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Pilates: The Male Dancer with Disc
Degeneration
Emma Turner June 2016
Course Year: May-‐August 2015 Brooklyn, New York
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Abstract:
“You are only as young as your spine is flexible.” – Joseph Pilates
One of the greatest benefits to Pilates is that it can strengthen the body in a
safe and caring manner, which when practiced regularly, can lead to lifelong
changes. In this paper, I will focus on the case study of a male ballet dancer with
multiple lumbar spine injuries and complications, limiting his ability to freely and
painlessly dance. First I will examine the anatomy of this region of the body, assess
and determine what would help strengthen and heal this area, and subsequently
develop a program applying the BASI Pilates principals and exercises for the male
dancer that will seek to improve his strength, stability, and mobility.
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Table of Contents:
Abstract 2
Anatomy of Lower Back 4
Case Study – including BASI system program 7
Conclusion 12
Bibliography 13
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Anatomy of the Lower Back/Lumbar Spine and Sacrum
There are three major regions to the spine as seen in the top right picture,
cervical, thoracic, and lumbar. The lumbar spine is what most people would refer to
as their lower back.
The lumbar spine/lower back region is probably one of the most common
areas of injury and/or pain in the body, particularly for dancers. Dancers are
expected to have hyper-‐mobility and flexibility but as a result they often lose
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control, stability, and strength, which can lead to painful and severe
underdevelopments and injuries.
The lumbar spine connects to the sacrum and is made up of articulating
vertebrae, whereas the sacrum is composed of non-‐articulating vertebrae. The
dynamic connection between the sacrum and the lumbar spine generates a constant
seesaw motion between the back and the hips. The Male pubic bone has less than a
90 degree angle of mobility. Furthermore, for a dancer such as in the case study that
follows, the lack of pubic bone and hip flexor mobility leads to more pressure and
weight on the lumbar spine; this is specifically apparent when lifting another body –
the female ballet partner – as seen in this image. (Photo credit: Rachel Neville)
In this case study, I will focus primarily on L3, L4, L5 lumbar nerves, as well
as S1, the sacral nerve. Simultaneously, it is important to be mindful of the health of
the hip flexors and psoas, specifically as to strength, tightness, and
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overcompensating patterns as this can directly contribute to spinal issues; for
example a hyper-‐mobile lumbar spine combined with extremely tight hip flexors as
the case study will show, creates a deadly combination falling into one flexibility
while being restricted by another. However, through Pilates exercises that include
strengthening the abdominals and lower back muscles, as well as exercises
stretching and increasing flexibility of the hips and front of the pelvis, the injuries
and complications of the dancer can be overcome or at the very least, put at ease.
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Case Study
Daniel Salas is a 22-‐year-‐old male ballet dancer who has been dancing over
40 hours a week for more than 7 years. Years of partnering and lifting young women
overhead, supporting their entire body weight in various positions, etc. have
contributed to Daniel’s immense lower back pain. It is my personal belief that this
pain was also due to the fact that the heavy lifting began during puberty, a
significant growth and hormonal period for the human body, and furthermore most
likely began before his muscular strength, bone density, and maturity for such heavy
lifting was truly ready.
Almost two years ago, a doctor finally specified that Daniel had various
injuries in L3, L4, L5, and S1 of his lumbar spine and sacrum. The injuries include:
bulging discs, disc degeneration, facet arthritis at L5 and S1, and finally, spinal canal
narrowing at L4 and L5. What truly made Daniel’s circumstances worse was that he
had hyper-‐mobility and flexibility in his lower back combined with extremely tight
hip flexors and a below-‐average degree of pelvic mobility.
The main objectives working with Daniel are to increase hip flexibility and
most importantly strengthen the rectus abdominus muscles, transversus
abdominus, obliques, and lumbar spine. It is extremely important that these
abdominal muscles are engaged at all times, especially during lifting. "The
contraction of the abdominals produce a pressurized cavity that helps to relieve any
weight that is put on the spine" (Low Back Pain Program). The lower back, erector
spinae muscles, which can specifically be considered the endurance muscles of the
back, should be strengthened in a way similar to a tightening, sort of compacting in
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this area as if two hands were wrapping around the lower back; ideally, the same
sensation of wrapping the abdominals only in the lumbar spine region.
BASI Block System Sample Class:
Warm Up: Pelvic Curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation
Foot Work: Reformer Foot Work – Parallel Heels, Parallel Toes, V-‐Position
Toes, Open V-‐Position Heels, Open V-‐Position Toes, Calf Raises, Prances, Prehensile,
Single Leg Heel, Single Leg Toes
I chose the Reformer for footwork because it will allow the back to be in a
relatively relaxed position as the abdominals stabilize and strengthen. With time, we
will progress to the Wunda Chair for footwork because it will challenge the lower
back muscles, however, I fear that when Daniel is fatigued from dancing this could
cause more pain as opposed to a positive result.
Abdominal Work: Coordination and The Hundred; ultimately, progressing to
The Short Box Series – Round Back, Flat Back, Tilt, Twist, Round About, Climb-‐A-‐
Tree.
The goal to progress to Short Box is because of the need for a male dancer
such as Daniel to maintain the range of motion in all directions that the body is
capable of moving. Short box work will establish the strength in flexion, extension,
and rotation, as well as a combination of these patterns while still encouraging
flexibility.
Hip Work: Extended Frog, Extended Frog Reverse, Down Circles, Up Circles
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Spinal Articulation: Starting with Pelvic Lift on the Reformer stabilizing the
carriage; progressing to Short Spine and ultimately, with time, advancing to Long
Spine.
Short Spine will allow for a stretch to the lower spine and hamstrings as the
carriage glides towards the bumper. Once the carriage reaches the bumper, Daniel
will also have more stability to lift up articulating through his back, thus
concentrating on the strength of the lift and not the instability of balancing that is
apparent in Long Spine. However, within a few sessions we work into Long Spine so
that the balance is tested and the strength to lift up through the back is challenged
and ultimately increased.
Stretches: Standing Lunge
Although, as a dancer, Daniel could do Full Lunge, I’ve chosen Standing Lunge
in order to focus on the hip flexor stretch and flexibility as opposed to the more
intense simultaneous stretch of both legs in Full Lunge.
Full Body 1: Down Stretch and Up Stretch 1, 2, 3
Down Stretch is a great exercise for Daniel because it challenges
stability/balance as well as the abdominals and additionally will stretch the hip
flexors. Up Stretch 1 is also beneficial because the lower back and sacrum regions
are elongated and expanded allowing Daniel to concentrate primarily on the wrap of
the abdominals. Ultimately, adding in Up Stretch 2 and 3 will challenge the full body
strength, however we will need time to advance to these movements as I don’t want
the full motion into plank/Front Support to end up putting more pressure on the
lower back if the abdominals aren’t activated.
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Arm Work: Arms Kneeling Series – Chest Expansion, Circles Up, Circles
Down, Triceps, Biceps
Arms Kneeling is perhaps one of the more difficult arm series. Daniel being a
conditioned dancer needs the challenge of this series, specifically for his actual arm
muscles as well as the challenge to maintain neutral spine while moving his arms
overhead. This is a great series to work on with him because it forces the
abdominals to contract and be active in order to keep the pelvis and hip flexors up
and the lower back in-‐line with the neutral posture and kneeling position.
Full Body 2: Long Back Stretch
This is an excellent exercise for Daniel considering his hyper-‐flexible back. It
challenges the abdominals transversus muscles as well as back extensors, while
simultaneously requiring him to maintain the stability of his trapezius (upper back)
and latissimus Dorsi (middle back). Additionally, there is a decent amount of arm
strength necessary to hold the body up in this exercise. The necessary strength and
mobility is great conditioning for Daniel.
(Additional) Leg Work: Side Splits
Lateral Flexion/Rotation: Starting with Side Stretch on the Wunda chair, and
advancing to Side Over on Box (Reformer) as his strength and ability to maintain
neutral spine and core stability increase.
Back Extension: Reformer – Breaststroke; Wunda Chair – Swan on Floor, to
Swan on Chair
Working on all three of these exercises allows Daniel to improve on both his
upper and lower back strength. The balance of the two is necessary. We start with
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Breastroke because this permits Daniel to work his upper back and practice a
healthy overhead motion/mobility that is apparent when lifting other dancers. One
of Pilates’ major points is a healthy body; however, there needs to be a strong
awareness on behalf of the teacher and client that hyperextension can occur with
this exercise and specifically the dancer population. The teacher needs to be mindful
that the client is engaging the abdominals and extending from the thoracic spine
versus collapsing into the lumbar. Ultimately, I want to work Daniel up to Swan on
the Chair because with the legs active and lifted – there is no leg support like in
Pulling Straps 1 or 2 – the lumbar spine will be activated even more intensely
balancing, stabilizing, and holding the legs while also articulating through the
thoracic spine into extension.
This particular conditioning program, as well as the progressive options, is
specifically designed to address the anatomical and muscular issues suffered by
male ballet dancers. Training this population needs to be aggressive enough to
maintain/encourage strength and flexibility, while simultaneously aiding and
refreshing their bodies so they are able to rehearse for anywhere from 4-‐6 hours a
day. Optimally, this program could be done 3-‐4 times a week resulting in deterring
and abating lower back pain, instability, and narrowing of the spinal canal. Such a
program applied to all male dancers prophylactically, may assist in preventing the
injuries and issues that have plagued Daniel.
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Conclusion
Daniel is a difficult case study for many reasons. He has many injuries, he not
only has to recover from these injuries but he also has to improve upon the
complications while continuing to dance. Unfortunately for Daniel, there is no ability
to stop dancing, focus on Pilates and overall body strengthening, and then return to
dancing. All of this work has to happen simultaneously. On the one hand, this forces
the aspect of rehabilitation in Pilates, I aim for his sessions to feel like therapy
compared to the rest of his time spent dancing. On the other hand, the difficulty of
strengthening and stabilizing has to be applied in the session, as this is the only way
to improve upon Daniel’s injuries and complications.
Through focusing on the areas of injury in L3, L4, L5 and S1, and being aware
of the hip flexors and psoas, Daniel will achieve a new understanding of how the
body works in relation to different regions and flexibility/tightness. In the BASI
program previously identified, we are able to strengthen the abdominals and lower
back muscles, while increasing flexibility of the hip flexors and finding a way around
his natural tightness of the psoas and hip mobility.
More than 6 years ago, Daniel and I were semi-‐professional dancers together.
I have watched as these issues started to plague, not just Daniel, but male dancers in
general. I have also seen the positive results that Pilates can bring to this specific
population of the dance world.
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Bibliography
Eidelson, Stewart, MD. “Lumbar Spine Anatomy.” Spine Universe. N.p. 22 Oct 2012. Web. 10 June 2016. http://www.spineuniverse.com/anatomy/lumbar-‐spine
“How Back and Abdominal Muscles Cause Lower Back Pain.” Low Back Pain Program. N.p. N.d. Web. 10 June 2016. http://www.lowbackpainprogram.com/back-‐and-‐abdominal-‐muscles.html
Matt, Margaret and Ziemian, Joe. Human Anatomy Coloring Book. New York: Dover Pub., 1982. Print.
“Vertebra and Spinal Cord (Cross-‐section View).” Inner Body. N.p. N.d. Web. 10 June 2016. http://www.innerbody.com/anatomy/skeletal/spine-‐vertebra-‐spinal-‐cord-‐cross-‐section