by rolling ASIS away from front of femurs and roll thoracic onto Barrel finding a neutral spine, reaching arms overhead, ex: circle arms out to sides, then forward, simultaneously, initiate from top of head and flex spine, bringing pelvis to vertical and weight on sit-bones 3. FLEX-BAND OPTIONS omit arm sequence and allow elbow flexion as required in: initiate by rolling ASIS away from front of femurs and continue to roll back over Barrel into extension as far as possible without over-extending cervical spine, tension Flex-Band as required for support, ex: initiate from top of head and flex spine, bringing pelvis to vertical and weight on sit-bones continued > 1705E-1 SUPPORT MATERIAL: RCCB1 SPINAL, PELVIC & SCAPULAR STABILIZATION: CADILLAC, CHAIR & BARRELS Appendix B Ladder Barrel Exercises STANDING OUTSIDE OF BARREL SCAPULA ISOLATIONS standing outside of Barrel, hands on Barrel, pelvis and spine neutral on incline, heels lifted as necessary, scapulae stabilized 1. PROTRACTION in: protract scapulae maintaining neutral pelvis and spine, ex: return 2. RETRACTION in: retract scapulae maintaining neutral pelvis and spine, ex: return 3. FULL RANGE in: protract scapulae maintaining stable pelvis and spine, ex: retract scapulae maintaining neutral pelvis and spine NOTE: Can be done with Flex-Band around scapula 3. BREAST STROKE PREP 3, hands under forehead standing outside of Barrel, legs long, abducted and parallel, pelvis and lumbar neutral on an incline, upper torso flexed over Barrel, hands under forehead, scapulae stabilized in: prepare, ex: extend upper torso into one long line, in: stay, ex: return SINGLE LEG EXTENSION standing outside of Barrel, one leg long with foot on floor, other leg bent with thigh against Barrel, abducted and parallel, pelvis and lumbar flexed against Barrel, upper torso neutral over Barrel, hands on Barrel slightly wider than shoulders, scapulae stabilized 1. KEEP KNEE BENT in: prepare, ex: maintaining knee flexion and extend gesture hip, in: return 2. BEND & STRETCH PUSH UP PREP standing outside of Barrel, hands on Barrel, pelvis and spine neutral on incline, heels lifted as necessary, scapulae stabilized in: prepare, ex: extend gesture hip and knee to reach to a long line, in: return 3. SINGLE LEG EXTENSION in: prepare, ex: extend gesture hip to reach leg to diagonal line, in: return NOTE: Can be done standing on Padded Platform Extender with hands holding Ladder and pelvis and spine neutral, hips flexed to accommodate neutral pelvic position NOTE: Can be done with Flex-Band around feet and holding ends of Band against Barrel 38 1. PUSH UP PREP in: for three counts, flex elbows further with each count, ex: extend elbows NOTE: Can be done with Flex-Band around back BREAST STROKE PREP standing outside of Barrel, legs long, abducted and parallel, pelvis and spine neutral on incline, upper torso flexed over Barrel, scapulae stabilized 1. BREAST STROKE PREP 1, hands on Barrel slightly wider than shoulders in: prepare, ex: stabilize scapulae, lengthen and extend thoracic and cervical spine, keeping bottom rib in contact with Barrel, in: stay, ex: return NOTE: Can use a Flex-Band around back over scapulae to provide further resistance 2. BREAST STROKE PREP 2, arms long by sides, hands by hips, palms facing in, shoulders relaxed forward in: open front of shoulders by bringing scapulae to neutral, ex: extend upper torso into one long line, in: stay, ex: return SHORT BOX SERIES STRAIGHT BACK seated upright, close to apex, pelvis and spine neutral, heels on rung to bring knees to hip-height, arms reaching forward holding ends of Flex-Band, scapulae stabilized 1. FLEX-BAND ANCHORED around first or second Ladder rung in: prepare, ex: hinge pelvis away from front of femur, maintaining neutral spine, in: stay, ex: return NOTE: Can have Maple Pole vertically behind back to provide feedback of spinal position continued > 1705E-1 SUPPORT MATERIAL: RCCB1 SPINAL, PELVIC & SCAPULAR STABILIZATION: CADILLAC, CHAIR & BARRELS push-thru bar with springs from above PUSH-THRU WITH FEET FOCUS ■ continued FOCUS (EXERCISES 1–3) ■ maintain stabilization of pelvis against unilateral leg movement maintain pelvis and spine neutral when legs lengthen to press bar through uprights imprint without sacrum leaving bed as knees flex, then lengthen legs toward ceiling articulate sequentially so each vertebra peels off bed separately during roll up and makes contact separately during roll down roll up only as far as upper thoracic, not on cervical spine maintain lumbar spine and pelvis neutral and pelvis neutral on femurs in top position maintain pelvis square; avoid rotation as one leg lifts off bar maintain pelvis stable in space as one leg lifts and/or as knees flex ESSENCE (EXERCISES 1–3) transversus abdominis to compress abdomen and stabilize lumbo-pelvic region; deep pelvic floor to aid in firing transversus; rectus abdominis and obliques concentrically to begin roll up, eccentrically at top, concentrically to begin rolling down, eccentrically at bottom; gluteus maximus and hamstrings concentrically to bring back of pelvis toward back of femurs, isometrically to maintain hips in extended position, eccentrically at bottom of roll down; obliques and multifidus to prevent rotation; scapular stabilizers TARGET MUSCLES: ■ ■ ■ ■ ■ ■ gluteus maximus and hamstrings isometrically on supporting side as the other leg lifts; obliques challenged to prevent rotation [1, 3] [2, 3] hamstrings concentrically to flex knees, eccentrically as knees extend MODIFICATIONS (EXERCISES 1–3) 1. PREP OMITTING ROLL UP. Just flex knees and control bar up as far as possible, keeping sacrum area on bed. Then flex knees and push bar through. 2. PREP OMITTING LEG LIFTS OR PUMPS. Just bring legs through and roll up without lifting legs off bar or pumping at top. Then roll down and push legs through. 3. FLEX KNEES. Keep knees slightly flexed during roll up and down. To focus on spinal articulation if legs cannot extend completely with sacrum on bed. spine during articulation; pelvis on femur of supporting leg/legs; torso in up position STABILITY: MOBILITY: spinal articulation; pelvis on femurs to roll; hip flexion and extension of gesture leg (in 1,3) SEQUENCING: spinal articulation from tail to upper thoracic on roll up, upper thoracic to tail on roll down 54 COORDINATION: complex sequence of movements with breath Modification 3 1. starting position 2. flex knees 3. lengthen legs halfway 4. roll up 5. long line 71 I N T E R M E D I AT E & A D V A N C E D C A D I L L A C M A N U A L • E X E R C I S E S © 2014 MERRITHEW CORPORATION. ALL RIGHTS RESERVED. MAY NOT BE REPRODUCED IN WHOLE OR IN PART.